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Rationale: Intensive care unit (ICU) nurses work in a demanding environment where they are repetitively exposed to traumatic situations and stressful events. The psychological effects on nurses as a result of working in the ICU are relatively unknown.

Objective: To determine whether there is an increased prevalence of psychological symptoms in ICU nurses when compared with general nurses.

Methods: We surveyed ICU and general nurses from three different hospitals (n = 351) and then surveyed ICU nurses throughout the metropolitan area (n = 140).

Measurements and Main Results: In both cohorts of nurses, we determined the prevalence of symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression using validated survey instruments. Within our hospital system, 24% (54/230) of the ICU nurses tested positive for symptoms of PTSD related to their work environment, compared with 14% (17/121) of the general nurses (p = 0.03). ICU nurses did not report a greater amount of stress in their life outside of the hospital than general nurses. There was no difference in symptoms of depression or anxiety between ICU and general nurses. In the second survey of ICU nurses from our metropolitan area, 29% (41/140) of the respondents reported symptoms of PTSD, similar to our first cohort of ICU nurses.

Conclusions: ICU nurses have an increased prevalence of PTSD symptoms when compared with other general nurses. These results may increase awareness of these symptoms in nurses and lead to future interventions that improve their mental health and job satisfaction and help retain ICU nurses in their profession.

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The Welsh Government commissioned the Royal College of Obstetricians and Gynaecologists (RCOG)andtheRoyal College of Midwives (RCM) to undertake a multidisciplinary review ofaspects of the maternity service provided by the then Cwm Taf University Health Board following the discovery of under-reporting of Serious Incident (SI) cases. A look-back exercise to January 2016 had previously identified 43 cases for review. These 43 cases were subject to internal review which identified shortfalls in service delivery and were submitted to the Health Board during September 2018. By analysing the findings from a Datix search for stillbirths dating back to 2010, a Consultant Midwife also identified 67 stillbirths which had not been reported by the Health Board via Datix.

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As the coronavirus pandemic in the U.S. appears to be turning a corner, another health crisis is brewing: Covid-19 survivors struggling to bounce back to their former selves. Of the more than 28 million Americans diagnosed with Covid-19, an estimated 10 to 30 percent — possibly as many as 8.4 million people — fall into the category commonly known as "long-haulers."
Despite the staggering numbers, there's no clear diagnosis, no standard care and no national guidelines for how these patients should be treated. There are hopeful signs, however. At special clinics around the country, a better understanding of the condition is emerging, according to a new analysis by NBC News.
NBC News identified more than 80 "post-Covid" clinics nationwide that are actively engaging with Covid-19 patients who continue to have symptoms months after their acute infection cleared. The 64 clinics surveyed by NBC News have seen nearly 10,000 patients — most likely just a sliver of the true number of people affected by a condition only recently given a name by the National Institutes of Health: "Post-Acute Sequelae of SARS-CoV-2 infection," or PASC. Millions of others may be seeking care with a personal physician or suffering alone.

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Background: There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.
Methods: We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 1⁄4 5; n2 1⁄4 5; n3 1⁄4 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.
Results: We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).
Conclusions: We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.

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the one-pager helps the ICU medical personnel to screen for ICU delirium among the ICU patients.

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Introduction

Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD.
Methods

Intensive care patients with an ICU stay of more than 72 hours were recruited to a randomised controlled trial examining the effect of a diary outlining the details of the patients ICU stay on the development of acute PTSD. The intervention patients received their ICU diary at 1 month following critical care discharge and the final assessment of the development of acute PTSD was made at 3 months.
Results

352 patients were randomised to the study at 1 month. The incidence of new cases of PTSD was reduced in the intervention group compared to the control patients (5% versus 13%, P = 0.02).
Conclusions

The provision of an ICU diary is effective in aiding psychological recovery and reducing the incidence of new PTSD.

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It is now well established that many patients ‏and caregivers suffer physical, psychological ‏and social problems in the years ‏and months following critical care discharge ‏(Herridge et al. 2011). Similar to many centres, ‏our intensive care unit (ICU) had no follow-up ‏service available to support patients through this ‏difficult recovery period (Griffiths et al. 2006). ‏To understand how best to create a service ‏that was safe, effective and person-centred, ‏two members of our multidisciplinary team ‏(MDT) undertook research programmes to ‏help identify the problems that patients faced ‏after ICU and to help understand the context ‏for change (Quasim et al. 2015; McPeake et ‏al. 2016).

