Talk therapy

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By the time I walked into Mr. P’s room, I just wanted ICU rounds to be over. It had been a long week. I was tired and I really wanted to sit down and take a mental break.

Mr. P was resting in bed, and his son was talking on a cell phone. He quickly hung up, then apologized, “I’m sorry, I was just talking to my sister.”

“No worries,” I replied. “Would you like to call her back? Would she like to listen in on rounds?”

Mr. P’s son called his sister. Locked in her bathroom, to get a few minutes away from her two toddlers, Mr. P’s daughter instantly became an active member of her dad’s team. We passed the cellphone from her dad’s nurse, to his pharmacist, and then to his physiotherapist, social worker and doctor. She asked us great questions, while answering our questions about how best to manage Mr. P’s symptoms.

Mr. P has lived with a permanent disability for over 20 years. His daughter has been his primary care giver and medical historian for much of that time. She knows him better than anyone else, whether it be regarding his wound care, medications, pain management, or therapies.

The expertise she shared helped us improve the care we were providing. Personally, I was energized by the whole experience. The look on Mr. P’s face as he listened to his daughter teach us about his care was a mix of pride and gratitude. The fatigue I carried into his room was lifted.

I wouldn’t have thought to have a family member call in to an everyday bedside rounds if Mr. P’s son hadn’t been talking on a cellphone that day. I’ve done many planned family meetings via teleconference but never a spontaneous one like this. I was reminded of Mr. P and his children as I read some of the recent emails on the Canadian Critical Care Google group.

Last week a nurse educator posed a question to the 700-odd members, asking about ICU policies or guidelines about cellphone and wireless device usage in the ICU. Two camps emerged.

A few participants raised concerns primarily focused on noise levels in the ICU. A nurse wrote, “My concern with cell phone usage in the ICU is the potential for the place to turn into a zoo… All it takes is one relative in every bay and the noise level increases exponentially.” Other participants raised similar concerns about the noise that could arise if cellphones are allowed in the unit.

But I was heartened that more people spoke up in favor of patients and families using cellphones.

“Technology is here folks, I say embrace it. If you can bring comfort to an ICU patient by giving them some FaceTime with a beloved, distant relative or friend then yes, let’s do it.”

“My suspicion is that families will be respectful and it would be a rarity that they would be loud.”

“[Cell phone] use has been fantastic. I will never forget the young girl who was scared but she was texting her sister who couldn’t be with her – she was about to be intubated and it really helped her.”

I did a double take the first time I saw one of my patients texting while intubated. I’m used to critically ill patients sitting up, awake, waving at me from their beds. But texting?!

To those who are reluctant, I say try it! Use your QI skills and curiosity to do a quick PDSA examining the effect of letting patients and families use cellphones in the ICU for a week. Measure the impact. Ask families, patients, and nurses how the week went. Analyze what you find, then share the results as a comment to this post. I’m interested to hear about your experiences.

Photo Credit: IronRodArt – Royce Bair (NightScapes on Thursdays)’s

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10 Responses to “Talk therapy”

  1. Shari Watson
    July 30, 2012 at 9:44 am #

    I remember the first time I suddenly realised we could use a cell phone to allow a daughter to say a final good bye to her dad. He was dying in our unit and his daughter was unable to get to the hospital. Whatever made me think of it, I don’t recall, but I have never forgotten it. I suggested we place a cell phone to her dad’s ear ( he was ventilated but still awake but very week) she was able to speak to him, he smiled when she was talking.
    I have seen this done a few times since, most recently my aunt(in Scotland) was able to say goodbye to my mom. Technology is a fabulous way to keep the human spirit intact.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      July 30, 2012 at 9:57 am #

      Hi Shari.

      Technology in the hospital can both create and break down barriers. Thank you for sharing your stories with us. And thank you for championing patient and family centred care within our hospitals.

      Susan

  2. Trish Paton
    July 20, 2012 at 11:05 am #

    What great insights. We do tend to think of devices (at least those that aren’t part of care) in a bit of negative light – I’m sure there are still lots of “no cells” signs in our facilities. The mainstream discussions about social media isolating people is also widespread. Your example, though, shows the opposite effects. The ability for family members to be part of the care conversations without having to be physically there seems like nothing but wins all around to me.

