Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis

Abstract

BACKGROUND

Severe acute pancreatitis (SAP) is a familiar critical disease in the intensive care unit (ICU) patients. Nursing staff are important spiritual pillars during the treatment of patients, and in addition to routine nursing, more attention needs be paid to the patient’s psychological changes.

AIM

To investigate the effects of psychological intervention in ICU patients with SAP.

METHODS

One hundred ICU patients with SAP were hospitalized in the authors’ hospital between 2020 and 2023 were selected, and divided into observation and control groups per the hospitalization order. The control and observation groups received routine nursing and psychological interventions, respectively. Two groups are being compared, using the Self-rating Anxiety Scale (SAS), Self-Determination Scale (SDS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and 36-item Short Form Health Survey (SF-36) scores; nursing satisfaction of patients; ICU care duration; length of stay; hospitalization expenses; and the incidence of complications.

RESULTS

After nursing, the SDS, SAS, and APACHE II scores in the experimental group were significantly lower than in the control group (P < 0.05). The SF-36 scores in the observation group were significantly higher than those in the control group (P < 0.05). The nursing satisfaction of patients in the experimental group was 94.5%, considerably higher than that of 75.6% in the control group (P < 0.05). The ICU care duration, length of stay, and hospitalization expenses in the observation group were significantly lower than those in the control group, and the incidence of complications was lower (P < 0.05).

CONCLUSION

For patients with SAP, the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

Key Words: Severe acute pancreatitis, Intensive care unit nursing, Psychological intervention, Changes of psychological status, Short Form Health Survey

Core Tip: Severe acute pancreatitis (SAP) is a dangerous acute clinical abdominal condition associated with high mortality. SAP treatment is usually performed in the closed environment of the intensive care unit, and an excellent psychological state helps exert the effect of various treatment methods and drugs to speed up disease recovery. We conducted a study on psychological interventions in 100 patients with SAP. This study found that psychological interventions effectively alleviated patients' anxiety, depression, and other adverse psychological conditions.

INTRODUCTION

Acute pancreatitis is an inflammation of the pancreas caused by the activation of pancreatic enzymes, which leads to digestion and necrosis of the pancreatic tissue. Severe acute pancreatitis (SAP) is a serious acute clinical abdominal condition with a high mortality rate. SAP treatment is complex, and the case fatality rate is as high as 10%-25%[1]. Once multiple organ failure occurs, the case fatality rate can be as high as 80%[2,3]. Some patients who survive after active treatment can still have different degrees of pancreatic insufficiency and high treatment costs, and the family and society have brought a heavy burden. When SAP occurs, patients should be treated and nursed in the intensive care unit (ICU) immediately to ensure their safety[4,5].

The process of planning and gradually changing an object's psychological behaviours, personality traits, or psychological issues in order to move it towards the desired outcome under the direction of psychological theories is known as psychological intervention[6]. With the gradual development of modern nursing, people have gradually realized that considering only the physiological aspects of nursing is not enough. Nonetheless, they must also consider the relationship between health and disease, such as psychological and social factors[7]. With the extensive development of SAP surgical treatment in the ICU, most patients experience anxiety, fear, insomnia, irritability, depression, and other emotions during perioperative nursing, which negatively impact surgical treatment and rehabilitation. Targeted psychological nursing interventions have become an essential topic in surgical nursing and have received increasing clinical attention. Targeted psychological nursing intervention can alleviate patients' emotions and reduce the negative effects of surgical treatment and rehabilitation.

This study offers a fresh perspective on ICU nursing in SAP by examining the impact of psychosocial treatments in ICU care for SAP.

MATERIALS AND METHODS

Participants

Based on the sequence of hospitalisation, 100 SAP patients who were hospitalised to our hospital's ICU between January 2020 and December 2023 were chosen and split into observation and control groups. There were 45 cases in the control group, 25 men and 20 women, aged 25–72 years, with an average age of 44.64 ± 3.72 years. There were 55 cases in the observation group, including 33 men and 22 women, aged from 24 to 73 years old, with an average age of 45.46 ± 3.25 years.

