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Psychology: Person-Centred Care a Key to Successful Recovery

  • Julie Highfield
  • Matthew Beadman
  • Dorothy WadeEmail author
Chapter
  • 49 Downloads

Abstract

Many patients find critical care admissions stressful, and subsequently survivors can experience symptoms of clinical depression, anxiety, posttraumatic stress disorder and cognitive impairment. Modifiable risk factors for psychological morbidity, including sedation practices, delirious experiences and acute stress in critical care units have been identified. The National Institute of Care and Health Excellence (NICE) now advocates psychological assessment and support for critically ill patients, and the UK’s Intensive Care Society supports the provision of senior practitioner psychologists in critical care to oversee acute and follow-up psychological services. While high-quality evidence from randomised trials and systematic reviews is still lacking to support the precise form and mode of delivery of psychological interventions most beneficial for critically ill patients. There are promising multimodal interventions in the acute setting include elements such as music therapy, multidisciplinary working with physiotherapists to promote optimal rehabilitation, complementary therapies, family support programmes and evidence-based psychological approaches for delirium, agitation, hallucinations, delusions and stress. Cognitive behavioural therapy for trauma, psychosis, anxiety and depression can be provided by specialist practitioner psychologists based in critical care follow-up services, familiar with the ICU context and embedded within multidisciplinary teams. Peer support, stress management or mindfulness groups may also be run as adjunct services. Cognitive interventions for critical care patients are being developed but are still in their infancy. A more holistic, psycho-social approach to the experiences of critically ill patients is receiving increasing support within intensive care medicine looking towards sucessful discharge.

