Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Perception of Intensive Care Unit Stressors by Patients in Malaysian Federal Territory Hospitals

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Perception of Intensive Care Unit Stressors by Patients in Malaysian Federal Territory Hospitals

Article excerpt


Intensive Care Unit (ICU) plays a major role for close monitoring of critically sick patients. It has high technology machines for better monitoring which requires higher trained nurses (Hupsey 2000; Simini 1999). The skillful ICU staff makes the patients feel safe and comfortable throughout the treatment (Burfitt et al. 1993). Despite this, the ICU stay is not something, which the patient looks forward to (Biancofiore et al. 2005; Cochran & Ganong 1989; Cornock 1998). This may be because of their poor condition, the crowded place, the high technology machines used, invasive procedures carried out, noise as well as the high cost of treatment (Singer et al. 1994). All these contribute to physical, psychological, and environmental stressors which take a toll on the patients (Bizek 2005; Hupsey 2000). Russell (1999) found that ICU patients were frequently stressed - with fear, lack of knowledge or information about their situation, cultural and language barriers, and a feeling of being disempowered being some of the factors.The patients are also psychologically and physically uncomfortable because of having to undergo procedures, some of them possibly humiliating, e.g. being physically examined or having a urinary catheter inserted (Marklew 2004).

There have been several attempts to identify the stressors in the ICU (Cochran & Ganong 1989; Cornock 1998; So & Chan 2004), but mostly in the western world and none in Malaysia. This study was based on Cocnock's (1998) research, and aimed to collate the perceptions of intensive care stressors faced by the patients in an ICU in Malaysia. As there had been no previous study in Malaysia, the findings will provide a greater understanding by nurses about patients' perceptions. It will also help in planning to deliver the best standard of care in anesthetics, intensive care, pain management and related services for patients.


There are basically three groups of stressors in the ICU - physical, psychological and environmental (Hartshorn & Sole 1997). Physical stressors refer to any medical device applied to the patient, such as tubes inserted in the mouth and nose, use of ventilators as well as the pain and discomfort suffered (Hweidi 2007). Psychological stressors occur when the patient is immobilised, restrained, confused and bored (Hweidi 2007). Environmental stressors refer to the things and conditions around the patient, such as an uncomfortable bed, being too hot/cold, lack of privacy, constant lighting and noise (Freedman et al. 1999).

Psychological stressors are the most common stressors in the ICU Syndrome (Cornock 1998), which is a condition that usually occurs after 48 hours in the ICU. It is characterized by altered mental functioning (confusion, disorientation, hallucinations and delusion), which resolves to normality once patients are discharge from the ward (Gelling 1994;Axell et al. 2002). It, however, impairs the patient recovery, and requires a longer stay in the ICU (Biancofiore et al. 2005). The longer ICU stay often results in higher financial costs (Lapsley & Melia 2001; Thungjaroenkul & Kunaviktikul 2006) and greater risk of complications. Although in general term it is known what the stressors are, it is not known if any one stressor is predominant in ICU patients in Malaysia.Therefore, this study seeks to determine the perceptions and severity of ICU stressors among patients.



This study is a cross-sectional survey using a face-to-face interview.


Adult ICUs from two government hospitals were selected because of their care for ventilated patients. Both hospitals are referral centres for patients in Malaysia. Overall, five ICUs were involved in the study including a General ICU, Urology ICU, and Coronary Care Unit (CCU). The total number of ICU beds in both hospitals was 44 with approximately 1920 admissions per year. This total number of admissions includes patients with and without ventilator support. …

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