Model essay on psychological care of icu patients: Psychological care of ICU critically ill patients Abstract ICU critically ill patients need isolated monitoring and treatment. The closed environment, unfamiliar monitors and therapeutic instruments are easy to cause psychological obstacles to patients, especially the cooperation of psychological care during treatment. Facing different conditions, the methods and contents of psychological care should be different at different stages of treatment. Comprehensive and reasonable holistic nursing is an effective measure to promote patients' mental health, especially for patients with serious illness, psychological counseling intervention should be further strengthened.
Intensive care unit; Severe patients; Psychological nursing
Patients in intensive care unit (ICU) are in critical condition, with rapid progress and great changes. ICU is usually a fully enclosed management department, and family members are generally not allowed to accompany it. The psychological reactions of different patients are also very different. Although the ICU is well-equipped and comprehensive in medical treatment, there are still patients who have adverse psychological reactions during the monitoring period. It is reported that the incidence of psychological disorders in ICU patients is 14%~72%[ 1]. How to carry out effective psychological care for patients with different diseases and types, reduce adverse psychological reactions, and make patients actively cooperate with treatment until their body and mind recover as soon as possible has become an urgent problem to be solved. Combined with clinical work, nursing is summarized as follows:
1 Causes of patients' negative emotions
1. 1 Influence of ward environment: ICU is the place where all departments and specialties of the hospital are concentrated. After waking up, patients show great panic, some are vague anxiety, some are worried, nervous and afraid of their own diseases. It is when night falls and there is silence around, at this time, the patient's fear and fear suddenly rise, and when he sees or hears the pain and death of others, he is anxious and afraid. Various advanced instruments and staff in ICU are constantly carrying out a series of complicated operations, but in order to facilitate monitoring and treatment, ICU has no? Time? The light is always on, I don't know day and night, I can't make any noise and I can't move. This environment is easy to make patients uneasy and produce psychological pressure [2].
1.2 Loneliness and depression: The patient struggled violently after waking up, and his spirit was listless and paralyzed, with apathy, severe insomnia and pessimism, mainly due to his lack of courage when he woke up after operation. Regeneration? This feeling. They want to be close to their relatives and get spiritual comfort, but most ICU patients are not allowed to be accompanied by their relatives, so they feel lonely and depressed.
1.3 Lack of trust is easy to suspect: in the ICU ward, apart from the limited visiting time and communication with medical staff, the visual stimulation of ICU patients is limited to the ceiling overhead and the surrounding white walls. Sound stimulation is limited to the monotonous sound of monitors, ventilators, nutrition pumps and oxygen pipes. Therefore, all kinds of sound and visual stimuli in ICU can induce patients to have adverse psychological reactions, resulting in patients' low cognitive and judgment abilities, cognitive obstacles to time and place, inability to correctly understand the instructions of medical staff on treatment and nursing, and suspicion that medical staff conceal their illness, do not provide medical history, and do not tell doctors and nurses any discomfort, thus lacking trust in medical staff.
1.4 Influence of sleep: Due to the continuous evaluation and treatment of patients in ICU, as well as the monitoring of their hemodynamics and respiratory status, patients constantly receive monotonous sensory input, which is easy to have adverse effects on sleep. In addition, nursing activities at night, the treatment of patients' basic diseases, the mechanical sound of instruments, the sound of alarm and the sound of tracheal sputum suction bring abnormal mental stimulation to patients, which will all cause patients to sleep badly.
1.5 economic concerns: ICU ward not only has high hospitalization expenses, but also has the basic expenses of hospitalization and general treatment and nursing, as well as the expenses of special examinations and expensive materials, which brings heavy economic and ideological burdens to patients and makes them unable to cooperate with treatment with peace of mind.
