Karnatovskaia Lioudmila V, Schultz Jason M, Niven Alexander S, Steele Amanda J, Baker Brittany A, Philbrick Kemuel L, Del Valle Kathryn T, Johnson Kimberly R, Gajic Ognjen, Varga Katalin
Department of Medicine, Mayo Clinic, Rochester, MN.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
Crit Care Explor. 2021 Apr 26;3(4):e0403. doi: 10.1097/CCE.0000000000000403. eCollection 2021 Apr.
Surviving critical illness often creates a lasting psychological impact, including depression, anxiety, and post-traumatic stress. Memories of frightening and delusional experiences are the largest potentially modifiable risk factor, but currently, there is no proven intervention to improve these inciting factors. Psychological support based on positive suggestion is a psychotherapeutic approach that can be provided even to patients in altered cognitive states and is therefore a viable psychotherapy intervention throughout the ICU stay. Traditional ICU care team members have limited time and training to provide such psychological support to patients. Doulas are trained supportive companions who have been effectively used to provide patient advocacy and emotional support in other clinical settings and may address this need. Our aim was to train and implement a psychological support based on positive suggestion program for the critically ill using doulas, and measure acceptance of this intervention through stakeholder feedback.
Doula training included three objectives: an introduction to ICU practice structure and policies; education about fundamental aspects of critical care conditions and procedures; and didactic and hands-on learning experiences in effective use of psychological support based on positive suggestion in the critically ill. Doulas were evaluated at the end of their training and during subsequent clinical activities using competency-based assessments as well as through survey-based questions and interviews with key stakeholders.
The ICU doulas performed psychological support based on positive suggestion on 43 critically ill patients in the ICU setting. Stakeholder feedback from nurses, patients, and patient families was positive. The majority (28/32) of surveyed bedside ICU nurses reported that the doulas' involvement was helpful for both patients and nurses alike. All interviewed family members offered positive comments about the ICU doula presence and of the 40 patients who recalled the intervention 37 found it comforting.
Our program successfully trained two doulas to work effectively in the ICU setting performing patient-centered psychological support based on positive suggestion interventions. Their training improved their skill sets and was reported as beneficial by patients, families, and critical care nursing. This training program offers a proof of concept that could be applied in other medical centers, bringing doulas more commonly into the ICU practice to help humanize the experience for patients, families, and medical teams.
从危重病中存活下来往往会产生持久的心理影响，包括抑郁、焦虑和创伤后应激障碍。可怕和妄想经历的记忆是最大的潜在可改变风险因素，但目前，尚无经证实的干预措施来改善这些诱发因素。基于积极暗示的心理支持是一种心理治疗方法，即使对认知状态改变的患者也可提供，因此是贯穿重症监护病房（ICU）全程可行的心理治疗干预措施。传统的ICU护理团队成员提供此类心理支持给患者的时间和培训有限。导乐是经过培训的支持伙伴，已在其他临床环境中有效用于为患者提供支持和情感支持，可能满足这一需求。我们的目标是培训并实施一项基于积极暗示计划的心理支持项目，让导乐为危重症患者提供服务，并通过利益相关者的反馈来衡量对该干预措施的接受程度。
导乐培训包括三个目标：介绍ICU的实践结构和政策；讲授重症监护病情和程序的基本方面；以及关于在危重症患者中有效使用基于积极暗示的心理支持的理论和实践学习经验。在培训结束时以及随后的临床活动中，通过基于能力的评估以及基于调查的问题和与关键利益相关者的访谈对导乐进行评估。
ICU导乐在ICU环境中对43名危重症患者进行了基于积极暗示的心理支持。护士、患者和患者家属的利益相关者反馈是积极的。大多数（28/32）接受调查的床边ICU护士报告说，导乐的参与对患者和护士都有帮助。所有接受采访的家庭成员对ICU导乐的存在都给予了积极评价，在40名回忆起该干预措施的患者中，37名患者感到安慰。
我们的项目成功培训了两名导乐，使其能够在ICU环境中有效地开展工作，基于积极暗示干预措施提供以患者为中心的心理支持。他们的培训提高了他们的技能，患者、家属和重症护理人员都报告说这是有益的。这个培训项目提供了一个概念验证，可以应用于其他医疗中心，使导乐更普遍地进入ICU实践，帮助患者、家属和医疗团队的体验更具人性化。
