Analysis of the stressful factors in an ICU

Background

The hospital atmosphere, notably in the ICU, submits the patient to psychological experiences that frequently influence them after ICU discharge. It is important to identify the stressful factors contributing to the development of this phenomenon.

Objectives

To identify and to stratify the stressful factors, in the patient's perspective, their relatives and the health care professionals, at an ICU.

Methods

A descriptive cross-sectional survey, carried out between June and November 2004 in a general ICU of a private hospital. The sample was composed of three groups: group 1 (G1) was formed by patients, group 2 (G2) by patient's relatives and group 3 (G3) by ICU health care personnel responsible for the included patients. In order to identify and stratify the stressful factors, we used the Intensive Care Unit Environmental Stressor Scale (ICUESS), composed of 40 assigned items scaled 1 (not stressful) to 4 (very stressful). The three groups answered in agreement with their perception of stressful factors for the patient. For each individual, a Total Stress Score (TSS) was calculated from the sum of all the answers of the scale.

Results

Thirty individuals were included in each group. The mean age of the three groups was: 57.30 ± 17.61 years for G1; 41.43 ± 12.19 for G2; and 40.82 ± 20.20 for G3. The mean TSS was 62.63 ± 14.01 for the patients; 91.10 ± 30.91 for the relatives; and 99.30 ± 21.60 for the health care professionals. A larger TSS was associated with patients without religion, that have more expensive health insurance and those that had attended university. Among the relatives, the parents had larger values of TSS. The respiratory therapists were the professionals that obtained a larger TSS and the smallest average was found among the doctors. The average of the patients' TSS was lower than that of the relatives and that of the health care professionals. There was no statistically difference between the latter two groups (family and professionals).

Conclusion

The perception of the main stressful factors was different among the three groups, especially when patients were compared with the relatives and health care professionals. These groups (family and professionals) believe that some factors are more stressful for the patient than the patient themself would have stated.