title: Developing a care program to better know the chronically critically ill.
abstract: Patients requiring prolonged periods of intensive care and mechanical ventilation are termed chronically critically ill. These patients present a challenge to the healthcare team. In the fast-paced environment of the intensive care unit, their slow progress can be a source of frustration. At the University Hospital Geneva, a team, led by a clinical nurse specialist, addressed this problem by implementing a new care program with a goal to better know this patient population and improve their care. Values of emancipatory practice development guided the project, which utilized an action research methodology. Key assessment tools included a nursing focused patient history at admission and weekly nursing rounds, which allowed for periodic holistic assessment and care planning. New interventions focused on communication, physical care, and providing a context of understanding for the patient beyond hospitalisation, operationalised as a patient diary. The structure of the new program allowed the nurses to develop new skills and provided an environment for dynamic reflection. The care of this demanding patient population is beginning to be perceived by nurses as challenging and interesting.
authors.affiliation: Nursing Directorate, Medical Intensive Care Unit, University Hospital Geneva, 1211 Geneva 14, Switzerland. Marie-Jose.Roulin@hcuge.ch
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Roulin
authors.forename: Rebecca
authors.initials: R
authors.lastname: Spirig
mesh_terms: D019985:Benchmarking / Q000458:organization & administration; D002908:Chronic Disease / Q000628:therapy*; D002983:Clinical Competence; D003142:Communication; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000628:therapy*; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D019359:Knowledge; D008134:Long-Term Care / Q000458:organization & administration*; D008487:Medical History Taking; D016294:Models, Nursing; D020380:Needs Assessment / Q000458:organization & administration; D009720:Nurse Clinicians / Q000458:organization & administration; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D018802:Patient-Centered Care / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D015397:Program Evaluation; D012107:Research Design; D013557:Switzerland; D017749:Total Quality Management / Q000458:organization & administration*