Efforts must be made to humanize intensive care as much as possible. Critical care units should be designed to focus on healing the body, the mind, with especial attention paid to a patient’s emotions. The physical environment has an impact on patient outcomes; the psychological environment can, too. A healing ICU environment will balance both.
A number of elements contribute to a healing ICU environment. The layout of a critical care unit helps create an environment that supports caregiving, which helps alleviate a host of work-related stresses. A quieter environment, one that includes family and friends, dotted with windows and natural light, creates a space that makes people feel balanced and reassured.
Modern intensive care is designed to saves lives. However, the substantial related financial costs are, for many, married to substantial costs in terms of suffering. In the sickest, the experience of intensive care is commonly associated with the development of profound physical debility, which may last years after discharge. Thus, home intensive care is an important concept for all seriously ill people and the families to explore.
The negative psychological impact experienced by ICU patients during their care is widely recognized, as is the persistence of psychological morbidity. Considering what care is genuinely in the best interest of a particular patient is a critical subject that must be explored by patients and their doctors together.
Dying patients may receive invasive medical treatments immediately before death, in spite of evidence of their poor prognosis being available to clinicians. The difficulties of ascertaining treatment preferences, predicting the trajectory of dying in critically ill people, and assessing the degree to which further interventions are futile are critical issues.
Enduring ethical complexities attending end of life care mean that the process of withdrawing or withholding medical care is associated with significant problems for clinical staff. Often these decisions are best made by families outside the hospital with home intensive care offering more flexibility in this regard.
The perceived differences between ‘killing’ and ‘letting die’ and the cultural constraints which attend the orchestration of ‘natural’ death is a hairline critical issue that sometimes can be worked around with special treatments not available yet in hospital ICU units.
Balancing action with non-action, and sometimes stepping out of the box of officially accepted medical treatments allows the family and one’s medical team leads to a diffusion of responsibility for the life or death of a patient. From the physician’s point of view, it is crucial to incorporate a patient’s family and the nursing staff into the decision-making process.
Obviously open conversations must be held regarding the balancing of the positive and negative impacts of intensive care. Such conversations should extend to individual patients and their families when considering what care is genuinely in their best interests.
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