Post-traumatic stress disorder among ICU healthcare professionals before and after the Covid-19 health crisis: a narrative review

Abstract Background The ICU (intensive care unit) involves potentially traumatic work for the professionals who work there. This narrative review seeks to identify the prevalence of post-traumatic stress disorder (PTSD) among ICU professionals; how PTSD has been assessed; the risk factors associated with PTSD; and the psychological support proposed. Methods Three databases and editorial portals were used to identify full-text articles published in English between 2009 and 2022 using the PRISMA method. Results Among the 914 articles obtained, 19 studies met our inclusion criteria. These were undertaken primarily during the Covid-19 period (n = 12) and focused on nurses and assistant nurses (n = 10); nurses and physicians (n = 8); or physicians only (n = 1). The presence of mild to severe PTSD among professionals ranged from 3.3 to 24% before the pandemic, to 16–73.3% after the pandemic. PTSD in ICU professionals seems specific with particularly intense intrusion symptoms. ICU professionals are confronted risk factors for PTSD: confrontation with death, unpredictability and uncertainty of care, and insecurity related to the crisis COVID-19. The studies show that improved communication, feeling protected and supported within the service, and having sufficient human and material resources seem to protect healthcare professionals from PTSD. However, they also reveal that ICU professionals find it difficult to ask for help. Conclusion ICU professionals are particularly at risk of developing PTSD, especially since the Covid-19 health crisis. There seems to be an urgent need to develop prevention and support policies for professionals

Le tissage de l’alliance thérapeutique en service de soins aigus

International audienceAbstract The therapeutic alliance is well-known to be a key factor in the effectiveness of therapy. It is a concept that is widely accepted in the world of research, and is defined by the establishment of an emotional bond that the psychologist forms with their patient, as well as the collaboration between the two partners allowing the definition of relevant goals and tasks recognized as effective to allow the best therapeutic progress for the patient. The studies have highlighted that the nature of the alliance varies according to the care context, the therapeutic approach, and characteristics of the patient and therapist. How is the therapeutic alliance established in an intensive care unit where the life or death nature of the situation intensifies the extreme somatic distress of the patients, disrupts their autonomy and the decision-making process, and marks the therapeutic relationship.The aim of this article is to define the therapeutic alliance in the context of intensive care unit, taking into account the temporality of the emergency, the plurality of actors involved in the care process: patient, close relations and healthcare workers, and the need to maintain the autonomy of a patient who is sometimes psychologically absent from the relationship. The hospitalized patients’s state of health leads to fluctuations of their state of consciousness, on a continuum ranging from coma to wakefulness, passing through phases of confusion. However, essential decisions are taken on their behalf, affecting both their life and their future.Those involved in the patient's care (carers, close relations) provide information to help inform decisions. The trusted support person testifies to what the patient may wish. Exchanges with all those involved in the situation are a prerequisite for the emergence and recognition of the patient's autonomy and subjectivity. A weaving therapeutic alliance is lead through the building of emotional bond of trust with all those involved (patient, family and carers), and by discussing the patient's state of health, experience and therapeutic project with those involved in the intensive care unit, in order to guarantee consent to care.This relational weaving also enables caregivers to gradually gain a more holistic view of their patients, supporting their thinking and the setting up of the best possible therapeutic strategy. Therapeutic objectives and techniques are regularly redefined to ensure they remain relevant as the patient's state of health evolves. This weaving of the alliance engages an ethical conflictuality, in which each person expresses his or her point of view, centered on the patient, and his or her singular experience with him or her, participating in a dynamic of adjustment to a common objective: optimal care for the patient, taking into account his or her opinion as far as possible. The therapeutic alliance that the psychologist establishes in the intensive care setting seems vital to preserving the patient's subjectivity.In this article, the theoretical-clinical thinking is based on anonymized clinical vignettes, preserving patient confidentiality. When vital emergency seems to relegate psychic life to the background, the development of a therapeutic alliance tailored to the characteristics of intensive care is essential to restoring the patient's autonomy and subjectivity.Introduction : L’alliance thérapeutique est reconnue comme un facteur clé d’efficacité thérapeutique. Elle fait l’objet d’une définition consensuelle dans le monde de la recherche, mais celle-ci varie selon les contextes de soin, les patients et leurs thérapeutes. Objectif : Après avoir défini les spécificités de la prise en charge dans un contexte de soin aigu et de réanimation, nous tentons de conceptualiser l’alliance thérapeutique en soin aigu, prenant en compte cette temporalité de l’urgence, la pluralité des acteurs concernés par la prise en charge : patient, proches et équipe soignante, et le maintien de l’autonomie d’un patient parfois absent psychiquement à la relation. Méthode : Nous menons une réflexion théorico-clinique élaborée à partir de vignettes cliniques anonymisées dans cet article. Conclusion : Lorsque l’urgence vitale semble reléguer la vie psychique au second plan, l’élaboration d’une alliance thérapeutique ajustée aux caractéristiques du soin aigu est essentielle pour restaurer le patient dans son autonomie et sa subjectivité

