PPT Psychological problems patients in critical care unit

1. PSYCHOLOGICAL PROBLEMS OF
PATIENTS IN CRITICAL CARE UNIT
Dr. MUHAMMAD ARSYAD SUBU
Assistant Professor of Psychiatric-Mental Health Nursing

2. INTRODUCTION
• Critical care is a term used to describe "the care of
patients who are extremely ill and whose clinical
condition is unstable or potentially unstable.“
• The practice of administering immediate and
continuous care to clients with actual or potentially
life-threatening health disorders
• In the US, more than 5 million clients are admitted
annually to intensive or critical care units.

3. COMMON DISORDERS IN CRITICAL
CARE UNIT
• Brain injuries
• Neurological dysfunctions
• Cardiovascular dysfunctions
• Pulmonary dysfunctions
• Childbirth/Pediatrics
Complications
• Infection/sepsis
• Shock and trauma
• Endocrine abnormalities
• Multisystem alterations
• Complex surgical procedures

4. CLIENT CHARACTERISTICS
• For the nurses caring for the critically ill:
• Resiliency
• Vulnerability
• Stability
• Complexity
• Resource availability
• Participation in care
• Participation in decision making
• Predictability

5. FACTORSAFFECTING CRITICAL CARE
ILLNESS
RECOVERY
Family Psychological
Social
Physical
Employment Pre-morbid state
Broomhead & Brett, Critical Care, 2002

6. PSYCHOSOCIAL PROBLEMS
IN CRITICAL CARE UNITS

7. PSYCHOSOCIAL EFFECTS
• Critical Care Unit environment:
• Noisy
• Stressful & foreign
• Confusing, no day/night
• Painful & uncomfortable
• Sleepless
• Psychoactive drugs
• Sickness.

8. COMMON PSYCHOLOGICAL
PROBLEMS IN CRITICAL CARE UNIT
• Stress
• Anger
• Depression
• Anxiety/Fear
• Posttraumatic stress disorder (PTSD)
• Delirium
• Helplessness and Hopelessness
• Sleep patterns & sleep quality,
• Low self-esteem
• Body image problem etc.

9. STRESS
• Clients in critical care units have stress as the reaction of
the body to stimulation which is dangerous to require the
body to make an adjustment to overcome the situation.
• In critical care units, psychological manifestations of
stress are agitation, restlessness, poor diet, diminished
appetite, and disrupted sleep.

10. ANGER
• Patients in critical care unit typically demonstrate behaviors that
are indicative of anger
• These behavior reflects feelings of helplessness and frustration
about the illness and the effects the illness has on clients’ daily
functioning
• Behaviors likely to be exhibited include demanding types of action,
loud verbalization, slamming of items, and social withdrawal.

11. DEPRESSION
• Clients in critical care units typically demonstrate symptoms of
depression related to disruption of daily functioning
• Signs include feelings of helplessness / hopelessness, flat
affect, poor eye contact, disrupted eating/sleeping patterns,
absence of motivation and compliance, and decreased energy
level.

12. ANXIETY/FEAR
• Clients in critical care units typically demonstrate feelings
and behaviors of anxiety/fear. It is the most frequently
occurring as manifestations of stress.
• Anxiety/fear results in autonomic nervous system
stimulation with increased heart rate, increased
respirations, increased visual acuity, diaphoresis,
shortness of breath, and restlessness.

13. POSTTRAUMATIC STRESS
DISORDER (PTSD)
• Treatments in an critical care unit is both stressful and
psychologically traumatic for patients
• Posttraumatic stress disorder (PTSD) symptoms have
been reported in three studies to have increased by 40% -
60% in critical care survivors.

14. DELIRIUM
• Delirium, or acute confusional state, is an organically caused
decline from a previously attained baseline level of cognitive
function
• Studies indicated that delirium is another psychological
problem among the patients admitted to critical care unit.

15. HELPLESSNESS
• Clients in critical care unit demonstrate feelings of
helplessness
• It relates to feelings of powerlessness associated with
being unable to change what is happening.

16. HOPELESSNESS
• In critical care units, patients’ feel hopelessness that relates
to feelings of despondency and loss of optimism
• This is reflected in feelings of loss of control (feeling that an
event can be managed) and increased dependency on
others

17. SLEEP PATTERNSAND SLEEP QUALITY
• Several studies have reported the effects of altered
sleep patterns and sleep quality in critical care unit
patients.
• These are bound to have a repercussion on the other
psychological parameters .

