Post-Traumatic Stress Disorder in the ICU and Associated Factors: A Preliminary Checklist

Critical illness exposes many patients to extreme stressors. During an ICU stay many patients experience respiratory distress, pain, have a fear of dying, and feel loss of control over their environment. Together, this puts patients in an ICU setting at risk for development of post-traumatic stress disorder (PTSD). PTSD that has been minimally addressed in the acute care nursing practice; there is a need to increase provider awareness and the ability to identify patients at risk for developing PTSD. The purpose of this Doctor of Nurse Practitioner (DNP) project was to examine the following: the incidence of PTSD in general ICU and trauma ICU patients after discharge; patient populations at risk for PTSD; ICU treatments and medications associated with PTSD; create a preliminary post-ICU PTSD checklist; provide clinical implications; create a patient education pamphlet and create a manuscript for peer review to Critical Care Nurse according to their specifications. In 2012 more than five million patients were admitted to a critical care unit (Society of Critical Care Medicine, 2012). It is estimated that 22-28% of patients from the general ICU population will have substantial symptoms of PTSD. These symptoms are long lasting, as most patients continue to have symptoms six months to a year following discharge from the ICU (Davydow, Gifford, Desai, Needham, & Bienvenu 2008; Rattray, Crocker, Jones, & Connaghan 2010). PTSD can have negative impacts on quality of life, productivity and use of health care resources (Jones et al. 2010; Kalia 2002). Furthermore, the survival rates of ICU patients continue to improve, it is important to address the long-term outcomes for these patients. Persons with PTSD have three distinctive recurrent symptoms: re-experiencing the trauma; avoidance of associated stimuli; and persistent symptoms of increased arousal. These comprehensive symptoms persist greater than one month and cause disturbances in social, or occupational functioning. Based on the review of the literature the following are independent ICU risk factors associated with the development of PTSD: ICU delusional and traumatic memories; benzodiazepine use; prolonged sedation; ICU length of stay greater than 5 days. These factors have been implemented into a preliminary ICU discharge PTSD checklist (Appendix A). The application of this preliminary ICU checklist will enable ICU practitioners to better identify patients at high risk for the future development of PTSD. Once patients have been identified as high risk for the development of PTSD they can then be referred for further psychiatric evaluation. A patient's risk for PTSD can be documented in the discharge summary; this will alert future healthcare providers to the potential risk of PTSD development. It is also reasonable that patients and their significant others be educated to their risk for developing psychological distress following an ICU stay.