(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.