2 Psychological nursing measures
2. 1 Attach importance to nurse-patient communication and enhance communication: Nurses are important regulators in the monitoring environment, and play an important role in regulating patients' emotions and alleviating patients' pain. Nurses should take the initiative to introduce ICU wards to patients and pay attention to communication with patients, so as to help alleviate patients' fears and nervousness, provide patients with high-quality and efficient services at any time, and meet patients' reasonable needs to the greatest extent. 2.2 Meet patients' needs: according to patients' psychological characteristics, try to meet patients' wishes. The indoor layout of ICU should be as close to life as possible to increase the flavor of life. The internal temperature, humidity and light can be adjusted, and there are good sound insulation or silencing devices to keep the environment relatively quiet. In addition, newspapers and magazines can be properly prepared for patients, so that patients can use headphones to listen to the radio and place their familiar items or family photos to change the boring ICU life to the greatest extent [3].
2.3 psychological counseling: ICU patients have great psychological changes during hospitalization, and their emotions fluctuate with their illness. Therefore, it is extremely important to do a good job of psychological counseling for patients. Psychological counseling is to gradually relieve patients' psychological problems and pressures through the analysis and guidance of nurses, so that they can change from unwilling to cooperate and accept treatment to actively asking for treatment, from wrong understanding to correct understanding, from escaping from reality to actively facing reality, and from bad psychological state.
2.4 Ensure the patient's sleeping environment: Sleep can not only ensure the patient's physical recovery, but also relax the patient's nervous mood, which is particularly important for the patient's rehabilitation. For example, provide soft, flat and clean beds, pillows with suitable height and bedding with moderate thickness, help patients to adopt comfortable lying posture, keep indoor air circulation, turn off fluorescent lamps at night, use wall lamps with soft light, minimize mechanical noise and artificial noise such as talking and walking, concentrate on treatment and nursing, reduce sleep interference to patients, and create a good sleeping environment for patients.
2.5 All nursing measures and operations should strive for the patient's cooperation: when the patient is awake, the nurse should obtain the patient's understanding and cooperation, and explain the purpose and steps to the patient before taking any measures and operations, so that the patient can actively cooperate with the treatment and avoid directly affecting the patient's mood.
3 discussion
Psychological care of critically ill patients mainly refers to the care of sober patients. Because of the critical illness and conscious mind, most patients have adverse psychological reactions such as anxiety, fear, depression and dependence. We aim at patients' bad emotions, timely guide and patiently explain, and increase patients' self-esteem and self-confidence. Communicating with patients in time, giving comfort and meeting their psychological needs have played an important role in patients' rehabilitation. Especially in the intensive environment of ICU, we use music therapy, which can relieve patients' excessive emotional and ideological pressure and play a due role in alleviating and preventing ICU syndrome. It is believed that the formulation and implementation of corresponding nursing intervention measures for the psychological problems of patients with tracheal intubation can reduce the occurrence of complications of tracheal intubation, greatly improve the mental health of patients, and play a positive role in smooth extubation and disease rehabilitation.
refer to
[1] Theory and practice of modern mechanical ventilation. Beijing. China Union Medical College Press, 2000,844.
[2] O Christina. A study on psychological stress-related diseases [J]. journal of traditional chinese medicine, 2004,22 (8):1414.
[3] Ma Min. Research and thinking on the influence of ICU environment on patients' body and mind [J]. China Journal of Nursing, 2004,39 (4): 306.
With the development of medicine and nursing science, more and more critically ill patients are admitted to the intensive care unit. For a long time, people often pay too much attention to the pathogenic role of physical factors and pathological factors in the whole process of disease, while ignoring the psychological influence, especially for conscious patients in ICU, the special ward environment has caused psychological obstacles to patients in different degrees. It is reported that the incidence of psychological disorders in ICU patients is 14%~72%. Therefore, in clinical nursing, nurses should not only do a good job in disease monitoring and basic nursing, but also actively do a good job in psychological nursing to alleviate patients' psychological obstacles, and implement corresponding nursing measures according to different psychological characteristics of different patients to cooperate with doctors' treatment. The author summarized the psychological problems, causes and nursing intervention measures of ICU patients.
