Perspectives of physicians and nurses on identifying and treating psychological distress of the critically ill

Intensive Care Registered Nurses knowledge, attitudes and perspectives of caring for patients with mental health conditions: A scoping review

BACKGROUND

Registered nurses (RNs) working in intensive care settings report challenges in supporting the physical as well as perceived additional psychological care of patients with mental health disorders (MHD).

AIM

To undertake a scoping review of RNs' knowledge, attitudes, and perspectives of caring for patients with MHD in an Intensive Care Unit (ICU).

METHOD

Arksey and O'Malley's 2005 scoping review methodology was used, and the quality of reporting was upheld with PRISMA-Scoping Review guidelines. A comprehensive literature search of peer-reviewed, published studies in English from 2013 to 2013 was conducted in six databases (CINAHL, PubMed, Joanna Briggs Institute, Scopus, Cochrane, and PsycINFO databases). All included studies were evaluated using Critical Appraisal Skills Program (CASP) to assess the rigor of each study.

FINDINGS

Seven studies were included, three qualitative and four quantitative studies. Most represented the Oceania region (n = 4). Thematic analysis identified four primary themes (i) developing knowledge and skills, (ii) variable empathy for patients, (iii) perceived safety concerns for patients and staff, and (iv) the need for clinical support.

CONCLUSION

RNs' knowledge, attitudes, and perspectives influence the care of patients with MHD in adult intensive care. Ensuring staff are equipped technically with knowledge and skills along with clinical resources is fundamental to promoting the physical and psychological well-being of patients with MHD in the intensive care setting.

Care Beyond Cure: Humanizing the Intensive Care Unit Journey

How to cite this article: Chacko B. Care Beyond Cure: Humanizing the Intensive Care Unit Journey. Indian J Crit Care Med 2024;28(10):901-902.

Humanizing the Intensive Care Unit: Perspectives of Patients and Families on the Get to Know Me Board

In this qualitative study, we explored perspectives of patients in the intensive care unit (ICU) and their families on the Get to Know Me board (GTKMB). Of the 46 patients approached, 38 consented to participate. Of the 66 family members approached, 60 consented to participate. Most patients (26, 89%) and family members (52, 99%) expressed that GTKMB was important in recognizing patient's humanity. Most patients (20, 68%) and families (39, 74%) said that it helped to build a better relationship with the provider team. 60% of patients and families commented that the GTKMB was used as a platform by providers to interact with them. Up to 45 (85%) of the family members supported specific contents of the GTKMB. In structured interviews (11 patients, 7 family members), participants additionally commented on ways providers used the GTKMB to communicate, support patient's personhood, and on caveats in interacting with GTKMB. Critically ill patients and families found the GTKMB helpful in preserving personhood of patient, fostering communication, and building relationships with clinicians.

Aloud real- time reading of intensive care unit diaries: A feasibility study

OBJECTIVES

Memories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories.

RESEARCH METHODOLOGY

Prospective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay.

SETTING

Various intensive care units in a single academic center.

MAIN OUTCOME MEASURES

Feasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not.

RESULTS

Overall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort.

CONCLUSION

We encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted.

IMPLICATIONS FOR CLINICAL PRACTICE

There is no recommendation to change current practice as benefits of the intervention are unproven.

Psychogenic stress in hospitalized veterinary patients: Causation, implications, and therapies

OBJECTIVE

To review the sources, adverse effects, diagnosis, treatment, and prevention of psychogenic stress in hospitalized human and veterinary patients.

DATA SOURCES

Data were collected by searching PubMed for veterinary and human literature from the past 10 years.

HUMAN DATA SYNTHESIS

Psychogenic stress has been linked to immune suppression; gastrointestinal, cardiovascular, and cutaneous diseases; delayed wound healing; alterations in pain perception; and neurologic impairment. Sources of psychogenic stress include environmental alterations such as excessive noise and light, social and physical factors, sleep disruption, drugs, and underlying disease. Nonpharmacologic options for stress reduction include environmental and treatment modifications, music therapy, and early mobilization. Pharmacologic options include sedation with benzodiazepines and dexmedetomidine. Trazodone and melatonin have been examined for use in sleep promotion but are not currently recommended as standard treatments in ICU.

VETERINARY DATA SYNTHESIS

Activation of the stress response in veterinary patients is largely the same as in people, as are the affected body systems. Possible sources of stress can include social, physical, and environmental factors. No gold standard currently exists for the identification and quantification of stress. A combination of physical examination findings and the results of serum biochemistry, CBC, and biomarker testing can be used to support the diagnosis. Stress scales can be implemented to identify stressed patients and assess severity. Nonpharmacologic treatment options include low-stress handling, pheromones, environmental modifications, and sleep promotion. Pharmacologic options include trazodone, benzodiazepines, dexmedetomidine, and melatonin.

CONCLUSION

The prevalence and clinical significance of psychogenic stress in hospitalized veterinary patients is unknown. Future studies are needed to specifically examine the causative factors of psychogenic stress and the effects of various therapies on stress reduction. The recognition and reduction of psychogenic stress in veterinary patients can lead to improvements in patient care and welfare.

Acute psychological trauma in the critically ill: Patient and family perspectives

OBJECTIVE

Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors.

METHODS

A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families.

RESULTS

Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; p<0.0001) and in ICU (rho=0.45; p=0.002). 70% of patients experienced fear of death, 38% had additional other fears, 48% had hallucinations. Concerns included inability to communicate (34%), environmental factors (30%), procedures and restraints (24%), and being intubated (12%). Emotional support of family/friend/staff/clergy (86%), and physical therapy/walking (14%) were perceived to be important mitigating factors. Clinicians' actions that were perceived to be very constructive included reassurance (54%), explanations (32%) and physical touch (8%).

CONCLUSIONS

Fear, hallucinations, and the inability to communicate, are identified as central contributors to psychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay.