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Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers*

Petrinec, Amy B. PhD, RN1; Mazanec, Polly M. PhD, RN1; Burant, Christopher J. PhD1; Hoffer, Alan MD2; Daly, Barbara J. PhD, RN1

doi: 10.1097/CCM.0000000000000934
Clinical Investigations

Objective: To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization.

Design: A single-group descriptive longitudinal correlational study.

Setting: Medical, surgical, and neurological ICUs in a large tertiary care university hospital.

Patients: Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient’s fifth day in the ICU.

Interventions: None.

Measurements and Main Results: Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p = 0.01) and emotion-focused (p < 0.01) coping decreased over time while avoidant coping (p = 0.20) use remained stable. Coping strategies 30 days after hospitalization (R2 = 0.50, p < 0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2 = 0.30, p = 0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity.

Conclusions: Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

2Department of Neurosurgery, University Hospitals of Cleveland, Cleveland, OH.

* See also p. 1334.

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Dr. Petrinec received support for article research from the National Institutes of Health (NIH). Her institution received grant support (5NR01NR013322). Dr. Mazanec consulted for End-of-Life Nursing Education Consortium (ELNEC) (receives an honorarium for teaching as a faculty member of the national ELNEC); received grant support from Cleveland Veterans Administration Medical Center (is the education/research coordinator on a specialty care cancer grant at the Veterans Administration [VA]); disclosed other relationships; received support for article research from the NIH, Wellcome Trust, Howard Hughes Medical Institute, and other; and disclosed work for hire and government work. Dr. Burant consulted for Analysis of Moment Structures Beta Tester, lectured for the Preconference Midwest Nursing Research Society Workshop 2014, and received support for article research from the NIH. His institution received grant support for Mapping the Complexity of End of Life Transitions in Chronically Critically Ill, CD4+ T and for B cell mechanisms of influenza vaccine nonresponsiveness in older adults (1 R01 AI 108972-01 NIH/National Institute of Allergy and Infectious Diseases). His institution received other support (International Psychogeriatric Association, work at VA Geriatric Research Education and Clinical Centers and VA project, “Chronic Renal Disease [CK] Advanced Practice Registered Nurse [APRN]–RN Care Management Support Team Pilot” an operational project supporting the strategic plan for the Chief Officer of Nursing in the Office of Nursing Services in FY2014–2015 and R01 NR013322-02). Dr. Daly is currently receiving a grant (#1RO1NR013322-01) from the NIH, which was the sole funding source for this study, and is employed by Case Western Reserve University (CWRU) (faculty of CWRU). Her institution received grant support from National Institute of Nursing Research (NINR) (5NR01NR013322 and a pending NINR grant). Dr. Hoffer has disclosed that he does not have any potential conflicts of interest.

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