Navigating Behavioral Health Challenges in Critical Care.

Patient-clinician communication is a key factor in provision of quality patient care and resulting outcomes.1,2 In the context of acute care settings, medical interventions and related stress are significant contributors to patient distress, which complicates communication.3,4 Verbal and nonverbal patient behaviors may predictably express meaningful needs and emotions. Conversely, behaviors may manifest as unclear communication randomly representing internal medical or emotional problems—sometimes creating safety concerns.We face challenges providing optimal care for acutely ill patients with behavioral health concerns. Many pressing behavioral health issues pertain to dementia, delirium, sleep disruption, aggression, and psychiatric comorbidities such as anxiety and depression.5–7 These issues may disrupt clinical workflow, impact quality of patient care, and diminish staff well-being.7–9 As technology and electronic solutions grow to manage the expanding health care system workload, our human, nurse-patient connection is more essential than ever.The goal of this symposium is to present actionable recommendations to help experienced and advanced practice registered nurses manage complex patient behavioral situations in acute care. Symposium authors examine dilemmas inherent in behavioral health concerns, emphasizing safety and respect for patients and staff alike. Meaningful patient-staff interaction is emphasized through a variety of positive, proactive approaches. These approaches encompass expert and advanced practice leadership opportunities to shape practice through program development and individualized treatment planning. Symposium topics were intentionally chosen for applicability to both large academic centers and critical access hospitals.This first article, by Delaney et al, provides expert guidance informed by psychiatric nursing principles to examine 5 critical domains of communication that are often overlooked in workplace violence prevention discussions. These domains observed throughout hospital settings, including acute care, reflect individual and institutional core challenges related to nursing practice and culture. Strategies to effectively approach the challenges in the nonpsychiatric acute care setting are proposed throughout the article. The authors address common assumptions about patient behavior that may block engagement—even between expert nurses and patients. Delaney et al present shifts in thinking away from these assumptions.Another important issue in acute care is how leaders support staff following a distressing or traumatic event. Derscheid and McKay highlight the possibility that staff could experience trauma from stressful behavioral situations encountered in acute care settings. Staff responses may depend on event dynamics and available resources after the event. The article offers direction to nurse leaders for ways to foster a supportive culture and outlines practical options following an event.The health trajectory of patients with cardiac illness is often complicated by psychiatric comorbidities. Otte et al describe a partnership between inpatient psychiatric and cardiology services to implement a multidisciplinary psychiatric consultation-liaison (C-L) service. The authors used the DMAIC (define, measure, analyze, improve, control) quality improvement process to develop a proactive, consultative approach for cardiac patients with psychiatric comorbidities and highlight evidence-based interventions by expert psychiatric nurses. This C-L intervention resulted in improved cardiac staff satisfaction and decreased patient readmission rates.Exposure to nature has long been promoted for its numerous health benefits. Tantam and colleagues’ scoping review synthesizes several theoretical perspectives on fresh air and provides evidence for the relationship between exposure to nature and its health benefits. The authors advocate provision of fresh air and natural spaces for patients admitted to the critical care setting. In addition, they emphasize the importance of determining individual patient benefits for this novel intervention. The proposed clinical 4 Ps approach optimizes the patient environment, enhances humanization, and highlights parallel exposure to nature while in the health care setting.Hung and colleagues offer 2 case studies using an innovative approach with robotic pets to foster moments of attention with cognitively impaired patients in acute care. This intervention applies the theory of mattering to embrace the concept that all persons are significant and capable of connection. The authors skillfully navigate risks and benefits of robotic pets to create patient connection; and they encourage thoughtful patient-staff engagement rather than passive patient activity.Use of physical restraints in clinical practice for behavior safety concerns can be complex and controversial. Publications addressing physical restraint use specifically among intensive care patients are rare but important. In this article, González-Gil and Acevedo-Nuevo illuminate considerations for physical restraint use among critically ill patients; and they regard restraints as both a risk factor for delirium and as an indication for patients already demonstrating delirium. From the perspective of Katharine Kolcaba’s Comfort Theory, the authors identify modifiable delirium risk factors and propose a comfort-care intervention bundle to prevent physical restraint use.Hospital stays in intensive care significantly disrupt sleep, which negatively impacts healing and cognition—especially for pediatric patients. Kalvas and colleagues confirm, through their RESTORE Resilience (R2) clinical trial, the disruptive effects of hospitalization on sleep continuity for critically ill children with respiratory failure. Their nurse-led R2 chronotherapeutic bundle intervention, which used hospitalized children’s sleep baseline data, offers hope for improved sleep behavior and timing.This symposium series on behavioral health issues is dedicated to nurses caring for patients who present behavioral challenges in acute care settings. Together, these 7 articles offer strategies to consider for implementation. I hope that something written here resonates with every reader, regardless of their role.