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Patients admitted into the ICU want to be able to decide their own futures and their families are faced with this burden
23 July 2012
Being admitted into an Intensive Care Unit is a stressful and disruptive experience for all those involved, especially the patients, who in 20% showed signs of anxiety and 23-27% showed signs of depression, and their family members, amongst whom the rate of anxiety rose to 76% and depression to 42-60%. The investigation, carried out by the Universitat Jaume I with the aim of developing prevention and intervention programs to improve the wellbeing and life of these people, also reveals important discrepancies between both the moment of deciding who makes decisions regarding the person admitted into hospital, in as much that the patients believe that they should be considered first, followed by psychologists and then doctors, leaving the family in last place, whilst family members believe that they should play a more relevant role than the doctor, leaving the patient in last place.
This information is the result of a doctoral thesis defended by Beatriz Gil-Julià, the title of which is “Emotional affectation associated to admittance into an Intensive Care Unit”. This thesis was supervised by Rafael Ballester, tenured professor in the Department of Basic and Clinical Psychology and Psychobiology and Ricardo Abizanda, former chief of service in the Intensive Care unit in the Hospital General in Castellon. It deals with the first inter-disciplinary thesis which has been presented since the Health Science Faculty was established and is a psychological investigation in the context of health. In this investigation, a part of results of a wider research project are presented. The wider investigation was financed by the Ministry for Education and Science and from a line of investigation which began in 2005 and has provided results in other areas such as psychological risks for the personnel who work in these units.
The Intensive Care Units (Unidades de Cuidados Intensivos) offer differentiating characteristics which together with the seriousness of the patient’s condition can result in a stressful and disruptive for those being admitted to hospital. Within this framework the general investigation has focused on the subjective reality associated with being admitted into an ICU, rating the grade of psychological affectation of patients and their families, such as the possible modulator role of different factors of the afore-mentioned affectation.
The highest rating in those aspects reviewed as part of a stay in an ICU was for medical attention, and the worst was the lack of tranquility and opportunities for distraction and entertainment. To be in pain, in bed all day and to be unable to be with close family have been identified as the most stressful factors. An interesting result, according to Gil-Julià, “is the decision-making process, where the patients consider themselves to be most important in this process, followed by the psychologist and the doctor, leaving family opinion in last place. Almost three-quarters feel perfectly capable to participate in the decision-making, although one in five view this more as a burden than a privilege”. As such, the majority prefers for doctors to be prudent when informing patients and do not divulge any information that is not yet certain, that is to say, that they do not anticipate possible risks.
With regards to family members, stress mainly arises through fear that the patient may die or suffer a serious medical setback and that they are unable to obtain pain relief as well as the unexpected admittance into the ICU and not being close to loved ones. Free time and work are also areas in families’ lives which are affected by the admittance into an ICU, and the family member most affected by this is the patient’s partner. They are very satisfied by the medical care received by the patient, although feel that there is a lack of support for family members. Curiously, in the decision-making process, they consider that they should have a more relevant role than the doctor and leave the patient themselves in last place. As the researcher explains “only a fifth feel capable of intervening in the decision-making process and for a little more than half, taking part in this is more of a burden than a privilege”.
This investigation is the first, necessary step towards being able to implement both prevention and intervention programs to improve the wellbeing and quality of life of people who, for various reasons, find themselves in this situation, which in turn would have major repercussions in the quality of care provided to both the patient and family members.
Begoña Gil. UJI.