Psychological distress in patients receiving critical care: An evolutionary concept analysis

Critically ill patients experience high levels of psychological distress; however, the recognition and management of psychological distress in the intensive care unit (ICU) remain underexplored. A concept analysis of psychological distress exists for some patient populations but none in critical care. The aim of this concept analysis was to clarify the contextual character of psychological distress in ICU patients, thereby improving recognition and management practices.

Rodgers' evolutionary approach aided a deeper examination of psychological distress in the critical care literature, identifying its surrogate terms, related concepts, attributes, antecedents, consequences, and implications for nursing practice and scholarship. Databases searched included CINAHL, PsycINFO, and MEDLINE. Additional searches were performed in Google Scholar and through citation chaining of relevant articles. A coding sheet was used to organise ideas and phrases from the interdisciplinary health literature for inductive analysis.

A total of 35 articles were included in the analysis, based on data saturation. The interdisciplinary literature revealed two surrogate terms (emotional distress and acute ICU psychological stress), one related concept (distress), four antecedents (impaired adaptation to stressors, ICU context of care, demographic and coping skills, and social support systems), and four defining attributes (traumatisation and acute affective reaction, distorted cognitive appraisal, feelings of dehumanisation and disconnection, and affecting the patient-family dyad). Consequences of the concept include chronic or long-term psychological distress, post-intensive care syndrome, poor health-related quality of life, and psychosocial functioning.

Psychological distress in critical care may partially be a social and structural consequence of increased pace of care in the ICU. Critical care patients and survivors could be evaluated for psychological distress and be referred to a psychologist for counselling if needed. This paper provides a novel understanding of psychological distress in critical care, highlighting its unique features and the necessity for an interdisciplinary approach to achieving patient emotional safety. These insights lay the foundation for future research and policy development in critical care settings.

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