Abstract

Purpose

When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up.

Methods

Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results.

Results

Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU.

Conclusions

Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.

中文翻译：

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重症监护提供者对丧亲家庭的支持：一项混合方法研究。

 抽象的

 目的

当人们在重症监护室 (ICU) 中去世时，多达一半的家人可能会经历严重的悲伤反应。虽然家属报告需要丧亲支持，但大多数重症监护室不会定期对家属进行随访。临床医生通常参与在死亡和临终期间为家庭提供支持，但人们对他们如何与丧亲的家庭一起工作却知之甚少。我们的目标是探索临床医生如何支持失去亲人的家庭，确定促进和阻碍支持的因素，并了解他们对后续行动的兴趣和需求。

 方法

对加拿大各地学术医院九个成人内外科 ICU 之一的护士和医生进行的混合方法研究。定量调查之后进行定性访谈，以反映、扩展和解释定量结果。

 结果

医生和护士都认为他们为失去亲人的家庭提供了富有同情心的支持。情感参与是支持的一个关键要素，但由于家庭的角色、责任、经验或单位资源，临床医生并不总是能够与家人互动。另一个可能促进或挑战参与的重要因素是家庭接受死亡的程度。临床医生有兴趣参与后续的丧亲计划，但他们的参与取决于时间、培训以及在 ICU 中管理与死亡和丧亲相关的情绪的能力。

 结论

确定了多种机会来加强当前对家庭的丧亲支持，包括 ICU 临床医生对正式后续计划的渴望。在项目设计中需要考虑许多心理、社会文化和结构因素。