The relationship of coping strategies with care needs and life expectancy in the families of patients hospitalized in intensive care unit

Abstract

Introduction

Hospitalization of a patient in the intensive care unit is considered a stressful event for family members, which can lead to psychological reactions and changes in care needs. Managing this experience and difficult conditions requires the use of appropriate coping strategies. Therefore, the present study was conducted to investigate the relationship between coping strategies, care needs, and life expectancy in the families of patients hospitalized in the intensive care unit.

Methods

The present descriptive-analytical study was conducted among the family members of patients hospitalized in the intensive care units and medical education centers of Qazvin city, Iran, in 2023–2024. 198 family members were included in the study using the Convenience sampling method. Schneider, Billings-Moss, and Lasky questionnaires were used, respectively, to collect data on patients’ life expectancy, coping strategies, and family care needs. Statistical analysis was performed using mean, standard deviation, frequency, percentage, and SPSS software version 22. To investigate the relationship between variables, univariate regression was first used; then, multivariate regression was used to adjust for the effect of confounding variables. The significance level of all tests was considered less than or equal to 0.05.

Results

Based on the study’s results, the total score of participants’ coping strategies was 50.45 ± 10.18. The results of the present study showed that the participants’ care needs, with a score of 134.08 ± 12.77, are higher than the average. Life expectancy was above average with a total score of 29.01 ± 5.02. The results of multiple regression showed that, with a unit increase in coping strategies, the participants’ life expectancy increased by 0.56 (β = 0.56 (0.29, 0.83), p < 0.001). However, no significant relationship was observed between coping strategies and care needs (β = 0.08 (-0.02, 0.19), P = 0.146).

Conclusion

The findings showed that the care needs and life expectancy of these people are above average, and coping strategies have a positive and significant relationship with life expectancy. Given the limitations of cross-sectional studies in inferring causal relationships, further studies are needed to identify the potential role of coping strategies in improving life expectancy. It is suggested that future studies examine the impact of targeted interventions that enhance coping strategies on the care needs and life expectancy of family members of patients hospitalized in intensive care units.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-025-03688-8.

Introduction

Coping is an individual construct and is influenced by several factors such as culture and social environment [1]. Two types of problem-focused and emotion-focused coping have been proposed by Lazarus and Folkman [2]. The purpose of the emotion-focused strategy is to get a better feeling by reducing the emotional effects of stress. However, in the problem-focused strategy, the purpose is for the individual to effectively control a situation using skills such as problem-solving [3]. In addition, a stressful situation can force a person to use adaptive, and maladaptive coping strategies [4]. The noteworthy point is that cultural beliefs may also affect the use of coping strategies and families use many emotion-focused and problem-focused strategies according to their cultural context [5, 6]. Many previous studies show that in different cultural contexts, various coping strategies are used by family members of patients hospitalized in intensive care units. For example, studies conducted in Iran show that family members of patients hospitalized in the intensive care unit use more emotion-focused strategies than problem-focused ones [3, 7]. Meanwhile, studies conducted in Brazil and the United States show that family members of patients admitted to the intensive care unit use strategies such as problem solving, social support, and avoidance [1, 8]. While the reviewed articles show that coping is a global phenomenon, the relevant and determining factors of choosing the type of coping strategy have not yet been well explored.

Knowing the behavior of dealing with stress in specific groups and people who experience similar conditions can be an important tool for nurses to develop effective interventions [1]. because, based on psychological theories, coping strategies play an important role in managing stressful situations and ultimately improving people’s physical and mental health [9]. In addition to the importance of coping strategies, it should also be noted that family members are an integral part of the care process for patients in the intensive care unit. Therefore, to reduce the level of their psychological problems, it is also important to identify and meet their needs [10].

Various urgent needs are created for the patient’s family during the hospitalization of the patient in the intensive care unit, and they face various emotional, cognitive, and social stresses [11, 12]. In addition, patient treatment decisions create problems for family members, and when patients are unable to participate in their treatment decisions, families endure more pressure [12]. The feeling of hope, assurance of care provided for the benefit of the patient, the need for information, respect, compassion, support, and access to the patient to maintain closeness have been expressed among these care needs [13–15]. Studies show that the family members of patients hospitalized in intensive care units experience various care needs. A subject that has been confirmed in world studies and in Iran [16–21]. Although the prioritization of needs may vary across different contexts [21], not meeting the psychological, social, and spiritual needs of the family with a patient hospitalized in the intensive care unit will affect the health of the family and consequently the health of the patient [22]. While related articles have investigated coping strategies and care needs as separate concepts, they have emphasized the importance of these two concepts [6, 13, 23]. There is an important gap in investigating and identifying the type of relationship between these two variables in different societies.

