Recent data has revealed that a significant proportion, up to 50-70%, of individuals who have survived the intensive care unit (ICU) stay confronting and battling psychosocial obstacles after their discharge (Rawal et al., 2017). Rawal et al. (2017) further explain that with limited awareness about PICS, the quality of life has significantly shifted to a low level. This brings attention to the frequently overlooked burden associated with Post-Intensive Care Syndrome (PICS). Post-intensive care syndrome (PICS) has recently been acknowledged as a clinical entity in individuals post-ICU. Dharmanand et al. (2021) highlight an increasing rate of ICU survivors, leading to a growing interest in Post-intensive care syndrome recovery. This review focuses on providing an overview of Post-intensive care syndrome; it will explore the psychosocial elements leading to PICS. Focusing on Post-traumatic stress disorder (PTSD) as the psychosocial element in adults, this study will evaluate a psychosocial intervention aimed at treating or preventing PICS and explore the role of nurses in these interventions. Finally, through research and reviewing different literature, this research will highlight how one can apply the evaluation results to one’s practice.
Post-traumatic stress disorder (PTSD)
Most critically ill survivors experience long-term psychosocial elements that alter their lives after ICU (Vlake et al. 2020). Therefore, surviving a critical illness does not always measure up to immediate recovery, leading to Post-intensive care syndrome (PICS). This equates to different psychosocial elements, and Post-traumatic stress disorder (PTSD) in adults is not an exception. 39 % of individuals going through Post-traumatic stress disorder (PTSD) are reported in patients who have survived ICU. The patients are also at an increased risk of committing suicide as compared to the patients who did not need ICU admission (Vlake et al., 2020).
Individuals who have been or observed a traumatic event are susceptible to developing post-traumatic stress disorder (PTSD), an intricate mental health condition. The enduring physical, cognitive, and psychological consequences encountered by individuals who have survived critical illness, with an emphasis on those who have undergone treatment in intensive care units (ICUs), are referred to as Post-Intensive Care Syndrome (PICS) (Myers et al., 2016). Murray et al. (2020) bring to light the fact that around a quarter of patients who have been to the ICU or received any form of treatment in the intensive care unit have a higher possibility of developing PTSD. Murray further argues with the high increase in ICU admissions following the COVID-19 pandemic, more patients are likely to suffer post-ICU PTSD. For survivors of intensive care units, the traumatic event could be the actual severe illness, intrusive medical procedures, or recollections of delirium brought on by anesthesia. Aside from the unusual sights, noises, and technology, another factor that may exacerbate the trauma is the experience of being in the intensive care unit (Marra et al., 2017).
Burki (2019) patients in the ICU are traumatized because they are faced with their mortality, hooked into machines that ensure they stay alive. If a patient had been diagnosed with anxiety disorder before going to ICU, chances of having PTSD post-ICU are high. Although research states that patients with sepsis or acute respiratory infection might have a higher susceptibility to PTSD, it does not necessarily choose or discriminate between the sick or the not-so-sick individuals. Individuals who have PTSD may experience different behaviors, such as avoiding people, places, or activities connected to the trauma. They could have heightened alertness (such as hypervigilance, irritability, or an increased startle reaction), feel emotionally numb, struggle with concentration, and have trouble sleeping. The impact can be profound, whereby an individual is challenged to resume their daily activities, such as work (Peris, 2011).
Psychosocial Intervention of PTSD
Psychosocial interventions are essential components in the treatment or prevention of Post-traumatic stress disorder (PTSD). One of the main ways of treating PTSD in Post-ICU patients is cognitive-behavioral therapy or CBT. Its main goal is to locate and reorganize harmful thought and behavior patterns that result from the trauma. Tanoue et al. (2018) explain the main benefit of having nurses trained in CBT approaches is the application of cognitive-behavioral therapy in the treatment of PTSD. This is a treatment-focused psychosocial intervention that uses different techniques to help patients deal with their problems and work towards getting better. Its capacity to treat trauma-related cognitive distortions, maladaptive behaviors, and emotional reactions accounts for most of its efficacy. Even though CBT for PTSD has shown promising results in several trials, it’s crucial to critically appraise its advantages, disadvantages, and possible areas for development. The critical importance of using CBT for PTSD is its organized and evidence-based approach to its treatment. Through a critical review of the evidence-based approach, it reveals both strengths and limitations while giving recommendations.
