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Background: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation., Objective: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients., Methods: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated., Results: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%., Conclusions: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers' sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role., (©2024 American Association of Critical-Care Nurses.)

Objectives: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE)., Methods: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients., Results: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates., Significance of Results: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

Cognitive load predicts one's ability to process information and learn from decision support interventions. The present study compared intrinsic and extraneous cognitive load levels resulting from exposure to two different electronic decision aids. A convenience sample of ninety-seven surrogate decision makers for critically ill patients were randomly assigned to receive either a single dose of a video-based or avatar-based decision aid. Intrinsic and extraneous cognitive load levels among recipients of the video-based decision support resource were lower than recipients of the avatar-based decision support resource. After controlling for age, the observed differences in intrinsic cognitive load were not significantly different, whereas the observed differences in extraneous cognitive load remained. Extraneous cognitive load is a modifiable factor to consider for future developers of decision support interventions that may determine the efficacy of efforts to support patients and family members with decision making., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Intense emotional distress and impaired information processing have been implicated in reducing a surrogate decision maker's ability to formulate informed health care decisions for a critically ill patient. The heightened intensity of negative emotions, mental effort, and impaired judgment is consistent with the manifestation of decision fatigue. The aim of this article is to describe the validity and reliability of the Decision Fatigue Scale (DFS) among surrogate decision makers of the critically ill. A convenience sample of 101 surrogate decision makers were administered the DFS and a battery of psychosocial instruments at two time points. The DFS was specified as a unidimensional measure with adequate internal consistency (Cronbach's αs = .87, .90) and stability reliability. Discriminant validity was established with measures of emotion regulation, anxiety, and depressive symptoms. The DFS is the first subjective measure of decision fatigue for surrogate decision makers of the critically ill that demonstrates satisfactory psychometric properties.

Background: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. Objectives: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. Methods: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. Results: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. Conclusions: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care. [ABSTRACT FROM AUTHOR]

Coping with a loved one's critical illness as a surrogate decision-maker (SDM) elicits intense psychological distress. Emotion regulation (ER) may mitigate psychological distress. However, ER tendencies and their effects on psychological distress vary by racial and gender identity, which can inform the tailoring of ER-focused interventions. For this study, we examined between-group differences and the moderating effects of race and gender on ER (reappraisal and suppression) and psychological distress. We recruited 274 SDMs from a Midwestern academic medical center. Men reported a greater tendency to use suppression than women, and SDMs identifying as non-White reported a greater tendency to use reappraisal and suppression. Reappraisal resulted in greater psychological distress for non-White men and less psychological distress for White women. Incorporating tailored ER skill building into supportive interventions may improve the short- and long-term psychological well-being of SDMs, which may improve their ability to make value-concordant decisions and fulfill other informal caregiving responsibilities. [ABSTRACT FROM AUTHOR]

Decision fatigue is an applicable concept to healthcare psychology. Due to a lack of conceptual clarity, we present a concept analysis of decision fatigue. A search of the term "decision fatigue" was conducted across seven research databases, which yielded 17 relevant articles. The authors identified three antecedent themes (decisional, self-regulatory, and situational) and three attributional themes (behavioral, cognitive, and physiological) of decision fatigue. However, the extant literature failed to adequately describe consequences of decision fatigue. This concept analysis provides needed conceptual clarity for decision fatigue, a concept possessing relevance to nursing and allied health sciences. [ABSTRACT FROM AUTHOR]

A discussion guide for the article "Written Communication, Visitation Policies, and Awareness of Meidcal Issues Among Intensive Care Unit Families" by Jared Greenberg is presented. It suggests written communication strategies as a promising method to enhance a surrogate decision maker's understanding of the clinical condition of the patient. Intensive care unit problems identified among the patients include respiratory failure, hypotension/shock, encephalopathy and renal failure.

Surrogate decision makers (SDMs) of the critically ill experience intense emotions and transient states of decision fatigue. These factors may increase the cognitive load experienced by electronic decision aids. This cross-sectional study explored the associations of emotion regulation (expressive suppression and cognitive reappraisal) and decision fatigue with cognitive load (intrinsic and extraneous) among a sample of 97 SDMs of the critically ill. After completing subjective measures of emotion regulation and decision fatigue, participants were exposed to an electronic decision aid and completed a subjective measurement of cognitive load. Multiple regression analyses indicated that decision fatigue predicted intrinsic cognitive load and expressive suppression predicted extraneous cognitive load. Emotion regulation and decision fatigue represent modifiable determinants of cognitive load among SDMs exposed to electronic decision aids. [ABSTRACT FROM AUTHOR]

Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies. Few studies demonstrated significant improvements in the primary outcomes. In conclusion, there is limited evidence on the effectiveness of end-of-life decision support for critically ill patients and their surrogate decision makers. Additional research is needed to develop and evaluate innovative decision support interventions for end-of-life decision making in the intensive care unit. [ABSTRACT FROM AUTHOR]

The article provides a discussion guide for the study "How Patients and Families Describe Major Medical Treatments: They Are No Longer Living, Just Existing." It presents a definition of life support and offers an overview of the scope of the study to clarify the concept of life support to maximize the provision of value-concordant care in the intensive care unit (ICU). Three categories of discourse related to major medical treatments (MMT).

A review of the article "Grief Reactions of Potential Organ Donors' Bereaved Relatives: An Observational Study," which appeared in a September 2020 issue of the journal, is presented.