INTRODUCTION

A literature review is an account of what has been already established or published on a particular
research topic by accredited scholars and researchers. (College of Nursing All India Institute of
Medical Sciences, New Delhi). The purpose is to establish the context, identify gaps, and
highlight key themes or debates within the existing body of work.

A well-executed review of literature typically includes the following components:

1. Introduction: Clearly defines the scope and purpose of the review, outlining the specific
research question or objective.

2. Inclusion Criteria: Describes the criteria used to select and include literature in the review,
such as publication date range, types of sources, and relevance to the research topic.

3. Organization: Organizes the literature logically, often chronologically or thematically, to

guide readers through the evolution of ideas and research in the field.

4. Critical Analysis: Evaluates the strengths and weaknesses of each source, highlighting
methodologies, key findings, and limitations. This critical analysis helps establish the
credibility and reliability of the existing literature.

5. Identification of Gaps: Points out areas where the current research falls short or where
additional investigation is needed, emphasizing the contribution the proposed research aims
to make.

6. Synthesis: Synthesizes information from different sources to build connections, identify

trends, and draw overarching conclusions or themes relevant to the research question.

7. Citations and References: Provides accurate citations for all sources consulted, following a
specific citation style (e.g., APA, MLA).
REVIEW OF LITERATURE RELATED TO ASSESS THE
ENVIRONMENTAL STRESSORS AMONG PATIENTS ADMITTED
IN MEDICAL INTENSIVE CARE UNIT.

1. Semra Bulbuloglu, Cinar, and Gulsum Nihal Çuruk, (2022) conducted this
study was conducted to evaluate the effects of environmental stressors on
patients’ intensive care experiences in medical, surgical, and COVID-19
intensive care units (ICUs). The study aim to evaluate how environmental
stressors impact the experiences of patients in medical, surgical, and COVID-
19 intensive care units (ICUs). Observational study design (likely retrospective
or prospective cohort). My sample size 231 patients admitted to medical and
surgical ICUs who agreed to participate. Two possible instruments were used
(study doesn't explicitly state which) Intensive Care Unit Environmental
Stressors Scale (ICUESS) - measures patients' perception of environmental
stressors, Intensive Care Experience Scale (ICES) - assesses a patient's overall
ICU experience. Results A negative and moderate correlation was found
between ICUESS scores (environmental stressors) and ICES scores (patient
experience). This means higher perceived stress correlated with a worse ICU
experience. COVID-19 patients scored higher on the environmental awareness
subdimension of the ICES, despite experiencing the same stressors as other
patients. The study suggests that environmental stressors have a significant
negative impact on a patient's ICU experience (approximately 13.9%). It's
important to note that this is a single study, and further research is needed to
confirm these findings.

2. Hacer Karaer et al. published in 2021 by investigated the environmental

stressors perceived by patients in the surgical intensive care unit (SICU) and
how it related to their satisfaction with nursing care, he researchers aimed to
identify and explore environmental stressors perceived by patients in the SICU
and examine how these stressors are associated with satisfaction with nursing
care The study included 83 patients hospitalized in the surgical intensive care
unit [Link] researchers used a Patient Information Form and the
Intensive Care Unit Environmental Stressor Scale to collect data, The study
found that the most significant stressors for patients were pain, inability to sleep,
lack of privacy, boredom, and short visiting hours. Interestingly, patients
 reported less stress from factors like hearing phone sounds or nurses being
preoccupied with medical devices rather than the patients themselves. the study
suggests that addressing these environmental stressors and providing good
nursing care can significantly improve a patient's experience in the SICU.

3. Maja Sterk, Natasa Fidler, Breda Zagar Koncilia (2021) Perceived Severity
of Stressors in the Intensive Care Unit: A Systematic Review and Semi-
Quantitative Analysis of the Literature on the Perspectives of Patients, Health
Care Providers and Relatives This study aimed to analyze existing research on
how patients, healthcare providers (HCPs), and relatives perceive the severity
of stressors in intensive care units (ICUs). The researchers wanted to Identify
the most frequently reported stressors in ICU settings. Compare how patients,
HCPs, and relatives perceive the severity of these stressors. This was a
systematic review, meaning they analyzed data from multiple previously
published studies. The study didn't use a single instrument as it analyzed data
from various prior studies. The analysis revealed Patients, HCPs, and relatives
all identified similar stressors in the ICU. Interestingly, patients generally rated
the severity of stressors lower compared to HCPs and relatives. Some of the
most frequently reported stressors included Pain Inability to sleep Lack of
privacy Emotional burden related to patients' condition Communication
difficulties with staff.

