Michael coordinated a collaboration study with the Tweed and Lismore Hospital Intensive Care Units (ICU)s. The study involves all family members of dying patients who are willing to participate, as well as staff caring for those patients.
The study is being conducted with the Organ Donation Specialist Nurse and ICU Clinical Nurse Consultant and is asking these group of people how they feel about aspects of care relating to symptom control, environment and communication in the ICU during a critical care episode of care.
At the time of Michaels report 20 patients had been included in this study; the intended recruitment number is 100.
Preliminary results show that 100% family members were either ‘completely satisfied’ or ‘very satisfied’ with aspects of care relating to symptom control and communication.
For questions relating to the environment this figure fell to 33-83%.
Amongst staff, 80-97% of responses to questions relating to communication and symptom control were in the top 3 categories.
However only 43-50% of responses relating to the environment were in the top 3 categories.
It is hoped that the results of the survey will reinforce good practice and advise of any improvements that are be needed. Preliminary results suggest that there is some dissatisfaction with the environment of the ICU. Both Tweed and Lismore ICUs are open plan, noisy, old fashioned ICUs, with other patients nearby and little privacy. Efforts are being made to allocate End-of-Life (EOL) patients to more private and separated corner spaces. Efforts are being made to incorporate aspects of the home environment and allow unrestricted access to visitors. So far these areas have undergone a change in walls pattern and a “pull out bed” introduced to allow families to sleep over next to their dying relative. Other issues identified in the survey will be addressed as they occur.
When the study is complete it will be presented at the ICU Managers meeting. It will also be used to advise of areas that need improvement, for example in submissions to obtain funding.
The long term goal should be to provide the opportunity for patients to be palliated in their home. This can be difficult for the complex ICU type patients, and efforts should initially focus on supporting less complex inpatients. In the longer term, there is no reason why this might not be extended to ICU patients.