Psychological recovery after intensive care: Outcomes of a long-term quasi-experimental study of structured nurse-led follow-up

Abstract

Objectives: To compare psychological recovery of patients receiving structured nurse-led follow-up and patients receiving usual care after intensive care discharge.

Design: Quasi-experimental study.

Setting: Single centre, university hospital, mixed intensive care patient population.

Main outcome measures: Symptoms of post-traumatic stress disorder, anxiety and depression measured three and four times over 12 months after intensive care discharge. Disturbing memories of the intensive care stay and psychological reactions (that one's life was in danger, threat to physical integrity, intense fear, helplessness, horror) three months after intensive care. A mixed effect model tested differences between the groups over time and regression model predicted post-traumatic stress at three months.

Results: The experimental group had significantly more symptoms of post-traumatic stress and anxiety than the control group over the 12 months. Patients from both groups had severe symptoms of post-traumatic stress. Patients with post-traumatic stress at three months had disturbing memories and psychological reactions.

Conclusion: The structured nurse-led follow-up did not improve patients' measured outcomes of psychological recovery after intensive care. Patients with severe symptoms of post-traumatic stress are of concern. Emphasis needs to be placed on disturbing memories of the intensive care stay and psychological reactions when constructing intensive care nurse-led follow-up.

Keywords: Anxiety; Clinical practice nursing research; Depression; Follow-up studies; Intensive care units; Memory; Patient appointments; Post-traumatic stress disorder.