Chapter 16: Care of the Highly Dependent and Critically Ill Adult

Ann is a 67-year-old woman, who was cared for within a general critical care unit for an extended period, after developing sepsis post-operatively. She was initially admitted electively to critical care for post-surgery care.

With a medical history of recently developing an acute exacerbation of Crohn’s disease, with developing severity of symptoms and was admitted to hospital for a total colectomy. She also has significant history of COPD and prone to chest infections. Therefore, the decision was taken for her to be admitted to critical care for the immediate post-operative period, to support her needs.

Ann remained ventilated following surgery, she then developed a severe left-sided pneumonia and unfortunately also suffered additional health setbacks, which required her to be supported and nursed within critical care for several weeks.

Following discharge to a general ward, although she remained weak, plans were already in place for her rehabilitation to continue upon discharge home, with support. The day before she was being discharged home, Ann developed confusion and expressed concerns and anxieties as she could not remember her prolonged critical care stay and could not understand why she was so weak. This was naturally very distressing for Ann, her family and the staff.

Ann’s family and the nursing and multi-disciplinary team, attempted to explain to Ann the care she had required within critical care, along with the challenges she had faced during her extended stay. Despite continued reassurances and discussions of events, Ann could not recall much of her last few weeks. This obviously resulted in considerable psychological and emotional distress, not only for Ann but also for her family. Ann’s holistic needs were addressed, and steps taken to support her and her family.

This scenario demonstrates the significance of ensuring person-centred care is provided compassionately, considering the needs of the patient, their family and of staff involved too. Effective communication and interpersonal skills are fundamental in ensuring the patient is cared for holistically.

Questions

  • Take a few moments to consider how you would cope with this scenario?
  • How would you allow the patient to express their anxieties and fears?
  • Which members of the multi-disciplinary team would be involved in providing ongoing care and support on Ann’s discharge?
  • Can you outline the support that would potentially be required following discharge?

Answers

  • Take time to listen to Ann’s anxieties and concerns. Acknowledge that you hear what Ann is saying and reassure her that you will all try to help explain this. Seek support from your mentor, listen to and observe how other staff are communicating with Ann and her family. Refer to nursing notes which will help to explain Ann’s stay and care in critical care. Allow Ann’s family to explain her experiences.
  • Give Ann time to explain and describe how she is feeling, listen attentively to all that Ann is expressing. If Ann becomes more distressed – consider calling other staff to help support Ann; call her family (if not present). Call the outreach team (if service in place).
  • Community team – nursing and social care staff, GP, physiotherapists, occupational therapists, dieticians, spiritual support.
  • Emotional and psychological support; rest and sleep patterns re-established physical support/rehabilitation, wound care, mobility support outpatient follow-up care spiritual support.