Hospitalization of the patient in the intensive care unit has other consequences for the family members [15]. The tense environment of the intensive care unit, seeing a loved one in critical condition, and worrying about the future cause many psychological pressures on the patient’s family members [22, 24]. And the patients’ families systematically experience a loss of hope and a feeling of emptiness [12]. Fear of possible loss leads to reactions such as mourning and despair [24, 25], and this multifaceted stressor may reduce subjective life expectancy through multiple biological, social, psychological, and behavioral pathways [11]. Previous studies have reported the life expectancy in the families of cancer patients at an acceptable level [26, 27]. The level of this variable in the family of hemodialysis patients has been reported as average [28]. But the important gap is the lack of a few studies on this variable in the families of patients hospitalized in the intensive care unit. Meanwhile, this care community has an acute condition, unique and different from other populations. The next gap is the lack of sufficient knowledge of the relationship between coping strategies and life expectancy in this group. While the use of effective and consistent coping strategies reduces stress and improves optimism about the future and life expectancy [29].

The available evidence shows the diversity of coping strategies and care needs in patients’ families in different care environments. However, a critical review of the literature reveals a significant and underexplored gap concerning the families of patients hospitalized in Intensive Care Units. although life expectancy has been investigated in the family members of patients with chronic diseases, this important variable has not been investigated in the family members of patients hospitalized in the intensive care units, who have unique and different conditions. The unique conditions that limit the generalizability of findings from other care settings to this context. Furthermore, and more importantly, the relationship between coping strategies, care needs, and life expectancy in this population remains largely unknown. Clarifying the status of these variables and their type of relationship can help in the development of targeted interventions and comprehensive support programs. To directly address these identified gaps, the present study was guided by the following research questions: What is the relationship between coping strategies and the care needs of family members of patients hospitalized in Intensive Care Units? What is the relationship between coping strategies and the level of life expectancy among these family members? Examining these questions and providing novel insights can help in designing and implementing care programs in this vulnerable group.

Methods

Setting and study design

The present descriptive-analytical study was conducted at three hospitals (Velayat, Rajaee, and Bu-Ali) affiliated with Qazvin University of Medical Sciences, Iran, in 2023–2024. The study setting comprised the trauma intensive care unit, cardiac intensive care unit, and internal medicine intensive care unit. The target population consisted of family members of patients admitted to these intensive care units. By using the following formula, considering α = 0.5 (type 1 error), β = 0.8 (type 2 error), = 0.81, = 2.89, = 0.62, and = 3.08, the sample size was 171 people, and 198 people were included in the study with a 15% dropout probability (Fig. 1) [10].

Fig. 1.

Sample size formula

Due to the limited number of intensive care units and the challenging nature of reaching this special population in this difficult family situation, sampling was done by convenience methods. However, for a wider range of people to participate in the study, sampling was done in the morning and evening shifts and on all days of the week.

Age above 18 years, having a direct role in patient care, literacy, and mastery of the Persian language, and informed consent were the criteria for entering the study. Participants were excluded from the study if they had the following conditions. Having a mental disorder (according to the person’s own statement), physical and mental disability, taking care of another family member at home or in the hospital at the same time, and unwillingness to continue studying.

The participants were selected in person and through visiting the hospital. The objectives of the study were explained for each of them separately. Participants were assured that their information would remain confidential and that they had the right to withdraw from the study. After going through these steps, written and informed consent was received from the participants. Questionnaires were completed in the presence of the researcher and before the patient’s visit. To complete the questionnaire and provide comfort to the family member, a private room was used (this room is available in all departments). The questionnaires were completed on different days of the week and in the morning and evening shifts. Individual questions were read to each family member, and their answers were entered into the questionnaire. If needed, more information was given to them. The duration of completing all the questionnaires for each person was between 30 and 60 min.

Tools

The first part is a checklist of demographic characteristics of the family, including age, sex, marital status, educational attainment levels, economic status of the family, relationship with the patient, and a checklist of demographic information of the patient including, age, sex, marital status, history of hospitalization in the intensive care units, and length of hospitalization.

Part 2: life expectancy questionnaire

This tool consists of 12 statements. Among these expressions, 4 expressions are used to measure operative thinking (questions 2, 9, 10, and 12), 4 expressions are used to measure strategic thinking (questions 1, 4, 6, and 8), and 4 deviant expressions (questions 3, 5, 7, and 11). Its scoring method is based on a 5-option Likert scale from 1 (totally disagree) to 5 (totally agree). The scoring of deviant expressions is removed to increase the accuracy of the test. To get a total score, the scores of the two subscales are added together. Therefore, the range of scores is between 8 and 40, and higher scores mean more life expectancy. Preliminary evidence on the validity and reliability of the instrument was reported by Schneider et al. The Persian version of the tool was validated by Shoaa Kazemi et al. with a Cronbach’s alpha of 0.79, and its face and content validity were confirmed. Internal consistency of the total instrument was reported between 0.74 and 0.84. Test-retest reliability is also 0.80. Generally, the validity and reliability of this questionnaire have been confirmed in Iranian society [30–35]. The internal reliability of the questionnaire in the present study was obtained using Cronbach’s alpha of 0.79.

Part 3: Critical Care Family Needs Inventory (CCFNI)

This questionnaire has 45 questions. The questions are distributed among 5 dimensions. The support dimension has 15 items (2–24–25–26–27–30–31–33–34–37) that address the family’s need for support structures during the patient’s hospitalization. The comfort dimension with, 6 items (8–20–21–23–28–32), deals with the personal comfort of families, which includes items such as a waiting room, telephone, toilet, and availability of good food. 8 items (3–4–11–13–15–16–19–38), are located in the information dimension, which examines the family’s need to receive real information from their patient. The proximity dimension with, 9 items (6–39–40–41–44–45), shows the family’s need to be in close contact with the patient physically and emotionally. This dimension includes frequent visits, receiving regular information, telling the patient’s condition changes over the phone, and transferring to another department. The Assurance dimension with 7 items (1–42–43]) includes items related to honesty, secrecy, and hope [36]. Answers to the questions are scored based on a four-point Likert scale (not important (1), slightly important (2), important (3), and very important (4). The total score of the questionnaire is 45–180. A higher score means more need. The translation and localization of the tool in Iran was done by Bandari et al. The face and content validity of the tool have been qualitatively checked and confirmed. Cronbach’s alpha coefficient for the whole questionnaire in Iran is 0.926; in the three dimensions of support, comfort, and Proximity, it is more than 0.70, and in the two dimensions of information and confidence, it is reported between 0.6 and 0.7 [21, 37]. In the current study, the reliability of this tool was at an appropriate level (Cronbach’s alpha = 0.88).

Part 4: billings and moss coping strategies questionnaire

This questionnaire has 32 questions and measures five areas of coping strategies: problem solving (3 questions: 1–3−32), cognitive evaluation (5 questions: 2–5-8–18−20), emotional control (11 questions: 6–7-10–12-13–14-17–21-28–29−30), social support (4 questions:4–9-11–16), and physical control (9 questions: 15–19-22–23-24–25-26–27−31). The answer to each question is a four-choice Likert scale (always 3, most of the time 2, sometimes 1, and never 0). A high score in each subscale indicates a high level of use of that component in a person. The final score of this questionnaire is obtained in the form of problem-focused and emotion-focused coping. The sum of the first two subscales (problem solving and cognitive evaluation) is problem-focused coping, and the sum of the next three subscales is emotion-focused coping. By ranking coping levels in the study by Yousefi et al., the individual’s use of all coping strategies is categorized as low (0 to 32), moderate (33–48), and high (more than 49) [13, 38]. The Persian version of this tool has been validated, and its validity and reliability have been confirmed. In Iran, the reliability coefficient of this questionnaire through the test-retest method was 0.79, and Cronbach’s alpha was 0.90 for the problem-solving subscale, cognitive evaluation was 0.68, emotional control was 0.65, social support was 0.90, and physical control was 0.90 [13, 39, 40]. In the present study, the internal reliability of the instrument was obtained using Cronbach’s alpha of 0.88.

Analysis

Data collection, coding, and entry were performed by members of the research team. The entered data were subsequently cleaned and screened for errors and missing values. Data analysis was done by a statistician. After entering the data in the software and cleaning it, the normality of the data was checked using the Kolmogorov-Smirnov test. Tests such as mean and standard deviation were used to describe quantitative variables, and frequency and percentage were used to describe qualitative/nominal variables. Considering that in different studies, different tools are used to measure the same variable, and taking into account the difference in the number of questions under the scales of one tool, to compare the results, the formula for standardizing scores in the range of 0–100 was also used (Additional file 1). In the present study, univariate and multivariate linear regression analyses were used to investigate the relationship between coping strategies and care needs and life expectancy. Also, considering the important role of demographic variables and clinical conditions of the patient in the study variables, in order to adjust the effect of confounding variables in separate analyses, the relationship between coping strategies, care needs, and life expectancy was calculated with these variables. To perform the analysis, first, univariate linear regression was performed. Then the variables that had a p-value less than 0.2 in the univariate analysis were entered into the multivariate regression model [41]. The Backward method was used to perform multivariate analysis. Therefore, using this regression model, Confander’s variables were adjusted, and the final relationship was calculated, and standard indicators were extracted.

Results

Out of 198 participants in the study, 75 (37.9%) were male, and the rest were female. The mean age of the samples was 39.68 ± 12.61 years. Most of the samples were in the role of children of patients (43.4%) and had high school diplomas (37.9%). The mean age of the patients was 56.01 ± 21.10 years. Most of the patients (64.4%) were female. The average number of hospitalization days of the patients was 13.51 ± 17.02 days (Table 1).

Table 1.

Demographic variables of family members and patients (N = 198)

Variable		N (%)
Marital status (family member)	Single	55(27.8)
	Married	143(72.2)
Marital status (patient)	Single	48(24.2)
	Married	150(75.8)
Educational attainment levels (family member)	Illiterate	4(2.0)
	Below high school diploma	59(29.8)
	High school diploma	75(37.9)
	University-educated	60(30.3)
Relationship with the patient	Parent	43(21.7)
	Sibling	35(17.7)
	Child	86(43.4)
	Spouse	20(10.1)
	Relative or friend	14(7.1)
Hospitalization history of family members in the intensive care units	Yes	63(31.8)
	No	135(68.2)
Economic status of the family	Excellent/Good	46(23.2)
	Average/Weak	152(76.8)
Length of hospitalization (day)	13.51 ± 17.02

Based on the study’s results, the total score of participants’ coping strategies was 50.45 ± 10.18. The average scores of problem-focused and emotion-focused coping strategies were 16.69 ± 3.43 and 33.76 ± 8.59, respectively. By standardizing scores from 0 to 100, family members use more problem-focused coping strategies (69.58 out of 100). The results of the present study showed that the participants’ care needs, with a score of 134.08 ± 12.77, are higher than the average. In this questionnaire, the highest score in the range of 0–100 was related to the need for assurance dimension, with an average of 22.20 ± 2.83 and a standard score of 72.43. And the lowest score related to the need for comfort dimension was 16.76 ± 1.97, and the standard score was 59.78. Based on the results of the study, the total score of life expectancy was 29.01 ± 5.02 (Table 2).

Table 2.

Life expectancy, coping strategies, and care needs of family members of patients hospitalized in the intensive care unit (N = 198)

Variable		Mean(± SD)	(95% CI)	Score of 100
Life expectancy	Operative thinking	14.54 ± 2.22	(14.23, 14.85)	65.87
	Strategic thinking	14.47 ± 3.20	(14.03, 14.92)	65.43
	Total	29.01 ± 5.02
Coping strategies	Problem solving	6.32 ± 1.89	(6.05, 6.59)	70.22
	Cognitive evaluation	10.37 ± 2.13	(10.07, 10.67)	69.13
	Emotional control	15.99 ± 4.01	(15.42, 16.55)	48.45
	Social support	7.46 ± 2.67	(7.09, 7.84)	62.17
	Physical control	10.31 ± 4.81	(9.63)	38.18
	Total: problem-focused coping	16.69 ± 3.43	(16.21, 17.18)	69.58
	Total: Emotion-focused coping	33.76 ± 8.59	(32.56, 34.97)	46.89
	Total (problem-focused + Emotion-focused)	50.45 ± 10.18
Care needs	Support	39.34 ± 4.56	(38.71, 39.99)	60.33
	Comfort	16.76 ± 1.97	(16.48, 17.04)	59.78
	Information	27.61 ± 3.55	(27.11, 28.10)	68.92
	Proximity	28.16 ± 3.47	(27.67, 28.64)	70.96
	Assurance	22.20 ± 2.83	(21.81, 22.60)	72.43
	Total	134.08 ± 12.77

Based on the results of univariate regression (Tables 3, 4 and 5), the age of the patient has a positive and significant relationship with the care needs (p = 0.004, β = 0.12) and life expectancy (p = 0.02, β = 0.04) of the family members. The relationship between the patient’s age and family members’ coping strategies was inverse and significant (p < 0.001, β=−0.12). However, the multiple regression analysis showed that the patient’s age has a significant relationship only with the life expectancy of the caregivers (p = 0.04, β = 0.04). The results of univariate regression showed that the life expectancy of married people is significantly lower than that of single people (p = 0.005, β=−2.22). In addition, the care needs of married people are significantly higher than those of single people (p = 0.002, β = 6.26). Based on the results of multiple regression analysis, with one unit increase in coping strategies, the life expectancy of the participants increases (0.83, 0.29) by 0.56 (p < 0.001). However, no significant relationship was observed between coping strategies and care needs (β = 0.08, P = 0.146).

Table 3.

Correlation matrix between coping strategies and life expectancy and care needs

	Life expectancy	Care Needs	Coping Strategies
Hope	1
Need	0.05	1
Coping Strategies	0.28	0.10	1

Table 4.

Univariate linear regression analysis of factors affecting life expectancy, coping strategies and care needs of families of patients hospitalized in the intensive care unit (N = 198)

Variable		β coefficient CI : 95%
		Life expectancy	Coping strategies	Care needs
Sex (family member)	Male	1	1	1
	Female	−0.53(−1.99, 0.92) P = 0.470	3.68(0.78, 6.59) P = 0.013	2.25(−1.43, 5.94) P = 0.229
Sex (patient)	Male	1	1	1
	Female	1.35(−0.11, 2.81) P = 0.071	2.77(−0.20, 5.73) P = 0.068	3.42(−1.43, 5.94) P = 0.229
Marital status (family member)	Single	1	1	1
	Married	−2.22(−3.76, −0.67) P = 0.005	−2.96(−6.13, 0.20) P = 0.067	6.26(2.34, 10.17) P = 0.002
Marital status (patient)	Single	1	1	1
	Married	1.89(0.26, 3.51) P = 0.023	5.12(1.86, 8.38) P = 0.002	2.77(−1.39, 6.94) P = 0.191
Educational attainment levels (family member)	Illiterate	1	1	1
	Below high school diploma	4.24(−0.84, 9.32) P = 0.101	0.11(−10.28, 10.50) P = 0.983	−22.10(−34.20, −10.00) P < 0.001
	High school diploma	4.23(−0.81, 9.28) P = 0.100	3.06(−8.26, 12.38) P = 0.694	−12.68(−24.70, −0.67) P = 0.039
	University-educated	5.43(0.35, 10.51) P = 0.036	2.95(−7.43, 13.33) P = 0.576	−20.72(−32.81, −8.62) P = 0.001
Relationship with the patient	Parent	1	1	1
	Sibling	1.89(−0.33, 4.12) P = 0.095	0.08(−4.32, 4.49) P = 0.969	7.09(1.47, 12.72) P = 0.014
	Child	2.03(0.20, 3.86) P = 0.029	5.88(2.26, 9.50) P = 0.002	5.55(0.93, 10.16) P = 0.019
	Spouse	1.03(−1.62, 3.68) P = 0.444	−0.25(−5.49, 4.99) P = 0.925	4.29(−2.40, 10.97) P = 0.208
	Relative or friend	3.868(0.85, 6.88) P = 0.012	−1.21(−7.18, 4.74) P = 0.688	11.62(4.01, 19.22) P = 0.003
Hospitalization history of family members in the intensive care units	Yes	1	1	1
	No	0.49(−1.03, 2.00) P = 0.526	0.42(−2.65, 3.49) P = 0.789	4.82(1.03, 8.62) P = 0.013
Economic status of the family	Excellent/Good	1	1	1
	Average/Weak	−0.094(−1.76, 1.58) P = 0.912	−1.21(−4.59, 2.17) P = 0.480	−3.26(−7.49, 0.96) P = 0.129
Length of hospitalization (day)		−0.02(−0.06, 0.02) P = 0.299	0.04(−0.04, 0.12) P = 0.366	0.05(−0.05, 0.16) P = 0.326
Age (family member)		−0.09(−0.14, −0.03) P = 0.002	−0.09(_0.20, 0.03) P = 0.134	0.15(0.01, 0.29) P = 0.033
Age (patient)		0.04(0.006, 0.07) P = 0.022	−0.12(0.06, 0.19) P < 0.001	0.12(0.04, 0.211) P = 0.004

Table 5.

Multiple linear regression analysis of factors affecting life expectancy, coping strategies and care needs of families of patients hospitalized in the intensive care unit (N = 198)

Variable		β coefficient CI : 95%
		Life expectancy	Coping strategies	Care needs
Sex (family member)	Male		1	-
	Female	-	1.90(−1.09, 4.90) P = 0.212	-
Sex (patient)	Male	-	1	1
	Female	0.98(−0.45, 2.42) P = 0.18	1.97(−0.96, 4.91) P = 0.186	2.04(−1.39, 5.49) P = 0.242
Marital status (family member)	Single		1	1
	Married	−1.70(−3.54, 0.13) P = 0.06	−1.48(−4.73, 1.76) P = 0.370	5.72(1.31, 10.12) P = 0.011
Marital status (patient)	Single		1	-
	Married	0.48(−1.41, 2.38) P = 0.61	2.35(−1.43, 6.14) P = 0.222	-
Educational attainment levels (family member)	Illiterate	1	-	1
	Below high school diploma	6.29(1.21, 11.37) P = 0.01	-	−17.15(−29.26, −5.04) P = 0.006
	High school diploma	4.60(−0.35, 9.56) P = 0.68	-	−11.57(−23.34, 0.19) P = 0.054
	University-educated	5.10(−0.008, 10.22) P = 0.05	-	−15.56(−27.72,) P = 0.012
Relationship with the patient	Parent	1	1	1
	Sibling	1.55(−0.93, 4.05) P = 0.219	−1.24(−5.86, 3.37) P = 0.595	6.49(0.55, 12.43) P = 0.032
	Child	0.31(−2.15, 2.78) P = 0.802	2.36(−1.98, 6.72) P = 0.285	5.64(−0.21, 11.51) P = 0.059
	Spouse	0.85(−1.91, 3.61) P = 0.545	−2.09(−7.54, 3.36) P = 0.450	2.11(−4.30, 8.53) P = 0.516
	Relative or friend	3.65(0.46, 6.85) P = 0.025	−2.68(−8.70, 3.33) P = 0.380	7.66(0.03, 15.30) P = 0.049
Hospitalization history of family members in the intensive care units	Yes	-	-	1
	No	-	-	3.23(−0.39, 6.86) P = 0.081
Economic status of the family	Excellent/Good	-	-	1
	Average/Weak	-	-	−2.15(−6.03, 1.73) P = 0.276
Age (family member)		−0.04(−0.11, 0.02) P = 0.206	-	0.11(−0.05, 0.28) P = 0.180
Age (patient)		0.04(0.00, 0.08) P = 0.040	0.06(−0.02, 0.14) P = 0.146	0.04(−0.04, 0.13) P = 0.328

Discussion

Coping strategy

The present study showed that families of patients hospitalized in the intensive care unit used more problem-focused strategies. This finding is consistent with studies conducted in similar clinical environments. The results of Pinheiro et al.‘s study showed that the relatives of patients hospitalized in the special department focus on problem-focused strategies [42], which is consistent with the findings of the present study. The comparable population and research environment are key factors contributing to the alignment between the findings of the two studies, as both were carried out in intensive care units and involved family members of patients. This finding is inconsistent with the findings of studies conducted in different populations. For example, in the United States, family members of patients with mental disorders use emotion-focused coping styles more [9]. The researcher believes that in explaining this difference, attention should be paid to hospitalized patients. The nature of hospitalized patients can affect the reaction of family members and the use of different coping styles. Although the context, human resources, and access to facilities can be considered factors influencing the adoption of a coping strategy, the main reason for the difference in the findings of the above study and the present study is related to hospitalized patients. Because the nature of patients suffering from mental disorders is different from patients admitted to special care units. The difference between the results of the present study and the findings of the study of Araghian Mojarad et al. [3] may be related to the nature of the stressor (acute crisis in the intensive care unit versus different and chronic challenges in the cardiac care unit). These contextual factors, the nature of the event, the understanding of people, and the preferences of family members, are probably considered to be the determining factors for adopting the type of coping strategy.

In explaining the use of problem-focused strategies by the samples of the present study, it is necessary to refer to the definitions of different strategies. In the problem-focused coping strategy, the focus is on the situation and trying to change the problem. While in the emotion-focused strategy, the focus is on controlling negative emotions. Therefore, the emotion-focused strategy may be effective in the short term, but it hinders psychological adaptation in the long term [43]. It seems that the long-term average number of hospitalization days of patients in this study has provided an opportunity for families to move from the initial emotional reaction to adopting an approach based on active interaction and problem-solving. Since problem-focused strategies are effective and consistent [7], the care team in the clinical department can move towards strengthening and supporting problem-focused strategies by providing sufficient information and family members’ participation in patient care decisions.

Care needs

The present study showed that the participants’ care needs are in the high range, which is in line with the findings of Aminipour et al.‘s study [21]. The use of a common assessment tool (CCFNI) and the same context as the study of family members of patients hospitalized in the intensive care unit with an unpredictable condition are considered to be the main reasons for the alignment of the findings of the two studies. This finding is also consistent with the results of the study conducted by Bandari et al. in Iran [37]. Given that both studies were conducted in Iran, similar cultural characteristics and care structures may account for the consistency in their findings. The high level of needs shows the need to pay more attention to adopting family-centered care models in this unit. The presence of families in the unit, emotional and psychological support, educational workshops, and improving communication with the patients’ family members can all be effective in meeting and providing the care needs of the family members.

After standardizing the scores in the range of 0–100 in the present study, the need for assurance was placed as the priority of the care needs of the participants, which is consistent with the findings of some studies [10, 21]. In explaining the similarity of the results of the above studies with the present study, it is necessary to refer to the samples of all three studies. The use of a similar research population has caused the results to be consistent with each other. This finding shows that creating confidence by providing accurate information and specifying the patient’s care and treatment path for family members is of great importance. Therefore, it is suggested that care and treatment personnel should keep the patient’s family members more informed about the treatment and care process and pay more attention to the need to create a relationship of trust and confidence. On the other hand, in the study of Hasandoost et al., support needs are prioritized [44]. Although the above study was conducted in the intensive care unit, the time of data collection could be one of the main reasons for the difference in results. The study by Hasandoost et al. was conducted before the outbreak of the Corona Virus Disease 2019 (COVID-19) pandemic. A period that brought about significant changes in the provision of care services. This pandemic can potentially affect the quality of communication with the patient’s family members by affecting the number and performance of healthcare workers [45]. This change in background factors, such as work pressure and changes in care protocols, probably explains the difference in the prioritization of care needs before and after the pandemic.

In the present study, the lowest priority of participants’ care needs was the dimension of comfort, which is in line with the findings of a study in Turkey [46]. In the early days of emotional distress and constant information seeking, it seems logical that comfort factors are of low priority [46]. But in the study of Aminpour et al., this dimension is the second priority, and the last priority of care needs is the support dimension [21]. Several contextual and methodological factors can influence the difference in results. These factors include the objectives of the study, the time of the study, the clinical characteristics of the hospitalized patients, and even the difference between the types of intensive care units. In addition, the number of nursing personnel and the workload may also affect the amount of attention paid to family members and, as a result, create a difference in their perceived priorities and unfulfilled needs. The difference in prioritizing care needs during the patient’s hospitalization in the intensive care unit should be considered in the development of targeted and effective interventions.

Life expectancy

The present study showed that the life expectancy of the participants is higher than the average. This is consistent with the findings of Dehghani et al.‘s study on mothers of children with cancer [26] and Goodarzi et al.‘s study on parents of children with autism [47]. In explaining the results, it should be said that when a family member needs help to adapt, the family’s performance has a supportive and decisive role, and when they feel empowered, they can also support their patient [26]. Since hope facilitates crossing important obstacles and bumps in the path [47], it seems that the participants of the present study were able to better manage to face the problems and hardships of the patient’s hospitalization by maintaining hope in life. The high level of life expectancy in these people indicates a significant capacity to adapt and the ability to perceive the stressful situation of intensive care as a non-threatening and positive event. This finding has an important clinical application for managers and policy makers. First, the care team should recognize this inherent resilience of people and use it to manage the situation better. Second, future research should move towards identifying the sources of this resilience, so that these factors can be strengthened and improved through some targeted interventions.

The relationship between variables

The important finding of this study was the positive and meaningful relationship between coping strategies and life expectancy. This shows that with a one-unit increase in coping strategies, the life expectancy of the participants increases by 0.56 units. This finding emphasizes the important role of coping strategies in life expectancy, which is in line with the findings of Sepahvandi et al.‘s study in the mothers of children with cancer [48]. Although coping strategies have been associated with issues such as caregiving burden [49], depression [50], and quality of life [51] in caregivers and relatives of various patients, few studies have examined the relationship between coping strategies and life expectancy among family members of patients. A study on more than 4000 healthy people in America showed that the use of maladaptive coping strategies is related to a shorter lifespan [52]. Although the above study differs from the current study both in the research community and in the tools used, it is consistent with the current study in terms of the relationship between coping strategies and life expectancy. A study among informal caregivers of lung cancer patients showed that coping styles are associated with beneficial findings (positive psychological responses) [53]. This is consistent with the findings of the present study. The alignment of the results of different studies with the present study shows that the research community of the above studies and the present study uses coping strategies appropriately and does not lose themselves against the existing pressures and experiences more life expectancy. The findings of this section support the integration of coping skills-enhancing interventions in educational and care programs for the families of hospitalized patients in the intensive care unit. Adopting targeted interventions can help to improve life expectancy in addition to improving coping strategies.

Studies show that active coping predicts life satisfaction, happiness, independence, competence, and communication as basic needs [54]. In other words, coping styles can reduce psychological discomfort to some extent and be beneficial for mental health. The theory of coping with stress also emphasizes that when people deal with stressful events, they should not only focus on negative emotions caused by stressful factors but also pay attention to positive psychological experiences [53]. Although some studies have shown that patients’ relatives need information to deal with stress [55], the present study showed that there is no significant relationship between coping strategies and care needs. A study in Turkey also showed that the need for information, Proximity, support, and comfort have a positive and significant relationship with the emotion-focused coping style [6]. The difference in the results of the two studies can be attributed to the difference in methodology, because the study conducted in Turkey considered sub-areas of care needs instead of the total score of care needs. A deeper explanation lies in the definition of the coping variable. Coping strategies, a person’s perception of himself and his behavior, are described to maintain balance in the path of personal growth and adapt to the needs of the environment [56]. In other words, adopting a coping strategy is influenced by personal understanding and evaluation of a stressful event. With the above explanations, this difference in results can be explained.

Limitations

The present study has several important limitations that should be considered in the interpretation of the findings. The self-report form of the findings creates the possibility of recall bias, which may affect the accuracy of the results. Although we tried to reduce this limitation by explaining the objectives of the study in detail and giving enough time to complete the questionnaire, this bias cannot be eliminated. Sampling by the convenience method and conducting the study in one province limits the generalizability of the results. A cross-sectional study rejects any causal inference. The heterogeneity of the roles of family members (mother, father, and child) was another limitation of the study, because care needs and coping strategies can change based on these roles. Insufficient sample size can increase the risk of type II error and limit the generalizability of results. Classification of family members based on their roles can provide more accurate information about the studied variables. Future studies with a larger sample size and in several provinces are recommended to increase the credibility of the findings. Another limitation of the study was that the emotional state of the participants at the time of completing the questionnaires may affect the results, so it was asked to complete the questionnaires in a calm and stress-free environment.

Conclusions

The findings of this study showed that the family members of patients hospitalized in the intensive care unit use both coping strategies, but they use problem-focused coping more. Therefore, managers and policymakers are expected to consider the empowerment of patients’ family members to strengthen effective and constructive coping methods. The findings showed that the care needs and life expectancy of these people are above average. It is expected that the nurses of the intensive care unit receive the necessary training on the importance of the care needs of the patients’ families and try to fulfill them based on these needs. In addition, according to the findings, coping strategies have a positive and significant relationship with life expectancy. It is very important to interpret this finding in the framework of the cross-sectional study design and negate any causal relationship between the two variables. Therefore, we can only say that these two variables are related to each other. For this reason, the potential role of coping strategies in improving life expectancy requires more studies. It is suggested that in future studies, the impact of targeted interventions promoting coping strategies on the care needs and life expectancy of patients’ family members should be investigated. In addition, it is recommended to conduct studies with a large statistical community to investigate the impact of different roles of family members on the type of needs and to adopt coping strategies.

Abbreviations

CCFNI

Critical Care Family Needs Inventory

COVID-19

Corona Virus Disease 2019

SPSS

Statistical Product and Service Solutions

Author contributions

All authors made the design of the study, YA and NSH participated in data collection, and the data were analyzed by ZH, NSH, and MS. The final report and article were written by MS and NC, and were read and approved by MS. The author(s) read and approved the final manuscript.

Funding

The study was not funded and supported.

Data availability

The datasets used and/or analyzed during the current study are available from the ‎corresponding author ‎on reasonable request.

Declarations

Ethics approval and consent to participate

The process of conducting the study started with the review and approval of the ethics committee of Qazvin University of Medical Sciences IR.QUMS.REC.1402.162. Full explanations about the purpose, method of conducting the study, and confidentiality of information were given to the participants. Written informed consent was obtained from all people. All the steps of the research were conducted according to the Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.