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Assessing the Level of Stress and Anxiety in Family Members of Patients

Hospitalized in the Special Care Units

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 Zarei et al., Int. J. Rev. Life. Sci., 5(11), 2015, 118-122

ISSN 2231-2935
Research Article
www.ijrls.pharmascope.org

Assessing the Level of Stress and Anxiety in Family Members of Patients

Hospitalized in the Special Care Units
Mohammad Zarei1, Mahdi Keyvan2, Haydeh Hashemizadeh3*
1
Faculty Member of “Nursing Department, Shirvan Nursing Faculty” & “Research Center of Natural Products and
Medicinal Plants”, North Khorasan University of Medical Sciences, Bojnurd, Iran
2
MSc, Imam Khomeyni Hospital of Shirvan, North Khorasan University of Medical Sciences, Bojnurd, Iran
3
Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad,
Iran, & Department of nursing, Quchan Branch, Islamic Azad University, Quchan, Iran

ABSTRACT

Stress of patients’ family members increases and ultimately cause disruption in the role and function of members
of the family. The aim of this study was assessing and comparing the stress, anxiety and depression in family
members of patients hospitalized in the special care unit. This descriptive analytic study is of comparative type
that was conducted on 200 family members, who were the first degree relatives of patients hospitalized in
Quchan's hospital in 2013. Data were collected by using the anxiety and stress scale (DASS) and they were ana-
lyzed by T-test and chi-square test. The results of the study indicated family members of patients, who have been
hospitalized in ICU, experience more anxiety and stress than family members of patients admitted to CCU. The
supports provided by nurses for families of patients, through the creation of appropriate therapeutic creates hope
in families and reduce their stress levels.
Keywords Stress; Anxiety; Intensive Units; Family.
INTRODUCTION unit, families of patients hospitalized in the special care
units, experience high levels of emotional stress [7],
Family, as the first and most basic social institution,
because in the early days of hospitalization of patients
possess a specific role, structure and culture. Moreo-
in ICU, immediate needs and psychological and social
ver, the family is the founder of the physical, cultural,
stresses are imposed on families of patients and they
spiritual, psychological and social health of its mem-
are facing with emotional, cognitive and social stress-
bers [1]. Therefore the stresses that are imposed on
ors [8]. When the patients are at the risk of death, their
family members affect the whole family and the dis-
families are experiencing the pressure of decision mak-
ease, as a stressful factor, can cause a crisis in the fami-
ing and the choice of treatment, which can cause
ly [2]. Crisis can disrupt the normal life and the roles
symptoms of mental and physical health in the families
[3].
that the most common symptoms are stress, anxiety
Incidence of a critical illness affects the patient and his and depression. These symptoms, in their turn, can
family [4]. These critical illnesses often occur for pa- affect the overall well-being of family members [5].
tients and their families, without any prediction and
According to the results of the study which was con-
warning and in short period of time [5].
ducted longitudinally in France, anxiety, depression
With the rapid development of technology, in 1960s and post-traumatic stress disorders (PTSD) are the psy-
the ICU was specified as an environment for providing chological effects of diseases in families of patients. 90
special care to critically ill patients with critical condi- days after being released from the hospital or death of
tions [5]. In a way that, each year in the United States, the patient, 33% of family members of ICU patients
approximately 20% of all deaths are occurring in the had moderate to high risk of PTSD. The level of this risk
ICU. This negative experience may affect family mem- was increased by 80% in family members who were
bers through increasing stress levels and the risk of involved in making the final decision. The extent of this
being affected by mental and physical symptoms [6]. risk is significantly higher in women and in cases where
Therefore, since in any life-threatening and serious enough time is not given for communication and the
illness, there is a need for admitting to the special care incomplete or incomprehensible information are pre-
sented to families.
* Corresponding Author Factors that cause stress and anxiety in special care
Haydeh Hashemizadeh unit include informational ambiguities, unclear progno-
haydeh_h_z@yahoo.com
sis, fear of death of patient, financial needs, disruption
©JK Welfare & Pharmascope Foundation | International Journal of Review in Life Sciences 118