    I hadn’t thought at all about the texting functions for intubated or otherwise unable to speak patients – but what a great connection to add to the mix.

    There may, indeed, be particularly noisy cell users, or those using on the floor inappropriately – but we can gently remind those folks to respect that the floor isn’t private, and that calls should be care related. We can even make that part of the care conversation right at the start of the process, so families and patients know that it’s welcomed but has some boundaries. And if we had a way to provide support for someone who doesn’t have a cell, or Face Time, and a family member who does – well, small things to make the patient and family more informed and at ease seem like pretty useful tools in the kit.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      July 30, 2012 at 10:06 am #

      Hello Trish
      Thanks for adding your observations and ideas to the conversation.

      You are right- social media can disconnect us from being in the moment (How many times today have you swerved out of the way of someone walking while looking at their iPhone?) but social media can also help us to stay connected or even reach out to others for help in times of need. I’m thinking about emails, texts, twitter feeds and blogs created by patients and families as they experience an illness.

      Since writing this post I’ve had many other families round with me using their cellphones. And what a great tool FaceTime has proven to be!

      Have a great day in Alberta!

      Susan

  3. Dan Florizone
    July 18, 2012 at 7:06 pm #

    This is an incredible example that reflects “Patient First” in action. This patient and her daughter experienced exceptional care and communication. The vast majority of patients and their families have cell phones – providing connectivity through data and voice from the palm of their hands. With the proliferation of cell phones – I wonder what other ideas we could generate that could generate and excel the kind of care experience we strive for? Thank you for this.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      July 18, 2012 at 9:21 pm #

      Hi Dan and thanks for your comments.

      Cellphones have allowed all of us to stay far more connected to each other than we have in the past. I’m loving the spontaneity and flexibility cellphones add to our communication back and forth with families. I’m not sure what took me so long to realize this! Historically we expected families to wait (and wait and wait) at the bedside if they wanted to talk to the doctor. That would drive me crazy if I was that family member. While our daily rounds occur in the ICU on a fairly regular schedule, it’s unrealistic to expect or demand that family members must be physically present to be involved.

      I’m sure we could do postop visits (and much more) for patients using FaceTime. I’ve seen expensive robots that create video links between remote sites and tertiary centres – an iPad or iPhone could easily do the same for a few hundred bucks. We just need to think differently.

      Susan

  4. Heather Thiessen
    July 17, 2012 at 9:16 pm #

    Hi Susan.

    Who would have thought a simple cell phone could make the whole difference in the world to a family knowing how their loved one is doing. How wonderful this is to include a family member who cannot make rounds. I am so proud of the wonderful strides you and many members of the ICU team are making to make sure no family member is without the knowledge of how the ICU patient is doing.

    My only wish is that we can somehow clone you and show other wards how it can be
    done.

    Keep up the amazing work!!!

    • Dr. Susan Shaw
      Dr. Susan Shaw
      July 18, 2012 at 9:23 pm #

      Thanks, Heather! Keep challenging us all to shift the way we do things to be more centred on the needs of our patients and families.

      Susan

  5. Carolyn Thomas
    July 17, 2012 at 11:36 am #

    Thanks so much for this, Dr. Shaw. It almost seems like a no-brainer, though, doesn’t it – let’s include the patient’s family members/caregivers in the care team?

    Technology is the only thing that makes this question slightly different than what should be basic protocol anyway. I hope your challenge to other ICU staff provokes some positive changes for patients.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      July 17, 2012 at 8:37 pm #

      Hi Carolyn, and thanks for adding your thoughts. It does seem like a no-brainer once you give it a try. I now round everyday in our ICUs with families at the bedside both in person and, increasingly, by cellphone. It’s made a huge difference to my practice and my joy at work.

      But this would be quite a change in practice for many physicians and nurses. It was scary for me the first time I tried it but I’m very glad I did!

      Susan

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