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Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.
January 15, 2016
Once discharged from the ICU, memories of the experience may invade the daily lives and long night hours of people who thought they had survived their crisis. It is a form of post-traumatic stress disorder (PTSD).
Most of us associate PTSD with soldiers returning from war. But intensive care patients have been added to ranks of those who are prone to the after effects of trauma. Post-ICU syndrome is real and, as are all other conditions that thrive in the memory, it is not consistently responsive to medication.
A new PTSD study by Dr. Mayur Patel and colleagues at Vanderbilt University Medical Center looked at PTSD in critical care survivors and distinguished those with previous history of PTSD. Their findings point out that 1 out of 10 ICU patients is at risk of experiencing new PTSD 3-12 months following his/her hospitalization.
The symptoms included nightmares, depression, anxiety, breathlessness — repeats of fears and events that happened. This is the first study to look at pre-existing risk factors, such as depression, PTSD from prior events, and mental illness.
Although 1-in-10 is lower than prior estimates, according to the Dr. Patel, it is close to the number of new cases coming from the U.S. military. Given that there are five million critical care survivors a year, the number of patients and families who are impacted is significant.
The environment experienced by patients in the ICU is often limited to the boundaries of their sensory system: what they touch, taste, smell, hear, and see. And, sometimes this is further limited to only what they hear. PTSD symptoms are often triggered by sounds and sights that are reminiscent of prior events.
Because of PTSD is memory based, it’s important to design the ICU experience to minimize trauma and mitigate negative experiences. Here are four ways to create more positive experiences for ICU patients:
1. Provide Positive Distractions
This includes music, humor, films, or programming like The C.A.R.E. Channel. Especially for patients who are semi-conscious or intubated, The C.A.R.E. Channel’s nature landscapes and original instrumental music conditions the room for healing. Many patients and family members have told us how much The C.A.R.E. Channel helped them during their recovery.
2. Conduct Intentional Interactions
This means being purposeful, focused, and fully present for the patient and family. Touching the patient’s hands, having eye contact when possible, and being engaged with the whole person, not merely his/her medication, vitals, and symptoms.
It is easy to understand that a busy nurse or aid, lab tech, or housekeeper just needs to do their job. However, they can almost forget the patient. In ICU, paying attention to the patient, noticing signs of distress and fear, and minimizing environmental stressors can lower the risk of PSTD once patients leave the ICU.
3. Be Sensitive to Noise
Noise is the number one irritant to a highly acute patient and, as well, to their family. Eliciting the startle response, for example, results in both physiological and psychological reactions: increased blood pressure, heightened heart rate, fear, and anxiety.
Florence Nightingale wrote, “Any sound that creates anticipation, expectation, or fear of surprise is that which damages the patient.” Close the door (if appropriate), quiet other patients and visitors and staff. Lower the volume of monitors (if appropriate).
Again, be sensitive to the television and the sounds that go directly to the patient’s ears. News stories about war, bombings, mass shootings, political rants, even dramas with people yelling at each other are not appropriate and can put the patient at risk. ICU Delirium is real, partially an outcome of confusion caused by a chaotic environment.
4. Do Continual Environmental Assessments and Interventions
Walk into the room with heightened awareness of everything that impacts the patient and family members. Since four of the five senses are the connection to the environment, look at what the patient is looking at, listen to what he/she hears, be aware of what touches the patient, and how the room smells. Remove unnecessary clutter. Make sure the bathroom is clean.
Most important, create and re-create a calm and peaceful place for healing.
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