APPLICATION OF CONCEPTS FROM CARING SCIENCE
Assignment Prompt
Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two. Identify the concept in Watson’s Theory of Caring that could represent or include the outcome. In our example, the outcome would be the changes in self through the change in the patient’s floor covering practice. Identify a practice that can be changed or implemented that may influence the outcome. Identify the concept in Watson’s Theory of Caring that includes the practice. In our example, the practice could be to improve the understanding of fall hazards through the engagement in a teaching-learning experience, one of Watson’s Caritas Processes. Identify exactly how these two concepts will be measured with their operational definitions. Develop a proposition between the two. Present your outcome in an APA formatted paper meeting the University’s standards for a written assignment.
Length: 5 to 7 pages including title and reference pages
References: 3 to 10. There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring. Use peer reviewed nursing references from last 5 years.
ANSWER
Application of Concepts from Caring Science
Introduction
Over the years, patients surviving life-threatening illnesses in the Intensive Care Units have continued to increase. However, most of the ICU survivors and their family members have suffered long term implications that result in post-intensive care syndrome (PICS) to an extent of hospitalization or readmission of the patient. Post intensive care syndrome is psychological, cognitive, and physical consequences that affect ICU survivors and family members. Cognitive impairment has occurred in more than 30 to 80 percent of the ICU survivors (Rawal, Yadav, and Kumar, 2017). Psychiatric illnesses such as depression, anxiety, and post-traumatic stress have occurred to more than 50 percent of ICU survivors (Rawal, Yadav, and Kumar, 2017). This paper will focus on improving post-intensive care to manage of PICS and PICS-F for ICU patients through critical care that includes a multi-disciplinary approach to eliminate the long term implications on ICU survivors. The paper will describe the efforts to eliminate PICS and PICS-F through ICU diaries to foster teamwork and coordinated communication between the ICU staff, family members, and the patient that will improve the quality of life.
Post Intensive Care Syndrome
Due to the advanced approaches in health care as well as healthcare changes, more people have been surviving critical illnesses within the ICU (Rawal, Yadav and Kumar, 2017). However, the nurses and physicians are focusing on the immediate short term results of the patients rather than the long term outcomes of the ICU survivors. Studies have revealed that the patient and family members experiences a combination of mental, emotional, and physical symptoms which persevere after the patient is discharged (Rawal, Yadav and Kumar, 2017).
Research indicates that even though survival has improved in the ICU, a large number of the patients have failed to get back to their normal levels of operation for months and to some even ages (Blair, Eccleston, Binder, and McCarthy, 2017). ICU survivors develop the emotional, body as well as mental symptoms that are linked to treatment approaches within the ICU. Ideally, this is because most of the ICU survivors have a memory gap as well as unpleasant recall after leaving the ICU. Therefore, these are memories are linked with the development of post-traumatic disorders, anxiety, and depression which lead to PICS.
Post intensive care syndrome linked impairments have a profound influence on family and patient lives. Considerably, a large number of the ICU survivors require assistance in their daily activities which results in the family members having to shift their work-life to provide care. Some of the family members develop depression and anxiety due to the post-intensive care syndrome that can persist in hospitalization thus being termed as PICS-family. To reduce and prevent PICS there is a need to prevent cognitive, psychological, and physical consequences during and after ICU hospitalization thus improving the quality of life.
The major risk factors for PICS include the presence and duration of delirium, prolonged mechanical ventilation, lack of knowledge and awareness, and hyperglycemia. Most of the patients cannot afford medications or follow-up and in-home physical therapy due to financial constraints. For instance, the introduction of the Post ICU clinic model was aimed at improving the quality of life for the ICU survivors. The Post ICU clinic consists of a team-based approach that may comprise of nurse practitioners, physicians, occupational therapists, pharmacists, physical therapists, and psychologists. However, this model has failed to improve the quality of life through critical care since they offer standard care that fails to care for post-intensive care complications.
Considerably, reducing post-intensive care syndrome can drastically improve the quality of life for the ICU survivors as well as their family members. There are various interventions that the healthcare providers can focus on to prevent the development of cognitive, psychological as well as physical health issues associated with ICU hospitalization. The focus of these initiatives is to reduce long term cognitive impairment.
