Page 156 - ACCCN's Critical Care Nursing

Psychological Care 7

Leanne Aitken
Rosalind Elliott

often additive or synergistic. While it is important to
Learning objectives ensure that assessment incorporates each of the indivi-
dual concepts, management may often target multiple
After reading this chapter, you should be able to: aspects concurrently.
● implement appropriate evidence-based strategies to reduce
patient anxiety ANXIETY
● describe the different instruments available to assess Anxiety can occur both during and following a period of
sedation needs in critically ill patients and discuss the critical illness. Anxiety has been defined as an unpleasant
benefits and limitations of each emotional state or condition. Within that broad defini-
1
● describe the three subtypes of delirium tion Spielberger recognises two related, but conceptually
● recognise risk factors for the development of delirium in the different constructs, specifically state and trait anxiety.
critically ill Trait anxiety, a personality characteristic, refers to the
● implement and evaluate delirium assessment screening relatively stable tendency of people to perceive stressful
1
instruments for the critically ill situations as stressful or anxiety-provoking. In contrast,
● implement appropriate evidence-based strategies to and of more immediate concern during the care of criti-
manage patients’ sedative needs cally ill patients, is state anxiety, an emotional state that
● integrate best practice into pain assessment and exists at a given moment in time and is characterised by
management ‘subjective feelings of tension, apprehension, nervous-
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● determine methods to promote rest and sleep for critically ness, and worry’. In addition, activation of the auto-
ill patients nomic nervous system is present during state anxiety.
Factors that have been identified as precipitating anxiety
include: 2,3

Key words ● concern about current illness as well as any underlying
chronic disease
anxiety ● current experiences and feelings such as pain, sleep-
lessness, thirst, discomfort, immobility
delirium ● current care interventions including mechanical ven-
sedation assessment and management tilation, indwelling tubes and catheters, repositioning
sedation protocols and suctioning
pain assessment and pain management ● medication side effects
sleep promotion ● environmental considerations such as noise and light
● concern about the ongoing impact of illness on
recovery.
INTRODUCTION Anxiety has been identified in approximately half of criti-
cally ill patients, with the majority of patients reporting
Care of the psychological health and wellbeing of patients moderate to severe anxiety in most cohorts. Further, the
4-7
is essential in the complex and multifactorial care of presence of anxiety in acute myocardial patients has been
critically ill patients. Patients experience an ongoing reported to be similar across multiple cultures. 4
compromise of their psychological health well beyond
hospitalisation, with this psychological compromise also There are both physiological and psychological responses
affecting their physical health. Aspects of psychological to anxiety, associated with feelings of apprehension,
health most relevant in the care of the critically ill include uneasiness and dread from a perceived threat. These
the recognition and management of anxiety, delirium, responses reflect a stress response and incorporate
sedation needs, pain and sleep. Although each of these avoidance behaviour, increased vigilance and arousal,
concepts is reviewed sequentially through this chapter, in activation of the sympathetic nervous system and release
reality it is often difficult to separate the issues as they are of cortisol from the adrenal glands. The humoral 133
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