Mind mapping on 'Communication in Pediatric Cardiac Intensive Care Unit' in collaboration with intensive nursing care

 

Samruddhi S Bhakare

Assitant Prof., Sadhu Vaswani Colleeg of Nursing, Pune

 

ABSTRACT:

Pediatric cardiac intensive care is a rapidly developing specialty that caters to the needs of children with heart disease. Communication in this intensive care unit is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm. Good communication in the critical care area is an expectation from patients, their families, and professional societies. Good communication is also an important concept in family-centered care that warrants deliberate ongoing communication. The ICU nurse is poised to be a key contributor of efforts to improve communication with patients and families in the ICU because they have always been strong advocates to meet the patients' needs. Indeed, because of the time spent in constant attendance at the bedside of the critically ill patient, ICU nurses build relationships with patients and their families. Often, the ICU nurse has in-depth knowledge of the patients' or families' concerns that has not been realized by other providers. As bedside caregivers, the ICU nurses are the professionals who have the most interaction with patients and their families in formal and informal ways. Armed with knowledge and skills of effective intensive care strategies, such as proactive communication, the ICU nurse is poised to be a major advocate to improve communication in the ICU with patients and their families.

The purpose of this article is to review the issue of communication in the PCICU, highlight strategies that may improve communication in the PCICU, and further stimulate the discussion about integrating how nurse can use the mind mapping concepts to improve communication in PCICU.

Conclusion: communication in the ICU is challenging and complex. The nurse's role is important in any strategy to improve communication. Developing ICU nurses' mastery of communication skills is gaining momentum as an effective strategy. The ICU nurse can be a key contributor to good, effective communication for PCICU patients and their families.

 

 

 

INTRODUCTION:

Pediatric cardiac intensive care is a rapidly developing speciality that caters to the needs of children with heart disease. With increasing complexity of heart repairs in the current era, dedicated pediatric cardiac intensive care units (PCICU) have become a necessity for the management of these critically ill children. Dedicated intensive care units (ICU), run by the multiprofessional team is known to produce better outcomes¹. The PCICU is a highly specialized area of expertise requiring acute assessment skill, development of critical thinking while understanding the implications of growth and development on physiologic and pathophysiologic process. It provides an environment for safe, effective, 24-hours nursing care to critically ill patients. ²

 

In developing countries including India, the development in PCICU physical facilities, man, material, equipments are well equipped and children are cared for at the best, but need for best communication lacks yet. Children's hospitals face unique challenges when they try to make practical improvements in their communication with children and family members. Effective communication is more crucial and often more complicated than it is with adult patients.

 

Communication in the intensive care unit (ICU) is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm.³

There are valuable techniques, tools, strategies that healthcare providers can utilize to communicate more effectively with even the youngest children who are admitted for treatment to hospitals, as well as with the family members who accompany them.⁴

 

Three types of communication challenges are found in this setting: those within the ICU team, those between the ICU team and the patient or family, and those within the patient’s family.³

 

As bedside caregivers, the ICU nurses are the professionals who have the most interaction with patients and their families in formal and informal ways. Armed with knowledge and skills of effective intensive care strategies, such as proactive communication, the ICU nurse is poised to be a major advocate to improve communication in the ICU with patients and their families.⁵

 

Times have changed, however, and so have our patients and their parents. In today’s scenario, patients are health care consumers, we are providers, and the traditional doctor-patient relationship has changed. Patients and parents today demand information, courtesy and time. Arrogance, taciturnity, and a generalised lack of communication skills are no longer acceptable to health care consumers.⁶ Regarding the provision of nursing care to children, words and behavior have a significant value. Hence, both verbal and non-verbal communication influences the reality in which the child is considered, changing their perception and allowing the establishment of effective communication.⁷

 

Apart from critical care of children, good communication is good medicine. It enhances the environment in the Critical Care unit, adherence to management care and has a therapeutic effect and better outcome.

 

Need for the study:

The Joint Commission on Accreditation of Health Care Organization (JACHO) has noted that poor communication is a factor in majority of sentinel events in the Critical care unit. The 2006 JACHO national safety patient goals include several requirements for improving communication throughout the hospital. The ideal communication system is difficult to achieve in health care for several reasons including authority gradients, time and physical restraints, technology limitations and perception that team work is not essential to good patient care outcomes.⁸

 

Society of Critical Care Medicine (SCCM) have suggested ICU clinical practice guidelines for caretakers in 2008(updated) and highlighted communication with families as an important nursing intervention. Family satisfaction improved and psychological distress decreased when ICU clinicians utilize communication skills that inform and support patients and families. Despite this evidence, communication with patients and their families continues to be sporadic and limited.⁹

 

Critical care nurse may need to undertake family liaison duties, such as providing support and education to both the patient and the patient’s family.¹⁰

 

It is important for the health care members of the Critical care area to be good communicators, but in our critical care unit, however, this essential component is still largely neglected. The nursing requires an education, administration, and innovation and research infrastructure that will foster and support the expert nursing practice along with communication.¹¹ Many medical and nursing institutes have started imparting the practice and skills for effective communication.

 

Communication in PCICU is best explained by a Mind Map Concept.

Mind mapping is a simple technique for drawing information in diagrams, instead of writing it in sentences. The diagrams always take the same basic format of a tree, with a single starting point in the middle that branches out, and divides again and again. The tree is made up of words or short sentences connected by lines. The lines that connect the words are part of the meaning.