of the daily programs, unfamiliarity with the environ-
ment and the regulations of unit [5]. Furthermore, fear
of death, unclear result, emotional distress, financial
concerns, changing roles, unfamiliarity with the proce-
dures of hospital and the emotional turmoil and sepa-
ration from family members, are several sources of
anxiety for the family [5-10].
A study was conducted by Novaes et al in 2001 at a
health center in South America on the families of pa-
tients that two weeks were passed since the hospitali-
zation of their patient in special care unit and the re-
sults of this study indicated many changes in the re-
sponse, behavior, lifestyle, daily activities, nutrition,
diet and sleep quality of 60% of family members [11].
In the study of Pang et al in 2008 that was conducted
on the causes of stress in the ICU fear of "death" was
reported to be the highest stressor factor among the
patients in ICU. Other important stressors included
putting the members of family under pressure to gain
satisfaction for treatment, the pain and length of stay
in ICU [12]. In a qualitative study, which was conducted
by Haim et al, 15 family members reported that the
experience of ICU is a specific and important threat
that can cause vulnerability, intense feelings, fear and
anxiety. Moreover, such an experience may cause dis-
ruption and changes in the relationships between fami-
ly members and thus create tension in roles [13].
In general, the results of these studies indicate that
spouses of ICU patients have reported multiple emo-
tions like anxiety, depression and fear. Findings also
showed that spouses are faced with multiple stressors
such as the possibility of losing their partner and cut of
family ties during the critical experience of spouses.
They have found that more than 50% of family mem-
bers report the symptoms of depression, melancholy,
suicide, low energy, and anxiety [6-9].
Although the care and support of family members is of
great importance, but studies show that people are not
paying enough attention to it and are not supported
[7]. Therefore it seems that specialized assessments
and interventions are necessary for families, because
anxiety may be interfered with the family's ability to
receive and understand information, maintenance of
adequate patterns of family functioning, effective use
of coping skills and provision of positive support for the
patient [10]. Therefore strengthening and establishing
family performance is important [7]. Therefore, since
families have beneficial effect on the patient and his
response to treatment, they act as a buffer for pa-
tient’s anxiety and also as valuable resources for pa-
tient care. However, when the anxiety of family is high,
they may not be able to support the patient and can
even transfer their anxiety to the patient. It seems that
the unmitigated anxiety of family can be manifested,
by itself, in mistrusting the staff, noncompliance with
treatment regimens, anger and frustration along with
care and even in legal documents. As family members,
©JK Welfare & Pharmascope Foundation | International Journal of Review in Life Sciences
Zarei et al., Int. J. Rev. Life. Sci., 5(11), 2015, 118-122
coping with sudden anxiety and critical nature of the
disease may lead to changes within the family unit.
Whether these changes are beneficial or adverse de-
pends on the unit and type of interventions provided
by health care specialists and response of family to the
critical disease [10].
METHODS
This is a descriptive-analytic study which has examined
and compared the psychological reactions of family
members of patients hospitalized in the special care
units of ICU and CCU in Quchan's Musa-ibn-Jafar hospi-
tal. The study population consisted of family members
(first degree relatives) of patients hospitalized in these
units and they were selected by using convenience
sampling method. The required sample size was de-
termined according to previous studies and in general
200 individuals were studied, in this way that, 100 fam-
ily members of ICU patients and 100 family members
of CCU patients, that were matched with each other in
terms of age, gender, education level, occupation, and
relationship with the patient, were included in the
study after obtaining informed consent.
Data collection tools, for this study, were arranged in
three sections: the first section included demographic
characteristics of intensive care patients, second sec-
tion was about the demographic characteristics of fam-
ily members of patients and the third section consisted
of short-form of depression, anxiety and stress scale
(DASS) that the subjects specified their answers in Lik-
ert scale and from not at all to so much. The obtained
data were analyzed by using SPSS software and chi-
square test and t-test.
RESULT
In examining the demographic characteristics, the re-
sults showed that in both studied groups male subjects
formed 54% of each group.59% of family members of
ICU patients and 49% of family members of CCU pa-
tients had diploma or higher degrees. 34% of family
members of ICU patients and 32% of family members
of CCU patients were self-employed. Given the per-
formed matching, no statistically significant difference
was observed between groups in terms of age, gender,
education level, occupation, relationship with the pa-
tient and marital status, while due to the higher partic-
ipation of family members of ICU patients in treatment
decisions, there was a statistically significant difference
between the two groups.
The age of subjects, in the group of the family mem-
bers of ICU patients was at least 13 years old and at
most 78 years old and the average age of this group
was 35/45 ± 14/63 and in the group of the family
members of CCU patients, it was at least 14 years old
and at most 80 years old and the average age of this
group was 38/59 ± 16/99.There was no statistically
significant difference between the two groups. In
terms of the duration of hospitalization, the minimum
119