Watson Theory of Transpersonal Caring
The concept of Watson’s theory can be used to establish a positive outcome for ICU survivors and family members suffering from PICS. Watson’s theory is focused on transpersonal caring by the care providers to ease the suffering by families and patients. The theory pays attention to the centrality of human care as well as the transpersonal relationships and its potential to improve the health outcome (Willis and DM, 2017). The transpersonal caring process refers to the human connection and its influence on the healing process. Considerably, the concept of transpersonal caring can lead to a positive outcome of post-intensive care syndrome through a positive healing process for the family and the ICU survivor.
Watson’s science of caring focuses on how the nurses express their care to patients and the humanistic approach of nursing. Watson in his theory stresses on humanistic approach which entails attending to biophysical, social-cultural, and spiritual individual needs (Willis and DM, 2017). Relatively, Watson adds that the goal of care is to help in achieving the highest level of coherence within an individual’s body, soul, and mind. Nursing approaching within the caring-healing process can be used to assist the healing process of a patient after leaving the ICU.
Among the 10 Caritas processes in the theory of transpersonal caring, Watson points out all ways of knowing and resourceful use of self as a fragment of the caring practice (Willis and DM, 2017). This means that artistry practices can be utilized to eliminate PICS and PICS-F. Prevention and management post-intensive care syndrome can be done through ICU Diary. ICU diary will contribute to reduced PICS and PICS-F. According to Watson, the ICU diary is considered as a combination of art and science since this process involves artistic approaches and scientific methods to create an artistic, creative and personal approach of care to the ICU survivors and their families.
ICU Diaries
Ideally, the family members and patients are often unaware of the challenges encountered by the ICU survivors after discharge. This results from poor communication, lack of information, and awareness. Relatively, patients in the ICU are under invasive treatments that involve mental and physical stress. Patients admitted to the ICU tend to suffer from delusional memories and memory loss linked to the events that occur in the Intensive Care Unit such as deep sedation and severe pain. Most ICU survivors only recall the events that happened within a state of delirium after being discharged from the ICU. Distorted memories are prevalent within the ICU survivors which can lead to depression, anxiety, and post-traumatic disorder after discharge.
As part of the nursing care for ICU survivors and their family members, ICU diaries are effective tools for the family members and the patient after discharge. This is because they offer information regarding the ICU experience from the ICU admission, daily treatment, daily life, and persons that came to the ICU to visit the patient (Blair, Eccleston, Binder, and McCarthy, 2017). ICU diaries are written by the family members, the medical staff, and nurses. The patients and family members can share information from the ICU which is an effective way of filling the memory gap and offer a sense of coherence. Evidence-based research practices have indicated that ICU diaries have effective health and life outcomes for ICU survivors and their families.
Clinical trials have been carried to examine the impact of ICU diaries in the mitigation of post-intensive care syndrome and quality of life for patients and family members. Studies have indicated that ICU diaries are long term perspectives of reducing depression and anxiety after discharge. The ICU diary has also enabled the family members to lower their psychological stress thus relieving them from acute stress symptoms. For instance, the ICU diary is written in sincerity which offers a way of discerning family frustrations, increasing family satisfaction, and improving the patient’s life through identifying where additional knowledge and education are needed.
The current recommendations are aimed at eliminating PICS and PICS-F as well as improving the quality of life for the ICU survivor through the transpersonal caring approach. Considerably, the transpersonal caring approach will focus embedding in family and patient-centered care to promote the presence of the family in the ICU encounter, support decision making on treatment as well as enhance communication. Coordination and communication of care are essential in empowering and engaging the patient and the family members. Ideally, the symptoms of PICS can be reduced through knowledge and engagement.
Family members should be made aware of what is happening to the patient to remain engaged in the caring process. The family members play a great role in improving the care of patients through decision making and care. Therefore, involving the family in patient care addresses the expectations of the family members. ICU diaries act as communication channels and mechanisms to help them withstand the tough times and the overwhelming emotional situation. Through reading the diaries the family members can document their presence for the patient, express their affection and love. Reading through the diary also makes the family members aware of the time, value, and commitment of the care providers thus perceiving the human dimension of care providers.
