How do I humanise patient care?

After-care, LIVES 2018 - PARIS

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(Nancy Kentish-Barnes)

Critical illness and ICU environment (culture, priorities and architecture) have significant impact on patient and relatives

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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.