The Psychological Impact of Admission to Intensive Care

This thesis illustrates the contribution of clinical psychology to the conceptualisation, measurement and mitigation of distress in families and staff, in the acute setting of intensive care. It examines, with reference to five separate papers, the extent and nature of the distress experienced by children and their parents in the year following discharge; the trajectory of recovery in quality of life in patient survivors and the impact of two forms of intervention - a) the provision of a follow up clinic appointment and b)Narrative Exposure Therapy - on parents’ psychological symptoms. The experience of intensive care staff is then described, drawing on the findings of two further papers which focus on the phenomenon of ‘burnout’ as well as examining traumatic and morally distressing aspects of this work. Aspects of experience unique to the children included early distress related to the impact of hallucinations and later on having to cope with the continuing impact of critical illness on their quality of life. Parents were troubled by the fear of loss and having to assimilate large amounts of important medical information in an emotionally demanding situation. Staff reported significant levels of emotional exhaustion and post-traumatic stress reactions. They also identified a number of aspects of their work as giving rise to moral distress, particularly in relation to treating patients with a poor prognosis. This synthesis demonstrates the value of examining different perspectives and the importance of measurement. It also highlights the potential role of a psychologist in intervention, both at the individual clinical level and at the organisational level, in a clinic and as part of the team. Finally examples are provided of the contribution this work has made to international outcomes research and to the current pressing debate on the assessment of distress in staff in this challenging setting.