ICU patients on mechanical ventilation lack an understanding of what transpired during that moment due to their critical illness. Mechanical ventilation leads to lack of memories and memory gaps which may affect the ability of the patient in coping up with the situation due to limited knowledge. Therefore, offering knowledge to patients is essential in ICU care. Knowledge can be offered through diaries to build on patient’s awareness and improve distorted memories (Fukuda, Inoue, Kinoshita & Yukawa, 2015). ICU diaries can be implemented by the family and care providers to meet a particular criterion to lower the likelihood of developing post-intensive care syndrome. For instance, patients that stay long on mechanical ventilation tend to lose their memory. Therefore, to reduce the syndrome, a diary can be kept at the bedside where the care providers and family are encouraged to write the daily happenings. The care provider can write the timeline regarding care practices and the procedures that the patient encountered while in the Intensive Care Unit.
Keeping an ICU diary is beneficial to the family members and the patient after the patient survival in the ICU. This is because ICU diaries have been linked to reduced depression, anxiety, and post-traumatic disorder as well as improved health and quality life after a long stay in the ICU (Barreto et al., 2019) The intensive care diaries enable the patients to make sense of themselves after leaving the ICU. This is because the diary offers a timeline of the encounters of the patient in the ICU. The ICU diary project supports health assessment efforts such as monitoring delirium scores and also encourages good communication between the patient, nurses, family members, and the team involved in the caring process.
To improve the effectiveness of Post ICU care, a particular focus on various guidelines is needed during the implementation of the ICU diary. The diary entries will be handwritten by the family members, medical staff, and nurse looking after the patient. The diary entries are required to include facts such as the recovery process, day to day activities, and treatment of the patient. The interaction with caregivers and the family members need to be mention. Additionally, the patient’s interaction with the medical staff and family members as well as the patient’s response to care needs to be mentioned.
The outcomes of the families and ICU survivors using the diary can be measured to assess the effectiveness of implement the ICU diary. The outcome of the nursing practice can be measured by utilizing surveys that can allow the collection of essential qualitative data. The family members and patients using the ICU diaries can be gauged three to five months once discharged to examine the PICS and PICS-F condition.
The proposition amid the concepts is that if the ICU dairy project is implemented properly, the family members and the care providers will engage in an effective caring process that improves the patient outcomes to eliminate post-intensive care symptoms. Utilizing Watson’s theory of transpersonal care and clinical trials, an improvement in care for ICU survivors and their family members can continue to be established to mitigate PICS and PICS-F. Considerably, the goal of care providers is to offer better health outcomes and high-quality care to both the family members and the ICU survivor through reducing the challenging outcomes linked to PICS and PICS-F.
Conclusion
In summation, critical illnesses and ICU stays have a great psychological impact on families and ICU survivors. Post Intensive Care syndrome has resulted in post-traumatic disorders, stress, and anxiety due to the memory gap resulting from ICU stays. Therefore, due to lack of effective care after ICU discharge, ICU survivors and family members experience PICS and PICS-F which affect their quality of life. ICU diaries have been considered effective care practices that could eliminate PICS and PICS-F alleviating depression, anxiety, and post-traumatic disorders due to effective communication and improved patient experience after discharge. ICU diaries project will improve the health outcome and nursing care practices for ICU survivors by eliminating PICS and PICS-F.
References
Barreto, B. B., Luz, M., de Oliveira Rios, M. N., Lopes, A. A., & Gusmao-Flores, D. (2019). The impact of intensive care unit diaries on patients’ and relatives’ outcomes: a systematic review and meta-analysis. Critical Care, 23(1), 411.
Blair, K. T. A., Eccleston, S. D., Binder, H. M., & McCarthy, M. S. (2017). Improving the patient experience by implementing an ICU diary for those at risk of post-intensive care syndrome. Journal of patient experience, 4(1), 4-9.
Fukuda, T., Inoue, T., Kinoshita, Y., & Yukawa, T. (2015). Effectiveness of ICU diaries: improving “distorted memories” encountered during ICU admission. Open Journal of Nursing, 5(04), 313.
Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive care syndrome: an overview. Journal of translational internal medicine, 5(2), 90-92.
Willis, D. G., & DM, L. S. (2017). Watson’s philosophy and theory of transpersonal caring. Nursing Theorists and Their Work-E-Book, 66.
