الفهرس 
ICU environment and its impact on patientsOnly 14 pages are availabe for public view
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Abstract
The specialty of intensive care medicine was developed as a consequence of the poliomyelitis epidemic of the 1950s, when widespread mechanical ventilation was required. Since then the importance of ICUs in healthcare system is without question. However, the ICU is a potentially hostile environment to the vulnerable critically ill patient. In addition to the physical stress of illness, pain, sedation, interventions, and mechanical ventilation, there are psychological and psychosocial stressors perceived by these patients. Frequently reported stressful environmental factors are noise, ambient light, restriction of mobility, and social isolation. This is thought to contribute to the syndrome known as ICU psychosis/delirium.
The environmental risk factors are essentially determined by the ICU architectural design. Understanding physical environmental stimuli in healthcare facilities will allow us to create environments that positively affect the healing process and well-being of patients.
Early in the history of nursing Florence Nightingale (1860) recognised the importance of the patient’s environment, specifically quiet, light, fresh air, cleanliness and warmth, to assist healing. She acknowledged the body-mind connection that plays a pivotal role in patient healing.
Delirium is a syndrome of several different etiologies characterized by a disturbance of consciousness with accompanying change in cognition. The diagnosis of delirium can be made on the basis of clinical history, behavioral observation, and cognitive assessment. The history should be accurately taken from family members and care givers to obtain precise information about the course of the mental status change and identify potential predisposing, precipitating, or perpetuating factors.
The mainstay of treatment remains the diagnosis and treatment of the conditions predisposing, precipitating, or perpetuating the delirium, non pharmacological therapies have an important role in both the prevention and treatment of delirium. They are targeted against risk factors for delirium, such as dehydration, immobility, sleep deprivation, visual impairment, cognitive impairment, and hearing impairment.
Post traumatic stress disorder is a condition categorized by an individual experiencing or witnessing a traumatic event involving actual or threatened death or serious injury. The event itself elicits a reaction of intense fear, helplessness and horror, and subsequently symptoms of intrusion, avoidance and arousal.
An important component of treating PTSD is the feeling of safety, and support, which can be done by care providers and the presence of frequent family visits, medications such as SSRI, tricyclic antidepressants, monoamine oxidase inhibitors and adrenergic inhibiting agents alleviate the symptoms of PTSD and are associated with improvements in overall functions.
Sleep disruption in the ICU is a phenomenon that has been observed. Subjective and objective measures of sleep quality indicate that the sleep of patients in the ICU is extraordinarily disturbed. Measures to reduce sleep alterations in ICU are not easy to implement. Interventions that may treat the sources of sleep deprivation could be adequate pain therapy, optimal psychological support, and a low degree of environmental noise and light.
Agitation is a state of extreme arousal, irritability, and motor restlessness that results from an internal sense of discomfort or tension. It’s the behavioral response to physical or emotional distress. Review of possible causes of agitation and trying to correct reversible causes of agitation is the first step in treatment. If the patient is still agitated after excluding these reversible causes then treatment will be according to the situation, using opioids, benzodiazepines or antipsychotics respectively.