Humanising intensive care

THIRUVANANTHAPURAM: Critical care has dramatically improved due to medical and technical developments in recent years. This has resulted in markedly better patient survival rates but leaving the modern critical care unit a dehumanised zone, a more or less hostile environment for everyone involved- patients, their families and even care providers.

With this in mind, we devised a plan for creating a more humanised environment within our critical care units. Multiple areas which required intervention include tender loving care and well being of patients, family participation in care, better communication by health professionals, liberal visitation schedules thereby preventing post- ICU syndrome in patients and family members and to block professional exhaustion syndrome in doctors.

Our ultimate aim is to offer an optimal intensive care, both from a technical and a humanitarian point of view. Let us consider a few of these areas.

Flexible visitation policy

Family visits to patients admitted in critical care units traditionally follow a restrictive model. This is based on the concept that frequent family visits interfere with optimal care. But experience in paediatric and neonatal ICUs where family involvement forms the mainstay of patient care suggests that this is a wrong notion.

Our patients’ families frequently demand more time with them. Family members often must align hospital visits with their work and domestic responsibilities, and hence a flexible visitation schedule is found to be more beneficial.

An open door policy in ICU may be both attainable and advantageous for both patients’ relatives and health care professionals. This will need some initial supervision and training from professionals, but we believe that the benefits are considerable.

The most responsible person is allowed to visit the patient at any time during 24 hours with a waiting period of 30 minutes so as to reduce the anxiety among relatives.

Improving communication skills

Training in communication skills and support strategies has been shown to promote unity among health care professionals. Transfer of information during shift changes and patient transfer to other units are frequently necessary, and effective communication skills are essential at these times. Critically ill people are often incapacitated and information about their status must be conveyed frequently to relatives.
Relatives were briefed about their loved ones health condition ten times a day of which four are by doctors which will also reduce the stress of the relatives to a greater extend.

Family participation in care

Family participation in the care of the critically ill patient is limited. A high prevalence of post-traumatic stress, anxiety and depression has been encountered among family members of critically ill patients. This may interfere with the routine work of the medical team. Family members may often wish to participate in patient care and many like to be with their loved ones at times of high vulnerability.
Detection prevention and management of Post Intensive Care Unit Syndrome (PICS)

PICS affects a significant number of intensive care patients after a critical illness. This is characterised by physical symptoms like persistent pain and weakness, neuro- psychological symptoms like disorders of memory, and emotional symptoms like anxiety and depression. Post traumatic stress can also affect the patient’s family members.  We have assessed anxiety levels of family members with an anxiety scale and compared results of those from a humanised ICU with one that is not and successful efforts has been made to help them come out of it.

Humanised architecture and infrastructure

The physical environment of ICU plays a key role in improving the physical and psychological states of patients, professionals and family members.Published guidelines intended to reduce stress and promote comfort suggest changes in light, temperature, acoustics, material and finishes, furniture and decor. Painting walls with a pink colour, providing bedside chairs for relatives and decorating walls with soothing paintings improve the general environment.

Subtle changes produced immense alterations in our ICU ambience. To humanize, is to address all facets of patient comfort. This project has been successfully practised in all the multidisciplinary ICU’s of KIMS from an year and will be implemented in other ICU by the end of 2018.
We have noted a definite positive change from our efforts to humanise critical care.
We believe that the change is essential, a change to alleviate and prevent the suffering of patient, relatives and care givers and we do believe that the intensivist has a moral charge to lead this inevitable change.
 
Dr  R Muraleedharan, Consultant  Intensivist, KIMS Hospital Thiruvananthapuram

(The views expressed by the author are his own)