University of Alberta, Canada.
La Trobe University, Australia.
Aust Crit Care. 2024 Jul;37(4):563-570. doi: 10.1016/j.aucc.2023.11.002. Epub 2024 Jan 12.
Critically ill patients experience intense physical and psychological stressors in the intensive care unit (ICU). More than half of ICU survivors report overwhelming mental health symptoms after ICU discharge, such as post-traumatic stress symptoms, anxiety, and depression. Relaxation-inducing integrative therapies such as guided imagery, massage, therapeutic touch, music therapy, and spirituality-based healing practices have the potential to promote comfort and relaxation and improve patient outcomes.
The aim of this study was to explore the attitudes of healthcare professionals towards the implementation of relaxation-inducing integrative therapies in critical care, barriers to implementation, and potential strategies to overcome them.
We conducted seven focus group interviews with 23 critical care clinicians (70% nurses, 17% allied health professionals, 13% physicians). Interviews were audiotaped and transcribed verbatim. Data were thematically analysed using an inductive content analysis approach.
Results reveal a constant interplay between mostly positive personal attitudes towards implementation of integrative therapies and the perceived culture and priorities of the unit. The main benefits for critically ill patients as perceived by participants were promotion of comfort, sleep, and coping, increase of trust, and decrease of pain and stress. As for barriers, dominant themes were a perceived lack of evidence, cost, and time constraints and the fear of loss of professional credibility. Participants related nurses' education and training, family involvement, and leadership were seen as main strategies for implementation.
The dominant ICU culture needs to be considered when implementing integrative therapies. Education, access to evidence, and role modelling are proposed as means to shift the ICU culture towards utilisation of integrative therapies in critical care.
危重症患者在重症监护病房（ICU）中会经历强烈的身体和心理压力。超过一半的 ICU 幸存者在 ICU 出院后报告出现严重的心理健康症状，如创伤后应激症状、焦虑和抑郁。诱导放松的综合疗法，如引导想象、按摩、治疗性触摸、音乐疗法和基于灵性的治疗实践，有可能促进舒适和放松，并改善患者的结局。
本研究旨在探讨医护人员对在重症监护中实施诱导放松的综合疗法的态度、实施障碍以及克服这些障碍的潜在策略。
我们对 23 名重症监护临床医生（70%护士，17%辅助医疗专业人员，13%医生）进行了 7 次焦点小组访谈。访谈进行了录音，并逐字记录。使用归纳内容分析方法对数据进行主题分析。
结果显示，个人对实施综合疗法的态度与科室的文化和优先事项之间存在着持续的相互作用。参与者认为，对重症患者的主要益处是促进舒适、睡眠和应对能力、增加信任以及减轻疼痛和压力。至于障碍，主要的主题是缺乏证据、成本和时间限制以及担心失去专业信誉。参与者认为，护士的教育和培训、家庭参与和领导力被视为实施的主要策略。
在实施综合疗法时，需要考虑 ICU 的主导文化。建议通过教育、获得证据和树立榜样来改变 ICU 文化，以促进在重症监护中使用综合疗法。
