PART I

PRELIMINARY

1.1 Background
Space Intensive Care Unit (ICU) is a special room for treating patients in
critical condition. The room was described as a room full of stress not only for
patients and their families, but also for health workers who work in the room
(Jastremski, 2000). Therefore, for nurses and other health professionals working
in the ICU need to understand about the stressor (stressors) in this room and also
on how to cope with such stress.
In nursing, health and mental illness is a dynamic range of a person's life.
Critical illness circumstances very big influence on the dynamics of healthy
ranges as in a state mental hospital experience a critical illness, a person
experiencing severe stress in which patients experience loss of health, loss of
independence, loss of a sense of comfort and pain due to her illness. As a critical
nurse, nurses must be able to cope with a variety of health problems including the
patient's psychosocial problems.
Nurses should not only focus on the physical problems experienced by the
patient. Failure to address the psychosocial problems patients may have an impact
on the worsening state of the patient because the patient may experience more
severe anxiety and refuse treatment.

1.2 Aim
To determine the Psychosocial Aspects In Critical Nursing.

CHAPTER II
DISCUSSION
2.1 Psychosocial Aspects In Critical Nursing
Psychosocial aspects of critical illness is a unique tangtangan for nurses
especially those in critical nursing. Nurses must be balanced to meet the physical
and emotional needs of his or her clients in an environment that can cause stress
and dehumanis. To achieve a balance iniperawat should have knowledge of how
critical that experienced nursing capable of affecting the psychosocial health of
the patient, family, and health.
Psychosocial support needed by patients in critical care units, including
assistance in overcoming the effects of hospitalization comparable with critical
illness experienced by the patient. Activity in the ICU disrupt patient care unit for
24 hours. Moreover, patients must cope with pain, fear of illness.
Realizing that threaten the environment such as in critical nursing unit, at this
point the nurse can be a negotiator for the patient. Here is a concept that can help
nurses be a good negotiator.
a. Sensory input
Sensory abnormalities are frequently encountered problem in critical care
units. Sensory input by using the five senses which has been used well can
not function optimally. Too many unwanted stimulus, such as excessive
noise and continuous, bright light and hypersensitivity can act as perverts
and bullies. Reduced stimulus such as darkness, silence and inactivity may
occur in the critical nursing unit. The quality and quantity of the stimulus
should be recognized and taken into account nurses.

1. sensory loss
The term used for identification of a variety of symptoms that occur
after a decline occurred quality and quantity of sensory input. Another
term that included the occurrence is isolation, confinement, limited
information, loss of perception and sensory limitations for 8 hours can
lead to symptoms of sensory loss, namely:
 1) Disorientation of time (lost awareness of time)
2) Boredom
3) delusions
4) Illusion
5) hallucinations
6) agitated
7) Depression
8) Existence Behavior / symptoms of psychosis
2. excess sensory
Symptoms that occur after a long exposure at high noise levels.
Tension and anxiety increased as a result of exposure to noise
continuously.
The amount and quality of the noise can be a factor of healing
patients. For example, a high noise level increases the need yeri
lowering drugs, loud laughter among health care workers caused anger
patients, critically ill patients lead normal egocentric they interpret all
conversations and actions aimed at him. Therefore, the talk and
laughter should not be sounded patient and away from the patient.
Here are the symptoms in relation to the high noise level:
1) Increased need for pain relief drugs
2) Can not sleep
3) Feeling scared, conversation and laughter aimed kpadanya
4) Mental confusion, delusions, illusions, hallucinations

Phychosis ICU circumstances caused by the environment:

1. Noise (heard talk of people, heard footsteps medical personnel in a
hurry, the sound of machine monitor)
2. Lighting (lights were bright and lively ICU continuous)
3. Limitation of movement because of the many devices installed in their
bodies
4. Male and female in one room (no privacy)
 5. The beds were uncomfortable
Phychosis ICU circumstances caused by medical personnel:
1. The inability of nurses in effective communication
2. Nurse difficulty in establishing a therapeutic relationship
3. The number of medical personnel in and out and perform assessments
and interventions
4. Medical personnel discussing patient's disease in the room, causing
anxiety even keperawatanutusasaan for patients.
Phychosis ICU circumstances caused by the family:
The lack of contact with family, but they need the support and the
presence of his family because, in general ICU limit family visits.
b. Psychosocial impact
Nursing care in patients admitted to the ICU or critical nursing still
considering aspects of bio, psycho, socio, spiritual, comprehensive
manner. Patients in the treatment of critical nursing can have negative
effects that can affect the patient's condition, including the impact on
psikososisal aspect. These impacts are:
1. delirium
Treatment in the critical care unit may become a serious trauma for
critical patients. As a result of the illness automatically triggers an
acute mental disorder. This condition can be shown at all ages, mostly
in the elderly. Onset is rapid and generally returned to normal. This
acute mental disorder affecting cognition, attention, and the
circulation of waking sleep. This mental disorder is named with the
term delirium. Here are the symptoms that occur sehub mgkn with
delirium:
1) Fluctuations in the level of consciousness
2) hallucinations
3) Disorientation object (person). Usually think of nurses is the
immediate family
4) severe anxiety
5) memory impairment
 6) Other symptoms: cognitive disorders, sleep cycle disorders,
waking up is not normal, psychomotor behavioral disorders,
cognitive disorders, impaired sensory perception, memory and
thinking.
7) Display behavior: disorientation of time and place, do not know
the person who is known, sensory disturbances, delusions that the
food was poisoned
8) Display sleep wake cycle behavior is not normal: insomnia, night
dreams, agitation time of darkness, when the focus decreases, less
vigilant or watchful excessive fluctuations in consciousness and
drowsiness
9) Psychomotor behavior display behavior disorders: ragu2,
fluctuation and agitation to somnolence, oppositional behavior
(fear).
2. Depression
Natural disturbances feeling that can be experienced by ICU patients.
Prawatan period of time, do not heal, the rules laid down in the critical
nursing unit makes the patient feel isolated because of the family may
not accompany the patient. Sad and feel disconnected with relatives or
family be risk factors for depression. Clinically, silent behavior and
sometimes - sometimes tears, feeling useless, no hope and do not
respond to the stimulus is a common behavior displayed patient.
Providing education or explanations to patients and families by nurses
are actions you can take. These interventions can reduce the response
that may occur as a result of mild depression. But when depression is
severe, it is necessary pharmacological action or to psychiatric
consultation.
The risk factors predisposing to depression as a medical disorder are:
1) Social isolation
2) Excuse me
3) financial distress
4) A history of mood disorders
 5) Abuse of drugs and alcohol
6) Suicide attempt
7) Pain
8) Loss of meaning in life
3. anxiety
Critical nursing unit can not be separated from the stimulus that
causes stress, for example, the procedure brsifat and very serious force
to be done. In other situations in critical units mgkn more patients
experienced keperawatanrihatinan and worry excessive variety of
tools that surround them. Fear / threat for hospitalized in critical
nursing unit can arise due to lack of information regarding the
situation of a breathing machine or facility and advanced technology
equipment that is attached to the patient's body with respect to the
management of the disease. Pain and death threats become very spook
patients, no family members who accompany, noise that occurs in the
environment or other beds also be a source of stress.
Anxiety can occur when sseorg experience the following:
1) threats of powerlessness
2) Lost control
3) Feeling loss of function and self-esteem
4) A failed defense
5) a sense of isolation
6) The fear of dying
The behavior often displayed: non-verbal response looked a tool
attached to him.
Physiologically on the monitor also shows jatung rate and blood
pressure increase. Nurses need to follow up on this to reduce anxiety.
The behavior of nurses is important is to explain and answer briefly and
clearly, about what triggers fear in patients. Responds quickly to
complaints such as pain felt threatening to patients. Here are some of
the possible interventions to reduce and control the patient:
1) breathing techniques
 2) muscle relaxation
3) preparing information
4) distraction techniques
5) Effective coping methods
The stress response in critically ill patients:
1) Metabolic response
a. Metabolism of protein and fluids
b. Response fluid and electrolyte
2) Hormonal Response to Stress
a. endocrine response
b. inflammatory response
c. immunological response

