An intensive care unit (ICU) provides intensive care to patients who are critically ill. However, it also can lead to the development of a psychiatric condition known as ICU psychosis. ICU psychosis develops in patients who have been admitted to ICU. It is a progression of delirium. As such, nurses need to be aware of this condition, must recognize the signs and symptoms of it and also must know how to treat it and prevent it.
ICU psychosis is believed to result from a number of environmental factors related with ICU. These include sensory deprivation, continuous exposure to light, the stress of being critically ill and sleep deprivation. Furthermore, the constant monitoring with medical equipment also helps to create stress in the individual.
ICU psychosis refers to psychosis that occurs after admission to an ICU. In the condition, the patient exhibits signs and symptoms associated with delirium and psychosis. The individual may not know where he or she is. Other psychiatric symptoms include auditory hallucinations, visual hallucinations, disorientation, paranoia, agitation, abnormal behavior and excitement (Maldonado, 2008, p. 657). Any signs and symptoms that are routinely seen in delirium and psychosis may be present in the diagnosis of ICU psychosis. However, the essential aspect of the condition is that it is a type of psychosis that occurs within the context of an ICU admission.
The impact of the condition on the work environment, as well as patient outcomes can be significant. The incidence of the condition is of significant debate. Studies have shown an incidence of 16% to 83%. Obviously, this wide a gap indicates that the condition is not well documented for studies. It also suggests that the condition may not be thoroughly documented because it has often been viewed as a “routine” outcome associated with ICU admission. However, it should not be viewed as routine. The condition obviously increases the amount of nursing care required for a patient with the condition. Furthermore, as with all psychiatric conditions, there is a risk of harm to the nursing staff that must not be ignored. Patients with ICU psychosis often require longer hospital stays; they also have higher mortality. There are also cognitive outcomes associated with the condition for the patient. The condition does not merely “disappear” when the patient is removed from the environment. Rather, studies have indicated that the patients may have long-lasting outcomes associated with it (Polderman & Slooter, 2007, p. 759).
The condition is obviously of significant importance to nursing and hospital administration. Nurses should be cognizant of the risks associated with constantly stimulating a patient with medical monitoring; for this reason, there should be more attention paid to the circadian rhythm by the nursing staff. Nurses must obviously always be concerned about anything that increases the risk of mortality for the patient. They must also be concerned about anything that increases safety risks on the job.
The ICU environment must be redone. This must include ways to reduce the sound to patients in the middle of the night; these sounds include the incessant beeping of monitors and phone calls. Furthermore, environmental changes may include artificial sunlight during the day and the darkening of the rooms at night. This can be accomplished with screens that project the image of windows. Natural stimulation of the patient may also occur through the use of a redesigned environment. Paging over hospital systems must not occur unless in the event of an emergency. The ICU environment can be redesigned in a way that would help keep patients tuned with the natural circadian rhythm. This may help to reduce some of the excess stimulation, as well as increase the patient’s ability to remain in touch with the reality of a daily schedule.