HOW ILLNESSES
AND INJURIES
AFFECT THE Sharon JT Fleming
MIND OF
NURS 4005 Topics in
Clinical Nursing
PATIENTS IN A
Instructor: Dr. Teresa
Russell
CRITICAL
SETTING
The purposes of this presentation focuses on how anxiety
and depression affect patients in a critical care setting.
Literature has well documented that patients in a critical
care setting, such as the ICU, suffer from
anxiety/depression/delirium and PTSD, well after
hospitalization (Spilman, Smith, Schirmer and Tonui, 2015).
It is important that regimented practices are in place in
diagnosing, assessing and treating the psychsomatic and
emotional needs of patients and the risks that presents
itself, if untreated. (Spilman, Smith, Schirmer and Tonui,
2015). A continual assessment of depressive symptoms
OVERVIEW such as restlessness and fatigue, are vital to early
treatment and care of these patients. Further, patients in
the ICU may not be able to show or report depressive
symptoms because of pain, medications, sleep deprivation
or on a ventilator. (Spilman, Smith, Schirmer and Tonui,
2015).
Brain disfunction, such as depression, delirium, and anxiety
in critically ill patients is progressively acknowledged as
one of the major clinical challenges. “The ‘hostile’ ICU
environments is itself an important contributor to the ICU-
acquired brain dysfunction and Interventions to humanize
critical care should be embraced and studied in a
systematic way.” (Meyfroidt & Smith, 2019)
MENTAL ILLNESS IN THE CHRONICALLY ILL PATIENT IN A CRITICAL
CARE SETTING
In a critical care setting, that is often an aggressive environment,
patients can show signs/symptoms of depression, delirium and
anxiety. When recognized at onset and if treated accordingly you may
create a better chance for immediate outcomes starting the process of
minimizing and further identifying the actual triggers possibly leading
to depression, level of delirium and the stages of anxiety for the
patient.
CREATING THE RIGHT ENVIRONMENT- CREATING SENSE UNDERSTANDING HEARING THEIR STORY IF THEY
LISTENING: WHAT MEDS IN - CAN SPEAK OR FAMILY CAN
CHARTING/HISTORY? IS PATIENT IN PAIN THEY CANNOT EXPRESS
EXPRESS/’SHOW (VENTILATOR ETC.)
PAYING ATTENTION TO PATIENT BEHAVIOR-
CREATING A SENSE OF SAFETY
RESTLESSNESS, FATIGUE
CASE STUDY- LISTENING THAT BIT FURTHER explains: “The way someone uses language, and describes an event, or their feelings, conveys
much more than the bare facts. Health professionals have been challenged to consider the contribution of narrative-based
medicine, where the story, and the telling and sharing of it, is as much part of the evidence as the data and incidents within it. A
nurse who actively listens to a patient telling their story is receiving and affirming the patient, and enabling them to build on the
story. Many of you will have had the experience, over a series of consultations with the same patient, of hearing a changed history
unfold as current and past illnesses are fitted into a bigger picture. You may have also helped someone go away with more
connected sense of their health because you have enabled them to link parts of their story together, and plana way forward. Much
of this happens through active listening.”(Bryant, L. (2009).
Recognizing these signs and symptoms contribute to the benefits of
aggressively gaining control of patient outcomes and behavior.
From the time of diagnosis of chronic illness, the psychological aspect of
care should be introduced, the treatment regimens begun with consults to
psychiatric practitioners
MENTAL Mental health needs of patients in the critical
ILLNESS IN care settings should be considered across the
illness/injury continuum.
THE From the time of diagnosis of chronic illness, the
psychological aspect of care should be introduced
CHRONICAL
at the beginning of treatment regimens with
consults to psychiatric practitioner.
Depression management should be vital to ideal
LY ILL patient care, not a consequential focus. (Gallo, J.J.,
Hwang, S., Joo, J.H., Bogner, H.R., Morales, K.H.,
PATIENT IN Bruce, M.L., and Reynolds III, C.F., 2015)
In a critical care setting, that is often an
aggressive environment, patients can show
A CRITICAL signs/symptoms of depression, delirium and
anxiety, and therefore it should be recognized at
CARE its onset and treated accordingly for better
patient outcomes.
