When Violet was able to communicate verbally she expressed her fear and anxiety related to memories of ‘voices of concern' (ICU healthcare personnel talking at her bedside) and times when she was ‘gasping for breath' when she was acutely unwell earlier during her ICU stay. Outline some nursing interventions that could have been implemented when she was acutely unwell that may have ameliorated
her fear and reduced the likelihood of her having unpleasant memories of that time.
What will be an ideal response?
Suggested response: When caring for unconscious/heavily sedated patients it is vital to communicate regularly (recognising that many sedative medications cause amnesia) using simple uncomplicated clear sentences and to avoid conducting anxiety-provoking conversations close to the patient's bed. Evidence from interviews with former ICU patients suggests that many critically ill patients are able to hear very well (even though they may be apparently unresponsive) and, what's more, they actually remember feeling a sense of relief when they were informed about what was happening.1 Essential information that should be conveyed to the patient is: • the patient's whereabouts and how they got to ICU • brief unconfronting information about their diagnosis • simple information about the invasive devices and machines attached to them • the people at the bedside and their names and roles • pre-emptive warning of procedures and treatments including what is to be done to them, the approximate time the procedure will take and the likely sensations involved (for example, ‘Violet, you need some physiotherapy for your lungs. The physiotherapist (Jane) and I need to remove the secretions in your lungs. This will take approximately 5 minutes. We will shake your chest gently and then place a small catheter in your airway to suction the secretions. This will feel uncomfortable; you will cough and it will feel like your breath has been taken away for a moment. I will tell you again just before we do this.' In addition, it is recommended that analgesia be administered for any potentially painful procedure and the patient informed that analgesia has been given to reduce the associated pain.2 It is important to note that many of these interventions may have been instigated but Violet did not remember. Importantly, she did recall ‘voices of concern', so that was a potential area for improvement for the healthcare professionals involved in her care.
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