Ahmadizadeh (2013) draws evidence from war veterans who had been exposed to traumatic events. The group was divided into four different types: the problem-solving, exposure, combined, and control group. Through critical review, results concluded that cognitive behavioral therapy can improve PTSD victims’ lives. An analysis of the efficacy of cognitive-behavioral therapy can begin with dividing PTSD patients into different groups. Mendes (2008) Through rapid appraisal, the clinical nurse uses a tool that helps determine the effectiveness of a study, Randomized Control Trials, which compares cognitive-behavioral therapy for PTSD treatment in adults. Long-term individual cognitive behavioral therapy (more than four sessions) was used in most of the included trials; brief individual cognitive behavioral therapy (four sessions or fewer) and group cognitive behavioral therapy combined with two separate sessions were used in the remaining studies. The comparison groups were the waiting list, exposure therapy, cognitive therapy, eye movement desensitization and reprocessing, and supportive therapy (which includes counseling, relaxation, and psycho-education). The results concluded that these therapies were equally effective in treating PTSD. Based on the evidence gathered, Öst (2023) concludes that Cognitive behavioral therapy is an effective way to treat PTSD in routine clinical care and treatment. Analyzing the population sampling of Ahmadizadeh (2013) and the patients going through Post-intensive Care Syndrome, they all have a similarity as both have gone through a traumatic event that led to a mental issue leading to PTSD. Based on the critical appraisal, Implementing CBT in treating PTSD is effective, with the rising question on costs and accessibility; by fostering resilience and self-efficacy, CBT gives people the skills they need to manage their PTSD symptoms autonomously.
Translation and Application of the Results of Critical Evaluation to my practice
As a nurse, it is essential to rely more on evidence other than trial and error to improve a clinical practice’s outcome and results. From the evidence collected, analyzed, and interpreted, I will evaluate the results through the symptoms depicted by the post-ICU patients, like flashbacks and intrusive thoughts. I will use different research and benchmark-specific results related to the situation to evaluate and make an informed decision. Through more research, I will develop skills and ideas like grouping my patients and testing each group while analyzing the results to come up with a solution. Before conducting research, I will Ascertain which elements of the assessment findings apply most directly to my work. I will Pay attention to areas that require correction or improvement or where I can further improve my practice by utilizing my talents. Furthermore, using informed consent is equally important; I will have signed documents and sit a patient down to explain both the benefits and the risks of an examination to get permission from the patient and the family. Doing this will promote transparency and ensure the patient’s autonomy and freedom to choose what they feel best.
Conclusion
The psychological component of PICS that affects a large percentage of ICU survivors and poses difficulties for their long-term recovery and quality of life is PTSD. Healthcare professionals can successfully assist the holistic recovery of ICU survivors and lessen the burden of PICS-related psychological morbidity by emphasizing psychosocial care and incorporating evidence-based therapies like CBT into post-ICU rehabilitation programs. Healthcare practitioners, mental health specialists, caregivers, and other interdisciplinary experts must collaborate to address the psychosocial aspects of PICS. The psychosocial impact of PICS affects not only the patients but also the caregivers. It is essential to stay close to post-ICU individuals and help them go through the situation, especially if someone starts depicting symptoms of PICS. PTSD can cause a significant hole in one’s life; it is caused by traumatic events an individual experiences in the ICU. It is also essential to encourage post-ICU patients to seek help and, most significantly, people living with PTSD to join therapy groups, ensuring they get help. Life after ICU can be different for patients, but as nurses and health professionals, it is essential to evaluate and analyze ways to either treat or prevent PTSD.
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es underlying PICS, paving the way for comprehensive post-ICU care methods.”
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