The modern critical care unit is a dehumanized zone, a more or less hostile environment for everyone involved- patients, their families and even care providers irrespective of advanced medical and technical developments

KIMS hospital Trivandrum devised a plan for creating a more humanized environment within its critical care units. Multiple areas requiring intervention were identified with the ultimate aim to offer an optimal intensive care both from technical and humanitarian point of view, the following programs were initiated

1. Flexible visitation policy

Family visits to patients admitted in critical care units traditionally follows a restrictive model. In India patient’s families frequently demand more time with them. Family members often have to align hospital visits with their work and domestic responsibilities and hence a flexible visitation schedule in ICU could should be both attainable and advantageous for patient relatives and health care professionals.

With this in mind we devised a plan for creating a more humanized environment within our critical care units. Multiple areas which required intervention included individualised care and wellbeing of patients, family participation in care, better communication by health professionals, liberal visitation schedules thereby preventing post- ICU syndrome in patients and family members and to block professional exhaustion syndrome in doctors . Creation of a friendlier environment was an important objective

The most responsible surrogate is allowed to visit the patient at anytime during 24 hours with a waiting period of 30 minutes so as to reduce the anxiety among relatives.

2. Improving communication skills

Sessions in communication skills and support strategies were held to promote inter-personal relationship and team spirit among health care professionals. Transfer of information during shift changes and patient transfer to other units are now smoother with effective communication skills.

Information on critically ill and incapacitated patients are tactfully provided and has reduced the friction which often arises between care providers and relatives during the course of a long admission.

Relatives are briefed about their loved ones health condition ten times a day of which four are by doctors which will also reduce the stress of the relatives to a greater extend .Narrative pamphlets about ICU rules are provided to the family at the time of admission.

3. Reducing Patient suffering.

Suffering and discomfort experienced by a critically ill patient may be due to many factors such as physical, psychological and the adverse ICU environment.

These needs were considered as key elements and training to health care professionals was carried out
While admitting a patient into our ICUs, he or she, or a family member, is asked to fill up the ‘KNOW ME CHART’. This helps us provide customized services such as favorite food, music or books to the patient. Ordinary objects such as spectacles go a long way to improve patient comfort. We provide religious books like the Bible, Gita or Quran for patients who ask for them.

We try to provide a fixed number of quiet hours for our patients. Ventilators and monitors are kept at night mode and alarms at low volumes to ensure sleep for six hours. Bed baths and needle pricks are avoided during these “night” hours. We also encourage patients to use ear buds and eye shields at this time.

All nurses carry sound levels /noise level meters to adjust noise levels of monitors/pumps to the recommended levels.

4. Family participation in care

Family members may often wish to participate in patient care and many like to be with their loved ones at times of high vulnerability. If clinical conditions are favorable relatives who desire to participate in patient care are allowed to work with the medical team in some aspects of basic care They are allowed to actively involve in grooming and feeding the patient, and in rehabilitation exercises like mobilization, chest physiotherapy and breathing exercises under the supervision of health professionals.

We ask relatives to keep a daily ICU progress diary of their patients which has helped in reducing ICU syndrome and this is handed over to them at the time of discharge

The presence of relatives during certain procedures has not been associated with negative consequences and is reportedly accompanied by changes in the attitude of professionals, such as greater concern and needfulness, during the witnessed procedure.

5. Detection prevention and management of Post Intensive Care Unit Syndrome (PICS)

The consequences of PICS affect the quality of life of patients and their families. We have assessed anxiety levels of family members with an anxiety scale and compared results of those from a humanized ICU with one that is not and successful efforts has been made to help them come out of it. Specialists in physiotherapy and rehabilitation, psychologists and psychiatrists render the continuous care that is necessary.

We have constituted an ICU survivor WhatsApp group named “PHOENIX’’ involving patients and their families. An after-care clinic in the same name is also run

6. Humanized architecture and infrastructure

The physical environment of ICU plays a key role in improving the physical and psychological states of patients, professionals and family members and we brought about changes in light, température, acoustics, material and finishes, furniture and decor. A wide lobby of curtained windows for day light, ambient music (string/saxophone ) and removal of overhead lights and fitting lights at the foot end and dynamic lighting has been provided using light meter so as to provide diurnal variations to the patients.

To humanize, is to address all facets of patient comfort. This project is being successfully practiced in all the multidisciplinary ICUs of KIMS and we have noted a definite positive change. We believe that the change is essential, a change to alleviate and prevent the suffering of patient, relatives and care givers and we also believe in the moral charge to lead this inevitable change.

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