Creativity in Healthcare

Have you had a family member or friend stay in the I.C.U (intensive care unit) for treatment of an illness?  Those of us who work in the critical care units (past tense in my case) are happy to see patients tranferred to step-down units because we feel we applied our best efforts in getting these patients on the road to recovery…and we did.  We stablized their bodies and healed them physically, but researchers are finding out that spending days, weeks or months on life support in the units can bring unexpected, long-lasting undesireable effects.

According to a New York Times article (Jan. 11, 2009), some patients  experience lingering effects from staying in the ICU for months to years after they are discharged from the hospital, such as:

• Lingering generalized weakness
• 25% of patients on mechanical ventiliation for a minimum of 5 days got so weak, they were unable to lift their arms
• Poor concentration
• Significant weight loss
• Some patients experienced symptoms of PTSD (post traumatic stress disorder) such as hallucinations, nightmares during sedation, mood disorders, anxiety, shortness of temper and frightening memories - click here for symptoms of PTSD in a previous post.

Dr. Dale Needham at John Hopkins has begun a 5 year study of patients discharged from the hospital and is finding many patients have difficulty in regaining their strength.  Families are finding their loved one(s) are not the same person anymore.  The difficultly lies in determining which disabilities come from the illnes as opposed to the I.C.U stay, when many patients are on a mechanical ventilator, and receives high doses of sedatives, narcotics and anesthetics.  Particularly surprising is how quickly patients loose their strength.

Patients in intensive care not only experience physical stress due to bodily trauma, but also psychosocial stressors with pain, inability to communicate, sleep deprivation, feelings of isolation or lonliness, and fear or anxiety being the most common.  A review of the literature has shown each of these stressors are associated with decreased immune functioning. (2)

In  Laitinen’s study, patients emphasized the importance and need of closeness with a healthcare professional whom they could trust to reduce feelings of anxiety, isolation and increased sense of security. (3)

And how are medical professionals addressing these issues? 

By…

• reducing sedation levels of pain medications, narcotics and anesthetics.
• getting patients mobilized and walking along with all the ICU paraphernalia like intravenous lines, ventilators, and monitoring equipment.
• mobilizing patients as soon as possible – patients seem to recover faster and spend less time in the intensive care and the hospital.  

Implement Creative Interventions for patients in the intensive care units

I encourage the use of Creative Interventions as non-invasive modalities to counter the psychosocial stressors and loss of strength patients experience during their intensive care stay.  Families and friends can help by bringing the supplies listed below, and more importantly, become active participants in their family member’s care.

Naturally, not all patients in the intensive care units will be capable of actively participating in creative interventions due to their conditions.   However, applying a headset to unconscious patients and playing soft soothing music is much better than hearing noxious noises and sounds of ICUs. 

Here are a few Creative Interventions to start with:

1. Headset,  ipod or CD player.  Encourage families and friends to compose the patient’s favorite playlist (soft and classical music are best), and play during visiting hours.  Nursing staff can apply this intervention during non-visiting hours.  I wrote several posts on the benefits of listening to music in reducing anxiety, pain, and as a form of relaxation.  The posts are titled, Rx: Listen to Music, Listening to Music: Another Creative Intervention.
2. Listening to music with headsets also reduces noise inherent in intensive care units.
3. Art-making activities: encourage families and friends to bring in simple art-making materials, such as watercolor markers and sketch pad or other creative materials. 
4. Engaging patients in creative activities provides a sense of enjoyment, pleasure and diversion in a bewildering and frightening environment.                                                                                                                                                                                                                                     
5. Give a lump of clay to patients with strokes (or any patient) to create small sculptures.  By manipulating the clay with their hands, the physical motions will help with maintaining muscle strength, dexerity, and divert their attention from their current situation.                                                                                                                                                                                                                                                                                    

Note: email me if you want the bibliography.