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NICE should advise post-ICU counselling

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NICE guidance on rehabilitation following critical illness should recommend access to specialist ICU counselling services, say nurse researchers.

Psychological problems are common after a stay in intensive care, yet the majority of trusts do not provide dedicated psychological services, said Christina Jones, nurse consultant in critical care follow-up at St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside.

In 2005 Ms Jones set up a nurse-led counselling service at the trust which she says has significantly reduced symptoms of distress in ICU patients.

She carried out a study of 40 critical care patients, comparing the specialist ICU service with an existing general counselling service. Results are due to be presented this week.

Subjects completed a questionnaire on symptoms, such as anxiety, stress and sleeplessness, before and after they were given counselling. Those in the specialist ICU group reported worse symptoms at baseline than the general group.

However, after the counselling both groups scored similar symptom scores, suggesting the specialist service had reduced symptom levels further than the general service.

Both patients and family members can access the service at Whiston Hospital, which now sees about seven patients a week. Sessions last for an hour to an hour and a half, and patients attend an average of six sessions.

‘A dedicated ICU counselling service is effective in reducing psychological symptoms but is demanding on the skills of the counsellor because of the high levels of dysfunction seen at initial assessment,’ said Ms Jones.

Ms Jones started the UK’s first follow-up service for ICU patients in 1990. ‘Nobody understood how long it took to get better and I started to see a pattern,’ she said. ‘It became apparent lots of patients had psychological problems.’

NICE is due to publish guidance on critical illness rehabilitation in March 2009. The guideline development group is due to meet for the first time in July this year.

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