RESUMO
BACKGROUND: Psycho-social support factors play an important role in the health status of the community. Their effect on the clinical course of critically ill patients is poorly known. One of the main obstacles for their study is the difficulty of the measurement of psychosocial factors in the critical care environment. The objective of this study is to build-up and validate an instrument to assess the psycho-social adjustment in critical care patients. METHODS: We have studied 214 adult patients admitted to the intensive care unit (ICU) in a public hospital with 420 beds. None of them was in coma or showed signs of encephalopathy or acute psychosis. Each patient was independently evaluated by two nurses that rated 15 variables related to the patient's psychosocial environment, without direct interview of the patient. The inter-observer concordance was assessed using the weighted kappa index. The internal consistency of the selected items was assessed by the Cronbach's index. RESULTS: The inter-observer concordance in the assessment of the different items was always higher than 0.4. The classical analysis of the internal consistency selected 7 items (environmental confidence, perceived family-support, refusal of the critical situation, irritation, affliction, empathy and liking) which showed an alpha coefficient of 0.77. The psychosocial adjustment scale built upon these 7 items showed a good inter-observer concordance (kappa = 0.71). CONCLUSIONS: Critical care nurses can reliably assess some psychosocial variables in critical care patients. These assessments allows the building of a scale of psychosocial adjustment in the ICU applicable to a wide variety of critical patients and that does not requires direct interview of the patient.
