Using psychologically informed care to improve mental health and wellbeing for people living with a heart condition from birth: A statement paper

Abstract

Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract).

An exploration of psychological trauma and positive adaptation in adults with congenital heart disease during the COVID-19 pandemic.

“…Further, our findings suggest that for this population the Adverse and Traumatic Experiences subscale, Personal Health influences the PTG subscale, Appreciation. This finding should be interpreted with caution, in the context of a population who have lived with health adversity from 'cradle to grave' often being told they are 'lucky to be alive' (Morton, 2020). However, having faced lifelong adversity this population may experience positive adaptation through increased appreciation following adverse life experiences, consistent with previous PTG studies (Stellar et al, 2015).…”

“…Feeling powerless, vulnerable and socially isolated whilst facing additional psychosocial stressors are risk factors which may contribute to the increased prevalence of PTSD reported in the CHD population (Morton, 2020). Findings from this study indicate the pandemic may be further exacerbating these factors with over half of participants reporting changes to their usual cardiac care during the pandemic and most reporting that they feel worried about becoming infected and seriously ill with the virus.…”

“…Certain risk factors increase vulnerability of developing a psychological disorder following exposure to psychological trauma including feeling helpless, poor social support, an accumulation of adverse events, other life stressors and pre-existing physical and mental health problems (Brewin, et al, 2000;Zeligman et al, 2017). Whereas protective factors can improve mental health outcomes mitigating the impact of psychological trauma including adequate social support and help seeking (Wilson et al, 2005) being able to control some aspects of what is happening, being able to access appropriate psychological support (Morton, 2020) and underlying 'assumptions' about the benevolence of the world, the meaningfulness of events, and the worthiness of the self (Janoff-Bulman, 1989).…”

“…Widely considered a success story of modern medicine, infants diagnosed with CHD today have over a 95 percent chance of reaching adulthood in comparison to 55 years ago when only 25 percent survived (Ooues, 2018). However, CHD is not curative and members of this population often endure a lifetime of medical monitoring and interventions with increased exposure to a range of psychosocial stressors that contribute to this increased psychological morbidity (Morton, 2020).…”

“Pain talk”: A triadic collaboration in which nurses promote opportunities for engaging children and their parents about managing children’s pain

“…Despite not yet being fully embedded in clinical pediatric practice, alignment to the concept of atraumatic care was evident in the nurses’ “pain talk” and their understanding of the importance of minimizing distress. More contemporary approaches to atraumatic care can be seen in the move to the use of psychologically informed care which aims to mitigate the challenges that procedures and interventions pose to children's short‐ and longer‐term mental health and well‐being 30 . Improvements such as promoting a soothing presence, promoting feelings of safety, providing appropriate emotional support, developing a healing environment, empowering children, and informing therapeutic practice 30 are evident in both nurses' “pain talk” and the efforts the nurses in our study went to create a positive “pain” experience for the children.…”