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

Lioudmila V. Karnatovskaia, Margaret Johnson, Travis J. Dockter, Ognjen Gajic

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that can impede its recognition and treatment in the ICU. Materials and methods Two distinct role-specific Web-based surveys were administered to critical care physicians and nurses in medical and surgical ICUs of 2 academic medical centers. Responses were analyzed in the domains of psychological trauma, exacerbating/mitigating factors, and provider-patient communication. Results A survey was completed by 43 physicians and 55 nurses with a response rate of 62% and 37%, respectively. Among physicians, 65% consistently consider the psychological state of the patient in decision making; 77% think it is important to introduce a system to document psychological state of ICU patients; 56% would like to have more time to communicate with patients; 77% consistently spend extra time at bedside besides rounds and often hold patient's hand/reassure them. Notably, for the question about the average level of psychological stress experienced by a patient in the ICU (with 0 = no stress and 100 = worst stress imaginable) during initial treatment stage and by the end of the ICU stay, median assessment by both physicians and nurses was 80 for the initial stress level and 68 for the stress level by the end of the ICU stay. Among nurses, 69% always try to minimize noise and 73% actively promote patient's rest. Physicians and nurses provided multiple specific suggestions for improving ICU environment and communication. Conclusions Both physicians and nurses acknowledge that they perceive that critically ill patients experience a high level of psychological stress that persists throughout their period of illness. Improved understanding of this phenomenon is needed to design effective therapeutic interventions. Although the lack of time is identified as significant barrier to ameliorating patient's psychological stress, the majority of clinicians indicate that they attempt to provide interventions to achieve this goal.

Original languageEnglish (US)
Pages (from-to)106-111
Number of pages6
JournalJournal of Critical Care
Volume37
DOIs
StatePublished - Feb 1 2017

Fingerprint

Critical Illness
Nurses
Psychology
Physicians
Intensive Care Units
Psychological Stress
Communication
Critical Care
Survivors
Noise
Decision Making
Therapeutics
Hand

Keywords

  • Communication in the ICU
  • Critical care nurse
  • Critical care physician
  • Critically ill
  • Psychological distress
  • Stress

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Perspectives of physicians and nurses on identifying and treating psychological distress of the critically ill. / Karnatovskaia, Lioudmila V.; Johnson, Margaret; Dockter, Travis J.; Gajic, Ognjen.

In: Journal of Critical Care, Vol. 37, 01.02.2017, p. 106-111.

Research output: Contribution to journalArticle

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abstract = "Purpose Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that can impede its recognition and treatment in the ICU. Materials and methods Two distinct role-specific Web-based surveys were administered to critical care physicians and nurses in medical and surgical ICUs of 2 academic medical centers. Responses were analyzed in the domains of psychological trauma, exacerbating/mitigating factors, and provider-patient communication. Results A survey was completed by 43 physicians and 55 nurses with a response rate of 62{\%} and 37{\%}, respectively. Among physicians, 65{\%} consistently consider the psychological state of the patient in decision making; 77{\%} think it is important to introduce a system to document psychological state of ICU patients; 56{\%} would like to have more time to communicate with patients; 77{\%} consistently spend extra time at bedside besides rounds and often hold patient's hand/reassure them. Notably, for the question about the average level of psychological stress experienced by a patient in the ICU (with 0 = no stress and 100 = worst stress imaginable) during initial treatment stage and by the end of the ICU stay, median assessment by both physicians and nurses was 80 for the initial stress level and 68 for the stress level by the end of the ICU stay. Among nurses, 69{\%} always try to minimize noise and 73{\%} actively promote patient's rest. Physicians and nurses provided multiple specific suggestions for improving ICU environment and communication. Conclusions Both physicians and nurses acknowledge that they perceive that critically ill patients experience a high level of psychological stress that persists throughout their period of illness. Improved understanding of this phenomenon is needed to design effective therapeutic interventions. Although the lack of time is identified as significant barrier to ameliorating patient's psychological stress, the majority of clinicians indicate that they attempt to provide interventions to achieve this goal.",
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