ABSTRACT
BACKGROUND: Psychological care should be provided in intensive care units (ICUs) because of the proven mental symptoms of patients and relatives. Even physicians and nurses can benefit from a corresponding care structure. Knowledge is lacking whether and how psychological care for patients and relatives as well as support for staff in German ICUs is implemented. For this reason, a survey was conducted among the members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) to gain an overview of the current structures and the need for psychological support. METHODS: The members of DIVI were invited to participate in a web-based survey. A total of 226 physicians and nurses took part in the survey. Analysis included statistics and group comparisons with Χ2 methods. RESULTS: In all care areas, psychological care of patients, relatives, and support for staff, respondents indicated a significant undersupply and expressed the need for improved care. A model which provides consular or team-integrated support based on the level of care is conceivable. DISCUSSION: The current state of psychological care in German ICUs does not cover the existing need. Consequently the development of concepts and the beginning of discussions on how appropriate psychological care can be implemented in the future is necessary.
Subject(s)
Emergency Medicine , Physicians , Critical Care , Humans , Intensive Care Units , Surveys and QuestionnairesABSTRACT
A high incidence of care-relevant psychological problems in critical care medicine has been reported among patients, their families and professional care givers. International guidelines give appropriate recommendations for such care. What is unclear, however, is just how the care and support are provided in day-to-day practice and, in particular, which service providers are responsible for this support. The present care situation was studied in a web-based survey (38% response rate) among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN). Most respondents reported a moderate to substantial need for psychological support of patients in intensive care and a substantial to very substantial need in the case of their family members. The need for support in the case of staff showed a relatively broad scatter in the assessment. Providers of care are mainly the members of the intensive care team themselves, while clinical pastoral counsellors in particular are also involved and, to a lesser extent, counselling or liaison services specializing in psychotherapy.
Subject(s)
Critical Care , Emergency Medicine , Counseling , Family , Humans , Surveys and QuestionnairesABSTRACT
BACKGROUND: Intensive care unit (ICU) treatment may be associated with mental symptoms such as anxiety, depressed mood, hopelessness and nightmares in critically ill patients. While many physical symptoms can be detected via standardized measures, an instrument to assess mental symptoms is actually missing. OBJECTIVES: An existing validated screening tool to detect mental symptoms in critically ill patients, the Intensive Care Psychological Assessment Tool (IPAT), has been translated into German and tested in two surgical ICUs and an intermediate care unit. MATERIALS AND METHODS: In addition to the German translation of the IPAT, Stait-Trait-Anxiety-Inventory (STAI-SKD) and Hospital Anxiety and Depression Scale (HADS-D) were used to determine convergent validity. Within a survey period of 3 months, a total of 90 awake and fully oriented patients were included in the study. RESULTS: Internal consistency of the German translation was lower than that of the original study. The initial factor structure was partially replicated. Convergent validity was demonstrated for depressive and anxiety symptoms, but not for the presence of delirium. Patients who completed the screening were frequently suffering from sleep disturbances, tension, anxiety and depressed mood. A total of 37% of the patients exceeded the cut-off and are considered at-risk patients for psychological sequelae. DISCUSSION: With regard to test quality, the results of the German version are currently not satisfactory. This may be due to the small sample size and sample selectivity, which is also the largest limitation of the study. The instrument proved to be practicable if patients can complete it as an interview. The adaptation for external assessment seems to be useful to capture psychological stress in patients with impaired communication and perception.
Subject(s)
Critical Care , Mental Disorders , Anxiety , Critical Illness , Humans , Intensive Care Units , Surveys and QuestionnairesABSTRACT
Intensive care treatment is proven to be associated with patients' mental symptoms. There is a correlation between acute stress and psychological sequelae, which has not yet been sufficiently theoretically substantiated. This case report illustrates the development of mental symptoms during and after intensive care treatment with reference to a psychotraumatological model. Above all, memories that are not related to reality but are associated with fear of death are potentially traumatic. A re-evaluation of these memories can help to prevent psychological sequelae. Psychoeducation, conversation with the staff of the intensive care unit (ICU) and the ICU diary are helpful instruments in this process. Continuous psychological care should be provided if acute psychological stress occurs during intensive care medical treatment.
Subject(s)
Anxiety , Stress Disorders, Post-Traumatic/therapy , Critical Care , Humans , Intensive Care Units , Stress, PsychologicalABSTRACT
The relatively high rates of mental stress among critically ill patients and their relatives implies the necessity of conceptually and financially embedded psychological care in intensive care units (ICUs). Professional associations also recommend the involvement of psychological professionals and screening of mental symptoms in critically ill patients. Intensive care medicine psychologists and psychotherapists take this as an opportunity to describe the content and goals of psychological care. Task areas are care for patients and relatives as well as staff support. Goals of psychological support in the ICU are detection of mental symptoms in patients and their treatment, psychological first aid for relatives in crisis situations, and support of the staff in terms of communication with patients and relatives as well as regarding development and maintenance of an adaptive coping style for dealing with emotionally challenging situations. Psychological care in the ICU is offered by psychologists, psychotherapists, or physicians with a psychotherapeutic qualification. The psychologist is integrated into the ICU team and has a proactive, resource-oriented, and supportive orientation. Psychological support can be an enrichment and a relief, both in the interdisciplinary treatment of patients as well as in the care of relatives, and also represent a resource for the team.
Subject(s)
Critical Care , Intensive Care Units , Adaptation, Psychological , Critical Illness , Humans , Stress, PsychologicalABSTRACT
BACKGROUND: Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications. METHODS: The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment. RESULTS: The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, nâ¯= 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, pâ¯= 0.23), and (b) for relatives' PTSD (2 studies, nâ¯= 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, pâ¯< 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, nâ¯= 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, pâ¯= 0.02; OR 0.27, 95%CI: 0.09-0.77, pâ¯= 0.01, respectively). Heterogeneity was between 0 and 54%. CONCLUSION: ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.