The Psychological Stresses of Intensive Care Unit Nursing

Work in the ICU provides formidable stresses for nursing personnel. A major problem is the repetitive exposure to death and dying, posing threats of object loss and personal failure. Defensive distancing techniques support continuing function but raise secondary adaptive problems. The impossible work overload and lack of gratification from obtunded patients add to the problems of maintaining self-esteem. The special nature of the work promotes communication breakdowns with physicians, relatives and nursing and hospital administration, leading to lack of support from these crucial groups--indeed added stress. The necessity for intimate cooperation leads to intragroup tensions. These and similar factors are examined in terms of their psychological and interpersonal demands and the adaptive maneuvers to which they give rise. From an analysis of these, measures are suggested for the structural, procedural and administrative improvement of the ICU; the role of a liaison psychiatrist is discussed.