Abstract

Advances in biomedical technologies and critical care are leading to increased survivorship rates of ICU patients. During critical care, patients confront a variety of stressors that may contribute to adverse psychological outcomes, including posttraumatic stress. The nature of posttraumatic stress in this population differs from that associated with traditional trauma. The phenomenon of medical trauma in ICU survivors is complex: it is highly subjective, exists on a continuum, is cumulative in nature and carries cumulative effects, involves a combination of endogenous and exogenous, physical and emotional stressors that vary in intensity and duration, occurs in an interpersonal context that involves medical professionals, and takes place in a controlled setting with particular sensory and architectural features. This dissertation adopts an ecological perspective to explore the individual and contextual dimensions of this phenomenon and how these mutually and dynamically influence one other. A critical review of the literature examines multiple levels and variables of influence: individual (e.g., age, sex, race/ethnicity), clinical (e.g., sedation, mechanical ventilation, restraints), relational (e.g., nature and quality of interactions with staff) and environmental (e.g., lighting, noise, privacy) and includes a review of interventions initiated in the ICU that aim to mitigate medical trauma (e.g., ICU diaries, eye masks, sedation vacations). Results elucidate the nature of the relationship between and amongst variables and show that clinical features represent the most significant risk factors while empathic, patient-centered interventions and approaches to care can cushion the impact of stressors. Treatment implications for individual outpatient therapy include the importance of establishing safety, knowledge about the nature of this type of trauma, and the awareness of the unique intrusion and avoidance symptoms in this population. There are special considerations for applicability of the data to COVID-19. Establishment of a unified construct, psychoeducation for staff, families, and patients, interdisciplinary and collaborative ICU teams, and use of technology are practical applications indicated from the review. Future research is needed that includes examination of the impact of race/ethnicity, socioeconomic status, and social support, utilizes the Enduring Somatic Threat (Edmondson) and/or Medical Trauma (Hall & Hall) models, and explores the influence of personality and resilience features.

Library of Congress Subject Headings

Intensive care units; Post-traumatic stress disorder; Social ecology

Date of Award

2022

School Affiliation

Graduate School of Education and Psychology

Department/Program

Psychology

Degree Type

Dissertation

Degree Name

Doctorate

Faculty Advisor

Shelly Harrel

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