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Applying Health Psychology to Clinical Services, Policy and Practice

Freedman, R (2014). Applying Health Psychology to Clinical Services, Policy and Practice. (Unpublished Doctoral thesis, City, University of London)


Background: When a loved one is admitted to intensive care it can be a traumatic experience for the patients’ relatives. Poor communication and lack of information from intensive care unit (ICU) staff members can have a negative impact on how relatives cope on an ICU and in the months following the experience. There is a need for interventions to improve these aspects and prepare relatives for what to expect on the ICU using a combination of written and verbal information.

Aims To conduct two separate but overlapping qualitative studies. Study 1: To explore how patients’ relatives experience an ICU, their needs during this time, their knowledge and understanding regarding decision making for patients who lack capacity, and their psychological needs on ICU. Study 2: To develop and pilot an intervention for patients’ relatives on the Critical Care Units (CCUs) at King’s College Hospital (KCH), to help them cope with the experience.

Method and Design: In study 1 data was obtained from semi-structured interviews with ten ex-ICU patients’ relatives recruited via a national charity, and ten nurses and consultants from the CCUs at KCH. In study 2 data was obtained via a focus group of nine senior nurses, from KCH. Data generated from both studies was used to develop the intervention which comprised an information booklet and verbal guide. The intervention was delivered by nurses to patients’ relatives on the Medical and Surgical CCUs for two weeks. Ten CCU staff members were interviewed about how the intervention had been received by patients’ relatives. Data was analysed using thematic analysis.

Results: Study 1 identified themes related to the importance of good communication with staff, the need for relatives to receive clear and honest information about their loved one, and about the ICU. Findings suggest that relatives lack knowledge and understanding about decision-making for patients who lack capacity and may need to be informed of this process at an early stage preferably in written form. Relatives and staff may also benefit from an ICU based counselling service. The focus group in Study 2 provided feedback on appearance, content and delivery of the booklet which informed the final draft. After the pilot, staff reported positive feedback from relatives and provided encouraging and constructive feedback about the booklet. Findings suggest the booklet has the potential to help patients’ relatives cope on the ICU but continued use and testing would better determine its efficacy. Patients’ relatives need to feel supported, well informed, and involved on the ICU. Including information about the decision making process in an information booklet may improve relatives’ understanding and acceptance of this issue. The booklet should be an adjunct to verbal communication from staff and be one of a range of resources accessible to patients’ relatives on the ICU.

Keywords: intensive care; critical illness; patients’ relatives; communication; information provision; coping; decision-making; mental capacity; intervention; psychology.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: School of Health & Psychological Sciences > Psychology
Doctoral Theses
Doctoral Theses > School of Arts and Social Sciences Doctoral Theses
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