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Belastungen für Patienten auf der Intensivstation

Eine Analyse unter Berücksichtigung der Kontrollierbarkeit

Stressors for patients in the intensive care unit

An analysis taking controllability into consideration

Wiener klinisches Magazin volume 23, pages 228–237 (2020)Cite this article

Zusammenfassung

Fragestellung

Es existieren bislang keine Untersuchungen zu Belastungen für Patienten der Intensivstation, die sowohl das Belastungsempfinden als auch die erlebte Kontrollierbarkeit erfassen. Mit dieser Untersuchung sollten die Fragen beantwortet werden, welche Situationen von Patienten der Intensivstation als belastend erlebt werden, ob diese aus Patientensicht kontrollierbar sind, und ob das Belastungserleben von der Kontrollierbarkeit abhängig ist.

Material und Methoden

Es wurde ein Fragebogen zu 18 potenziell belastenden Situationen für Patienten der Intensivstation konzipiert. Diese sollten hinsichtlich ihres Vorkommens, der Wiederholungshäufigkeit, der Belastung und des Kontrollempfindens beurteilt werden. 198 Patienten der chirurgischen Intensivstation und 100 Patienten der allgemeinchirurgischen Normalstation wurden während ihres stationären Aufenthalts befragt.

Ergebnisse

Patienten der Intensivstation erinnerten signifikant mehr Belastungssituationen als die der Normalstation (M ± SD = 10,2 ± 2,7 vs. 6,6 ± 2,0; d = 1,48; p < 0,001) und empfanden diese als belastender (mittlere Belastung: M ± SD = 3,6 ± 1,5 vs. 2,2 ± 1,3; d = 1,01; p < 0,001). Die belastendsten Situationen für intensivpflichtige Patienten waren „Fixierung der Arme“ (M ± SD = 7,47 ± 3,27), „maschinelle Beatmung“ (M ± SD = 7,36 ± 3,29) und „endotracheales Absaugen“ (M ± SD = 7,19 ± 2,99). Je weniger Kontrollierbarkeit von Patienten der Intensivstation erlebt wurde, umso ausgeprägter waren die aktuelle Angst zum Befragungszeitpunkt und das mittlere Belastungsempfinden (r = −0,20, r = −0,36; p < 0,01).

Schlussfolgerung

Erlebter Kontrollverlust steht in deutlicher Beziehung zum Ausmaß der Belastung, die intensivpflichtige Patienten erfahren. Dies ermöglicht Überlegungen zur Reduktion der Belastung auf Intensivstationen.

Abstract

Objective

Studies on stress factors for patients in intensive care units (ICU) have so far concentrated on whether certain stressors have occurred or how stressful they were. There are no studies on stress for patients in ICUs that measured both the perception of stress and the chances perceived to control it; however, loss of control can result in long-term psychopathological consequences, such as depression or posttraumatic stress disorder. Therefore, a questionnaire was developed to evaluate the influence of controllability on perception of stress. The aim of this study was to answer the following questions: which situations were experienced as stressful by patients in ICUs, whether patients perceived them as being controllable and whether the experience of stress depended on the controllability? Furthermore, it was examined which stressful situations are specific to ICUs.

Material and methods

The questionnaire included 18 potentially stressful situations for ICU patients. These situations were assessed with respect to the occurrence, frequency and duration, the impact of stress and the perception of control. In addition, anxiety was assessed using STAI-X1. A total of 198 ICU patients and 100 patients hospitalized in a general surgery ward were interviewed.

Results

Patients in ICUs remembered significantly more stressful situations than those on the normal ward (M ± SD = 10.2 ± 2.7 vs. 6.6 ± 2.0; d = 1.48; p < 0.001) and perceived them as more stressful (mean stress: M ± SD = 3.6 ± 1.5 vs. 2.2 ± 1.3; d = 1.01; p < 0.001). The most stressful situations for ICU patients were fixation of the arms (M ± SD = 7.47 ± 3.27), mechanical ventilation (M ± SD = 7.36 ± 3.29) and endotracheal suctioning (M ± SD = 7.19 ± 2.99). Approximately one third of patients underwent these situations. Situations experienced by more than 90% of ICU patients were evaluated as being the least stressful experiences, including infusion (M ± SD = 2.7 ± 2.7), measuring heart activity (M ± SD = 2.3 ± 2.7), taking blood samples (M ± SD = 2.2 ± 2.7), and temperature control (M ± SD = 0.9 ± 1.7).

Controllability experienced by ICU patients negatively correlated with anxiety (r = −0.20, p = 0.004) and mean sensation of stress (r = −0.36; p < 0.001). When comparing stress levels of ICU patients who perceived controllability in a given situation to those who did not, the greatest effects (Cohen’s d > 1.4) were observed for the situations presence of a bed barrier (M ± SD = 0.1 ± 0.4 vs. 5.9 ± 2.8), lighting at night (M ± SD = 0.7 ± 1.7 vs. 5.7 ± 3.3), presence of a ventilation tube (M ± SD = 2.5 ± 2.1 vs. 6.7 ± 3.0) and repositioning of the patient (M ± SD = 2.5 ± 2.9 vs. 6.7 ± 2.9).

Conclusion

The experience of loss of control seems to negatively modify the impact of stressors. Thus, an increase in aspects of controllability could reduce the burden on patients during intensive care.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Marlene Reinberger,  Elke Muhl, Carla Nau &  Michael Hüppe

  2. Klinik für Allgemeine Chirurgie, Universität zu Lübeck, Lübeck, Deutschland

    Ralf Bouchard

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  1. Marlene Reinberger
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  2. Ralf Bouchard
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  3. Elke Muhl
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  4. Carla Nau
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Correspondence to Michael Hüppe.

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Interessenkonflikt

M. Reinberger, R. Bouchard, E. Muhl, C. Nau und M. Hüppe geben an, dass kein Interessenkonflikt besteht.

Die Untersuchung wurde mit Zustimmung der lokalen Ethikkommission der Universität zu Lübeck durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Reinberger, M., Bouchard, R., Muhl, E. et al. Belastungen für Patienten auf der Intensivstation. Wien klin Mag 23, 228–237 (2020). https://doi.org/10.1007/s00740-020-00367-9

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  • DOI: https://doi.org/10.1007/s00740-020-00367-9

Schlüsselwörter

  • Stress
  • Fragebogen
  • Angst
  • Körperliche Fixierung
  • Kontrolle

Keywords

  • Stress
  • Questionnaire
  • Anxiety
  • Physical Restraint
  • Control