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Belastungen für Patienten auf der Intensivstation

Eine Analyse unter Berücksichtigung der Kontrollierbarkeit

Stressors for patients in the intensive care unit

An analysis taking controllability into consideration

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Zusammenfassung

Fragestellung

Es existieren bislang keine Untersuchungen zu Belastungen für Patienten der Intensivstation, die sowohl das Belastungsempfinden als auch die erlebte Kontrollierbarkeit erfassen. Mit dieser Untersuchung sollten die Fragen beantwortet werden, welche Situationen von Patienten der Intensivstation als belastend erlebt werden, ob diese aus Patientensicht kontrollierbar sind, und ob das Belastungserleben von der Kontrollierbarkeit abhängig ist.

Material und Methoden

Es wurde ein Fragebogen zu 18 potenziell belastenden Situationen für Patienten der Intensivstation konzipiert. Diese sollten hinsichtlich ihres Vorkommens, der Wiederholungshäufigkeit, der Belastung und des Kontrollempfindens beurteilt werden. 198 Patienten der chirurgischen Intensivstation und 100 Patienten der allgemeinchirurgischen Normalstation wurden während ihres stationären Aufenthalts befragt.

Ergebnisse

Patienten der Intensivstation erinnerten signifikant mehr Belastungssituationen als die der Normalstation (M ± SD = 10,2 ± 2,7 vs. 6,6 ± 2,0; d = 1,48; p < 0,001) und empfanden diese als belastender (mittlere Belastung: M ± SD = 3,6 ± 1,5 vs. 2,2 ± 1,3; d = 1,01; p < 0,001). Die belastendsten Situationen für intensivpflichtige Patienten waren „Fixierung der Arme“ (M ± SD = 7,47 ± 3,27), „maschinelle Beatmung“ (M ± SD = 7,36 ± 3,29) und „endotracheales Absaugen“ (M ± SD = 7,19 ± 2,99). Je weniger Kontrollierbarkeit von Patienten der Intensivstation erlebt wurde, umso ausgeprägter waren die aktuelle Angst zum Befragungszeitpunkt und das mittlere Belastungsempfinden (r = −0,20, r = −0,36; p < 0,01).

Schlussfolgerung

Erlebter Kontrollverlust steht in deutlicher Beziehung zum Ausmaß der Belastung, die intensivpflichtige Patienten erfahren. Dies ermöglicht Überlegungen zur Reduktion der Belastung auf Intensivstationen.

Abstract

Objective

Studies on stress factors for patients in intensive care units (ICU) have so far concentrated on whether certain stressors have occurred or how stressful they were. There are no studies on stress for patients in ICUs that measured both the perception of stress and the chances perceived to control it; however, loss of control can result in long-term psychopathological consequences, such as depression or posttraumatic stress disorder. Therefore, a questionnaire was developed to evaluate the influence of controllability on perception of stress. The aim of this study was to answer the following questions: which situations were experienced as stressful by patients in ICUs, whether patients perceived them as being controllable and whether the experience of stress depended on the controllability? Furthermore, it was examined which stressful situations are specific to ICUs.

Material and methods

The questionnaire included 18 potentially stressful situations for ICU patients. These situations were assessed with respect to the occurrence, frequency and duration, the impact of stress and the perception of control. In addition, anxiety was assessed using STAI-X1. A total of 198 ICU patients and 100 patients hospitalized in a general surgery ward were interviewed.

