Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
ChapterThree: Treatment
Helpful Tip: Visits in the
Intensive Care Unit
Patients in the intensive care unit (ICU) are particularly
vulnerable, may feel isolated, and commonly have complex
communication needs. Many ICU patients are intermittently
or continually intubated, may require the use of a
continuous or bi-level positive airway pressure (CPAP or
Bi-PAP) machine, or may be at various levels of sedation.
These patients must have unrestricted access to their
chosen support person while in the ICU to provide
emotional and social support. In addition, the presence of a
surrogate decision-maker to participate in care discussions
and advocate on behalf of the patient is vital for the patient
who is unconscious and unable to speak for him or herself.
cultural, religious, or spiritual beliefs or practices. For
example, in some cultures, the patient’s family may want
to light candles under the patient’s bed. The use of
candles may not be permitted in the hospital; however,
one potential compromise is to suggest that the family
use battery operated flashlights instead of candles.
• Note any cultural, religious, or spiritual needs that
influence the patient’s care in the medical record and
communicate patient preferences to staff.
❑ Monitor changes in dietary needs or
restrictions that may impact the patient’s
care.
Dietary needs and restrictions should be identified during
the admission and assessment processes, but new needs and
restrictions may arise because of the patient’s medical
condition or during the course of treatment.
• Inform the patient of any new dietary needs or
restrictions based on his or her treatment or medications.
• Note emergent dietary needs or restrictions in the
medical record and communicate changes to staff.
• Notify the hospital’s food service to accommodate the
patient’s needs.
Example Practice: Identifying
Patients with Communication Needs
The family of a profoundly deaf woman reported that
environmental services staff had not attended to the
patient’s room. Specifically, the bathroom had not been
serviced and the trash had not been emptied. The
environmental service provider reported that nobody
responded each time she knocked on the door. Not wanting
to disturb or wake a sleeping patient, she proceeded to the
next patient room.
While direct care staff were aware through chart review of
the patient’s communication needs, other providers—
whose service contributes to the patient’s quality of care
and comfort—were unaware of her impaired hearing
status. To address this, the hospital created a universal
tracking symbol for hearing status and placed an ‘ear’ on
the door of hearing impaired patients to alert all staff of the
patient’s status.
❑ Ask the patient to choose a support
person if one is not already identified.
Patients should have an opportunity to identify an
individual to provide emotional support, give comfort, and
alleviate fear during the course of the patient’s hospital stay.
The patient’s needs may change along the care continuum,
and a patient who did not choose a support person at
admission or assessment may choose to do so at any point
during the course of treatment.
• Explain the purpose of the patient’s support person,
including limitations if the presence of the individual
infringes on others’ rights, compromises safety, or is
medically or therapeutically contraindicated.
• Make staff aware the patient has chosen a support
person to be present during the course of stay.
• Allow the patient access to the support person at all
times.
• Ask if the patient would like to involve the chosen
support person during rounds, patient education, and
other crucial decision making and care processes. The
support person may or may not be the patient’s
designated surrogate decision-maker.*
* On April 15, 2010, President Obama released a presidential memorandum for the secretary of the Department of Health and Human Services respecting
the rights of hospital patients to receive visitors and to designate surrogate decision-makers for medical emergencies regardless of their
status of legally recognized immediate family members (available at http://www.whitehouse.gov/the-press-office/presidential-memorandum-hospital-visitation).
(Accessed on July 22, 2010.)
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