4. Corinne S. Lessard et al. (2021) conducted a study an international tool to

measure perceived stressors in intensive care units: the PS-ICU scale The
objective of this study was to develop and validate a reliable and internationally
applicable tool to measure perceived stressors in intensive care units (ICUs).
The aim of the study, The researchers aimed to create a scale specifically
designed for ICU professionals (nurses and physicians) that would Identify a
wide range of stressors relevant to ICU work. Be applicable across different
countries and healthcare systems. The methodology this was a three-phase study
conducted between 2016 and 2019. Here's a breakdown of the phases
Researchers interviewed ICU nurses and physicians from four countries
(Canada, France, Italy, and Spain) to identify specific stressors they experience
in their work environment ,Based on the interviews, a provisional 99-item scale
was developed and pre-tested with a smaller group of ICU professionals from
 the same countries, The refined 50-item PS-ICU scale was administered to a
larger sample of ICU professionals across the four countries to assess its validity
and reliability. The study used Instrument the newly developed PS-ICU scale, a
50-item questionnaire that measures perceived stressors across six broad
dimensions, Lack of fit with families and organizational function in Patient- and
family-related emotional load, the sample size 497 ICU healthcare professionals
from Canada, France, Italy, and Spain. The study result found that the PS-ICU
scale demonstrated good psychometric properties (meaning it's a reliable and
valid measure). It effectively captured a range of stressors specific to ICU work
environments and functioned well across the different countries involved.

5. Junling Wang et al. (2019) conducted study The Influence of Environmental

Stressors on Intensive Care Unit Patients' Experiences. This study investigated
how exposure to environmental stressors in the ICU is associated with patients'
experiences during their stay. The aim of the study researchers wanted to
explore how, the presence of various stressors, the severity of those stressors
the duration of exposure to stressors. Methodology was a multicenter
observational study. Researchers recruited adult patients who were admitted to
the ICU of one of three general hospitals in China for at least 48 hours. The
instrument Instruments employed a two-part data collection process researchers
collected information about patients' demographics, medical conditions, and
ICU length of stay, Stressors and Experience Measures, This tool assessed
patients' exposure to 30 different environmental stressors in the ICU. Sample
size of the study included 300 patients admitted to the ICU. Results of the study
found a positive correlation between exposure to environmental stressors and a
negative ICU experience. Here are some key takeaways, Patients exposed to a
higher number of stressors and for longer durations reported lower satisfaction
with care.

6. Yucel Gultekin, Seda Banu Akıncı, and Halil Kaya Yorgancı (2018)
conducted a study on Physical and psychological stressors adversely affect the
treatment and length of stay of patients in intensive care units. The aim of study
to describe environmental and psychological factors affecting ICU patients
using the Intensive Care Unit Environmental Stressor Scale (ICUESS) and to
determine the priorities of these factors, especially in patients who did and did
 not undergo surgery, The Methodology ICUESS was administered to patients
in the General Surgery Intensive Care Unit (GSICU) and the Anesthesiology
and Reanimation Intensive Care Unit (ARICU) in Hacettepe University School
of Medicine. The patients’ age, gender, marital status, educational status, cause
of hospitalization, and ICU length of stay were questioned and recorded. The
sample size 98 patients, 80 in the General Surgery Intensive Care Unit and 18
in the Anesthesiology and Reanimation Intensive Care Unit, and total patient
(188) were included in the study between May 1, 2015 and October 31, 2015.
Fifty-six of the patients were male (57.1%) and 42 were female (42.9%). The
mean age of the patients was 55.1±15.1 years. The instrument used data
patients’ age, gender, marital status, educational status, cause of hospitalization,
and ICU length of stay were questioned and recorded. the result shows that
elimination or modification of these factors would contribute positively to the
treatment of intensive care unit patients and shorten their length of stay in the
intensive care unit.

7. Hana Locihova et al (2017) conducted study Patients' and Health Care

Providers' Perception of Stressors in the Intensive Care Units This study aimed
to compare how patients and healthcare providers (HCPs) perceive stressors in
the intensive care unit (ICU). the aim of study he researchers wanted to, Identify
the most common stressors reported by both patients and [Link] the
severity of these stressors between the two groups. The methodology was a
descriptive comparative study. Researchers recruited patients who had been
discharged from the ICU and the nurses who cared for them. Data was collected
through pairing (patient-nurse). Family members were not included in this
specific study. Instrument of the study used a Czech version of the standardized
questionnaire, The Environmental Stressor Questionnaire (ESQ). This
questionnaire likely asked about various aspects of the ICU environment and
how stressful patients and nurses found them. The sample size study included
90 participants: 30 patients, 30 nurses who cared for the patients, and 30 family
members (though the analysis focused on patient-nurse comparisons). The
results patients, nurses, and family members all identified similar stressors in
the ICU. Interestingly, nurses and family members tended to rate the severity of
stressors higher than the patients themselves. Pain, lack of sleep, and feeling out
 of control were some of the most frequently reported stressors for patients.
Nurses perceived inability to communicate and lack of control over the patient's
situation as significant stressors.