Keywords

Psychology Trauma Delirium Cognition 

References

  1. 1.
    Intensive Care National Audit and Research Centre. The Case Mix Programme Annual Quality Report 2015/16 for adult critical care. 2017. https://onlinereports.icnarc.org/Home. Accessed 29 Sept 2019.
  2. 2.
    Wade DM. Doctoral thesis: prevalence and predictors of psychological morbidity and quality of life after discharge from Intensive Care. London: University College; 2010.Google Scholar
  3. 3.
    Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med. 2010;38(11):2155–60.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Wade DM, Howell DC, Weinman JA, Hardy RJ, Mythen MG, Brewin CR, et al. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Crit Care. 2012;16(5):R192.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Carruthers H, Gomershall T, Astin F. The work undertaken by mechanically ventilated patients in intensive care: a qualitative meta-ethnography of survivors’ experiences. Int J Nurs Stud. 2018;86:60–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Alonso-Ovies A, Heras La Calle G. ICU: a branch of hell? Intensive Care Med. 2016;42(4):591–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Nelson JE. The symptom burden of chronic critical illness. Crit Care Med. 2004;32(7):1527–34.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007;33(6):978–85.PubMedCrossRefGoogle Scholar
  9. 9.
    Maldonaldo JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of Delirium. Crit Care Clin. 2017;33(3):461–519.CrossRefGoogle Scholar
  10. 10.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Jackson JC, Santoro MJ, Ely TM, Boehm L, Keihl AL, Anderson LS, et al. Improving patient care through the prism of psychology: application of Maslow’s hierarchy to sedation, delirium and early mobility in the ICU. J Crit Care. 2014;29(3):438–44.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Needham DM, Davidson J, Cohen H, Hopkins RO, Weinart C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Wade DM, Brewin CR, Howell DC, White E, Mythen MG, Weinmart JA. Intrusive memories of hallucinations and delusions in traumatised intensive care patients: an interview study. Br J Health Psychol. 2015;20(3):613–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Davydow DS, Gifford JM, Desai SV, et al. Post-traumatic stress disorder in general intensive care survivors: a systematic review. Gen Hosp Psychiatry. 2008;30(5):421–34.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Davydow DS, Zatzick D, Hough CL, Kanton WJ. In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission. Ann Am Thorac Soc. 2013;10(5):450–7.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–16.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med. 2014;2(5):269–379.CrossRefGoogle Scholar
  18. 18.
    Wolters AE, Peelen LA, Welling MC, Kok L, de Lange DW, Cremer OL, et al. Long term mental health problems after delirium in the Intensive Care Unit. Crit Care Med. 2016;44(10):1808–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Wade DM, Hankins M, Smyth DA, Rhone EE, Mythen MG, Howell DC, et al. Detecting acute distress and risk of future psychological morbidity in critically ill patients: validation of the intensive care psychological assessment tool. Crit Care. 2014;18(5):519.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Wade D, Als N, Bell V, Brewin C, D’Antoni D, Harrison DA, et al. Providing psychological support to people in critical care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity. BMJ Open. 2018;8(7):e021083.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Masand PS. Side effects of antipsychotics in the elderly. J Clin Psychiatry. 2000;61(suppl 8):43–9.PubMedGoogle Scholar
  22. 22.
    Pritchard JC, Brighty A. Caring for older people experiencing agitation. Nurs Stand. 2015;29(30):49–58.PubMedCrossRefGoogle Scholar
  23. 23.
    Rogers C. On becoming a person. New Edition; 2004.Google Scholar
  24. 24.
    Bowers L, Brennan G, Winship G, Theodoridou C. How expert nurses communicate with acutely psychotic patients. Ment Health Pract. 2010;13(7):24–6.CrossRefGoogle Scholar
  25. 25.
    Morandi A, Brummel N, Ely E. Sedation, delirium and mechanical ventilation: the ‘ABCDEF’ approach. Curr Opin Crit Care. 2011;17(1):43–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Basten CJ, McGuire BE. Delirium: the role of the psychologist in assessment and management. Aust Psychol. 2011;35(3):201–7.CrossRefGoogle Scholar
  27. 27.
    Scottish Intercollegiate Guidelines Network (SIGN) 157. Risk reduction and management of delirium. Edinburgh: SIGN; 2019. 47 p.Google Scholar
  28. 28.
    Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, et al. Haloperidol and Ziprasidone for treatment of Delirium in critical illness. N Engl J Med. 2018;379:2506–16.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Med. 2019;45(1):1–12.PubMedCrossRefGoogle Scholar
  30. 30.
    National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults: Clinical Guideline 83. 2009. https://www.nice.org.uk/guidance/cg83. Accessed 29 Sept 2019.
  31. 31.
    National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults: NICE Quality Standard 158. 2017. https://www.nice.org.uk/guidance/qs158/resources/rehabilitation-after-critical-illness-in-adults-pdf-75545546693317. Accessed 29 Sept 2019.
  32. 32.
    The Faculty of Intensive Care Medicine. Guidelines for the Provision of Intensive Care Services. Edition 2. June 2019. https://www.ficm.ac.uk/sites/default/files/gpics-v2.pdf. Accessed 29 Sept 2019.
  33. 33.
    Birk JL, Sumner JA, Haerizadeh M, Heyman-Kantor R, Falzon L, Gonzalez C, et al. Early interventions to prevent post-traumatic stress disorder symptoms in survivors of life-threatening medical events: a systematic review. J Anxiety Disord. 2019;64:24–39.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Wade DF, Moon Z, Windgassen SS, Harrison AM, Morris L, Weinman JA. Non-pharmacological interventions to reduce ICU-related psychological distress: a systematic review. Minerva Anestesiol. 2016;82(4):465–78.PubMedGoogle Scholar
  35. 35.
    Peris A, Bonizzoli M, Iozzelli D, Migliaccio ML, Zagli G, Bacchereti A, et al. Early intra-intensive care unit psychological intervention promotes recovery from post-traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care. 2011;15(1):R41.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Bryant RA. Acute stress disorder. Curr Opin Psychol. 2017;14:127–31.PubMedCrossRefGoogle Scholar
  37. 37.
    National Institute for Health and Care Excellence. Post-traumatic stress disorder: NICE Guideline 116. 2018. https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adults. Accessed 29 Sept 2019.
  38. 38.
    WHO. Psychological first aid; Guide for field workers. 2011. https://www.who.int/mental_health/publications/guide_field_workers/en/. Accessed 29 Sept 2019.
  39. 39.
