What clinical practices for intensive care psychologists in France? A national survey

The emotional stakes in intensive care units (ICUs), linked to the severity of the illness, make the presence of psychologists essential for patients, relatives, and healthcare professionals [1]. In France, ICU psychologists are recruited at the instigation of the head of the unit or facility, but the COVID-19 health crisis highlighted the importance of the psychological impact of intensive care [2] and led to the decree of April 26, 2022, on the operating conditions in ICUs, which requires the presence of psychologists in these units (https://www.legifrance.gouv.fr/eli/decret/2022/4/26/SSAH2206984D/jo/texte). However, little attention has been paid to their practice and role in the ICU [3]. The aim of our survey was to describe the practice of intensive care psychologists in France.

A questionnaire was designed by our team of researchers, psychologists, and ICU staff. It consisted of 72 questions (closed and open-ended questions),divided into five main themes: 1/ taking up a position in the ICU, 2/ working in the ICU with patients, relatives, and healthcare professionals, 3/ working conditions, 4/ professional resources, and 5/ initial training and training needs of the psychologist (Questionnaire in the supplementary material).

A total of 295 email addresses of ICU psychologists were identified within the 316 French healthcare institutions (IGAS—General Inspectorate of Social Affairs; 2021). Between February and April 2023, the psychologists identified were asked to complete the questionnaire via a LimeSurvey link. The responses were analyzed using descriptive analysis of quantitative and qualitative data.

Of the 295 psychologists listed, 153 (143 female and 10 male) responded to the questionnaire (Table 1). The psychologists worked in a unit with an average of 23 beds (standard deviation = 15). Although there appeared to be a relationship between the number of beds in the unit and the workload, the results showed a wide disparity between the number of beds and the amount of time psychologists spent in the ICU.

Table 1 Demographic characteristics and work context of ICU psychologists

ICU psychologists interviewed worked the majority of psychologists surveyed interacted with patients (90%), families (84%), and healthcare professionals (67%) more than once a week. Their psychological practice is based on the theoretical models of psychoanalysis (80%). Only 63% of the psychologists had an office or a dedicated workspace. In addition, the head of the ICU defined the psychologist’s tasks in 64% of the cases. However, these tasks remained unclear for 47.5% of these psychologists. Almost half of the psychologists (44.4%) wanted to continue working in the ICU, but 13.7% of them were considering leaving their position and 15% said they were planning to leave the hospital.

Our survey shows that ICU psychologists developed a wide range of specific tools and devices (Additional file 1: Tables S2, S3, S4). In this context of acute care and serious illness, the psychologist must meet and engage with the patient, family or healthcare professionals to understand their difficulties and adjust to their needs. These various discussions often took place in the common areas of the ICU (patients’ rooms, corridors, rest rooms, etc.). These “informal” encounters, without an appointment, represented a “therapeutic priming” which required flexible modes of interviewing adapted to the diversity of places and people involved.

With patients, psychologists developed a clinical approach based on a variety of interpersonal relationships using slates, eye-tracking, touch, gaze, and psycho-corporal practices (relaxation, hypnosis, virtual reality, etc.). With families, they relied on pamphlets to explain the care environment to the family [4] and especially to visiting children [5]. They also used diaries to support the family and the patient in the ICU or during post-ICU consultations.

The involvement of psychologists with patients and their families extended well beyond the ICU. Indeed, the psychological impact of the ICU after discharge led them to develop their practice in other hospital units by offering post-ICU counseling, thus linking the different phases of hospitalization and the post-ICU period.

Finally, an explicit request for the psychologist by the healthcare professionals was rare. As a result, the presence of psychologists dedicated to the ICU seems crucial as it allows psychologists to fully understand the working environment of healthcare professionals and to develop relationships with the team over time, thus creating a climate of trust in which to make a request [2].

The main limitations of this study are, on the one hand, its observational design, which does not allow us to conclude whether one psychological practice is more relevant than another. Second, the sample remains selective, as not all psychologists working in an ICU participated in the survey. However, our results highlight the richness and diversity of psychological interventions in the ICU and post-ICU and underline the importance of developing studies on psychological devices/tools in order to better support and recognize the role of the ICU psychologist.