CARING FOR THE VENTILATED PATIENT IN THE NON-ACUTE SETTING
By Magi Livardis, General Manager, ProVita International Medical Centre, Abu Dhabi
‘’step down units’’ to accommodate patients who need both acute and chronic ICU care one has to ask do we really need these? Surely ICU beds need to be used for the acute ICU patient? Chronic ventilated patients usually remain in ICU because there is nowhere else for them to go due to the fact they need qualified ICU staff to monitor and care for them. Many acute care hospitals have, in an attempt to relieve ICUs, added extensions and “Step Down” units in order to clear beds. This caused additional problems as they then had to staff and manage these units. One has to also ask if the hospital is the correct setting for these patients? Hospitals and especially ICUs are not conducive with normalcy. Chronic ventilated patients within ICUs are usually not seen as a priority by staff and, unfortunately because of a shortage of allied medical staff, do not receive the rehabilitatory care that they should. Historically patients from this
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region were sent abroad to Europe for rehabilitation and treatment. Significant medical need exists across the MENA for the provision of care for ventilated patients in an environment that allows them a better quality of life. A long-term care facility considers the
patient’s potential and quality of life not merely their pathophysiology. Patient care should then be mapped with emphasis put on development, nurturing and normalcy with both short-term and long- term goals determined. For the seriously ill, ventilated patient
three core elements impact their sense of wellbeing for a more positive existence: Quality of life - QOL is a broad multidimensional concept that usually includes subjective evaluations of both
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ith most ICUs asking for resources to open additional beds, build extensions or
positive and negative aspects of life. It is a challenge to measure as each individual’s QOL depends on different variables. Although health is important there are other domains, for instance, social situation, family, stimulation, aspects of culture, values, and spirituality. There are things that we cannot change for these patients but by caring for them to the best standard and having the resources and time to ensure that they realise their value does make a difference. A long-term care facility is a patient’s ‘home’ and it should feel that way to them and their families. Human Potential – the ability for each of us to reach goals. Care staff should believe in every patient’s Human Potential and encourage self development. This could be some form of studying or enjoying recreational activities with the required help. Each
day brings new challenges and new joys. The sense of accomplishment they feel in carrying something out for themselves, which to us seems so small, cannot be put into words. Normalcy - Yes they may be on mechanical ventilation but they still have an identity and a presence. Care must reflect the patients age and personality and each one will have different preferences for their everyday activities. For the paediatric patients who have been in ICUs they have not been used to play times, nap times, TV time and bed time. They have no normal routine. For adults it can be participating in their general care or perhaps having their children eat with them. Families should also be encouraged to treat the patient normally. Of utmost importance is that patients and their relatives participate in all areas of decision-making. ■
AH
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