Exploring Intensive Care Nurses' Experiences and Perceptions of Patients With a Co-Morbid Mental Health Disorder

Background

Patients with a co-morbid MH disorder are roughly twice as prevalent in intensive care units (ICU) than in other general secondary care areas. Such patients may be subject to social stigma and diagnostic overshadowing while being nursed in general healthcare settings. Studies in non-ICU areas suggest that staff lack knowledge and work in a non-collaborative manner, impacting negatively on the delivery of holistic humanised care. There is limited evidence on this topic from the perspective of ICU nurses.

Aim

This study aimed to add to the small body of evidence exploring how ICU nurses experience caring for patients with an MH disorder.

Study Design

A pragmatic approach was taken. Twelve members of registered ICU nursing and advanced practice staff were recruited via social media and professional networks. Participants engaged in online individual semi-structured interviews which were audio-recorded. The transcripts were checked and then analysed using a six-stage reflexive thematic analysis process.

Findings

Five themes were identified: (1) frustration and futility, (2) the impact of a lack of knowledge, (3) perceptions, (4) unpredictable and violent and (5) the ICU environment is unsuitable.

Conclusions

The findings of this study indicate that ICU nurses require additional support, education and clinical leadership to manage patients with an MH disorder. Participants expressed feelings of frustration regarding patients' limited access to on-going MH support. Participants appeared especially uncomfortable when caring for patients who had self-harmed or attempted suicide. A need for further research into the experience of MH patients in ICU is indicated.

Relevance to Clinical Practice

Due to the high prevalence of patients with an MH disorder in ICU, it is important that ICU nurses understand their specific needs and how socially held stigmatised views can impact on care. Stigma and previous traumatic events can lead to staff avoiding engagement with MH patients. Strong clinical leadership, collaborative working and continued education are necessary to support both staff and patients.