A Thematic Analysis of Family Perspectives on Traumatic Stress and Critical Illness of a Loved One
Background: Trauma-informed care is a promising framework for understanding and ultimately mitigating traumatic stress associated with critical care. Specific components of trauma-informed adult critical care have not been defined. Research Question: How do family members with traumatic stress experience ICU care of a loved one? Study Design and Methods: Family members of mechanically ventilated patients who endorsed substantial historical trauma or current traumatic stress during their loved one's ICU stay were recruited from 9 ICUs in 1 urban and 1 suburban-rural health system. Family members participated in semistructured interviews eliciting their perceptions of traumatic stress during ICU care and aspects of critical care that modified stress. Interviews were transcribed and emergent themes were captured through iterative coding, case narrative memos, and abductive thematic analyses. Interviews continued until, through concurrent analyses, both thematic saturation and information power were reached. Results: Among 26 family members, the median age was 53.2 years (interquartile range [IQR] 48.3-61.1 years) and most were female (n = 20 [76.9%]) and Black (n = 14 [53.8%]). Family members endorsed a median of 9 (IQR, 5-13) potentially traumatic events in their lifetimes. Emergent themes included: (1) behaviors suggestive of possible trauma responses (eg, vigilance) during ICU stays, (2) reluctance to disclose prior trauma to ICU clinicians because of concerns about bias or lack of support, (3) perception that surrogate decision-making and caregiving responsibilities exacerbated stress, and (4) structural and procedural aspects of ICU care reduced or amplified stress, including presence (visitation) policies, physical hospital and ICU environment, and family support resources. Interpretation: Family members of critically ill patients described potential traumatic stress responses during ICU experiences and identified components of critical care that may complement and expand existing models of family-centered ICU care to incorporate trauma-informed approaches.
