The impact of a prolonged stay in the ICU on patients’ fundamental care needs

Abstract

Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes.

The culture conversation: Report from the 2nd Australasian ILC meeting—Auckland 2019

“…On the other hand, nursing colleagues report failures in fundamental care because of unit culture, dominant biomedical models and routines that do not cater to the patient. The example provided was a nurse who told a fatigued patient in ICU, desperate for sleep that he must stay awake demanding he opened his eyes and told him he needed to adjust to the routine (Minton et al., 2018).…”

“…How fundamental care is “done” is being measured (Parr, Bell, & Koziol‐McLain, 2018) in two district health boards (DHBs), and there is a growing emphasis on patient stories and experience measures to help organisations “own” the care that is delivered. Researchers across Australia and New Zealand are actively researching the fundamentals of care and have published their findings (Conroy, 2018; Feo, Frensham, Conroy, & Kitson, 2019; Kitson, 2018; Minton, Batten, & Huntington, 2018). However, questions remain about why the fundamentals of care are still not delivered in a safe, consistent manner.…”

Patient autonomy in a high‐tech care context—A theoretical framework

“…Referring to autonomy in relation to patients in high‐tech care environments could be seen as paradoxical, as in most cases, they are vulnerable and could lack physical and/or metacognitive capacity (Levinsson, ), thus prohibiting them from remaining or becoming autonomous. Nevertheless, patients in high‐tech care environments, for example patients being cared for in intensive care units, belong to a vulnerable group in need of individualised care building on the nurse's ability to acknowledge each and every patient (Minton, Batten, & Huntington, ). There are also difficulties putting this somewhat abstract concept into practice and trying to extend understanding by performing empirical studies involving patients in high‐tech care contexts.…”

“…and/or metacognitive capacity (Levinsson, 2008), thus prohibiting them from remaining or becoming autonomous. Nevertheless, patients in high-tech care environments, for example patients being cared for in intensive care units, belong to a vulnerable group in need of individualised care building on the nurse's ability to acknowledge each and every patient (Minton, Batten, & Huntington, 2018).…”

Fundamental care—the quest for evidence

“…Furthermore, when we think of fundamental care, we often think of hospital care and in this special issue of the journal, and we see compelling arguments for the importance of fundamental care in a range of in‐hospital care settings, including critical care (Minton, Batten, & Huntington, ) and surgical environments (Jangland et al., ). However, in addition to its importance in the hospital setting, excellent fundamental care should occur right across the care trajectory, in all settings, wherever patients are and wherever care is delivered.…”