 

 

Figure1: Mind Map on Communication in PCICU

 

 

Table1: Concepts of the Map explained:

1.	Pre-rounding Phase:	i. This deals with the Nursing shift change.
		ii. Hand over to day shift staff.
		iii. Strictly remember to avoid communication error
		iv. Do clinical assessment
		v. Synthesize data in a daily progress note.
		vi. Formulate a tentative day plan
2.	Multidisciplinary rounds:	i. PCICU Intensivist leads the round.
		ii. Prefer Emergency conditions first
		iii. Comprehension presentation of patient data to the team in an uniform structure to be followed by all.
		iv. Incorporate a ' Daily Goal chart' for focusing care.
3.	Communication with the family:	i. Family centered care in PCICU should be corporated
		ii. Presence of family members during decision making rounds.
		iii. Keep family updated regarding progress of child, current physical status, details of illness, major concerns in next 24  hours, anticipated duration of ICU stay, economic consideration.
4.	Establishing Policies and Procedures:	i. Controlling practice variation in delivering quality patient care
		ii. policies and protocols to be communicated regularly to all health care members.
		iii. Keeping policies & procedures periodically reviewed and updated according to currently available evidence.
		iv. Critical evaluation in each situation to provide an individualized approach to client care.
5.	Data collection system:	i. Maintain accurate records. ii. Clear and complete recording of client status
		iii. Electronic medical records to be learnt and followed, practiced as it is the need of the hour.
6.	Quality Control:	i. All structure, procedure and clinical activities occurring in critical care to be periodically evaluated.
		ii. HICC (Hospital Infection Control Committee) team to be active and ideal  to reduce chances of infection in the PCICU
7.	Staff Education:	i. Special knowledge area education to the team regarding Humanised care to the critically ill child and family.
8.	Leadership Role in PCICU:	i. Administrative Hierarchy to be clearly delineated.
		ii. Leader has vital role to streamline the multidisciplinary teamwork.
		iii. Leader should always be ideally available to guide the team.
9.	Ensuring Team harmony and managing conflicts in the unit:	i. Healthy working relationships among team members although varying in professional profile, clinical skills, knowledge and managerial capacities. ii. Maintaining team co-operation and team spirit by all.
10.	Dealing with patient complications:	i. Avoid attempts of blaming others. ii. Identify the complications, its root cause, analysis to be performed. iii. Changes be made in the protocol and system to prevent similar events in the future.
11.	Decision Making:	i. All experts to combine their clinical skills, past experiences and knowledge to analyze the situation at hand, to decide the best course of action compatible with the current practice guidelines and translate them into action plan at the bedside.
12.	Retention of personnel:	i. More trained and skilled personnel at all levels of care in the department.
		ii. Appropriate time limit in the working hours.
		iii. Offering better incentives helps in retaining the existing personnel.
		iv. Reduce stress, emotional exhaustion and burnout with role diversification in the care unit.
13.	Consideration of cost containment:	i. Reduce expenditure without compromising quality.
14.	Application of Critical Pathway:	i. Early de-intensification in the PCICU. ii. Proper medication management
		iii. Reduction of laboratory tests
		iv. Early extubation
		v. Reduce ICU stay

 

 

CONCLUSION:

Good communication is an art that is so far acquired, developed and improved by experience. However, it can also be taught, and assessed, by means of using maps, guidelines and structured programs. Medical and nursing students will gradually have increasing levels of training in this essential aspect of medicine and nursing. Though formal training is not easily available to doctors and nurses in jobs or practice, we can improve our communication skills with some personal efforts. This will lead to better patient and parent satisfaction and perhaps better clinical outcomes.

 

REFERENCES:

1.        Balchandran Rakhi, Nair S G et al. Dedicated Pediatric cardiac intensive care unit in a developing country: Does it improve the outcome?. Annals of Pediatric cardiology. Jul -Dec; 4(2); 2011: 122-126.

2.        Marcin JP, Rutan E, Rapetti PM, Brown JP, Rahnamayi R, Pretzlaff  RK.. Nurse staffing and unplanned extubation in pediatric intensive care unit. Pediatric Critical Care Med.. May 6(3); 2005: 254-7.

3.        Grant Marian. Resolving Communication challenges in the Intensive care unit. Advance Critical Care Nursing. April-June 2015 Vol.6:123-126.

4.        Balckstone Sarah, Pressman Harvey: Effective Communication in Children's hospitals: A handbook .URL: http:// www.patientprovidercommunication..net/2012

5.        Maria Yolanda Fox. Improving communication with patients and families in the intensive care unit.  Journal of Hospice and Palliative Nursing. Lippincott Williams & Wilkins. 16(2); 2014:93-98    

6.        Mehta Parang M. Communication Skills- Talking to parents. Indian Pediatrics. Vol 4, April 2008:300

7.        Hockenberry Marilyn. Wong’s Essentials of Pediatric Nursing. Elseiver publishers. 2010; 08^th edition: pp.551.

8.        Maheshwari P, Vaidya V, Yadav P. Advances in pediatrics. A. Suchdev, Jaypee publishers, 20122^nd edition.; Vol1. pp.793-795.

9.        Fisher MD. Needs of parents in a Pediatric intensive care unit. Critical Care Nursing. URL: http://www. pubmed 1994;14:82-85

10.     Health Times article: What is a Critical care or Intensive care Nurse? Torrens university Australia. URL:http:/www.medscape. 03.12.2015

11.  Carnevale Franco A. Nursing Care in the Pediatric Intensive Care unit. URL:http://www.researchgate. March 2008. 10.1007/978-1-84800-921-9_8, 1-4.

 

 

 

Received on 29.12.2016          Modified on 15.01.2017

Accepted on 30.01.2017          © A&V Publications all right reserved