Research study highlights complexities of ICU environment
A qualitative research study by the Critical Care Research Group (CCRG) at The Prince Charles Hospital (TPCH) has explored issues experienced by staff in the intensive care setting as part of a project to improve the intensive care unit (ICU) environment.
Assoc Prof Dylan Flaws has been investigating the challenges of working in an intensive care setting
Metro North psychiatrist and Clinician Research Fellow Associate Professor Dr Dylan Flaws said that working in an intensive care setting can be physically and psychologically challenging because of the tremendous responsibility staff feel when caring for someone so unwell.
“ICU staff need to manage the complex emotions that can arise in patients and their family members, who are often scared, in pain or don’t feel in control of their situation. This can lead to challenging interactions which can range from irritability to verbal or physical aggression,” Assoc Prof Flaws said.
“The study found that staff experienced varying levels of uncertainty in handling situations, sometimes feeling ill-prepared to handle some of the complex situations that arise.
“Sometimes they felt uncertain in complex situations, but generally they were more confident, as the behaviours seemed understandable to the situation, or their existing skills in managing distress were sufficient.”
A common observation was that any person could become agitated and exhibit challenging behaviours, potentially threatening their own or others’ safety, especially when patients were distressed, delirious, or at critical stages in care such as waking an intubated patient from sedation.
Staff felt unsure where the person’s behaviour was less understandable or predictable, or they doubted that their existing skills were appropriate to the situation.
Assoc Prof Flaws said the study highlighted that caring for a person living with mental illness experiencing a critical illness, can involve unanticipated scenarios or responses from the patient.
“For example, a person who has suffered a non-accidental injury may react to pain or distress differently from anticipated, or the person’s ability to understand what is happening is clouded by an illness like depression or psychosis,” he said.
“The study highlighted that staff typically feel a deep sense of responsibility to their patients, and many wanted to improve their skills or support in knowing how to provide these patients with the best critical care they can.
“The research highlights the many complex challenges of caring for critically ill patients, especially those living with a mental illness.
“Notably, it emphasises that staff want to feel prepared and more confident to handle these challenges by having the necessary skills to manage a highly emotional health care environment.
“Having the necessary skills and support will allow staff to provide the best possible care to critically ill patients and protect their own well-being in the process.”
The CCRG research team has published a follow-up paper provided practical advice to critical care staff about caring for patients undergoing a critical illness while living with a mental illness.