N&AHP Case-based fundamentals: Ethical aspects

By Κατερίνα Ηλιοπούλου, Nikolas Efstathiou (members of the N&AHP committee)

Ethical aspects within decision-making about whether a patient should undertake a significant abdominal operation are intertwined with his/her ICU mobilization plan and psychosocial challenges.

Patients’ views and wishes should be considered in decision-making. Patients and their family need to be appropriately informed about what the outcomes for the patient might be. Autonomy, beneficence, non-maleficence and justice should be integrated with decision-making. Only the patient, having capacity, is to decide what course of actions meet personal perceptions about quality of life.

Patient’s mobilization is based upon several factors, namely, the endotracheal tube tolerance, tolerance to weaning, pain levels. There are cases that the ICU patient may refuse to get mobilized. Therefore, it is important a. the physio team to build rapport with the patient prior to mobilization and b. the healthcare team to keep patients pain-free and to provide reassurance. Discussion about whether and at what extend the operation will affect the patient’s mobility is also essential. Pre-rehabilitation information, including setting realistic expectations with the patient meaningful for his recovery trajectory, should also be provided.

Testimony from a COVID-19 patient from the first wave of the pandemic who developed delirium due to his ICU stay highlighted the need for highly trained and empathetic healthcare providers. The patient has been keeping a personal progress chart helping him to monitor his progress, as his constant fear is that he is performing at a low level due to remaining cognitive deficiencies. He revealed that going back to the ICU was very helpful. He also found of enormous help the support of the outreach team located in his city, Manchester. ICUsteps booklet helped him and his family to get information about what they might experience post ICU. As he was feeling isolated, he reached for help to ICUsteps support group. His ‘take home’ message was that an MDT approach, including collaborative goals for ICU patients experiencing delirium, is imperative.

Check out ICUsteps here