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Quality of Care

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ICU patients need to feel safe, a feeling that is influenced by family, friends, ICU staff, and other factors

Patients who are admitted to an intensive care unit (ICU) are seriously ill and often very frightened. It is not surprising then that the overwhelming need of ICU patients is to feel safe, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00094). Nurses can intervene in many ways to foster the feeling of safety in these critically ill patients, says Judith E. Hupcey, R.N., Ed.D., C.R.N.P., of the Pennsylvania State University School of Nursing.

Dr. Hupcey conducted unstructured tape-recorded interviews with 45 critically ill adults, who stayed at least 3 days in the medical or surgical ICU of a large rural hospital. She interviewed them once they were stable in the ICU or immediately following their transfer to a general unit. Dr, Hupcey then analyzed the tapes to develop a model of the psychosocial needs of ICU patients.

ICU patients said that the perception of feeling safe was influenced by family and friends, ICU staff, religious beliefs, and the perception that they knew what was happening to them and they were regaining control. For example, if patients felt a loss of control during periods of confusion or they lost trust in the staff, they felt unsafe. Knowing what was happening to them provided reassurance and appeared to help ICU patients "get through a terrible experience." Those who said they did not know or understand their situation began to refuse treatments, fight with the staff, and feel frightened. Some even became paranoid that the staff were "out to get them."

Patients spent enormous amounts of energy trying to pull the pieces of the ICU experience together. At times, families were the source of this information. Patients in families that withheld information from them said they listened to the nurses and physicians during rounds to try to piece together what was happening to them. Nurses can work closely with family members to build trusting relationships with patients and families, and they can include family members as part of the team. Family members in turn can help to provide support for patients.

See "Feeling safe: The psychosocial needs of ICU patients," by Dr. Hupcey, in the Journal of Nursing Scholarship 32(4), pp. 361-367, 2000.

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