The purpose of this study was to determine the intensity of environmental stressor, posttraumatic stress disorder, and quality of life in ICU (Intensive Care Unit) survivors after intensive care, and to explore the factors affecting posttraumatic stress disorder and quality of life in order to provide objective data on the risk of posttraumatic stress disorder in ICU patients and basic data that could help develop an intervention for reducing posttraumatic stress disorder and for improving the quality of life.
Data were collected from 116 patients who were discharged from ICU in a university hospital in Deajeon, Korea from April 1, 2017 to March 23, 2018. The environmental stressor, posttraumatic stress disorder, and quality of life were measured by the ICUESS, IES-R-K, and EQ-5D-3L respectively. The collected data were analyzed by using an SPSS PASW Statistics 18.0 program to perform descriptive statistics, t-test, ANOVA, Pearson''s correlation coefficients, and multiple regression analysis.

The results of this study were as follows:

1. The average score of environmental stressors (ICUESS) perceived by patients was 1.49(SD=0.38) immediately after ICU discharge. In the category of ICU environmental stressor, the highest mean rating perceived by patients was immobilization, followed by isolation, sleep deprivation, sensory deprivation, disorientation, and depersonalization.

2. The results from IES-R-K revealed that 19 patients (16.4%) reported experiencing posttraumatic stress disorder. The degree of the respondents’ posttraumatic stress disorder symptoms was an average of 7.81(SD=10.04), with 7 patients (6.0%) categorized into the low-risk group for posttraumatic stress disorder and 12 patients (10.4%) categorized into the high-risk group for posttraumatic stress disorder.

3. They scored an average of 0.64(SD=0.32) for the quality of life immediately after ICU discharge and average of 0.82(SD=0.16) for the quality of life 1 month later after ICU discharge. The quality of life was improved over time.

4. The characteristics of patients who showed statistically significant differences in posttraumatic stress disorder 1 month later after ICU discharge were as follows: this study found that there was a significant difference depending on Departments of Medicine (t=-2.32, p=.022), experience of ICU re-entry (t=-2.13, p=.035), previous psychological drug history (t=-2.10, p=.038), using psychotropic drugs and narcotic analgesics in ICU (t=-4.11, p<.001), Demerol (t=-3.54, p=.001), Fentanyl (t=-1.99, p=.049), Codeine (t=-2.49, p=.014), anxiolytic agent (t=-2.03, p=.045), painkiller (t=-3.90, p<.001), and ICU admission after cardiac intervention or surgery (t=-2.08, p=.040).

5. The characteristics of patients who showed statistically significant differences in quality of life immediately after ICU discharge were as follows: this study found that there was a significant difference depending on gender (t=2.39, p=.021), education level (F=4.43, p=.005), prior job before ICU (t=2.20, p=.030), entry route (t=4.91, p<.001). types of ICU (F=16.44, p<.001), sedation status when entering ICU (t=-2.20, p=.029), Departments of Medicine (t=3.32, p=.001), ventilator (t=2.71, p=.008), using psychotropic drugs and narcotic analgesics in ICU (t=3.86, p<.001), Demerol (t=3.67, p<.001), Fentanyl (t=2.80, p=.006), sedatives (t=3.55, p=.001), pain killer (t=3.99, p<.001), restraint (t=2.70, p=.008), APACHE II score (r=-.34, p<.001), basal kidney disease (t=2.63, p=.010), frightening experience in ICU (t=2.54, p=.012),

6. The characteristics of patients who showed statistically significant differences in quality of life 1 month later after ICU discharge were as follows: this study found that there was a significant difference depending on age (t=2.40, p=.018), living with family (t=-2.45, p=.016), prior job before ICU (t=2.63, p=.010), sedation status when entering ICU (t=-3.00, p=.007), experience with CPR (t=-6.13, p<.001), using psychotropic drugs and narcotic analgesics in ICU (t=2.76, p=.007), APACHE II score (r=-.29, p=.002), basal heart disease (t=2.29, p=.024).

7. Factors significantly affecting posttraumatic stress disorder 1 month later after ICU discharge were found that pain killer (β=.392, p=.013) had the greatest impact. followed by environmental stressor score (β=.299, p=.001), experience of ICU re-entry (β=.238, p=.006). These variables accounted for 25.3% of posttraumatic stress disorder 1 month later after ICU discharge.

8. Factors significantly affecting the quality of life immediately after ICU discharge werev found that pain killer (β=-.255, p=.048) had the greatest impact. followed by the ICU entry route (β=-.247, p=.020), APACHE Ⅱ score (β=-.221, p=.009), prior job before ICU (β=-.200, p=.018), gender (β=-.185, p=.038). These variables accounted for 37.6% of the quality of life immediately after ICU discharge.

9. Factors significantly affecting the quality of life 1 month later after ICU discharge were found that posttraumatic stress disorder (β=-.299, p=.001) had the greatest impact. followed by sedation status when entering ICU (β=.264, p=.004). These variables accounted for 29.1% of the quality of life 1 month later after ICU discharge.

In conclusion, environmental stressor is the factors affecting posttraumatic stress disorder and posttraumatic stress disorder is the factors significantly affecting the quality of life 1 month later after ICU discharge. It is necessary to concentrate on nursing intervention to reduce environmental stressors for ICU patients. If Nursing Interventions focused on the immobilization and isolation, which are the greatest stress factors, would not only reduce environmental stress but also contribute to the reduction of posttraumatic stress disorder and the quality of life later.