None listed
Conditions
Brief summary
With advances in medicine, more people are surviving critical illnesses. The psychological impact of critical illness and intensive care units (ICU) on survivors is considerable. Psychologists have a unique opportunity to contribute to early rehabilitation in ICU. However, there is a need to evaluate whether providing psychological services early in a patient's recovery can be done. The current research aims to study whether implementing a psychology service in the Logan Hospital ICU is feasible and accepted by both patients and staff. Recruited patient participants will be screened for psychological distress using validated measures at different times in their recovery, and they will receive psychological care as required. Evaluation of the implementation of the ICU psychology service will involve collecting feasibility outcomes, the degree to which patients find the model of care acceptable, as well as staff perceptions of the service after its implementation. The current research findings will inform future research regarding the implementation of embedded psychology services within ICU and guide the development of such a service within the Logan Hospital.
Interventions
The purpose of this study is to: (1) evaluate the feasibility of implementing early psychological screening and interventions at the time of a patient’s Intensive Care Unit (ICU) admission and; (2) Assess patient and ICU staff acceptability of the novel intervention. The study will have 2 phases: Phase 1 will deliver the psychological intervention to patients in the ICU and assess patient acceptability and; Phase 2 will assess staff acceptability of the intervention implementation.
PHASE 1 – Ps
The purpose of this study is to: (1) evaluate the feasibility of implementing early psychological screening and interventions at the time of a patient’s Intensive Care Unit (ICU) admission and; (2) Assess patient and ICU staff acceptability of the novel intervention. The study will have 2 phases: Phase 1 will deliver the psychological intervention to patients in the ICU and assess patient acceptability and; Phase 2 will assess staff acceptability of the intervention implementation. PHASE 1 – Psychological intervention Psychological screening - All consenting participants will be administered the Intensive Psychological Assessment Tool, a quick routine screening tool to detect acute psychological distress in ICU. Stepped psychological care interventions - All identified at-risk participants will then be offered stepped psychological care. Following a hierarchical approach, patients will receive simpler interventions first and progress on to more complex interventions, as informed by patient needs. Level 1: Participants presenting with normative / sub-thresholds ICU-related psychological distress will be offered psychological first aid, prevention, and monitoring. Participants will be offered basic education regarding common experiences in ICU and associated psychological complaints. Participants will receive information about preventing the onset or worsening of psychological symptoms through the promotion of safety and hope, arousal reduction, and connection with loved ones. This intervention can be administered in 1-2 sessions depending on participant’s tolerance of intervention. The intervention is expected to take between 30 to 60 minutes, depending on the participant's intervention tolerance and/or interfering symptoms (e.g., fatigue, pain), and will be conducted one on one. Level 2: Participants who present with mild to moderate ICU-related psychological distress will be offered Cognitive Behavioural Therapy (CBT) for acute psychological distress. All participants who score equal or greater than 7 on the IPAT will be offered brief CBT interventions targeting psychological symptoms of concern. There are no recommended number of sessions for CBT as a brief intervention in ICU, and these may be dependent on participant’s treatment goals and length of ICU admission. Level 3: Participants presenting with severe and persistent mood, anxiety, and trauma related disorders, who are resistant to interventions at Levels 1 and 2, will be offered specialised psychological interventions (e.g., comprehensive suicide/self-harm assessments, safety planning interventions). The intervention will be delivered by a trained clinical psychologist working in the ICU. The interventions will be offered 48 hours into the patient’s ICU admission and when medically suitable, as determined by medical staff and clinical indicators. Patient interviews - Interviews will be administered 90-day after hospital discharge, over the phone or videoconferencing. Interviews will last no longer than 60 minutes and will explore participants’ experiences of receiving early psychological care in ICU. Interviews will be conducted by a member of the research team not directly working in the ICU. Phase 1 is anticipated to occur within 6 to 12 months. PHASE 2 – Staff acceptability of intervention Phase 2 will commence once the last participant in phase 1 has been recruited and all data collection timepoints have occurred. ICU clinical staff will be invited to participate in a semi-structured interview aiming to explore their perspectives regarding the implementation of the psychological intervention in ICU. Interviews will be completed in person at the Logan Hospital by a member of the research team not directly working in the ICU. Interviews will take no longer than 40 minutes to complete.
Sponsors
Jessica Hampton
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants - Patients: • Patient is aged 18 years or greater • Admitted to the ICU and who are expected to remain in the ICU greater than 48 hours • Patient’s levels of alertness and sedation score between +1 and –1 on the RASS, as assessed by the treating medical officer and nursing staff at time of enrolment • Patient’s level of consciousness score 15 on the GCS as assessed by the treating medical officer and nursing staff at time of enrolment • English-speaking Participants - Clinicians: All ICU clinicians employed in the ICU at the time of recruitment will be eligible to participate in PHASE 2. Medical, nursing, and allied health clinicians working in the ICU will be invited to take part in the study.
Exclusion criteria
Participants - Patients: • Pre-existing cognitive or intellectual impairment • Patient’s reason for ICU admission is due to a medical issue directly resulting from a suicide of self-harm attempt; and/or the patient is identified to be experiencing active symptoms of psychosis or mania, related to a mental illness, as determined by the treating medical officer. • Receiving end-of-life care • Readmission to ICU within the current hospitalisation • Previous enrolment in the PICUP study Participants - Clinicians: Nil.
Outcome results
None listed