SETTING
TEACHING PLAN THAT HELPS BOTH PATIENTS AND CAREGIVERS
IN PREVENTING OR MANAGING PSYCHOLOGICAL
MANIFESTATIONS ASSOCIATED WITH AN ILLNESS, OR HEALTH
CRISIS, IS ESSENTIAL FOR PATIENTS TO UNDERSTAND AND
TEACHING HAVE BETTER OUTCOMES IN CARE.
TEACHING PLAN:
PLAN FOR
WRITTEN INFORMATION AND EDUCATION ON THE ADDED
DIAGNOSIS OF ANXIETY AND DEPRESSION TO THEIR
CHRONIC ILLNESS OR THE CRISIS SITUATION THAT
PATIENT
BROUGHT THEM TO THE CRITICAL CARE SETTING
INCLUDE FAMILY IN THE DISCUSSION SO THAT PATIENT
CAN FEEL MORE COMFORTABLE
AND PROVIDE THE DIAGNOSIS MEANING IN LAYMAN’S TERMS
PROVIDE RECOMMENDED PLAN OF CARE: MEDICATION(S)
AND NON-PHARMACOLOGICAL METHOD AND LISTEN TO
FAMILY PATIENT CONCERNS TO ALLEVIATE ANXIETY, FEAR, AND
STIGMATISM ASSOCIATED WITH DIAGNOSIS
EXPLAIN THE MEDICATION BEING GIVEN, ITS USE AND WHY
THIS WOULD PROVIDE BETTER PATIENT OUTCOME.
The most common medical treatment option
for patients in the critical care setting
exhibiting signs and symptoms (s/sx) of anxiety
and or depression is through medication after
diagnosis.
Medication regimens are prescribed based on
MEDICAL the needs of the patient and diagnosis. This
can be for temporary relief of symptoms while
in the critical care setting or depending on the
TREATMEN severity of diagnosis and symptoms, can
continue well after leaving the critical care
T OPTIONS setting. (Meyfroidt & Smith, 2019)
It is imperative that the patient is educated on the
medication, the indication for, and the length of
time patient will be on medication. Nurses can
print materials for patients/families explaining the
medication, its use and prescription dosages and
how often medication is given or should be taken.
There are non-pharmacological options such as
care partners being actively engaged in care
There are non-pharmacological options such as
care partners being actively engaged in care
Facilities making visiting hours more accessible
NON- to families to visit and extended stay for care
partners
MEDICAL something personal from home that patient
gets comfort from such as blankets and photos
TREATMEN music patient loves via personal radio/cd’s in
room, brought in by family member
TS
The role of a nurse is to not only take care of
the physical well-being of a patient as they
worked through chronic illness, but to also take
care of the psychological aspect of care as
well. We as nurses also need to be cognizant
of the ethical issues that come along with care
of patients that develop depression. Their
SUMMARY whole being (holistic) should be of focus. It is
imperative that patients be able to have some
control, or gain back some of their control, in
order to feel whole and not a burden to family
and friends. Participation in care is key and the
interaction between nurse-patient becomes
center focused. Continuous dialogue with all
health care practitioners and patients leads to
better patient care and outcomes.
REFERENCES
Bryant, L. (2009).The art of listening. Practice Nursing, 37(6), 49-52
Gallo, J.J., Hwang, S., Joo, J.H., Bogner, H.R., Morales, K.H., Bruce, M.L., and Reynolds III, C.F., (2015).
Multimorbidity, depression, and mortality in primary care: Randomized clinical trial of an evidence-based
depression care management program on mortality risk. Journal of General Internal Medicine, vol 31, 380-
386 (2016) doi:10.1007/s11606-015-3524-y. Retrieved from
http://link.springer.com/article/10.1007/s11606-015-3524-y#citeas
Meyfroidt, G., & Smith, M. (2019). Focus on delirium, sedation and neuro critical care 2019: towards a more
brain -friendly environment? Intensive Care Med (2019) 45:1292-1294 https//doi.org/10.1007/s00134-019-
05701-2
Spilman, S.K., Smith, H.L., Schirmer, L.L., & Tonui, P.M. (2015. Evaluation and treatment of depression in
adult trauma patients. Journal of Trauma Nursing, 22(1), 17-22. doi:10.1097/JTN.0000000000000102
