Symptom management in the intensive care unit: Toward a more holistic approach *

Background The coronavirus disease 2019 pandemic has exacerbated staffing challenges already facing critical care nurses in intensive care units. Many intensive care units have been understaffed and the majority of nurses working in these units have little experience. Objective To describe how the skilled tele–intensive care unit nurses in our health system quickly changed from a patient-focused strategy to a clinician-focused approach during the coronavirus disease 2019 crisis. Methods We modified workflows, deployed home workstations, and changed staffing models with the goal of providing additional clinical support to bedside colleagues while reducing exposure time and conserving personal protective equipment for those caring for this highly contagious patient population. The unit changed focus and granted more than 300 clinicians access to technology that enabled them to care for patients remotely, added nearly 200 mobile carts, and allowed more than 20 tele–intensive care unit nurses to work from home. Results Tele–intensive care unit nursing provided clinical knowledge to the nurses covering current and expanded critical care units. Using technology, virtual rounding, and increased collaboration with nurses, tele–intensive care unit nursing minimized the risk to bedside nurses while maintaining a high level of care for patients. Conclusion Tele–intensive care unit nurses provided a proactive, holistic approach to caring for critically ill patients via camera as part of their routine workflow. In addition, during the coronavirus disease 2019 pandemic, these nurses created a new strategy in virtual health care to be implemented during a crisis.

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Service evaluation of the bereavement care delivered in a UK intensive care unit

British Journal of Nursing ◽

10.12968/bjon.2021.30.11.644 ◽

2021 ◽

Vol 30 (11) ◽

pp. 644-650

Author(s):

Daniel Harris ◽

Petra Polgarova ◽

Lisa Enoch

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Holistic Approach ◽

Service Evaluation ◽

Traumatic Experience ◽

Post Traumatic Stress ◽

Prolonged Grief ◽

Loved One ◽

Death Care ◽

Bereavement Care

Background: Losing a loved one in the intensive care unit (ICU) can be a traumatic experience. The literature highlights that relatives of those who have died in ICU can experience symptoms of stress, anxiety, depression, post-traumatic stress disorder (PTSD) and prolonged grief. Aim: To evaluate the service delivery of the bereavement care that is provided on a 20-bed general ICU. Methods and analysis: A literature review informing and supporting the service evaluation and development of the questionnaire. Thematic analysis was undertaken using the six-phase framework. Findings: Five main themes were found: timing; care, dignity and respect; support; information; and memory making. Bereavement care is described as after-death care. However, the participants stipulated that bereavement care should be discussed prior to the death. Participants described using a range of interventions, such as memorial services, condolence letters, follow-up meetings and diaries. Conclusion: Bereavement care was regarded as an important aspect of the care delivered in ICU. It was evident that participants strived to deliver an holistic approach, yet some found this difficult to achieve.

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Trends in Pediatric Palliative Care Research (TPPCR) 2021; Issue #3: Commentary on Guttmann et al and Dryden-Palmer et al.

10.31219/osf.io/54tky ◽

2021 ◽

Author(s):

Christina Vadeboncoeur ◽

TPPCR

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Critical Care ◽

Intensive Care ◽

Symptom Management ◽

Neonatal Intensive Care ◽

Moral Distress ◽

Pediatric Palliative Care ◽

Pediatric Critical Care ◽

Intensive Care Unit Staff

This TPPCR commentary discusses the 2021 paper by Guttmann et al and Dryden-Palmer et al., “Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff” published in the Journal of Pain and Symptom Management and the 2021 paper by Dryden-Palmer et al., “Moral Distress of Clinicians in Canadian Pediatric and Neonatal ICUs” published in Pediatric Critical Care Medicine.

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Liaison Psychiatry: A Role on the Medical Intensive Care Unit

The International Journal of Psychiatry in Medicine ◽

10.2190/nwmj-y1x5-glqp-5l4d ◽

1982 ◽

Vol 11 (4) ◽

pp. 379-386 ◽

Cited By ~ 2

Author(s):

Nathan Billig

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Setting ◽

Medical Intensive Care Unit ◽

Holistic Approach ◽

Separate Entity ◽

Liaison Psychiatry ◽

Case Conferences ◽

Medical Intensive Care

A psychiatric liaison program on a medical intensive care unit is described. The principle elements of the program include the psychiatrist becoming a member of the MICU “team” via: 1) attendance at morning medical rounds; 2) conducting case conferences; 3) availability to the nursing staff as a separate entity; 4) consulting with the unit directors; and 5) supervising a resident in psychiatry in his consultative work on the unit. The liaison psychiatrist's presence on the team facilitates an holistic approach to the patient and deals with intra-staff and patient-staff reactions in the critical care setting.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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