Results

Patients in ICUs remembered significantly more stressful situations than those on the normal ward (M ± SD = 10.2 ± 2.7 vs. 6.6 ± 2.0; d = 1.48; p < 0.001) and perceived them as more stressful (mean stress: M ± SD = 3.6 ± 1.5 vs. 2.2 ± 1.3; d = 1.01; p < 0.001). The most stressful situations for ICU patients were fixation of the arms (M ± SD = 7.47 ± 3.27), mechanical ventilation (M ± SD = 7.36 ± 3.29) and endotracheal suctioning (M ± SD = 7.19 ± 2.99). Approximately one third of patients underwent these situations. Situations experienced by more than 90% of ICU patients were evaluated as being the least stressful experiences, including infusion (M ± SD = 2.7 ± 2.7), measuring heart activity (M ± SD = 2.3 ± 2.7), taking blood samples (M ± SD = 2.2 ± 2.7), and temperature control (M ± SD = 0.9 ± 1.7).

Controllability experienced by ICU patients negatively correlated with anxiety (r = −0.20, p = 0.004) and mean sensation of stress (r = −0.36; p < 0.001). When comparing stress levels of ICU patients who perceived controllability in a given situation to those who did not, the greatest effects (Cohen’s d > 1.4) were observed for the situations presence of a bed barrier (M ± SD = 0.1 ± 0.4 vs. 5.9 ± 2.8), lighting at night (M ± SD = 0.7 ± 1.7 vs. 5.7 ± 3.3), presence of a ventilation tube (M ± SD = 2.5 ± 2.1 vs. 6.7 ± 3.0) and repositioning of the patient (M ± SD = 2.5 ± 2.9 vs. 6.7 ± 2.9).

Conclusion

The experience of loss of control seems to negatively modify the impact of stressors. Thus, an increase in aspects of controllability could reduce the burden on patients during intensive care.

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Literatur

  1. Alasad J, Ahmad M (2005) Communication with critically ill patients. J Adv Nurs 50:356–362

    Article  Google Scholar 

  2. Alasad JA, Abu Tabar N, Ahmad MM (2015) Patients’ experience of being in intensive care units. J Crit Care 30:859e7–859e11

    Article  Google Scholar 

  3. Aslan Ö, Tosun B (2015) Cardiovascular surgery patients: intensive care experiences and associated factors. Asian Nurs Res (Korean Soc Nurs Sci) 9:336–341

    Google Scholar 

  4. Berntzen H, Bjørk IT, Wøien H (2018) “Pain relieved, but still struggling”—critically ill patients experiences of pain and other discomforts during analgosedation. J Clin Nurs 27:e223–e234

    Article  Google Scholar 

  5. Bortz J, Schuster C (2010) Statistik für Human- und Sozialwissenschaftler, 7. Aufl. Springer, Berlin, Heidelberg

    Book  Google Scholar 

  6. Cusack P, Cusack FP, McAndrew S et al (2018) An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. Int J Mental Health Nurs 27:1162–1176

    Article  Google Scholar 

  7. Cutler LR, Hayter M, Ryan T (2013) A critical review and synthesis of qualitative research on patient experiences of critical illness. Intensive Crit Care Nurs 29:147–157

    Article  Google Scholar 

  8. Davydow DS, Gifford JM, Desai SV et al (2008) Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 30:421–434

    Article  Google Scholar 

  9. Dziadzko V, Dziadzko M, Johnson M et al (2017) Acute psychological trauma in the critically ill : patient and family perspectives. Gen Hosp Psychiatry 47:68–74

    Article  Google Scholar 

  10. Egerod I, Bergbom I, Lindahl B et al (2015) The patient experience of intensive care: a meta-synthesis of Nordic studies. Int J Nurs Stud 52:1354–1361

    Article  Google Scholar 

  11. Guttormson JL (2014) “Releasing a lot of poisons from my mind”: patients’ delusional memories of intensive care. Heart Lung 43:427–431

    Article  Google Scholar 

  12. Guttormson JL, Bremer KL, Jones RM (2015) “Not being able to talk was horrid”: a descriptive, correlational study of communication during mechanical ventilation. Intensive Crit Care Nurs 31:179–186

    Article  Google Scholar 

  13. Jones C, Bäckman C, Capuzzo M et al (2007) Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med 33:978–985

    Article  CAS  Google Scholar 

  14. De Jonghe B, Constantin JM, Chanques G et al (2013) Physical restraint in mechanically ventilated ICU patients: a survey of French practice. Intensive Care Med 39:31–37

