(Nancy Kentish-Barnes)
Critical illness and ICU environment (culture, priorities and architecture) have significant impact on patient and relatives
Arriving in ICU
- Signs / way-finding systems (Davidson Crit Care Med 2007)
- Waiting: initial communication and reassurance, estimating time before pt is ready for visit
- Seeing pt: touching / talking to pt – encourages togetherness
- ICU team: introduction, name badges
- Place: privacy, natural lighting, furniture, positive distractions (art or photos to personalise room), clock (visible to pt)
Patient experience
- Discomforts: question pt, noise from alarms and verbal communications
- Thirst bundle (oral swab, cold water spray, lip moisturiser (Thirst Bundle – Puntillo ICM 2014)
- Restraint alternatives (bed net, sleeper bag, surveillance)
- Psychological distress: music, 5-minute foot massage, relaxation / hypnosis
- Technology: look at patient before machines, eye contact, empathy
- Lack of agency: encourage pt choice to promote sense of control over decisions and own body
- Lack of memory: Post ICU burden include nightmares, memories
- ICU diary: multiple contributors, factual narrative, written messages of caring, transparency
- Vulnerable relatives: anxiety, depression common, understand 50% of medical info
- Visiting policy: prolonged time in waiting room prevents relatives from leaving ICU to self-care, worry re pt welfare / transparency when they can’t see pt
- Child visits: Adapted leaflets for children, also to guide ICU team, child psychologist
- Communication: by far non-verbal cues are picked up over words; family-support pathway (daily nurse communication and at least 2 multidisciplinary team-family meetings)
- Relatives participation in care: listen to pt, relatives
Leaving ICU
- Ward transfer: positive indicator of progress but anxiety/stress due to reduced presence of healthcare team
- Information in anticipation of ward environment: written, family conference, video
End-of-life in ICU:
- Pt’s wishes, spiritual support, family needs
- Acknowledge emotions, elicit questions, understand pt as a person
- Discontinue unnecessary monitoring, tests and treatments
- Increases satisfaction and trust
- Decreases risk of PTSD, anxiety and depression following death
In practice, for units that have not specifically adopted ‘humanising care approach’, start by creating an ICU workgroup to create a dynamic around humanisation – this allows addressing of staff concerns e.g. visiting policies / timing of EOL care etc.