Date of Award

May 2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

AkkeNeel Talsma

Committee Members

Michelle Lobchuk, Vipavee Thongpriwan, Shawn Cahill

Keywords

Anxiety, Coping, Family, Satisfaction with Care, Stress, Trauma

Abstract

Background: Surprisingly few studies have considered the impact of trauma on adult family members of those admitted to the acute care, rather than ICU. Throughout the course of hospitalization, as patients move through different levels of care, family members must learn to adapt to, and cope with changes in care delivery. Purpose: To explore the literature to understand the state of the science, to assess the psychosocial and functional impact on family of adult trauma in acute care, and to identify predictors of coping and satisfaction with care provided to meet their needs. Design: The Lazarus & Folkman (1984) Stress, Appraisal and Coping Theory framed this non-experimental descriptive, correlational design. Methods: Eighty-six family members of adult trauma survivors completed six questionnaires, 72 hours after unexpected hospitalization, to assess Stress (IES-R), Anxiety and Depression (HADS), Coping (CISS-SSC), and Satisfaction with Care (CCFSS). A demographic questionnaire was used to describe the sample and previous trauma was assessed using Life Event Checklist-DSM5. Predictors for coping and satisfaction with care were explored. Results: The mean scores indicated high anxiety and stress levels. Patients were predominantly male (N= 59, 68.6%), while the caregivers were female (N=60, 69.8%). Almost half (48.9%) scored above clinically relevant levels on the HADS-anxiety subscale, and 51.9% had positive IES-R scores above the cut point ≥33 for severe stress, consistent with symptoms of acute stress disorder. Respondents scored in the low to medium range on the CISS-SSC, coping scale. They were generally moderately satisfied with care provided. Communication identified as a need by family members. Hierarchical regression models identified anxiety as the primary predictor of coping. Other predictors included age, gender, number of dependents, and previous trauma. Conclusion: The impact of the traumatic injury in this study is similar to that reported within critical care literature and offers insight into the psychosocial impact on family of adult trauma survivors. This is the first study to distinguish between critical and acute care environments. Results provide guidance for the development of interventions and strategies to mitigate negative consequences on the patient, staff and family.

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