2.2 Efforts To Solving Critical Psychosocial Patient

After the nurse is able to overcome the stress itself, then he can work to
address patient and family stress. Here are some actions that can be performed by
nurses to reduce stress in patients in the ICU.
2.2.1 environmental modifications
The first is to change the ICU environment. ICU environment
should always be modified to make it more flexible despite using a lot
of equipment with advanced technology, and to improve the
environment more favorable to the process of recovery (healing
patients) (Jastremski, 2000).
The concept of patient-focused services enable to promote the
universal room. Availability of portable and smaller demand for
improved service closer to patients than the patients who come to the
 place of service. The possibility to create a small work stations
(Decentralization of nursing activities) for each patient will be less
stressful for the patient (Jastremski, 2000).
Super-sophisticated equipment such as remote monitoring for all
patients through the monitor on all the beds of patients who can be
monitored via the TV. So the nurses can monitor patients Bed 1 despite
being located close to the patient Bed 2 (Jastremski, 2000).
Besides using advanced technology as above for the efficiency and
effectiveness of services to patients, healing environment (healing
environtment) also need to be created. The flexibility of the bed
environment (bedside environtment) can be maximized when all
disedikan a controlled environment in the patient's room.
Thermostats, light switches, sound systems, window blinds and
lain2 must be controlled separately for each patient (Jastremski, 2000).
Pengontrollen noise level (noise) and normal sleep promoting important
as the setting fluid intake.

2.2.2 Music therapy

Besides the environmental modifications as described above,
another way to reduce stress in patients admitted to the ICU is music
therapy. The aim of music therapy is to reduce stress, pain, anxiety and
isolation. Several studies have examined the effect of music on patients
being treated physiology and found that music therapy can lower heart
rate, cardiac complications and increase the temperature ferifer in AMI
patients. Also found that music therapy can reduce stress patients
(Jastremski, 2000; Harvey, 1998; White, 1999).
Music that used to be the sound of water, the sound of rain, wind
noise or nature sounds (Jastremski, 1998). Each - each patient is given a
headset to listen. Reduction of light in the evening will also reduce
stressors for patients.
2.2.3 Involving his family and facilitate family in the care of critically ill
patients
 An Environmental ICU must be able to accommodate the needs of
patients and their families (Jastremski, 2000). Patients must be very
expect emotional support from family (Olsen, Dysvik & Hansen, 2009)
therefore need to be more flexible visiting hours. During visiting hours
only 2 times a day. This needs to be modified, especially for someone
who is very meaningful for the patient. Besides, the family should be
given a comfortable waiting room with bathroom facilities, TV and
internet connection (Hamilton, 1999).

Figure 1. Waiting Room Families Less Support

 Figure 6. Example of Supporting Family Waiting Room

2.2.4 therapeutic communication

Nurses and other health professionals often forget or lack of
attention to the problem of communication with patients and their
families. Based on the systematic review conducted by Lenore & Ogle
(1999) to the study of communication nurse in the ICU patients in
Australia found that nurses in the ICU communication is still very poor
even though they have a very high knowledge about therapeutic
communication.
This is also experienced by the author when his close friend treated
in the ICU. He was in hospital ICU nurses K is very ttdak consider her
feelings and patient when communicating. Very supportive and tend to
apathy. Another study by McCabe (2002) in Ireland with
phenomenology approach also shows the same thing. However, the
nurse can do a good and effective communication with patients when
nurses use person-centered care approach.
 Figure 3. Critical Nurses Communicate With Patients

Person-centered care is a term used in health care to describe

pilosofis approach to a particular mode of care (certain models in
nursing). The main concept of person-centered care is a commitment to
find a nursing service needs of individuals in the context of pain
experience, personal beliefs, culture, family situation, lifestyle and the
ability to understand what is perceived by the patient. This approach
requires nurses to move beyond just the health needs of the patient to
the ability to understand and be responsive to the inner world of the
individual - membuka world of experiences and what this means to
them (Hasnain, et al., 2011; Clift, 2012 ).
 CHAPTER III
COVER

3.1 Conclusion
Patients - patients admitted to the ICU all subjects were patients - patients
who are experiencing a critical situation. Critical circumstances is a condition
where the patient's critical illness are particularly at risk of dying. At this critical
state patients experience psychosocial problems seriously enough and therefore
needs serious attention and handling as well as from nurses and other health
professionals who merawatanya. In providing nursing care in these critically ill
patients, nurses must demonstrate a professional attitude and sincere with a good
approach and communicate effectively to the patient.

3.2 Suggestion
This paper is expected by the students are able to determine and implement
psychosocial aspects in critical keperawatn and what efforts can be made to to the
problem - the psychosocial issues that occur in the critical nursing particularly in
patients, family, yourself, and other health personnel.