    Wade DM, Mouncey PR, Richards-Belle A, Wulff J, Harrison DA, Sadique MZ, et al. Effect of a nurse-led preventive psychological intervention on symptoms of post-traumatic stress disorder among critically ill patients: a randomised clinical trial. JAMA. 2019;321(7):665–75.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Fowler D, Garety P, Kuipers E. Cognitive behaviour therapy for psychosis: theory and practice. Chichester: Wiley; 1995.Google Scholar
  41. 41.
    Bennun I. Intensive care unit syndrome: a consideration of psychological interventions. Br J Med Psychol. 2001;74(3):369–77.PubMedCrossRefGoogle Scholar
  42. 42.
    Varga K, Varga Z, Frituz G. Psychological support based on positive suggestions in the treatment of a critically ill ICU patient—a case report. Interv Med Appl Sci. 2013;5(4):153–61.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Sideris T. From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account. Med Humanit. 2019;45(1):37–44.PubMedCrossRefGoogle Scholar
  44. 44.
    Cohen JN, Gopal A, Roberts KJ, Anderson E, Siegal AM. Ventilator dependent patients successfully weaned with cognitive behavioural therapy: a case series. Psychosomatics. 2019;60:612–9.PubMedCrossRefGoogle Scholar
  45. 45.
    National Institute for Health and Care Excellence. Depression in adults: recognition and management clinical guideline: NICE guideline [CG90]. 2009. https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-975742636741. Accessed 29 Sept 2019.
  46. 46.
    Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med. 2014;40(3):370–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee HW, Park Y, Jang EJ, Lee YL. Intensive care unit length of stay is reduced by protocolised family support intervention: a systematic review and meta-analysis. Intensive Care Med. 2019;45(8):1072–81.PubMedCrossRefGoogle Scholar
  48. 48.
    Rosa RG, Falavigna M, da Silva DB, Sganzerla D, Martins M, Santos S, et al. Effect of flexible family visitation on delirium among patients in the intensive care unit. JAMA. 2019;322(3):216–28.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Bench S, Day T, Heelas K, Hopkins P, White C, Griffiths P. Evaluating the feasibility and effectiveness of a critical care discharge information pack for patients and their families: a pilot cluster randomised controlled trial. BMJ Open. 2015;5(11):e006852.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:b3723.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Schofield-Robinson O, Lewis SR, Smith AF, McPeake J, Alderton P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev. 2018;11.Google Scholar
  52. 52.
    Girbes AR, Beishuizen A. Interfacing the ICU with the general practitioner. Crit Care. 2010;14(3):172.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    McPeake J, Shaw M, Iwashyna TJ, Daniel M, Devine H, Jarvie L, et al. Intensive care syndrome: promoting independence and return to employment (InS:PIRE). Early evaluation of a complex intervention. PLoS One. 2017;12(11):e0188028.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Griffiths RD, Jones C. Filling the intensive care memory gap? Intensive Care Med. 2001;27(2):344–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, et al. Effect of an ICU diary on post-traumatic stress disorder symptoms among patients receiving mechanical ventilation: a randomised clinical trial. JAMA. 2019;322(3):229–39.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Aitkin LM, Rattray J, Kenardy J, Hull AM, Ullman AJ, Brocque L, et al. Perspectives of patients and family members regarding psychological support using intensive care diaries: An exploratory mixed methods study. J Crit Care. 2017;38:263–8.CrossRefGoogle Scholar
  57. 57.
    McPeake J, Hirshberg EL, Christie LM, Drumright K, Haines K, Hough CL, et al. Models of peer support to remediate post-intensive care syndrome: a report developed by the Society of Critical Care Medicine Thrive International Peer Support Collaborative. Crit Care Med. 2019;47(1):e21–7.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Theikling. Support groups for ‘ICU survivors’ are springing up. But will patients traumatised by intensive care show up? Stat News. 2017. https://www.statnews.com/2017/07/24/icu-patient-support-group/.
  59. 59.
    Haines KJ, Sevin CM, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, et al. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Intensive Care Med. 2019;45(7):939–47.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Jensen JF, Egerod I, Bestle MH, Christensen DF, Elklit A, Hansen RL, et al. A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomised controlled trial, the RAPIT study. Intensive Care Med. 2016;42:1733–43.PubMedCrossRefGoogle Scholar
  61. 61.
    Cox CE, Hough CL, Jones DM, Ungar A, Reagan W, Key MD, et al. Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial. Thorax. 2018;74(1):33–42.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Cox CE, Hough CL, Carson SS, White DB, Kahn JM, Olsen MK, et al. Effects of a telephone- and web-based coping skills training program compared with an education program for survivors of critical illness and their family members. a randomised clinical trial. Am J Respir Crit Care Med. 2018;197:66–78.PubMedCrossRefGoogle Scholar
  63. 63.
    Brewin CR, Rumball F, Happé F. Neglected causes of post-traumatic stress disorder. BMJ. 2019;10:365.Google Scholar
  64. 64.
    Hulme T. Using eye movement therapy to reduce trauma after intensive care. Nurs Times. 2018;114(3):18–21.Google Scholar
  65. 65.
    National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical Guideline 113. 2019. https://www.nice.org.uk/guidance/cg113. Accessed 29 Sept 2019.
  66. 66.
    Jackson JC, Ely EW, Morey MC, Anderson VM, Denne LB, Clune J, et al. Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomised controlled pilot investigation. Crit Care Med. 2012;40(4):1088–97.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Wilson JE, Collar EM, Kiehl AL, Lee H, Merzenich M, Ely EW, et al. Computerised cognitive rehabilitation in intensive care unit survivors: returning to everyday tasks using rehabilitation networks-computerised cognitive rehabilitation pilot investigation. Ann Am Thorac Soc. 2018;15(7):887–91.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Wang S, Hammes J, Khan S, Gao S, Harrawood A, Martinez S, et al. Improving recovery and outcomes every day after the ICU (IMPROVE): study protocol for a randomised controlled trial. Trials. 2018;19(1):196.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Mouncey PR, Wade D, Richards-Belle A, Sadique Z, Wulff J, Grieve R, et al. A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT. Health Serv Deliv Res. 2019;7(30).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Julie Highfield
    • 1
  • Matthew Beadman
    • 2
  • Dorothy Wade
    • 3
    Email author
  1. 1.University Hospital WalesCardiffUK
  2. 2.Royal Surrey County HospitalGuildfordUK
  3. 3.University College London HospitalsLondonUK

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