Objective: Family members of intensive care unit (ICU) patients often experience psychological symptoms related to postintensive care syndrome-family (PICS-F), which are closely linked to the extent to which their information needs have been met. The aim of this study was to identify family members' perceptions of unmet information needs in communication with ICU staff and to explore their association with psychological symptoms related to PICS-F. Methods: This single-centre, cross-sectional questionnaire study included family members of patients admitted to an emergency ICU who were surveyed between 1 and 12 months after ICU discharge. Perceptions of unmet information needs were assessed using a 21-item questionnaire. Anxiety, depression, and post-traumatic stress disorder-related symptoms were measured using the generalised anxiety disorder-7, Patient Health Questionnaire-9, and Impact of Event Scale-Revised, respectively. The proportions of unmet needs were calculated for each item, and the prevalence of psychological symptoms was estimated using established cut-off scores. Associations between unmet information needs and psychological symptom scores were explored using univariable and multivariable linear regression analyses. Results: Of the 550 family members invited to participate, 194 returned completed questionnaires, corresponding to a response rate of 35.3%. The prevalence of anxiety, depression, and post-traumatic stress disorder-related symptoms was 8.2%, 8.8%, and 17.5%, respectively. The proportion of perceived unmet information needs ranged from 9% to 26%. The most frequently unmet needs concerned recovery (26%), how and when family members would be informed (24%), and patients' psychological distress (24%). In contrast, information needs regarding weaning (10%), hearing (10%), and neurologic status (9%) showed the lowest proportions of unmet needs. In the exploratory multivariable analyses, unmet needs regarding patient "appearance", "physical pain", "news", and "decision-making" showed potential positive associations with psychological symptoms. Conclusions: Family members reported unmet information needs after ICU discharge, particularly regarding recovery, communication timing and methods, and psychological distress. These findings highlight the importance of assessing not only whether information is provided but also whether it is understood and responsive to families' evolving needs. Several unmet information needs showed potential associations with PICS-F-related psychological symptoms. Further research is needed to confirm these exploratory findings and inform the development of communication interventions. (c) 2026 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Objectives The aim of this study was to explore antidepressant use in invasively ventilated patients in intensive care who were able to be given medicines enterally (i.e. via feeding tube). As a secondary observation, we examined whether withholding an antidepressant was associated with positive Confusion Assessment Method - Intensive Care Unit (CAM-ICU) scores. Methods A 12-month (1st Jan 2020 to 31st Dec 2020) retrospective cohort study was conducted in the ICU of a 484-bed tertiary referral hospital. Invasively ventilated patients capable of receiving enteral medicines were included. Results Of invasively ventilated ICU patients prescribed antidepressants prior to admission, 93% had their antidepressants withheld (for part, or all) of their ICU stay and antidepressant withholding was associated with higher odds of a positive CAM-ICU score. Invasively ventilated patients who had an antidepressant withheld were over five times more likely to have had a positive CAM-ICU score during their ICU stay. Availability of a buccal dosage form or a dosage form that could be given enterally did not impact prescribing or administration of pre-existing antidepressants or facilitate swapping to an alternative antidepressant. Conclusions Antidepressant withholding is frequent in invasively ventilated patients in intensive care who were able to be given medicines enterally. An association was identified between antidepressant withholding and positive CAM-ICU scores, warranting further investigation. Given the observed association between antidepressant withholding and positive CAM-ICU scores, review of antidepressants management may be reasonable when managing invasively ventilated patients with positive CAM-ICU scores.