Risk and protective factors for the possible development of post-traumatic stress disorder among intensive care professionals in France during the first peak of the COVID-19 epidemic

International audienceBackgroundIntensive care units (ICU) are among the healthcare services most affected by the COVID-19 crisis. Stressors related to insecurity, unpredictability, patient death and family distress are significant, and put healthcare workers (HCWs) at high risk of post-traumatic stress disorder (PTSD). The aims of this study were to measure the prevalence of post-traumatic stress disorder in HCWs and to identify risk factors and protective factors during the epidemic in France.MethodsDuring the first peak of the epidemic (from 22 April to 13 May 2020), we assessed sources of stress (PS-ICU scale), mental health (GHQ-12) and coping strategies (Brief-COPE). Three months later (03 June to 6 July 2020), PTSD was assessed using the IES-R scale, with additional questions about sources of support. Data were collected using self-report questionnaires administered online.ResultsAmong 2153 professionals who participated in the study, 20.6% suffered from potential PTSD, mostly intrusion symptoms. Risk factors for the development of PTSD were having experienced additional difficult events during the crisis, having a high level of psychological distress, a high level of perceived stress related to the workload and human resources issues, the emotional burden related to the patient and family, and stressors specific to COVID-19 during the first peak of the crisis. The use of positive thinking coping strategies decreased the relationship between perceived stress and the presence of PTSD, while social support seeking strategies increased the relationship. Finally, the HCWs preferred to use support from colleagues, relatives and/or a psychologist, and very few used the telephone hotlines.ConclusionThe epidemic has had a strong traumatic impact on intensive care HCWs. Given the risk of PTSD, we need to consider implementing easily-accessible support services that focus on positive thinking coping strategies, during and after the crisis

Impact psychologique de la pandémie de COVID-19 sur les soignants

International audienc

Impact psychologique de la pandémie de COVID-19 sur les soignants

International audienc

Giving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach

Purpose Data are scarce regarding the experience of critically ill patients at high risk of death. Identifying their concerns could allow clinicians to better meet their needs and align their end-of-life trajectory with their preferences and values. We aimed to identify concerns expressed by conscious patients at high risk of dying in the intensive care unit (ICU). Methods Multiple source multicentre study. Concerns expressed by patients were collected from five different sources (literature review, panel of 50 ICU experts, prospective study in 11 ICUs, in-depth interviews with 17 families and 15 patients). All qualitative data collected were analyzed using thematic content analysis. Results The five sources produced 1307 concerns that were divided into 7 domains and 41 sub-domains. After removing redundant items and duplicates, and combining and reformulating similar items, 28 concerns were extracted from the analysis of the data. To increase accuracy, they were merged and consolidated, and resulted in a final list of 15 concerns pertaining to seven domains: concerns about loved-ones; symptom management and care (including team competence, goals of care discussions); spiritual, religious, and existential preoccupations (including regrets, meaning, hope and trust); being oneself (including fear of isolation and of being a burden, absence of hope, and personhood); the need for comforting experiences and pleasure; dying and death (covering emotional and practical concerns); and after death preoccupations. Conclusion This list of 15 concerns may prove valuable for clinicians as a tool for improving communication and support to better meet the needs of patients at high risk of dying