Impact of a nurse-driven patient empowerment intervention on the reduction in patients' anxiety and depression during intensive care unit discharge: a randomized clinical trial

Abstract

Objectives: To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. Design: A prospective, multicenter, randomized clinical trial. Setting: Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. Patients: Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)] before ICU discharge. Intervention: The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. Measurements and results: Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG (n = 91) and CG (n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression (p < 0.001) and the presence of depression (p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. Conclusions: We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials.