Table 3.

Coping Strategies Used by ICU Family Members

Coping Strategy/Style of Coping	Example(s) From ICU Family Members
Problem-solving
Strategizing	Talking through concerns
Instrumental action	Involvement in patient care Advocacy
Planning	Making tentative funeral plans Discussing advance directives
Information seeking
Reading	Of the internet, laboratory results, electronic medical record
Observation	Of staff, patient, monitors
Asking others	Asking staff or other family members for information Seeking to know what is happening when it is happening Preference for having information, whether good or bad news
Helplessness
Cognitive interference	Forgetting to take daily medication
Cognitive exhaustion	Difficulty concentrating at work
Avoidance/escape
Cognitive avoidance	Pushing away thoughts of the future, or of death Deferment (ie, “taking it a day at a time”) Not making plans; not thinking about future decisions until required
Behavioral avoidance	Avoiding rounds, conflict, certain staff, seeing other patients
Wishful thinking	Seeking hope from staff, through prayer Belief in miracles Managing hope by balancing with realism Hoping medical crisis will lead to better self-care
Self-reliance
Strength	Relying on one’s own inner strength
Emotion regulation	Emotional containment, stoicism Avoiding crying in front of others or for fear of not being able to stop Hopefulness; creating positive atmosphere Avoiding getting hopes up
Emotional expression	Crying readily, or after a period of containment Laughter and humor
Behavior regulation	Food: eating, getting guest trays, going to restaurants, taking supplements Sleep: returning home to sleep, getting hotel room, leaving patient’s room to sleep Exercise and relaxation: walking, going outdoors, seeing sights, meditation
Behavioral expression	Physically destructive behavior as substitute for emotional venting
Emotional approach/anticipation	Anticipating an emotional rollercoaster Not wanting “sugar-coated” information
Support seeking
Contact seeking	Seeking company, proximity to people Seeking personable interactions with staff Social media, phone, text, and e-mail
Comfort seeking	Mutual support, keeping each other motivated Seeking out staff members who bring comfort
Instrumental aid	Fundraising or logistical support from coworkers, employers, friends Family members taking turns being at hospital, or communicating news to other family Transportation assistance
Spiritual support	Clergy, chaplain, faith community, prayers of others, scripture reading Own faith, prayer, meditation Belief in miracles, in healing power of positivity, or that God will provide
Isolation
Seeking solitude	Finding a place in the hospital or elsewhere to be alone
Avoiding others	Avoiding hostile relatives Drawing patient room curtains
Accommodation
Distraction	Reading for pleasure, talking, joking, working
Cognitive restructuring	Reframing, rationalizing, or reasoning as a means of self-calming Adjusting expectations or anticipating cognitive adjustments
Acceptance	Fatalism, or surrender to “God’s plan” Ceasing to worry about what is not under one’s control Choosing to trust (hospital, staff, one’s own decisions)
Normalization	Keeping up normal routines at home, and with children
Deference	Putting own needs second to patient, staff, other family Seeking to please staff in hopes of receiving better patient care
Negotiation
Bargaining	Asking staff for more time to make decisions
Persuasion	Advocating for patient or self Persuading family members or staff during decision-making
Priority setting	Prioritizing advocacy for patient over self-advocacy Communicating patient care priorities to staff Deferring problems that can be addressed later
Submission
Intrusive thoughts	Thoughts of patient “popping out” while trying to do something else
Opposition	Physical or verbal aggression with staff or other family