Inclusion criteria: (1) According to the "Chinese guidelines for the management of acute pancreatitis (2021)" developed by the Pancreatic Diseases Group of the Gastroenterology Branch of the Chinese Medical Association, every patient satisfied the SAP diagnostic criteria[8]; (2) No history of mental disorders or psychiatric diseases; (3) Admitted to ICU; and (4) Patients and their families gave informed consent and signed.

Exclusion criteria: (1) Combined with severe liver, kidney, and other organ function abnormalities; (2) Comprehension and speech impairments; (3) Individuals with depression caused by primary depression or other diseases; and (4) Other reasons for dropping out of the study halfway.

Methods

Normal nursing care was provided to the control group, including assessing the patients' condition, vital sign support, strict observation, analgesic care, maintaining various pipes, recording fluid intake and outflow, and nutritional support. Based on the control group, the observation group underwent the following psychological intervention: (1) Cognitive psychological intervention: Most patients due to the lack of awareness of their disease, coupled with the postoperative ICU after seeing a variety of indwells on the body and unfamiliar with the surrounding instruments so that patients are prone to anxiety and fear. Furthermore, other psychological and severe cases may even develop mental disorders. Therefore, nursing staff needs to conduct health education for patients, introduce the etiology and possible complications of SAP, inform patients about the use and importance of the indwelling pipeline and the effect of treatment, eliminate patients' doubts, help them establish confidence in healing, and help improve patients' awareness of the self-protection pipeline, which is conducive to the improvement of treatment effect and prognosis; (2) Psychological support: After the patient is transferred to the ICU, the accompanying time of the family is limited, coupled with an unfamiliar hospital environment. Patients are prone to loneliness, resulting in depression, which has a specific impact on the development of nursing work. Nursing staff need to communicate with patients actively. Moreover, they should carefully observe changes in their mental state, master the psychological problems and needs of patients through communication, provide targeted psychological counseling, and meet the reasonable requirements of patients as far as possible. Simultaneously, encourage and comfort them, eliminate their negative emotions, and improve patient compliance to ensure the smooth progress of nursing work; and (3) Environmental management: First, the noisy environment will aggravate the anxiety and depression of patients. Therefore, the nursing staff first needs to ensure a quiet indoor and outdoor environment, adjust the volume of the monitoring instrument to a minimum, turn off the unused instrument in time, and prevent the nursing staff from talking and laughing loudly. Second, it is necessary to keep the indoor light soft, organize the items in time, and ensure that the indoor items are neatly placed. Furthermore, the preferred items should be placed near the patient according to their preferences to provide a comfortable and warm rest environment.

Evaluation index

Mental state before and after nursing was evaluated using the Self-rating Anxiety Scale (SAS)[9] and Self-Determination Scale (SDS)[10]. The twenty items on the SAS self-report scale address a range of anxiety symptoms, including physical and psychological symptoms Higher scores indicate more severe symptoms. The SAS scores range from 20 to 80 Less than 50 points overall is considered normal; 50–59 represents mild anxiety, 60–69 represents moderate anxiety, while 69 or higher denotes severe anxiety. The SDS comprises 20 items that represent an individual's subjective emotions of depression. Each item is categorised into four grades based on the frequency of symptoms, with 10 positive and 10 reverse scores. The SDS standard score had a cut-off point of 53 points, with mild depression being defined as 53–62, moderate depression as 63–72, and severe depression as 73 or higher.

The Acute Physiology and Chronic Health Evaluation (APACHE) II score was used to evaluate symptom improvement before and after nursing[11]. The APACHE II comprises acute physiology, age, and chronic health evaluation. An APACHE II score of 71 is the theoretical maximum; the greater the score, the more severe the illness. The two groups' ICU monitoring duration, length of stay, and hospital costs were noted, and a statistical analysis was performed to determine the frequency of problems, which included sepsis, respiratory failure, heart failure, acute kidney failure, and gastrointestinal bleeding The quality of life following nursing was assessed using the 36-item Short Form Health Survey (SF-36), which assessed physiological function, mental health, emotional role, physical pain, vitality, social capacity, and overall health score[12]. The standard formula is used to calculate the conversion score, so that each dimension can be converted into 0-100 points, and the conversion score of each dimension = [(actual score - lowest possible score)/general average possible score] × 100.