Keywords intensive care unit; Nursing; Psychological support
1psychological problems of ICU patients
1. 1 Extreme nervousness, fear and anxiety, anxiety and fear are the most common emotional reactions of ICU patients. The sudden change of disease, the change of environment and the death of other patients around will make patients feel nervous and anxious. In addition, ICU wards are not allowed to be accompanied by family members, which makes patients feel scared in unfamiliar environments.
1.2 Lonely and depressed patients move to a new and unfamiliar environment, isolated from the outside world, unable to be accompanied by their families, and medical staff rarely communicate with them. In addition, the sound interference of various monitoring instruments and ventilators in the ward makes patients feel lonely and depressed.
1.3 ICU syndrome ICU syndrome refers to a group of syndromes with mental disorders during ICU monitoring. The clinical manifestations of patients are varied, with different degrees, mainly mental disorder, accompanied by other symptoms, including delirium, thinking disorder, emotional disorder, headache, insomnia and so on.
1.4 invalid denial refers to the fact that an individual intentionally or unintentionally takes some invalid denial behaviors, trying to alleviate the fear and anxiety caused by health problems, which are mainly manifested in the denial of the disease and the resistance to the environment. He thinks that his illness is very mild and does not need all kinds of supervision, and asks to leave the hospital as soon as possible.
1.5 self-image disorder refers to the health problems of patients in terms of feelings, cognition, beliefs, values, and changes in physical appearance, structure and function. For example, after amputation, patients feel physically disabled, confused about the future, and feel pain.
1.6 Sleep disorder Sleep disorder is caused by pathological changes in the physiological mechanism of sleep, such as difficulty in falling asleep, easy waking, dreaminess, insomnia and other different degrees of sleep quality and quantity damage, which brings troubles to patients' physical and mental health and is mostly related to patients' own diseases, environmental factors and drug effects.
1.7 dependence on ventilator and ICU ward Patients who have been mechanically ventilated in ICU for a long time are used to passive ventilation. Once they leave the ventilator, they will feel unable to breathe. Due to the differences in staffing and technology between ICU ward and general ward, patients are worried that they will relapse if they are transferred to general ward, so they often show childish behavior and are unwilling to leave ICU ward, hoping to get comprehensive care.
2 Causes of various psychological problems in ICU patients
2. 1 Related factors of diseases Many diseases will not only affect the physical function of patients, but also affect the spirit of patients. For example, patients with respiratory failure, due to lung ventilation and ventilation dysfunction, lead to impaired gas exchange, hypoxemia and carbon dioxide retention; Due to the sharp decrease of effective circulating blood volume and insufficient blood perfusion in tissues and organs, shock patients suffer from cerebral ischemia and hypoxia. These diseases will not only lead to delirium in different degrees, but also cause a series of negative emotions such as irritability, anxiety and fear.
2.2 Patients' cognitive factors Due to the sudden change of the disease, patients' physical functions are damaged or restricted, and patients have insufficient understanding of the disease, thinking that the change of the disease will lead to their own death, thus generating anxiety and fear. The experience and knowledge level of the disease will also make different patients with the same serious condition have completely different reactions and consequences.
2.3 The influence of the environment The structure, staffing and instruments of ICU wards are not quite the same as those of ordinary wards, and patients and their families who have just entered ICU cannot accompany them. In daily work, medical staff will spend more energy on the treatment and monitoring of patients' condition, while ignoring communication with patients. In addition, the ICU ward generally requires 24-hour lighting, and the influence of various lights and various instruments alarms has caused the hearing and visual burden of patients, leading to anxiety and insomnia.
