Clinical Experiences of Working with ICU Patients

I have been doing some work since last summer with the Intensive Care Unit team (ICU) supporting their patients who have had an ICU stay within an NHS trust setting. It has been quite an insightful experience so far with the variation of difficulties these patients have faced and are still facing, often combining physical as well as mental health issues. This article is about sharing those experiences.  

Complex psychological issues

The complex types of psychological issues patients have reported whilst being in ICU have included delusions and hallucinations of events / conversations which can be very disturbing for them especially when they remember very little of what actually happened and when others i.e., staff and or family / friends try and help fill those gaps, then the distress around not being to recall this information.

Quite a lot of them reported having been in a coma and a sense of time they lost whilst being in a coma, and some reported this to feel like a near death experience. This is distressing for the patients as they are struggling to recall what happened, along with a fear of it recurring and therefore the trauma this leaves behind. A lot of patients have reported having vivid dreams, more so nightmares and waking up in a sweat. This again can be linked to the trauma they may have experienced whilst being on the unit.

There is a lot of uncertainty having to be managed, especially when the patient might be on certain medications. This may also affect their cognitive ability to think clearly, there is also often a fear of the unknown around what will happen next. There may still be a stigma attached to places like the ICU with the pandemic and Covid, and how patients managed at that time, and therefore some patients can be fearful of entering such locations due to this preconceived expectation.

Providing support

I have provided psychological support for a lot of patients who have had traumatic experiences with their ICU stay, especially around their missed days / weeks when they may have been in a coma. Additionally, when physical health has changed, there is a lot of work on adjustment of how the patient's circumstances allow them to live and looking at better ways of managing this. For example, a lot of patients report shortness of breath, fatigue and other health problems arising due to being in hospital for so long.

Outside of the day-to-day health issues related to this there are other implications too, for example, being unable to work or having to change the type of work they can now do, potentially leading to financial difficulties. In general, quality of life is significantly affected and then the slow and long process of adjusting to this brings challenges of its own.

My clinical experience has shown that psychological therapies such CBT and EMDR can be very helpful in supporting such complex difficulties that may arise within this clinical population. I would use EMDR to focus on working on the trauma (s) and grounding techniques and CBT to look at challenging unhelpful thinking, goal setting, any exposure work that may be necessary to support the patient to transition as well as possible back into normal life. 

After care

Overall, it is fair to state that unless a person is unwell, they would not be admitted to ICU. But once they have stayed there and the initial health problem has been addressed it can bring a wealth of effects of its own because of the journey they experience.

The team in hand do offer after care / support to these patients which is reassuring for the patients who choose to attend, that they are not alone. The ICU staff offer a weekly meeting on MS teams for an hour where patients share their experiences, ask the staff mainly nurses any questions they have, and they do some mindfulness meditation towards the end of the session too.

The support of others who have been in similar situations to themselves is very powerful as it helps patients to realise that they are not the only ones experiencing this and more so that it could be a result of the struggles faced whilst in ICU with their health. This is why it is crucial to try and communicate to these patients the importance of attending such sessions.  
    
Dr Sindeep Lehl is a Principal Counselling Psychologist, working within the NHS. She specialises in physical health, especially obesity, and is a member of the BPS, BABCP, SIGOPAC, and the EMDR academy.