Impact of diarrhoea in intensive care unit: A questionnaire-based study of effect on workload and mental health among nursing staff.

INTRODUCTION

The intensive care unit (ICU) is a challenging work environment where nursing staff play a vital role in the care of critically ill patients with vigilant monitoring and timely administration of medications, along with the general care of a patient. Nursing is a rewarding and meaningful profession as they make positive impact on the lives of patients and their families.^[1] Many of them are mentally stressed because of high workload, personal issues, understaffing, and they witness constant suffering of the patients, including deaths.^[2] Managing diarrhoea patients is also one such risk factor. Incidence of diarrhoea in the ICU is 12.9-38%.^[3,4] Most used definitions of diarrhoea are the World Health Organisation (WHO) definition (>3 loose stools/24 hours) and the Bristol stool form scale (Types 6 and 7). Diarrhoea in the critically ill impacts patient dignity, exacerbates patient morbidity through dermal injury, impaired enteral uptake and subsequent fluid and electrolyte imbalance and increases nursing workload and ICU costs.^[5,6]

There is limited research on the effect of diarrhoea among ICU patients on nursing workload and nursing mental health. In this questionnaire-based study, we plan to explore the difficulties faced by nursing staff and the effect on the workload and mental health due to diarrhoea in ICU patients.

MATERIAL AND METHODS

This was a questionnaire-based study conducted among the nursing staff working in the ICU. Institutional ethical board clearance was taken for the study, and the study was registered in the Clinical Trials Registry of India (CTRI/2025/11/097154). The study was conducted after obtaining informed consent from the nursing staff working in the ICU with work experience >6 months.

Preformed questionnaire (Online mode-Google forms) containing 16 questions was used to collect basic information of the participant, information on the effect on workload and mental health due to diarrhoea in the ICU. Many questions were based on the need for recovery (NFR) scale, which is a validated tool to assess the work burden.^[7,8]

The sample size for the study was based on Heidegger et al.^[9] according to the formula given by Lemeshow et al, 1990.^[10] With 95% confidence interval, the proposed sample size for the study was 147. Responses were stored in a folder with 100% of response rate. Data was then recorded in an MS Excel spreadsheet program. Descriptive statistics were represented in the form of means/standard deviations and medians/interquartile ranges for continuous variables, and frequencies and percentages for categorical variables. Data was presented in a graphical manner wherever appropriate for data visualisation using histograms/box-and-whisker plots/column charts for continuous data and bar charts/pie charts for categorical data.

RESULTS

Our survey included 246 participants, of which 65.9% were female nursing staff, of whom more than 75% had ICU working experience for more than one year. We included staff working in all kinds of ICUs; the majority of them were from medical (45.5%) and multi-disciplinary (35%) ICUs. 54.5% of the total participants followed the WHO definition of diarrhoea, whereas 34.1% of them followed both the WHO definition and the Bristol stool form chart to define diarrhoea. 96.8% of them agree that more than one caregiver is required to manage a patient with diarrhoea, but more than 63% of the time, extra caregivers are not available. There is a delay in providing other treatment or care to patients with diarrhoea, as per 43% of the staff. The majority of them (78%) get frustrated when they are taking care of a patient with diarrhoea. And the majority of them have trouble concentrating (75%), feel exhausted (89%) and need to be alone (70%) after working with a patient with diarrhoea [Table 1]. All of them (100%) suffer from one or more symptoms of work-related stress, among which headache (53.3%), fatigue (38.6%) and insomnia (30.5%) are common [Figure 1].

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Figure 1: Bar graph representing various overwork and mental stress symptoms among ICU nursing staff. ICU: Intensive care unit

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DISCUSSION

The WHO defines ‘health’ as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Protection and restoration of mental health is very crucial for everyone.^[11] Occupational mental health is a field of public health focused on maintaining and promoting the psychological, emotional, and social well-being of employees within the workplace. Nursing staff are at high risk of work stress and mental health problems with various risk factors, which lead to mental health symptoms.

Managing diarrhoea patients is also a stressful job for ICU nurses, which is often underrecognized. In this survey, we collected responses from 246 ICU nursing staff regarding the work stress and mental burden when they were assigned diarrhoea patients. As mentioned in the results above, nursing staff spend most of their time cleaning the loose stools, and most of the time it requires more than one caregiver, but they are not available many times. More than 75-80% of the ICU nursing staff taking care of diarrhoea patients suffer from one or multiple symptoms of work burden and mental stress, including headache, fatigue, indigestion, anxiety, depression, and insomnia. In our literature search, we did not find any similar survey or study on mental health and work burden among nursing staff taking care of diarrhoea patients in the ICU. It is very crucial to recognise such symptoms early and address them promptly.

There are various tools to recognise and measure these symptoms, which include the hospital anxiety and depression scale (HADS) and the NFR-11 questionnaire.^[7,8] The main purpose of this survey is not only to identify the proportion of problems but also to address them with appropriate measures [Table 2].

CONCLUSION

Mental health and work-life balance are very important in everyone’s life. Nursing staff come across many risk factors affecting their mental health, which are potentially modifiable, like understaffing, overwork, personal issues, limited resources, and the unavailability of extra caregivers. Managing a diarrhoea patient in the ICU is often an underrecognized risk factor. Most of the nursing staff suffer from one or more symptoms of overwork and mental stress. It should be recognised early with various validated tools and with frequent communication. They must be promptly addressed by various strategies from the organisational level to the individual level, including proper staffing, adequate resources, enough breaks from work when needed, self-care and frequent training.