    Article  Google Scholar 

  15. Kalfon P, Mimoz O, Auquier P et al (2010) Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med 36:1751–1758

    Article  Google Scholar 

  16. Kapfhammer HP (2010) Posttraumatic stress disorder in survivors of severe somatic illness and ICU treatment. Eur Psychiatry 25:173

    Article  Google Scholar 

  17. Laux L, Glanzmann P, Schaffner P, Spielberger C (1981) Das State-Trait-Angstinventar Beltz, Weinheim

    Google Scholar 

  18. van de Leur JP, van der Schans CP, Loef BG et al (2004) Discomfort and factual recollection in intensive care unit patients. Crit Care 8:R467–73

    Article  Google Scholar 

  19. McGiffin JN, Galatzer-Levy IR, Bonanno GA (2016) Is the intensive care unit traumatic? What we know and don’t know about the intensive care unit and posttraumatic stress responses. Rehabil Psychol 61:120–131

    Article  Google Scholar 

  20. Nelson JE, Meier DE, Oei EJ et al (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282

    Article  CAS  Google Scholar 

  21. Nikayin S, Rabiee A, Hashem MD et al (2016) Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry 43:23–29

    Article  Google Scholar 

  22. Novaes MAFP, Knobel E, Bork AM et al (1999) Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med 25:1421–1426

    Article  CAS  Google Scholar 

  23. Novaes P, Aronovich A, Ferraz MB, Knobel E (1997) Stressors in ICU: patients’ evaluation. Intensive Care Med 23:1282–1285

    Article  CAS  Google Scholar 

  24. Parker AM, Sricharoenchai T, Raparla S et al (2015) Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 43:1121–1129

    Article  Google Scholar 

  25. Puntillo KA, Max A, Timsit JF et al (2014) Determinants of procedural pain intensity in the intensive care unit: the Europain® study. Am J Respir Crit Care Med 189:39–47

    PubMed  Google Scholar 

  26. Rabiee A, Nikayin S, Hashem MD et al (2016) Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med 44:1744–1753

    Article  Google Scholar 

  27. Rattray J, Johnston M, Wildsmith T (2004) The intensive care experience: development of the ICE questionnaire. J Adv Nurs 47:64–73

    Article  Google Scholar 

  28. Rotondi AJ, Chelluri L, Sirio C et al (2002) Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med 30:746–752

    Article  Google Scholar 

  29. Wade DM, Hankins M, Smyth DA et al (2014) Detecting acute distress and risk of future psychological morbidity in critically ill patients: validation of the intensive care psychological assessment tool. Crit Care 18:519

    Article  Google Scholar 

  30. Warlan H, Howland L (2015) Posttraumatic stress syndrome associated with stays in the intensive care unit: Importance of nurses’ involvement. Crit Care Nurse 35:44–52

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Reinberger, E. Muhl, C. Nau &  M. Hüppe

  2. Klinik für Allgemeine Chirurgie, Universität zu Lübeck, Lübeck, Deutschland

    R. Bouchard

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  1. M. Reinberger
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  2. R. Bouchard
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  3. E. Muhl
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  4. C. Nau
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Correspondence to M. Hüppe.

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Interessenkonflikt

M. Reinberger, R. Bouchard, E. Muhl, C. Nau und M. Hüppe geben an, dass kein Interessenkonflikt besteht.

Die Untersuchung wurde mit Zustimmung der lokalen Ethikkommission der Universität zu Lübeck durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Reinberger, M., Bouchard, R., Muhl, E. et al. Belastungen für Patienten auf der Intensivstation. Anaesthesist 69, 555–564 (2020). https://doi.org/10.1007/s00101-020-00798-3

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  • DOI: https://doi.org/10.1007/s00101-020-00798-3

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