Stress and Coping Mechanisms Among Families of Critically Ill Patients in the Intensive Care Unit

Sulistiyani Sulistiyani* -  Politeknik Kesehatan Kementerian Kesehatan Jayapura, Indonesia
Theresia Febriana Christi Tyas Utami -  Politeknik Kesehatan Kementerian Kesehatan Jayapura, Indonesia

Introduction: Families of critically ill patients often experience psychological stress due to the uncertainty and emotional burden of intensive care environments. Objectives: This study aimed to examine the relationship between stress levels and coping mechanisms among family members of patients admitted to the Intensive Care Unit (ICU). Methods: A quantitative analytic design with a cross-sectional approach was used, involving 30 respondents selected through quota sampling. Data were collected using structured questionnaires to measure stress levels and coping strategies, and analyzed using Spearman’s rho correlation. Results: The results showed that 60.0% of respondents experienced high levels of stress (Level IV), and 70.0% employed maladaptive coping mechanisms. A moderate positive correlation was found between stress and coping (r = 0.365, p = 0.024), indicating that higher stress levels were associated with an increased use of maladaptive strategies. Conclusions: The study concludes that family members of ICU patients are prone to psychological distress and often lack effective coping mechanisms, highlighting the need for family-centered interventions to support emotional resilience and adaptive coping.

Keywords : stress; coping mechanism; ICU; family caregiver; psychological support

  1. Azoulay, E., Pochard, F., Kentish-Barnes, N., Chevret, S., Aboab, J., Adrie, C., ... & Schlemmer, B. (2005). Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 171(9), 987–994. https://doi.org/10.1164/rccm.200409-1295OC
  2. Back, A. L., Arnold, R. M., & Tulsky, J. A. (2014). Mastering communication with seriously ill patients: Balancing honesty with empathy and hope. Cambridge University Press.
  3. Curtis, J. R., White, D. B., & Engelberg, R. A. (2016). Practical guidance for evidence-based ICU family conferences. Chest, 150(4), 856–861. https://doi.org/10.1016/j.chest.2016.05.007
  4. Davidson, J. E., Aslakson, R. A., Long, A. C., Puntillo, K. A., Kross, E. K., Hart, J., ... & Curtis, J. R. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical Care Medicine, 45(1), 103–128. https://doi.org/10.1097/CCM.0000000000002169
  5. Folkman, S., & Moskowitz, J. T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745–774. https://doi.org/10.1146/annurev.psych.55.090902.141456
  6. Fumis, R. R. L., Ranzani, O. T., Martins, P. S., & Schettino, G. (2015). Emotional disorders and religious coping in families of ICU patients: A prospective study. Chest, 148(4), 972–978. https://doi.org/10.1378/chest.15-0903
  7. Gries, C. J., Curtis, J. R., Wall, R. J., & Engelberg, R. A. (2010). Family member satisfaction with end-of-life decision making in the ICU. Chest, 137(5), 1105–1113. https://doi.org/10.1378/chest.09-2106
  8. Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2018). Family health care nursing: Theory, practice, and research (6th ed.). F.A. Davis Company.
  9. Kentish-Barnes, N., Chevret, S., & Azoulay, E. (2009). Impact of a proactive strategy on the psychological well-being of family members of critically ill patients. Critical Care Medicine, 37(2), 544–549. https://doi.org/10.1097/CCM.0b013e3181958f31
  10. Lautrette, A., Darmon, M., Megarbane, B., Joly, L. M., Chevret, S., & Azoulay, E. (2007). A communication strategy and brochure for relatives of patients dying in the ICU. New England Journal of Medicine, 356(5), 469–478. https://doi.org/10.1056/NEJMoa063446
  11. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing.
  12. McAndrew, N. S., Leske, J. S., & Schroeter, K. (2012). Ethical concerns of family members during critical illness. Dimensions of Critical Care Nursing, 31(2), 104–110. https://doi.org/10.1097/DCC.0b013e3182440de9
  13. Minton, C., Batten, L., & Shaw, K. (2019). Family resilience and its association with family functioning and quality of life in ICU. Nursing in Critical Care, 24(5), 283–289. https://doi.org/10.1111/nicc.12364
  14. Myers, D. G. (2009). Psychology (9th ed.). Worth Publishers.
  15. Nolen-Hoeksema, S. (2001). Gender differences in depression. Current Directions in Psychological Science, 10(5), 173–176. https://doi.org/10.1111/1467-8721.00142
  16. Paasche-Orlow, M. K., & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31(Suppl 1), S19–S26. https://doi.org/10.5555/ajhb.2007.31.supp.S19
  17. Pochard, F., Darmon, M., Fassier, T., Bollaert, P. E., Cheval, C., Coloigner, M., ... & Azoulay, E. (2001). Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Critical Care Medicine, 29(10), 1893–1897.
  18. Seaman, J. B., Arnold, R. M., Scheunemann, L. P., & White, D. B. (2017). An integrated framework for effective and efficient communication with families in the ICU. Annals of the American Thoracic Society, 14(9), 1550–1556. https://doi.org/10.1513/AnnalsATS.201612-1009FR
  19. Shaw, D. J., Davidson, J. E., Smilde, R. I., Smedick, D., & Agan, D. (2016). Impact of a family presence policy on families and staff in the ICU. Critical Care Nurse, 36(6), e15–e20. https://doi.org/10.4037/ccn2016254
  20. Torke, A. M., Sachs, G. A., Helft, P. R., Montz, K., Hui, S. L., Slaven, J. E., & Callahan, C. M. (2012). Scope and outcomes of surrogate decision making among hospitalized older adults. JAMA Internal Medicine, 172(15), 1283–1289. https://doi.org/10.1001/archinternmed.2012.1809
  21. van Beusekom, I., Bakhshi-Raiez, F., de Keizer, N. F., Dongelmans, D. A., &
  22. van der Schaaf, M. (2016). Reported burden on informal caregivers of ICU survivors: A literature review. Critical Care, 20(1), 16. https://doi.org/10.1186/s13054-016-1185-9
  23. Wendlandt, B., Ceppe, A., Cox, C. E., et al. (2019). Economic and social burdens of informal caregiving for ICU survivors. Chest, 155(6), 1237–1245. https://doi.org/10.1016/j.chest.2019.02.010

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