Psychology: Person-Centred Care a Key to Successful Recovery

Abstract

Many patients find critical care admissions stressful, and subsequently survivors can experience symptoms of clinical depression, anxiety, posttraumatic stress disorder and cognitive impairment. Modifiable risk factors for psychological morbidity, including sedation practices, delirious experiences and acute stress in critical care units have been identified. The National Institute of Care and Health Excellence (NICE) now advocates psychological assessment and support for critically ill patients, and the UK’s Intensive Care Society supports the provision of senior practitioner psychologists in critical care to oversee acute and follow-up psychological services. While high-quality evidence from randomised trials and systematic reviews is still lacking to support the precise form and mode of delivery of psychological interventions most beneficial for critically ill patients. There are promising multimodal interventions in the acute setting include elements such as music therapy, multidisciplinary working with physiotherapists to promote optimal rehabilitation, complementary therapies, family support programmes and evidence-based psychological approaches for delirium, agitation, hallucinations, delusions and stress. Cognitive behavioural therapy for trauma, psychosis, anxiety and depression can be provided by specialist practitioner psychologists based in critical care follow-up services, familiar with the ICU context and embedded within multidisciplinary teams. Peer support, stress management or mindfulness groups may also be run as adjunct services. Cognitive interventions for critical care patients are being developed but are still in their infancy. A more holistic, psycho-social approach to the experiences of critically ill patients is receiving increasing support within intensive care medicine looking towards sucessful discharge.