2.4 Treatment factors Due to the disease, patients are often given certain sedative drugs, such as Li Yuexi, which will cause patients' dependence on drugs to a certain extent and affect their sleep state. In the course of treatment, all kinds of pipes directly involve the important organs of patients, such as all kinds of drainage tubes, tracheal intubation, deep venous catheter and so on. , will cause psychological distress to patients, anxiety, fear and self-image obstacles. In addition, due to the inquiries and records of medical staff, it will involve the privacy of some patients who usually don't talk to others, which will make patients feel anxious and afraid that their information will be leaked. 3 nursing intervention measures
3. 1 Stabilize the patient's mood In clinical work, medical staff should be calm, calm and serious, do not discuss the illness in front of patients, and do not answer patients' inquiries? I don't know? Or? You don't need to know? Wait, don't panic about the sudden illness, so as not to aggravate the patient's fear. Because of the influence of disease changes on physical function and the unpredictability of disease prognosis, patients will be psychologically unbalanced. Effective and reasonable psychological counseling should not force patients to control their emotions, but gradually stabilize and guide them. For patients with stable condition, do not discuss the condition with the patient, and at the same time inform the patient's family to keep the patient confidential and do protective medical care.
3.2 Psychological support and social support ICU patients often feel inferior because of physical reasons and environmental influences. In clinical work, medical staff should strengthen communication with patients, make patients' mentality tend to be peaceful through the expression of language and emotional contagion, and feed back patients' positive information, such as the improvement of some laboratory indicators and the normalization of vital signs, so as to increase patients' confidence in cooperating with treatment. Family members are not allowed to stay in the ICU ward. The visiting system can be appropriately liberalized, and the family members and friends of patients can be mobilized to strengthen the encouragement and support for patients, so that patients can feel warm.
3.3 Improve the cognitive ability of patients with diseases, and the lack of disease-related knowledge can easily make patients feel fear and anxiety. Therefore, in clinical work, while monitoring and treating patients, it is necessary to explain relevant medical knowledge to patients, so that patients can deepen their understanding of their own diseases, understand the latest development of medical level, help patients look at their own conditions objectively, and help patients naturally decompress.
3.4 Creating a good environment and unfamiliar environment can easily make patients feel uneasy and lonely. In their daily work, medical staff should try to reduce noise, speak softly and don't make any noise. Various instruments and breathing opportunities in ICU have various alarms, which will increase patients' anxiety and affect their sleep. Therefore, in clinical work, it is necessary to adjust the alarm volume of various instruments to a suitable level, and once the alarm sounds start, the alarm causes will be eliminated.
3.5 Eliminating Dependence Psychology Patients who are dependent on the use of ventilators should explain to them the reasons for using ventilators and the reasons for withdrawing them now, so that patients can understand that their condition has recovered to the point where they don't need ventilators, and at the same time, tell them that ventilators should be placed at the bedside and should not be worn at any time if they feel unwell, so as to relieve their nervousness. For patients who want to be transferred from ICU, it is necessary to do a good job of explanation, and at the same time explain that his condition has greatly improved, and continue the follow-up treatment after going to the general ward, so that patients can establish confidence in overcoming the disease and enhance their own disease resistance.
4 abstract
ICU inpatients are in critical condition and conscious, and most of them have adverse psychological reactions such as anxiety, fear, depression and dependence. In view of patients' bad emotions, timely counseling and patient explanation can increase patients' self-esteem and self-confidence. Communicate with patients in time, give comfort, meet their psychological needs, and create a good environment for patients. Think about what the patient thinks and worry about what the patient is anxious about? It can play an important role in the rehabilitation of patients.
Take the exam and contribute.
Ma Min. Research and thinking on the influence of ICU environment on patients' body and mind [J]. China Journal of Nursing, 2004,39 (4): 306.
[2], Yao, Prevention and care of ICU syndrome [J]. PLA Nursing Journal, 2002,438+09 (1): 27-29.
Wen, Liao. Psychological reaction and nursing care of patients with traumatic paraplegia [J]. modern journal of integrated traditional chinese and western medicine.2005, 14 (2): 262.
Wang Zhihong, Zhou Lanshu. Intensive care [M]. People's Military Medical Publishing House, 2003+066.
[5] Liu Rong. ICU nurses and nursing care of patients dependent on ventilator [J]. Journal of Practical Nursing, 2003,438+09.72
Related articles on psychological nursing papers of icu patients;
1. On the psychological nursing papers of icu patients
2. Psychological nursing papers
3. Psychological nursing papers
4. Psychological nursing papers
5. Nurses' Mental Health and Maintenance Papers