Date of Award

2014-05-01

Degree Name

PhD Nursing

Dissertation Committee

Lois Howland, DrPH, MSN, RN, Chairperson; Ann Mayo, RN, DNSc, FAAN; Cynthia Connelly, PhD, RN, FAAN

Keywords

nursing, patient outcomes, Post-ICU patients, Posttraumatic Stress Disorder, quality of life, symptoms

Abstract

Background: Patients receiving critical care are experiencing post-traumatic stress syndrome (PTSS) as a result of life-saving interventions received in the intensive care unit (ICU). PTSS is associated with poor patient outcomes and decreased quality of life compared to post-ICU patients without PTSS. Personal and clinical characteristics that place patients at higher risk for PTSS are still being examined. It is also unknown to what extent patients are being screened for ICU-induced PTSS. Objectives: This body of work aims to examine the risk factors associated with ICU-related PTSS and describe the screening experiences of patients who recently received care in an ICU. The work will be presented in three manuscripts. Methods: A single-center, descriptive, correlational design was used. Personal and clinical characteristics were obtained from medical records on a sample of 41 patients recently transferred out of the ICU. Two to 4 weeks after hospital discharge, patients completed the PTSS-14 and a Screening Experience Questionnaire via telephone. Screening experiences and the feasibility of the PTSS-14 in this population was described and associations between the personal and clinical characteristics and PTSS-14 scores were examined. Results: The first manuscript titled "ICU-related PTSD; The Importance of Nurse Involvement" is under review at Critical Care Nurse. The purpose of this manuscript is to examine current literature addressing risk factors, negative health outcomes, and nursing roles in identifying patients at risk for PTSS. The second manuscript titled "A Concept Analysis of ICU-related PTSD" is under review at Journal of Advanced Nursing. The purpose of this manuscript is to report a concept analysis of ICU-related PTSD. Manuscript three is titled "Identification of Posttraumatic Stress Disorder Symptoms in Post-ICU Patients" and is being submitted to American Journal of Critical Care. The purpose of this manuscript is to report the study's results. It was found that the majority of patients were not screened, and none received education about the risk of PTSS after ICU care. The PTSS-14 was found to be an acceptable and feasible way to identify at risk patients and higher PTSS-14 scores were correlated with depression, moderate levels of sedation, number of days sedated, and delirium. Further research is needed to address strategies in implementing early screening for PTSS, and to determine if early identification and referral of at-risk patients can reduce the incidence of PTSD in this population.

Document Type

Dissertation: Open Access

Department

Nursing

Included in

Nursing Commons

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