The document discusses the critical care environment's impact on patients and families, emphasizing the stress and anxiety faced in the ICU. It outlines the role of nurses in providing psychosocial support through effective communication, noise reduction, and reorientation strategies. The document also highlights the challenges faced by families and patients post-ICU, including relocation stress and potential long-term psychological effects.

1. PATIENT AND FAMILY RESPONSE TO THE CRITICAL
CARE EXPERIENCE.

2. Introduction
•Nurses play a unique role in addressing the needs of
patients and families in a busy and complex
environment

3. Critical Thinking Challenge
•Think about the critical care environment:
•How would you describe the ICU?
•What sights, sounds, and smells do you experience?
•How would your family react to the situation?

4. Critical Care Environment
•Designed for efficient, lifesaving interventions
•Patients and families often have little advance
preparation for the environment
•Stress
•Anxiety

5. •How should ICU environment be???

6. Modification of Environment
•Noise reduction
Acoustical tiles/designs
Soothing music
Private areas for communication between caregivers
and with family members
•Adequate lighting
Natural lighting
Night-day organization
•Design of new units to promote health and safety

7. Quick Quiz!
QN. Which of the following is associated with high
levels of noise in the critical care unit?
a) Alcohol withdrawal syndrome
b) Hypotension
c) Normal oxygen saturation
d) Sleep disruptions

8. The Critically ill Patient
•QN. Which Factors influence Patient responses in
ICU?

9. Factors that influence Patient responses in ICU:
Age
Developmental stage
Prior illness or hospitalization experience
Family relationships and social support
Coping mechanisms
Beliefs about life and death
Spirituality
Cultural considerations

10. •In your opinion what are the top most stressors of
patients in ICU and why????

11. The top most stressors of patients in ICU
Pain
Inability to sleep
Financial

12. “Sharing”
•Have you ever encountered a friend or a relative who
recovered from ICU?
•If yes what did he or she recall while in ICU?

13. Patients’ Recall About Critical Care
•Difficult communication
•Pain
•Thirst
•Difficulty swallowing
•Anxiety
•Lack of control
•Depression
•Fear
•Discomfort
•Difficulty sleeping
•Loneliness
•Thoughts of dying
•Physical restraint

14. How Would You Feel if This Were Your
Family Member?

15. Pts in ICU needs Psychosocial Support (goals)
•Ensure safety
•Reduce sleep deprivation
•Reduce harmful sensory overload
•Increase pleasant sensory input
•Provide reorientation

16. •What are strategies to achieve these goals?

17. strategies to achieve these goals.
•The nurse can do all of these things to provide psychosocial
support.
Communication is a key part of this, providing reorientation
and reassurance to the patient. Talk to the patient.
•Several interventions are effective:
Scheduling uninterrupted sleep time
Reducing sensory noise and light sensory stimulants
Asking family members to bring in meaningful items, such
as photos that can be posted
Using clocks, calendars, and windows to assist in
reorientation

18. Quality of Life After Critical Care
•Discharge from critical care can be difficult for patients and
families
•Relocation stress
Fear of abandonment
New routines
New staff
New roommates
•Prepare patients and family members for transfer from the
unit

19. Quality of Life After Critical Care (Cont.)
•Post–critical care symptoms
oFatigue, sleep disturbance
oPain, muscle weakness
oPoor concentration, impaired memory
oPoor appetite
•Posttraumatic stress disorder may develop in patients or
families

20. Geriatric Concerns
•Diminished ability to adapt to, or cope with, stressors of
critical illness
•Prolonged length of stay
•At greater risk for negative outcomes
Increased mortality
Functional decline
Decreased health-related quality of life

21. Family Members
•Critical illness/injury affects the whole family
•Uncertainty
•Loss of control

22. Family Needs for a critically ill patient.
Receiving re-assurance
Remaining near the patient
Receiving information
Being comfortable
Having support available

23. Care for the family
•Family Bundle A family bundle is to provide structure
for planning and carrying out family care
•The family bundle is based on five concepts (EPICS)
•Evaluate
•Plan
•Involve
•Communicate
•Support

24. VALUE Mnemonic (Care for the family con’t)
•Value what the family tells you
•Acknowledge family emotions
•Listen to family members
•Understand the patient as a person
•Elicit questions from family members