Objectives The aim of this study was to map structured communication interventions for families or surrogate decision-makers of adult intensive care unit (ICU) patients, describe their main characteristics and reported outcomes, and organise reported intervention components into a descriptive communication-domain map. Review Method Used A scoping review using descriptive evidence mapping and a combined deductive-inductive synthesis of communication domains. Data Sources Sources of evidence included PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, ClinicalTrials.gov, and reference list screening. Review Methods Eligibility criteria included primary studies reporting structured communication protocols, frameworks, checklists, bundles, tools, or reproductible interventions implemented by ICU clinical teams to support communication with families or surrogate decision-makers of adult ICU patients. Two reviewers independently extracted study and intervention characteristics, outcomes, measurement approaches, and quantitative findings, and reported limitations using a standardised form. Reported intervention components were charted and organised into descriptive communication domains through a combined deductive–inductive synthesis process; disagreements were resolved by consensus. Results Nine studies (2010–2022) were included and grouped into structured communication frameworks, educational/training interventions, and multicomponent bundles. Reported communication components were unevenly represented across included sources. Empathy/emotional support, knowledge transmission, summarisation, and value elicitation were among the most frequently described components, whereas ethical considerations, cultural adaptation, time management, nonverbal communication, and supportive aids were less frequently reported in published intervention descriptions. Outcomes were predominantly perceptual and process related. Conclusions Structured ICU family communication interventions are heterogeneous in design, delivery, and outcome assessment. This review provides an evidence map of intervention types and a descriptive-domain map of reported communication components. These findings may support the development and reporting of more comprehensive, context-sensitive ICU family communication interventions.
Background In Australia, the traumatic brain injury (TBI) inequity gradient disproportionately impacts Aboriginal communities, contributing to significant health and social impacts. Objectives This study sought to understand the TBI journey for Aboriginal patient and family TBI journey to identify quality indicators and determinants that shape health, healing, and wellbeing. It is part of the larger Australian Traumatic Brain Injury National Data project. Methods The Australian Traumatic Brain Injury National Data project was overseen by an Indigenous Data Governance Committee. Participants were recruited through existing networks. Data collection drew on Indigenous research methods of yarning and Yuri Ingarninthii. Deidentified transcripts were analysed thematically using qualitative analysis software NVivo (v12). Results Four yarning sessions were conducted with participants (>18 years old), with a mix of patients and family. Three interconnecting thematic domains were identified: (i) Injury event and in hospital care (support initiatives and care challenges) and (ii) Postdischarge care and ongoing support (allied health, abandonment, mental health, peer support, carer support, and financial hardship); along with (iii) TBI determinants for Aboriginal patients (family or community support, inner strength and resilience, cultural practice, cultural safety, transgenerational impacts, memory loss, and mental health). Conclusions Understanding TBI quality indicators and determinants for Aboriginal communities is essential for development of culturally grounded, safe, strength-based prevention, models of care, and support initiatives. These findings deepen existing knowledge, through centring Aboriginal voice, relationality, and lived experience, offering nuanced insights into TBI determinants not previously reported but are critical to promoting health and wellbeing outcomes and enabling Aboriginal TBI patients and their families to recover, heal, and thrive.
Background Pre–rapid response team (pre-RRT) systems are designed to facilitate early recognition and management of deteriorating hospitalised patients. In 2022, our institution implemented a novel role-based asynchronous messaging platform to support urgent clinical review (UCR) activations. Objectives To describes the frequency, timing, nature, and appropriateness of UCR activations and evaluates utilisation of the communication platform. Methods A retrospective observational study was conducted including all UCR messages sent via a role-based communication system at a tertiary Australian hospital between January and June 2024. Message metadata were analysed to describe activity patterns and response times. A systematic sample of every fifth UCR message underwent detailed review to assess appropriateness and reasons for escalation. Results During the six-month study period, 27 401 UCR messages were sent, representing a median of 182 (interquartile range: 164–201) activations per day. Activations demonstrated marked diurnal variation, peaking during nursing handover and routine observation periods. Median time to first written response was 9 min (interquartile range: 2–26). Detailed review of 5524 messages found that 99.6% were sent by nursing staff and 98.6% were directed to medical teams. Most reviewed messages (96.6%) were appropriate UCR-related communications, while only 3.4% were unrelated to the escalation process. Tachycardia (22.3%), hypotension (14.4%), and tachypnoea (12.2%) were the most common physiological triggers. Clinical concerns including uncontrolled pain, possible cardiac ischaemia, and bleeding were also frequent reasons for escalation. Conclusions Pre-RRT activations represent a substantial component of hospital clinical workload, with approximately 1000 UCR events occurring each week. A role-based asynchronous messaging platform enabled granular communication, an average medical response time of between 9 and 14 min, and was used appropriately in the vast majority of cases. These findings provide insights into the operational burden of pre-RRT systems and may inform future strategies to optimise escalation pathways, clinician workload, and patient safety.