length of stay in ICU was 2 days and maximum length
of stay was 42 days and in average, the length of stay
of patients in this unit was 9/97 ± 7/2 and in CCU the
minimum length of stay in ICU was 1 day and maximum
length of stay was 15 days and in average, the length of
stay of patients in this group was 6/17 ± 2/53 that
there was a statistically significant difference between
the two groups. In terms of age, the minimum age of
patients in the ICU was 17 years old and maximum age
was 80 years old and the average age of this group was
49/76 ± 16/24.58% of patients hospitalized in this unit
were male and 42% were female. The minimum age of
the patients in CCU was 30 years old and maximum age
was 80 years and the average age of this group was
52/38 ± 11/77. 59% of patients hospitalized in this unit
were male and 41% were female. Most causes of hos-
pitalization in the ICU were brain traumas with 29%and
most causes of hospitalization in CCU were heart at-
tacks with 32%.Demographic characteristics of the two
groups are shown in Tables 1.
Regarding the study of the psychological reactions of
family members of patients hospitalized in special care
units of ICU and CCU, it was found that the mean score
of anxiety, stress and depression, in family members of
patients hospitalized in the ICU, were respectively
19/10 ± 5/11 and 20/55 ± 4/730 and 18/61 ± 5/26 and
in family members of patients hospitalized in the CCU,
these scores were 16/05 ± 5/52 and 17/02 ± 5/43 and
15/63 ± 5/10, respectively. In evaluating the two
groups by using the t-test, according to the aforemen-
tioned items, it was specified that two groups had sta-
tistically significant differences in psychological reac-
tions. (Table 2)
DISCUSSION
Seeing beloved ones in a threatening situation and
stressful environment of special care unit with sophis-
ticated equipment and technology is often among the
factors that increases psychological stress of family
members. In such situations, due to intense fear and
anxiety, family members neglect their basic and essen-
tial needs and just think of the patient and the issues
related to him [14].
The results of our study, in evaluation of psychological
reactions of family members of patients in the two
groups indicated that the Level of anxiety in family
members of ICU patients was significantly higher than
family members of CCU patients. To justify this part of
the study, we can say that serious illness of a family
member and hospitalization of a family member in
special care unit is a strong stressor that causes chang-
es in the familial structure and role and it is along with
some emotional reactions such as anxiety. In a study
that was conducted by Pochard and colleagues in
France, 544 family members of hospitalized patients
were studied and it was found that 57/5 % of family
members of patients were experiencing anxiety that
among them 82/7% of anxious people were the spous-
©JK Welfare & Pharmascope Foundation | International Journal of Review in Life Sciences
Zarei et al., Int. J. Rev. Life. Sci., 5(11), 2015, 118-122
es of patients and the anxiety was significantly higher
in individuals who had to make decisions about their
patient [5]. Many believe that a number of factors
could cause anxiety in these families including the type
of disease, the relationship of patient with family and if
the patient is the breadwinner of family, the patient's
condition and the type of disease [15]. Disability in
meeting some needs of families of patients in special
care unit can cause anxiety [4]. Paying attention to the
role of the nurse and her interventions to prevent anx-
iety of families of hospitalized patients, especially in
intensive care, is essential and important. Since pre-
vention is better and cheaper than treatment, so pre-
vention of anxiety is of great importance socially and in
terms of health [15].
The results of our study, in the field of evaluating stress
and depression in both groups indicated that stress
and depression levels in family members of ICU pa-
tients were significantly higher than family members of
CCU patients.
Studies show that family members of ICU patients ex-
perience actual negative changes and effects in their
lives that with the passage of time, stress of family
members increases and ultimately cause disruption in
the role and function of members of the family [5-16].
In a study, conducted by Rodriguez & Gregorio in 2005,
on psychological adjustment in relatives of severely
injured patients who were hospitalized in special care
unit, it was found that relatives experience an emo-
tional distress, as a result of the situation which was
created due to the incident, along with the feeling of
dissatisfaction, anxiety, guilt, humiliation and useless-
ness [17]. In another study, carried out by Mana and
colleagues (in 2007), the stress and adjustment of Chi-
nese families in Hong Kong was examined and it was
determined that high levels of stress, unexpectedly,
was experienced by women, who had lesser access to
educational facilities and in people whose relatives
were hospitalized in ICU [18]. These findings were also
reflected in review studies conducted by Adam
(2009).They have reported that the spouse, women
and children are significantly at the risk of being affect-
ed being anxiety, depression and post-traumatic stress
disorders. Other reported risk factors include low edu-
cational status, admission of patients to the special
care unit without previous planning and incomplete
information about the status of the patient [19]. An-
other study conducted in France by Azoulay et al
showed that 70% of family members of patients, who
were hospitalized in the special care unit, have experi-
enced post-traumatic syndrome and65% of them
showed symptoms of anxiety and depression [20]. Si-
ahkali and colleagues in their study showed that many
stressors such as severe and incurable illness or hospi-
talization of one of the members in the hospital can
lead families towards crisis and cause depression in the
family. Basically, patients of critical care units are ill
and in need of specialized care or they are going to die.
120
 Zarei et al., Int. J. Rev. Life. Sci., 5(11), 2015, 118-122

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