Introduction:
The intensive care unit (ICU) is critical to today's healthcare system. The growth of this section has made the care of very ill people feasible. It enables the use of more technically focused technologies to monitor and obtain instant information about any changes in the patient's physiological parameters, allowing the development of new tactics to preserve life. As a result, many patients with severe illnesses and many families of patients with chronic, life-threatening disorders opt for a trial period of intensive care. In this aspect, the intensive care unit has given many critically sick patients hope, and many of them have survived life-threatening diseases that could only be treated in the intensive care unit.
What Are the Psychological Consequences of Intensive Care?
A critical care admission can have a significant psychological impact. Patients have been documented to experience acute stress and altered states of consciousness. As a result, there is a significant prevalence of psychological illness among survivors, including post-traumatic stress disorder (PTSD), sadness, and anxiety. According to studies, more than half of critical care patients experienced symptoms of a psychiatric condition after their admission. The ability to do daily activities is also frequently impaired by cognitive deficiencies in concentration, memory, and executive function.
Illness, pain, sleep deprivation, thirst, hunger, dyspnea, abnormal noise and light, nakedness, lack of self-worth, inability to speak, isolation, dread of death, and witnessing other people suffering and dying are all stresses that patients face in the ICU. In response, they may have intense emotional or behavioral reactions such as worry, panic, low mood, wrath, or agitation. Patients may find it challenging to endure interventions such as mechanical ventilation (MV) or intrusive monitoring for cardiovascular support. Furthermore, in intensive care, the onset of delirium, involving scary symptoms such as hallucinations and paranoid delusions, is prevalent. Post-ICU PTSD may include flashbacks, nightmares, and painful recollections of hallucinations and delusions, whereas delirium is related to later cognitive damage.
What Are the Immediate Consequences of Psychotic Illnesses in the Critical Care Setting?
The immediate consequences are as follows:
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Delirium-related issues.
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Hallucinations.
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Delusions.
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Nightmares and dreams.
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Anxiety.
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Relocation anxiety.
Delirium:
The prevalence of delirium in a critical care setting is significantly higher than in comparable ward settings. In contrast to delirium caused by organic sources, delirium in critical care might be caused by inorganic causes. Inorganic causes include ventilation, monitoring, motion restrictions, sleep disruption and deprivation, luminosity levels, and a lack of orientation. Organic sources include infection, sepsis, analgesia, and so on. Delirium can be categorized under the general heading of acute brain dysfunction. It has four distinct characteristics:
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A sudden shift or fluctuation in a patient's mental state.
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A need for more concentration.
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Disorganized thought.
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An altered state of awareness.
Hallucinations and Delusions:
Hallucinations, common in critical care and often caused by many pathologies, can be a terrifying occurrence. From strange daydreams or pictures to distressing paranoid persecutory delusions, hallucinations, and nightmares, up to 74% of patients hospitalized in a critical care environment experience them. Hallucinations and delusions may linger after patients are discharged from critical care and even after they are returned home.
Dreams:
In critical care, dreams, reality, and surreal experiences commonly collide. Patients may retain factual memories, hallucinations, dreams, and nightmares, but they may also be unable to distinguish between actual and unreal events. Again, the causes are multifaceted: sedative withdrawal, sleep disturbance, ventilation, or medications. Unfortunately, not all dreams are immediately remembered, and patients may recollect their dreams months or years after the critical care experience. At this time, critical care follow-up clinics can assist patients in deciphering their dreams and dealing with any complications that may arise. Dreams about critical care, like hallucinations and delusions, might last for months after they have been discharged.
What Are Psychotic Illnesses That Occur Following Discharge From Critical Care?
Amnesia:
The ability to remember the critical care event varies greatly and may be affected by the duration of stay, critical disease severity, and anesthesia. According to a study, 43 % of patients did not recollect their critical care stay, and only 16 % could recall getting information during their critical care hospitalization. Some data suggest that short-term amnesia occurs in some people as a psychological protection mechanism to prevent remembering upsetting events.
Acute Stress Disorder and Post-traumatic Stress Disorder (PTSD) :
Acute stress disorders (ASDs) are distinguished by a manifestation of psychological distress, with the patient exhibiting dissociative symptoms (such as numbing, depersonalization, or dissociative amnesia) up to one month after a traumatic experience. Traumatic situations can create PTSD, which can linger for years afterward. Typical symptoms include:
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Reliving the events in nightmares or flashbacks.
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Avoiding stimuli connected with the trauma.
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Hyperarousal symptoms.
Critical care can be considered a traumatic event and might trigger PTSD symptoms after discharge. Interventions such as intubation, endotracheal suctioning, central venous and arterial catheter insertion, broncho-alveolar lavage, dressing change, or even repositioning and carrying out hygiene needs can be traumatic and cause physiological changes in a critically ill patient or a patient who is unable to communicate. As a result, pain, anxiety, claustrophobia, and dread may arise, even if only in anticipation of intervention. Such procedures may also cause flashbacks and anxiety in patients after discharge from the critical care unit.
What About the Recovery From the Psychological Consequences of Intensive Care?
Rehabilitation for persons with psychological disorders following critical care necessitates the engagement of both family and health experts. Families may be able to provide continuous emotional support that experts can only supply occasionally and not always when it is most needed. A study looked into practical mechanisms for dealing with psychological consequences. The imagery was employed to relieve anxiety and was beneficial, so relatives were asked to learn the techniques and apply them for the patient's benefit. The imagery program's adherence was weak. Although this is only one example of a lack of family support, it emphasizes the role families may play in healing. The use of pharmaceutical measures, such as antidepressants, should not be overlooked or undervalued. Psychotherapeutic interventions alone may not be sufficient to aid the patient's rehabilitation, especially in the case of PTSD.
What Are the Impacts of Nursing Care in Recovery?
In addition to some of the methods mentioned above, additional measures may assist nurses in providing the best possible care for critically sick patients' psychological well-being.
Preoperative verbal and written information has been proposed to lower anxiety in critical care patients. Reassurance that their experiences are a component of the critical care procedure may help alleviate anxiety and distress symptoms while in critical care.
Nurses must also be aware of the interdependence of physiological and psychosocial difficulties in critical care. Anxiety is not only connected with increased morbidity and mortality in patients, but nurses may notice manifestations and repercussions of anxiety as an increase in one or more of the following: heart rate, blood pressure, peripheral vasoconstriction, dysrhythmias, and respirations.
How Does Follow-up Play a Role in Recovery?
Follow-up may play a role in hastening patient recovery and adjustment to life outside of critical care by referring those encountering difficulties to other specialties or acting as a counseling and advising service in and of itself. Reassuring patients is an essential aspect of follow-up. While the implications of critical care should not be understated, quality of life following discharge is often favorable. In contrast, quality of life scores, particularly for people who have been ventilated for an extended time, are sometimes lower than in general populations.
Conclusion:
In critical care, it is necessary to examine both critical extrinsic and intrinsic aspects and longer-term difficulties that may impair psychological well-being. Psychological concerns impact recovery following critical care; ensuring that all areas of a patient's health are taken care of ensures an optimal recovery environment. Early detection of ASD and PTSD symptoms, as well as early treatments, are required. Nurses are uniquely positioned to recognize, measure, and optimize patients' psychological well-being, and they must be acutely aware of practices that may aid or hinder patients' recovery. Understanding the relationships between physiological and psychological health assists the critical care team recognize the necessity of improving psychological care. Critical care follow-up is vital in resolving psychological difficulties that arise after being discharged from critical care.