Statistical methods

SPSS Windows software version 26.0 was used to analyze the data, and the mean ± SD and n (%) were used to express the measurement and count data, respectively. Normal analysis and homogeneity test of variance were carried out on the measurement data. If the data followed normal distribution and the variance was homogeneous, t test (two-tailed) was carried out; otherwise, non-parametric test was carried out. The count data were analyzed by χ² tests, and P < 0.05 indicated that the difference was statistically significant.

RESULTS

Comparison of mental state and severity of illness before and after nursing

There were 55 patients in the observation group and 45 patients in the control group, of which 58 were men and 42 were women, with a mean age of 54.74 ± 12.955 years. There were no significant differences in the SDS, SAS, and APACHE II scores between the two groups at admission (P > 0.05). After nursing care, the scores of the two groups were significantly lower than those at admission. The SAS score of the observation was 37.78 ± 6.525 points, which was considerably lower than that of the control group (42.82 ± 4.207 points; t = -4.474, P < 0.001). The SDS score of the observation group was 39.31 ± 3.620 points, significantly lower than that of the control group (56.22 ± 7.856 points; t = -14.236, P < 0.001). The APACHE II score of the observation group was 20.62 ± 1.958 points, significantly lower than that of the control group (25.33 ± 1.871 points; t = -12.222, P < 0.001), and the difference between groups was statistically significant (Table 1).

Table 1 Comparison of mental state and severity of illness before and after nursing.

Groups	n	SAS		t value	P value	SDS		t value	P value	APACHE II		t value	P value
		Before	After			Before	After			Before	After
Observation group	55	45.67 ± 4.426	37.78 ± 6.525	7.439	< 0.001	58.89 ± 6.106	39.31 ± 3.620	20.458	< 0.001	38.05 ± 6.908	20.62 ± 1.958	18.010	< 0.001
Control subjects	45	45.73 ± 4.459	42.82 ± 4.207	3.186	0.002	60.16 ± 6.060	56.22 ± 7.856	2.659	0.009	38.29 ± 6.747	25.33 ± 1.871	12.412	< 0.001
t value		-0.048	-4.474			-1.034	-14.236			-0.171	-12.222
P value		0.962	< 0.001			0.304	< 0.001			0.865	< 0.001

SAS: Self-rating Anxiety Scale; SDS: Self-Determination Scale; APACHE: Acute Physiology and Chronic Health Evaluation.

Comparison of SF-36 scale scores before and after nursing intervention

Following nursing care, the observation group's SF-36 scores were significantly higher than the control group's for physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, mental health, and general health (P < 0.05; Table 2).

Table 2 Comparison of 36-item Short Form Health Survey scale scores before and after nursing intervention (min, mean ± SD).

Groups	n	PF	RP	BP	GH	VT	SF	RE	MH	Total
Observation group	55	45.36 ± 3.658	62.65 ± 4.213	58.07 ± 6.315	58.75 ± 6.210	60.51 ± 6.076	59.18 ± 4.643	57.38 ± 5.438	57.36 ± 5.923	58.33 ± 6.209
Control subjects	45	40.96 ± 3.398	47.53 ± 4.429	49.93 ± 2.871	52.58 ± 2.241	53.22 ± 3.147	50.33 ± 2.714	51.58 ± 2.943	52.84 ± 3.247	53.18 ± 3.291
t value	-	6.188	17.448	7.991	6.329	7.281	11.296	6.427	4.583	5.041
P value	-	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

PF: Physical functioning; RP: Role-physical; BP: Bodily pain; GH: General health; VT: Vitality; SF: Social functioning; RE: Role-emotional; MH: Mental health.

Comparison of nursing satisfaction

The nursing satisfaction of patients in the experimental group was 94.5%, which was significantly higher than that in the control group (75.6%; P < 0.05; Table 3).

Table 3 Comparison of nursing satisfaction between two groups.

Groups	n	Satisfaction	More satisfactory	Dissatisfaction	Overall satisfaction, n (%)
Observation group	55	38	14	3	52 (94.5)
Control subjects	45	21	13	11	34 (75.6)
χ2					8.593
P value					0.014

Comparison of hospitalization indexes

The ICU care duration, length of stay, and hospitalization expenses in the observation group were significantly lower than those in the control group, and the incidence of complications was lower (P < 0.05; Table 4).