8. Ismail Azizi-Fini, Mohsen Adib – Hajbaghery, Roya Ahmadi (2016)

conducted a study aimed to compare patients’ and nurses’ views of the traumatic
stressors inherent in intensive care units This study aimed to compare patients’
and nurses’ views on the stressors to be found in intensive care units, This cross-
sectional study was conducted on 120 patients who were hospitalized in ICUs
and 60 nurses who worked in the ICUs at Shahid Beheshti Hospital, Kashan,
Iran, in 2014, My sample size120 patients who were hospitalized in intensive
care units, as well as 60 nurses who worked in the intensive care units, in Iran
in 2014. The study instrument consisted of two parts, namely a demographic
questionnaire (age, sex, level of education for nurses, and length of
hospitalization for patients) and Cochran and Ganong’smodified intensive care
unit environmental stressor scale. The study instrument consisted of two parts,
namely a demographic questionnaire and Cochran and Ganong’s modified ICU
environmental stressors scale (ICUESS) (20). The demographic questionnaire
consisted of questions about the nurses’ age, sex, and marital status, as well as
the patients’ age, sex, marital status, education level, and length of stay in the
ICU. The result shows mean scores of the stressors were 123.23±17.81 and
125.16±17.35 from the nurses’ and patients’ viewpoints, respectively (P >
0.05). A lack of control over urine and stool, fear of death, pain, and having a
tube in the mouth or nose were the most important stressors from both the
patients’ and nurses’ viewpoints.

9. Nurdan Yıldırım, Gülseren Kocaman in (2014) conducted a study This study

aimed to explore the connection between stressors experienced by patients in
the ICU and their overall experience in that setting. This study aimed to explore
the connection between stressors experienced by patients in the ICU and their
overall experience in that setting. The researchers wanted to identify, The types
of stressors patients encounter in the ICU. How these stressors are linked to a
patient's satisfaction with care and the presence of frightening experiences
 during their stay. This was a descriptive, cross-sectional study. Researchers
recruited patients who had been admitted to the general ICU of a university
hospital for at least 24 hours. The study utilized two instruments Intensive Care
Experience Scale: This tool assessed patients' experiences in the ICU, including
satisfaction with care and presence of frightening experiences. A researcher-
developed questionnaire: This questionnaire gathered information about
patients' sociodemographic characteristics, details about their illness, and the
specific stressors they encountered during their ICU stay. The study found a
positive correlation between certain stressors and a patient's ICU experience.
Here are some key takeaways. Increased noise levels (equipment and
surrounding conversations) were linked to a more negative experience. Patients
who reported feeling thirsty or lonely tended to have a less positive experience.
Conversel, the inability to speak and limitations on physical activity were
negatively associated with satisfaction with care. the sample size of the patient
is 116 suggests that some restrictions might be perceived as stressful, even if
implemented for the patient's safety.

10. Angélica Adam Barth et al. (Sep - oct 2014) conducted study Stressors in the
relatives of patients admitted to the intensive care unit study aimed to identify
and categorize the main sources of stress experienced by relatives of patients
admitted to the ICU. The researchers wanted to understand which aspects of the
ICU environment and patient condition caused the most stress for relatives. the
methodology was a cross-sectional, descriptive study. Researchers recruited
relatives of patients admitted to the adult ICU of a teaching hospital between
April and October 2014. The instrument used a questionnaire containing three
sections, Identification information and demographics of the relative, Clinical
data of the patient,25 stressors adapted from the Intensive Care Unit
Environmental Stressor Scale (ICUESS) Relatives rated the severity of each
stressor on a scale of 1 (not stressful) to 4 (very stressful). the s ample size the
study included 72 relatives of patients admitted to the ICU. The result of study
found that the most significant stressors for relatives were, The patient being in
a coma Uncertainty about the patient's prognosis, Lack of information from
the medical team, Feeling helpless and unable to comfort the patient, The ICU
environment itself, perceived as aggressive and threatening.
SUMMARY

Studies suggest that assess the environmental stressors among patients

admitted in medical intensive care unit.

Here's a breakdown of the key points:

• Improved patients care: Research indicates that found a positive correlation

between exposure to environmental stressors and a negative ICU experience.
Here are some key takeaways, Patients exposed to a higher number of stressors
and for longer durations reported lower satisfaction with care.
• Reduced Complications: Pain, lack of sleep, and feeling out of control were
some of the most frequently reported stressors for patients. Nurses perceived
inability to communicate and lack of control over the patient's situation as
significant stressors.

CONCLUSION

Intensive care unit Environmental stressors scale for observe patient perception
outcomes in patients who have a brief review on patient admitted in medical
ICU Research suggests these programs can be particularly beneficial for:

• Improved patients care: It effectively captured a range of stressors specific to

ICU work environments and functioned well across the different countries
involved.

• Reduced Complications: Interestingly, nurses and family members tended to

rate the severity of stressors higher than the patients themselves. Pain, lack of
sleep, and feeling out of control were some of the most frequently reported
stressors for patients.
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