الفهرس 
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Abstract
Apatient is admitted into ICU when she/he requires constant observation from the medical team because the medical condition is serious or the patient is post major surgery. Several studies identified psychological repercussions of ICU stay, caused by a combination of physical pain, physical environment, and isolation from family, apprehensions about the medical outcomes, dependency and loss of autonomy. Known as ICU trauma, they include intense adverse emotions such as fear, anxiety, agony, loneliness, bewilderment, depersonalisation, hopelessness and acute confusion, feelings of purposelessness and loss of confidence (dependency and vulnerability powerlessness, frailty and vulnerability and feelings of insecurity (Harding, et al., 2019).
Bio-psychosocial approach includes the influences of biological factors, psychological factors, and social factors when looking at overall health. The bio-psychosocial approach focuses on the biology or physiology underlying health; the psychology of thoughts, feelings, and behaviors influencing health; and the ways that society and culture all influence health. The bio-psychosocial approach allows the health care providers to see how health changes not only biologically, but how the patients’ inner thoughts and feelings and the society around them influences their perception and determination of health (Bolton, & Gillett, 2019).
The aim of this study is to:-
Assess bio-psychosocial and educational needs for critically ill patients through.
1) Assess physical needs of critically ill patients.
2) Assess psychological needs of critically ill patients.
3) Assess social needs of critically ill patients.
4) Assess educational needs of critically ill patients.
Research questions:-
1) What are the physical needs of critically ill patients?
2) What are the psychological needs of critically ill patients?
3) What are the social needs of critically ill patients?
4) What are the educational needs of critically ill patients?
Research design:-
A descriptive exploratory design was utilized to achieve the aim of this study.
Setting:
The study was conducted in ICU unit at Benha teaching hospital, which located at 4th floor and included 24 beds distributed in 8 rooms. The researcher selected this setting because she is teacher at the technical institute of nursing/Benha teaching hospital and responsible for teaching and training the second year students in the selected previously mentioned setting.
Subjects:
A purposive sample of 285 patients was selected from the previously mentioned setting, according to the following criteria:
Tools of data collection:-
Data was collected using the following tools:
I: Patients’ interview questionnaire:
This tool was developed by the investigator in Arabic language based on reviewing of the related literatures (Moseley, 2020 and Obestendorf, 2018) and it included the following parts:
First part: Demographic characteristics;It involved items related to including age, sex, marital status, level of education, work, and work nature.
Second part: Patient’s clinical data; it included items related to present history and past medical history.
Three Part: Patients’ knowledge; it used to assess patients’ educational need related to disease, medication, nutritional regimen and importance and allowed or contraindicated activities.
II: Patients’ physical assessment sheet.
It was developed by investigator after reviewing related literatures to assess patients’ physical needs including respiratory system, cardiovascular system, gastrointestinal system, elimination system, nervous system, skin system and musculoskeletal system, mobility (ADLs) and pain.
III: Patients’ Psychological assessment Scales:
It used to assess phychological need of critical ill patients’ under anxiety and depression scales.
I V: Patients’ Social Dysfunction Rating Scale:
It was used to assess social need among the patients’ under study.
Pilot study:
A pilot study was carried out on 10 % of study subjects (29 patients) to test clarity, feasibility and applicability of the data collection tools. The subjects who were included in the pilot study were included in the study sample because no modification was done after conducting the pilot study.
Results:-
The results of this study reveled the following:
• Less than half of patients (49, 8%) were in the age group between [40-60] years’ old, and (98, 9 %) of them were married. Concerning to their educational level (52, 6%) of them were not read and write, 61, 8% of them not work, and for (75%) of them was crafts.
• More than half of patients’ (54%) had satisfactory level of knowledge regarding disease and therapeutic regimen. While, 46% of them had unsatisfactory level of knowledge
• Physical needs mean score among of the studied patients was the highest mean scores regarding total body systems need followed by pain & ADLs (16.14 ± 6.34, 7.6 ± 5.4&3.2± 3.7) respectively.
• Around the half of the studied patients’ under study (50, 5%) had severe anxiety level and (45, 1% &38.9%) of them had mild to moderate and sever depression level respectively.
• Around the half of the studied patients’ under study (50, 9%) had sever social dysfunction
• There was statistically significant relation between patients’ educational need and their demographic data concering gender (with p value.037*).
• There was a statistically significant relation between patients’ physical needs and their demographic data; age, gender, education & work nature of at p- value P<0.05.
• There was a highly statistical significant relation between total anxiety level of the studied patients’ and their demographic data; age& marital status at p- value (0.001**).
• There was a high statistically significant relation between total depression level of the studied patients’ and their demographic data;age & gender& marital status and work at p- value <0.001.
• There was highly statistically significant relation between the studied patients’ social needs and their demographic data; age, marital status, education& work with p value 0.001.
• There was highly statistically significant positive correlation between physical need, psychological, social and educational needs at (0.18**,.608* &.667**) respectively. Also there was highly statistically significant positive correlation between psychological need and social & educational needs at (0.34**& 0.26**).
• Finally highly statistically significant positive correlation between social need and educational need at (.828**) among the studied patients.
Conclusion
Based on the finding of the current study, it can be concluded that:
Regarding educational need, less than half of studied patients had unsatisfactory level of total knowledge about disease and therapeutic regiment. Regarding physical needs of the studied patients, the highest total mean scores were regarding total body systems need followed by pain and activities of daily living respectively.
As regards psychological needs, more than half of the studied patients had severe anxiety level and more than one third of them had severe level of depression. Which refrected high need level. Moreover than half of the studied patients had severe level of social dysfunction which indicated high need level.
Recommendations
The results of this study projected the following recommendations:-
• Health education for critical ill patients should be started from the first day of their admission to the intensive care unit and continue after discharge.
• A simplified and comprehensive booklet should be available for critical ill patients including the most information regarding disease, therapeutic regime and self-care after discharge.
• Multidisciplinary team approach is necessary for management of critical ill patients for meeting the studied bio- psycho social & educational needs.
• Further studies are recommended to study the effect of designing and implementing educational program for nurses based on the studied bio-psychosocial and educational needs assessment for critical ill patients to improve nurses’ performance and consequently enhance the quality of life for such group of patients.
• Replication of this study on large number of the patients in different critical care units in different hospitals is recommended to generalize the study results.