From this work, four main challenges were ‏identified:

There is minimal evidence of how and ‏when rehabilitation services should ‏be delivered (Mehlhorn et al. 2010), ‏despite an abundance of literature ‏describing the issues for ICU survivors ‏and their families.
The hardships facing ICU patients ‏are often not apparent to hospital ‏management. Readmissions to hospital, ‏increased general practitioner (family ‏physician) visitations and the increased ‏reliance on welfare benefits are distributed ‏amongst a variety of budgets, ‏which do not necessarily appear related ‏to an ICU admission.
Finding staff with the time and ability ‏to do something new that is different ‏from their traditional ICU role can be ‏problematic.
Finding physical space with a suitable ‏area to hold a rehabilitation programme ‏can be difficult.

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Delirium is one of the most common behavioral manifestations of acute brain dysfunction in the intensive care unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools. In delirious patients, a search for all reversible precipitants is the first line of action and pharmacologic treatment should be considered when all causes have been ruled out, and it is not contraindicated. Long-term morbidity has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop posttraumatic stress disorder related to their critical illness experience.

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The terms intensive care unit (ICU) syndrome and ICU psychosis have been used interchangeably to describe a cluster of psychiatric symptoms that are unique to the ICU environment. It is often postulated that aspects of the ICU, such as sleep deprivation and sensory overload or monotony, are causes of the syndrome. This article reviews the empirical support for these propositions. We conclude that ICU syndrome does not differ from delirium and that ICU syndrome is caused exclusively by organic stressors on the central nervous system. We argue further that the term ICU syndrome is dangerous because it impedes standardized communication and research and may reduce the vigilance necessary to promptly investigate and reverse the medical cause of the delirium. Directions for future research are suggested.

Numerous authors have noted a cluster of psychiatric signs and symptoms that may occur in patients who are treated in an intensive care unit (ICU) or high-dependency ward and have termed this syndrome ICU psychosis, postoperative delirium, and ICU syndrome; when patients have undergone heart surgery, it has been called postcardiotomy delirium or cardiac psychosis. Frequently, this syndrome is assumed to be peculiar to ICUs.

The aims of this article are to review the etiology and nature of this syndrome and then to discuss the implications of this review for nosology and management. Is there actually a psychiatric syndrome that is attributable to some feature of the ICU experience, or is this "syndrome" most accurately and most helpfully classified as a delirium? We argue that the latter is true and that it is possible and preferable to describe the disorder using established medical nomenclature. Appropriate classification will help to demystify the concept, ensure that crucial organic causes are sought and found, indicate optimal management, and facilitate standardized research.

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This booklet contains advice and information about intensive care. It tells you how critical illness may be treated and what recovery may be like. Not every patient will experience all of these things, but they are more likely to if they have been in intensive care for more than a few days. Most of this booklet is written for patients but there is a section specifically for relatives and visitors. By reading this booklet, relatives will learn what a patientʼs recovery may involve and it will give them the answers to some of the questions they may have.

Brief description of media:

This booklet contains advice and information about intensive care. It tells you how critical illness may be treated and what recovery may be like. Not every patient will experience all of these things, but they are more likely to if they have been in intensive care for more than a few days. Most of this booklet is written for patients but there is a section specifically for relatives and visitors. By reading this booklet, relatives will learn what a patientʼs recovery may involve and it will give them the answers to some of the questions they may have.

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Having a relative, partner or close friend in an intensive care unit (ICU) has a huge impact not only on patients, who may be unconscious or sedated at the time, but also on their relatives, whose lives may suddenly be turned upside down as they wait by the patient's bedside, not knowing whether they will live or die. Generally patients who stay in ICU the longest are those who are admitted as emergencies. Planned surgery patients tend to have a relatively short ICU and general ward stay, sometimes with a brief spell in a High Dependency Unit. Everyone who has been in intensive care recovers at his or her own pace. Many patients leave hospital very physically weak and complete recovery can sometimes take up to two years, particularly if they were admitted to ICU because of an emergency illness, surgical complication or accident.

Here people talk about supporting and caring for a relative, partner or close friend at home when they'd been discharged from hospital after being in ICU. Patients came back home at different stages of recovery. Some still found it difficult to walk. Others were able to walk with the help of a stick, Zimmer frame or wheelchair. Many were still very weak. The experiences of relatives and close friends ranged from those who provided a lot of support to the ill person at the beginning but soon resumed their normal lives, to those who became full time carers because the ill person's health had deteriorated so much after critical illness that they couldn't manage on their own.