18. LOW SELF-ESTEEM
• Patients in critical care units have feeling of low self-esteem
• A person with low self-esteem feels unworthy, incapable, and
incompetent.
• Because the person with low self-esteem feels so poorly or
inability about him or herself, these feelings may actually cause
the person's continued low self-esteem.

19. BODY IMAGE PROBLEM
• Patients in critical care units have body image problem
• It is an intellectual or idealized image of what
one's body is or should be like that is sometimes
misconceived in such problem on patients in critical care
units.

20. NURSING CARE FOR PATIENTS WITH
PSYCHOSOCIAL PROBLEMS
IN CRITICAL CARE UNITS

21. ASSESSMENT
• The nurse uses various resources to collect
psychological, biological, and social data in critical
care units
• Subjective and objective psychosocial symptoms,
family/significant other reports, and diagnostic reports
are considered in the assessment phase.

22. NURSING ASSESMENT
A. DATA COLLECTION:
• Identification data: name, age, sex, marital status, education, occupation,
economic status etc.
• Subjective data: (What did patient or family say-use direct quotations)?
• Objective Data: (what did you see, hear, smell, feel – first finding) and measure?
• Client lab values, test results
• Medications
• Doctor’s diagnosis

23. NURSING ASSESMENT
B. ANALYSIS OF DATA
• Data are critically examined
• Utilizing the scientific knowledge
• From this data, the reader must be able to tell that he/she really
has a problem
• Based on the analysis, nursing diagnosis is made
• Include at least three subjective and/or objective data that lead
to the nursing diagnosis)

24. PSYCHOLOGICALASSESSMENT
• Elicits clients’ emotional reaction & coping abilities and support resources
• A stress appraisal should be done with identification of the source of
stress, number of stressors, and duration of stressors
• Depression symptoms assessment should be completed with notation of
time of initial symptoms, duration of symptoms, and physical
appearance.

25. PSYCHOLOGICALASSESSMENT …
• Identification of coping behaviors is part of the psychological
assessment and includes assessment of adaptive and maladaptive
behaviors as well as emotional stage of the illness
• Clients often progressively move through stages of illness and
interventions should be planned according to the emotional stage

26. THESE STAGES INCLUDE
• Denial of the illness and associated limitations.
• Anger at loss of control and associated limitations.
• Bargaining, with a plea for another chance and a seeking of new
answers/treatments
• Depression when grieving occurs due to loss or anticipated loss.
• Acceptance when conflicts are resolved and the client
participates in care.

27. NURSING DIAGNOSIS
• NOT doctor’s diagnosis
• Two statements are required for each nursing diagnosis.
• Must be patient and/or family focused; measurable; time-
specific; reasonable.
• Statement of Problem ( physical, emotional, or social)
• Nursing diagnosis [NANDA List] plus etiology

28. SOME NURSING DIAGNOSIS
• Decrease orientation
• Altered socialization & Impaired communication
• Risk for acute confusion
• Anxiety & Fear
• Decreased activity & Self-care deficit
• Reduced attention and concentration
• Low self-esteem and self-concept
• Increased ides of guilty unworthiness
• Decreased sleep and appetite

29. PLANNING
• As soon as the patient’s problem are identified or nursing diagnosis
made, planning of nursing care begins.
• The planning consist of:
• Determining priorities
• Setting goals
• Selecting nursing actions
• Developing /writing Nursing Care Plan (NCP).

30. IMPLEMENTATION
NURSINGACTIONS/RATIONAL
• Nursing actions:
• Actions to relieve problem and help client achieve goal & each
must be specific and complete statements, including who, what,
where, when, how, how long, and how often, etc.
• Label (IDC): Independent, Dependent, Collaborative
• Rational: Tells why each action should help achieve the goal &
Provide reason why intervention is indicated

31. NURSING INTERVENTION
• Interventions for clients in critical care unit include:
• Use of empathy and compassion
• Focus on aspects of the client’s life that were positive
• Spirituality assessment and reinforcement
• Support of family and significant others
• Allowing client dignity, client control, and use of pain
management.

32. EVALUATION
• Question: Have goals been partially or fully met?
• Describe in terms of the outcome criteria
• How would you revise the plan of care according the
patient’s response to current plan?

33. RE-EVALUATION
• Re-Assessment
• Revise diagnosis
• Make a different outcome
• Revise intervention
• Revise the time or duration

34. THANK YOU