Table 4 Comparison of hospitalization indexes between the two groups.

Groups	n	ICU care duration (day)	Length of stay (day)	Hospitalization expenses (ten thousand yuan)	Occurrence of complications, n (%)
Observation group	55	2.16 ± 0.834	18.27 ± 1.661	7.90 ± 0.700	4 (7.3)
Control subjects	45	4.11 ± 1.465	22.58 ± 3.130	10.46 ± 2.115	11 (24.4)
t/χ2	-	-8.349	-8.805	-8.431	5.724
P value	-	< 0.001	< 0.001	< 0.001	0.024

DISCUSSION

At least two of the following three requirements should be satisfied for a SAP diagnosis: (1) Upper abdominal pain, increased serum amylase level by more than three times; (2) Acute pancreatitis on computed tomography or magnetic resonance imaging, accompanied by extensive peripancreatic exudation or pancreatic necrosis, or pancreatic abscess; and (3) Organ failure[13,14]. SAP belongs to the category of acute severe diseases; its condition is critical, its prognosis is poor, and it directly threatens the safety of patients. Even after being out of danger, there may still be different degrees of pancreatic function problems that can lead to fever, abdominal pain, shock, and other symptoms in patients, thus seriously affecting their quality of life.

Since the treatment of SAP is primarily conducted in the closed environment of the ICU, patients suffer apparent physical pain and face a series of psychological stress reactions, resulting in psychological abnormalities and disorders that seriously affect treatment and prognosis. As the only spiritual pillar of patients, nursing staff play a vital role in creating and maintaining a good mental state. An excellent psychological state helps to exert the effects of various treatments and drugs but also helps to enhance patients' enthusiasm for treatment, take the initiative to participate in self-care, and speed up the recovery of the disease. Therefore, in ICU care, in addition to routine condition monitoring, medication guidance, pipeline care, and health education, attention should be paid to the psychological state of patients and the timely detection of their adverse emotions through reasonable psychological counseling methods to help patients establish confidence in rehabilitation, better cooperate with nursing work, and promote the improvement of nursing quality.

In the process of psychological intervention, nursing staff should observe and communicate with patients promptly to obtain recognition and support for patients in the treatment process. In this study, psychological intervention was added to the experimental group of patients, and the results showed that there were no statistically significant differences in the SDS, SAS, and APACHE II scores between the two groups before nursing (P > 0.05). Nevertheless, they were significantly reduced after nursing (P < 0.05). Following nursing care, the experimental group's SDS, SAS, and APACHE II scores were considerably lower than those of the control group (P < 0.05), in line with the majority of the experimental findings[15,16].

After receiving nursing care, the observation group's SF-36 score was considerably greater than that of the control group (P < 0.05). Additionally, the experimental group's patient nursing satisfaction rate was 94.5%, significantly higher than the control group's 75.6%, and the difference was statistically significant (P < 0.05)[17,18]. These results indicate that psychological interventions can significantly alleviate patients' anxiety and depression and improve nursing satisfaction. The results of hospitalization indicators showed that ICU care duration, length of stay, as well as hospitalisation expenses were considerably lower in the observation group compared to the control group (P < 0.05). There was also a significant reduction in the incidence of complications. It has been thoroughly proven that the application effect of psychological interventions in ICU nursing for SAP is exact. This can better help patients adjust their mentality, actively cooperate with treatment, promote early remission of the disease, improve the quality of life, and reduce the burden of life. It is worthy of clinical promotion and use.

However, there are some limitations to this study. First of all, due to various reasons, the survey sample is limited to our hospital, and the sample size is relatively small. In addition, the quality of surveys and data analyses involving only patients in the region cannot be fully guaranteed. Therefore, the findings are representative of this region only, and further studies with a wider and diverse population range are needed if they are to be generalized to other regions.

CONCLUSION

In conclusion, for patients with SAP, standardized psychological intervention measures can effectively alleviate adverse psychological conditions, such as anxiety and depression. Furthermore, they accelerate physical rehabilitation by improving treatment and nursing compliance, which has significant clinical application value.