Reducing Social Harm in the ICU

An article in the Boston Globe focuses on the affect that healthcare has on patients–even when they are sedated or in an ICU setting. The results show that many patients, though made well by procedures performed on them, end up still be emotionally troubled and traumatized after the experience. In fact, about a quarter of ICU patients suffer from PTSD in the same way combat soldiers and rape victims can experience it. Here are a couple of highlights:

  1. Under sedation, patients still feel medical staff around them, and the affect of heavy instrumentation beeping at them.
  2. Providing injections in the middle of the night without warning or introducing themselves.
  3. Examiners will walk in the room, push sheet down and examine someone’s body without explaining themselves.
  4. Trainees will come in to watch, when really no approval for their being introduced to the patient’s situation has been made clear to patients and families.

To remedy this, $30 million was provided by the Gordon and Betty Moore Foundation to improve ICU care at several hospitals. These leading hospitals are utilizing iPad apps that serve a few different purposes:

  1. Families are encouraged to download patient biographies that the staff should review before performing on them.
  2. Nurses are keeping journals to fill in the memory gaps under sedation, and to provide context to what was done while in ICU.
  3. Families are also encouraged to write in the journals so as to help “piece together the puzzle.”

The article did not say what ultimate improvements were found from this effort to be more communicative, and less intrusive of patients in ICU. And they did acknowledge that it’s sometimes all they can do in a busy hospital arena to keep patients alive and healthy, much less respond to their psychological comfort. But clearly there is an opportunity for staff to find better ways to provide greater clarity, communications, and respect to patients and their need for modesty and appearance.

As a healthcare provider yourself:

  1. Do you believe that how doctors and nurses treat a patient may add to some social harm?
  2. How could you better demonstrate respect to patients–even under sedation or in an ICU environment?
  3. How much time to you take to personally understand and know the patients you are touching and providing intimate care for?
  4. Do you introduce yourself, or explain yourself to someone under sedation when you enter a room to provide care?
  5. How well do you communicate before, during and after the time a patient has spent in ICU both with the patient and their family?

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