6.6.2 Benchmarking a nurse-led counselling service for intensive care (31)

Christina Jones, Nurse Consultant Critical Care Follow-up, Intensive Care Unit, Whiston Hospital, Prescot, United Kingdom Co authors: Susan Hall & Sandra Jackson christinajonesc@aol.com

Abstract:

Background:

Psychological problems are common after critical illness in an intensive care unit (ICU) (Jones et al 2006). Dedicated psychological services are not provided by the majority of Trusts. The nurse-led counselling service at Whiston was formally established in 2005 and sees patients and families.

Aim:

To benchmark the ICU counselling service against a well established service and to examine the effectiveness of the service in terms of symptom reduction and client perception of change.

Methods:

This was a prospective study undertaken in 2 counselling services, one dedicated ICU and one general service. The clients were asked to complete the CORE-OM and PSYCHLOPS at the initial assessment and the end of counselling.

Results:

48 clients overall completed the initial CORE-OM and PSYCHOPS questionnaires, with 40 completing the end of counselling questionnaires. Two clients died due to complications of their critical illness. The clients attending the ICU service scored higher on the total score and several of the domains of the initial CORE-OM (total p=0.043, symptoms p=0.044, function p=0.008) than those attending the general service. Symptom levels were similar for both sets of clients by the end of counselling. Repeat measures ANOVA showed a significant reduction in the CORE-OM total score and the individual domain scores from the start to the end of counselling (p < 0.0001). All clients completing the follow-up reported feeling significantly better.

Discussion:

This study showed that a dedicated ICU counselling service is effective in reducing distress but demanding on the skills of the counsellor because of the high levels of dysfunction seen at initial assessment. Such as service needs to be able to offer a range of therapies from highly skilled staff.

Conclusion:

A dedicate ICU counselling service is effective in reducing psychological symptoms but demanding on the skills of the staff.

Biography:

Having trained originally as a biochemist I retrained as a nurse. I was employed as a research nurse to set up a follow-up programme at Whiston Hospital in 1990. My PhD was to design and test a rehabilitation package for ICU patients to take home with them. This package is now part of our standard discharge package. I became a Nurse Consultant in Critical Care Follow-up in October 2003. I completed a Post Graduate Diploma in Counselling and Psychotherapy in 2004 and run the counselling service for ICU patients as well as running the follow-up clinic and seeing patients on the wards and at home.