Date of Award

2007-04-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; Jane M. Georges PhD, RN; Linda D. Urden DNSc, RN, CNA-BC, FAAN

Keywords

end of life care, Intensive Care Unit, life-threatening illness, nursing, symptoms, terminal illness

Abstract

The purpose of this study was to examine the symptom burden and severity of symptom distress reported by ICU patients at high-risk for death and to compare patient-rated symptoms and distress for concordance with symptoms reported by a family member. A prospective, correlational design with two data-points was used to study a convenience sample of 80 patients and 53 family members. The Condensed Memorial Symptom Assessment Scale (CMSAS) was used to gain patient/proxy report of symptoms on the first and third day after admission to the ICU. The majority of patients were symptomatic (98%), reporting an average of 10.23 symptoms. Most common symptoms reported on Day-1, were lack of energy (fatigue) and difficulty concentrating, with a mean symptom distress score of 2.96 (SD = 0.70) and 2.79 (SD = 0.84), scored on a scale of 1 = low symptom distress to 4 = high symptom distress, respectively. The CMSAS Total Distress Score was 2.24 (SD=0.66). The Physiological Symptom Distress Subscale (CMSAS-PHYS) score was 2.19 (SD=0.71). Approximately 97.9% of patients reported psychologic symptoms (sadness, worry, nervousness) with a mean symptom distress score of 2.45 (SD=0.66), measured by the Psychological Symptom Distress Subscale (CMSAS-PSYCH). On Day-3, 65 of the patients were still in the ICU. The most prevalent symptom reported was difficulty sleeping (90.8%), with a medium intensity distress score of 3.79 (SD=1.06). Eighty percent of patients reported additional symptoms: lack of energy, lack of appetite, pain, dry mouth, feeling drowsy, shortness of breath, and difficulty concentrating, with a moderate intensity mean score of 3.42. Overall distress increased among all symptoms, as measured by the CMSAS-Total Distress Score of 3.17 (SD=0.44), and the two distress subscales: CMSAS-PHYS mean score of 3.07 (SD=0.46) and CMSAS-PSYCH means score of 3.46 (SD=0.52). Hospital mortality was 17 (21%) during initial hospitalization and 16 (25%) at 3-months follow-up. Family members correctly estimated the presence and absence of symptoms 85.5% of the time, yet rated the patients' physiologic symptoms higher than psychological distress. This study identified ICU patients near death experience a significant burden of multiple symptoms, yet receive limited treatment for significant symptom distress. A need for widespread institution of symptom management strategies with proven effectiveness is indicated. Further research is needed to develop and test new evidence-based interventions to serve as a practice standards in the delivery of consistent, high quality care for all dying patients.

Document Type

Dissertation: Open Access

Department

Nursing

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