Basic Principles of Critical Care

1. PSYCHOSOCIAL SUPPORT FOR
PATIENTS
Gradian Health Systems
Basic Principles of Critical Care
PSYCHOSOCIAL DIMENSIONS OF CARE

2. Disclaimer
Basic Principles of Critical Care Training I Psychosocial Support for Patients
Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications
regarding medical care and clinical service delivery. The tables, checklists, and other clinical
documents referenced in this training have not been validated in all settings. These documents are
intended to serve as examples only. We recognize that all clinical training content and activities
must be customized to meet the needs of each facility and its clinical staff, factoring in available
resources, practitioner skill level, and other environmental considerations.
For any questions regarding the contents or applications of this training,
please contact Gradian Health Systems:
40 W 25th St, 6th Floor
New York, NY 10010 USA
+1 212-537-0340
training@gradianhealth.org

3. Module 8
Gradian Health Systems
Basics Principles of Critical Care
Psychosocial Dimensions of Care

4. Module 8: Psychosocial Dimensions of Care
MODULE OVERVIEW
Lesson 1 I Psychosocial Support for Patients
Lesson 2 I Psychosocial Support for Staff
Lesson 3 I Psychosocial Support for Relatives
Lesson 4 I Cognitive Behavioral Therapy
Basic Principles of Critical Care Training I Psychosocial Support for Patients

5. Components of the Gradian CCV SystemLesson 1: Psychosocial Support for Patients
Lesson Objectives
• Understand the impact and causes of acute stress in the ICU
• Define and identify PTSD
• Identify strategies for stress reduction in ICU
Basic Principles of Critical Care Training I Psychosocial Support for Patients

6. Components of the Gradian CCV SystemLesson 1: Psychosocial Support for Patients
Key Concepts
• Acute stress
• PTSD
• Intensive Care Psychological Assessment (ICPA)
• Withholding treatment
• Withdrawing treatment
Basic Principles of Critical Care Training I Psychosocial Support for Patients

7. Components of the Gradian CCV SystemPsychosocial Support for Patients
Psychosocial Issues in ICU
• Stress elevates adrenaline and cortisol levels in the body, leading to a fight or
flight response and elevated blood pressure, heart rate, and respiration
• For a healthy individual, the fight or flight response to stress helps cope with
the stressor
• Critically ill patients may not be able to withstand the effects of stress, which
can lead to deterioration in their condition or delay their recovery
Basic Principles of Critical Care Training I Psychosocial Support for Patients

8. Components of the Gradian CCV SystemPsychosocial Support for Patients
Psychosocial Issues in ICU
• Studies show ICU survivors reported lower quality of life (QoL) than members
of the general public
• QoL improves over time, but remains lower than that of the general population
• Controlling patients’ stressors may decrease the physiological and
psychosocial effects of an ICU stay, possibly preventing disease
complications and decreasing the length of stay in the hospital
• ICU staff may be able to manipulate the ICU environment to minimize causes
of stress, providing a less stressful and healing setting for patients and
families
Basic Principles of Critical Care Training I Psychosocial Support for Patients

9. Components of the Gradian CCV SystemPsychosocial Support for Patients
Acute Stress in ICU
• Acute stress increases morbidity and mortality
• Cognitive deficits in memory, attention, and executive function affect activities
of daily living, often long after discharge
• It is important to detect and minimize acute stress where possible
Basic Principles of Critical Care Training I Psychosocial Support for Patients

10. Components of the Gradian CCV SystemPsychosocial Support for Patients
Acute Stress in ICU
• Extreme levels of acute distress and a high prevalence of psychological
morbidity are common in critically ill patients, including:
• Post-traumatic stress disorder (PTSD)
• Depression
• Anxiety
• Anger or agitation
• Hallucinations or delusions due to withdrawal of sedation, sepsis, and
sleep deprivation
• Patients often continue to deal with psychological disorders months after
discharge
Basic Principles of Critical Care Training I Psychosocial Support for Patients

11. Components of the Gradian CCV SystemPsychosocial Support for Patients
Causes of Acute Stress in ICU
• Life-threatening illness
• Invasive medical procedures (e.g. mechanical ventilation)
• Pain and discomfort
• Inability to communicate
• Pain, sleep deprivation, thirst, hunger, dyspnea,
• Unnatural noise and light, nakedness, and lack of dignity
• Isolation, fear of dying, and witnessing other people suffering and dying
Basic Principles of Critical Care Training I Psychosocial Support for Patients

12. Components of the Gradian CCV SystemPsychosocial Support for Patients
Evidence for Early Psychological
Interventions in ICU
• Patients in the intervention group showed
lower rates of anxiety and depression than
the control
• High risk for PTSD was significantly lower in
patients receiving early clinical psychologist
support than in the control group
• The percentage of patients who needed psychiatric medications at 12 months was significantly
higher in the control group than in the patient group
Basic Principles of Critical Care Training I Psychosocial Support for Patients

13. Components of the Gradian CCV SystemPsychosocial Support for Patients
Post-Traumatic Stress Syndrome
• Re-experience of the trauma and avoidance of stimuli likely to remind the
patient of the trauma
• Involves intrusive memories and vivid images of the event during waking
hours; can be so intense that the person loses contact with their surroundings
• Nightmares are common
• Avoidance of stimuli likely to trigger the individual including avoidance of
conversations, places, people and activities associated with the trauma
• Hyperarousal (e.g. sleep disturbances, irritability, and difficulty concentrating)
Basic Principles of Critical Care Training I Psychosocial Support for Patients

14. Components of the Gradian CCV SystemPsychosocial Support for Patients
Intensive Care Psychological Assessment (IPAT)
• Have you been feeling hopeless?
• Have you been feeling tense?
• Have you been feeling panicky?
• Have you felt that people were deliberately trying to harm or hurt you?
• Do upsetting memories of intensive care keep coming into your mind?
• Have you been feeling sad?
• Has it been difficult to sleep?
• Has it been hard to communicate?
• Have you had hallucinations (seen or heard things you suspect were not
really there)?
• Have you felt disorientated (not quite sure where you are)?
Basic Principles of Critical Care Training I Psychosocial Support for Patients

15. Components of the Gradian CCV SystemPsychosocial Support for Patients
Stress Reduction for ICU Patients
• Reassurance, emotional support
• Effective pain management
• Encouraging family to be present
• Patients with family at the bedside are shown to have less irritability
lower delirium severity
• Effective communication
• Listening to patient concerns
• Assessing stressors
• Clarifying information with patients and family members
• Explaining plan of care
• Educating patients about any planned procedures
Basic Principles of Critical Care Training I Psychosocial Support for Patients

16. Components of the Gradian CCV SystemPsychosocial Support for Patients
Stress Reduction for ICU Patients
• Environmental control
• Reducing noise
• Controlling lights and room temperature
• Not disturbing patient’s sleep
• Using pillows for support
• Repositioning for comfort
Basic Principles of Critical Care Training I Psychosocial Support for Patients