News Brief: ICU Staff May Suffer From Psychiatric Difficulties

Psychiatric stress on caregivers is anarea of mental health care that is oftenoverlooked. In particular, caregiversin high-pressure medical settings,such as ICUs, can suffer from highlevels of stress. As part of a largerreview of psychiatric problems incritically ill medical patients publishedin the January issue of TheAmerican Journal of Medicine, StuartJ. Eisendrath, MD, and J. JewelSchim, MD, of the University ofCalifornia at San Francisco, examinedthe effect of psychological stresson ICU staff.

The unique character of the ICUcan magnify anxiety, depression, andsubstance abuse, all of which are welldocumented among ICU staff. Inaddition, many suffer from burnout,resulting in emotional exhaustion,diminished empathy for patients, anddecreased productivity. ICUs tend tobe chaotic and noisy and to have acontinual stream of medical personnelat all hours, all of which cancontribute to stress levels.

Those who seek ICU jobs are oftenperfectionists who set very highexpectations for themselves. As aresult of such expectations (eg, savingevery patient), even realistic achievementsmay be perceived as failures.Sleep deprivation, long work hours,and changing schedules, particularlyfor residents, may add to the stresslevels of ICU personnel. This stressmay manifest in a number of ways,such as avoiding patients or theirfamilies, conflicts with other caregiversover treatment plans, anger, orpursuing life-saving treatments thatare ultimately futile.

Despite these difficulties, researchershave made progress in identifyingways to reduce ICU staff stress.Support groups, consultation withtrusted colleagues, and identificationof staff emotions can all help in normalizingreactions and improving patient-caregiverrelations. Adjustments tothe physical ICU environment, suchas noise reduction, better scheduling,and consistent leadership can alsohelp improve ICU staff morale.

The researchers concluded, “Havinga forum to express difficulties,stress management programs, andongoing review of policies and procedurescan also be implemented as keyfeatures enhancing prevention andearly identification of burnout.”