Psychological and emotional support for patients in the intensive care unit: the role of the nurse

Abstract

Patients admitted to Intensive Care Units (ICUs) face extraordinary physiological and psychological stressors that may significantly affect their short- and long-term well-being. While the primary focus in ICU care traditionally centers on physiological stabilization and life support, an increasing body of evidence suggests that psychological and emotional dimensions are equally crucial to patient recovery. The complex and often overwhelming ICU environment can precipitate a range of psychological reactions including anxiety, fear, confusion, hallucinations, and emotional detachment. These experiences, if left unaddressed, may contribute to long-lasting psychological morbidity, including post-traumatic stress disorder (PTSD), depression, and post-intensive care syndrome (PICS). This master’s thesis explores the critical role that nurses play in providing psychological and emotional support to ICU patients, with a particular focus on the ICU at Kindred Hospital South Florida, Hollywood. Nurses are uniquely positioned to recognize and respond to the psychosocial needs of critically ill patients due to their close proximity, continuous presence, and holistic approach to care. However, despite the acknowledged importance of emotional support, many ICU settings continue to lack formal protocols, adequate training, and institutional emphasis on the emotional care dimension. The primary aim of this study is to evaluate the effectiveness, scope, and limitations of nurse-led psychological and emotional support in the ICU. The study seeks to understand current practices, identify common challenges encountered by ICU nurses, and explore patients' perceptions of the emotional care received. Through both qualitative and quantitative methods, the study gathers evidence that informs best practices and policy recommendations for improving the psychosocial climate of critical care environments. The study was conducted at Kindred Hospital South Florida, Hollywood ICU, and involved both nursing staff and recently discharged ICU patients. Data were collected through structured interviews, self-reported questionnaires, and observational checklists. Nurses were asked to describe their approach to emotional support, perceived challenges, and institutional facilitators or obstacles. Patients, in turn, reflected on their ICU experience, their emotional state during hospitalization, and the perceived impact of nursing interventions on their psychological well-being. Findings from the study reveal that emotional distress is nearly universal among ICU patients, although its intensity and expression vary widely. Common stressors identified include fear of death, feelings of helplessness, loss of control, physical pain, communication difficulties, and sleep deprivation. Patients who received consistent and compassionate emotional support from nurses reported lower levels of fear and anxiety, stronger trust in the care team, and a more positive overall ICU experience. Nurses employed a range of emotional support strategies, including therapeutic communication, presence at the bedside, empathetic listening, touch, patient advocacy, and reassurance. However, nurses also reported substantial barriers to providing consistent emotional support, such as high workload, insufficient staffing, limited training in psychological care, and lack of formal institutional guidelines or protocols addressing psychosocial needs. Importantly, the study identified that nurse-patient interactions characterized by active listening, continuity of care, and respect for patient dignity had the strongest positive impact on emotional well-being. Conversely, patients who experienced abrupt care transitions, lack of communication, or impersonal interactions were more likely to report emotional detachment and persistent psychological symptoms post-discharge. The findings of this research underscore the urgent need to integrate structured emotional support into the standard ICU nursing practice. To this end, the study proposes a multifaceted nursing framework that includes: • Incorporating emotional assessment tools into routine ICU patient evaluations; • Providing training programs for nurses focused on psychological first aid, trauma-informed care, and therapeutic communication; • Embedding emotional care protocols into ICU guidelines and nursing workflows; • Strengthening nurse-patient continuity to foster trust and individualized care; • Establishing institutional recognition and support for emotional care as a core component of ICU nursing. The scientific novelty of this work lies in its practical, real-world exploration of emotional support practices in the ICU, a subject often underrepresented in clinical guidelines despite its significance. By grounding the study in firsthand observations and experiences from a functioning ICU in the United States, the research provides valuable insights into both the universal and context-specific dimensions of psychosocial care in critical settings. From a practical standpoint, the outcomes of this study offer actionable recommendations for healthcare institutions, nursing educators, and policy-makers seeking to improve the quality and humanity of intensive care services. The results also highlight the need for ongoing interdisciplinary collaboration between nurses, psychologists, physicians, and families to ensure holistic and compassionate care delivery. In conclusion, this thesis affirms that emotional and psychological support is not a secondary aspect of critical care but a central, therapeutic intervention essential for the well-being and recovery of ICU patients. Nurses have both the potential and responsibility to deliver this care, but to do so effectively, they require institutional support, appropriate training, and systemic integration of emotional care principles into ICU practice. Recognizing and addressing the emotional needs of patients can transform the ICU experience from one of fear and isolation to one of dignity, compassion, and healing.