We could enjoy yesterday the article Supporting families improves communication and reduces ICU stay after an excelent research in NEJM, showing a family-support intervention leaded by nurses. So, the show must go on! Daniela Lamas has publicated the editorial Nurse-Led Communication in the Intensive Care Unit.
Every day and from beside, nurses embrace and accompany millions of people around the world. They inherit communication failures (involuntary, not believing) and have to deal with very difficult situations by the fact of being there. The first reflection: no one cared to teach us these skills.
One of the greatest successes in the ICU, which has made possible to decrease mortality, is that we have all protocols for everything, except the most important one: communication.
You should not doubt that we put our best intentions trying to do our best, but as it said, “Wars beggin from good intentions”.
The main intervention of the study was to train ICU nurses in communication skills and to give them the following responsibilities: preparing surrogates for physician-led family meetings, attending meetings to make sure essential content was discussed, debriefing with the family after the meetings, and checking in with the family on a daily basis. On this, authors demonstrated scientifically that this so cheap intervention improves the satisfaction, the quality of the information and the people-centered care.
In this study, the ICU stay was reduced (= saving costs) on the basis that patients who were going to die, they did before, ie, Society understand that there are much more important things to survive at all costs when a person is living the process of dying: the quality of that time of life and the reduction of suffering is non-negotiable.
Historically in the ICU, victories have been measured for saved lives and the primary outcome of our studies was always to reduce mortality. It seems that we have finally begun a profound change in which to continue caring intensively does not necessarily mean surviving the ICU, and also a good death could be considered a victory of our care.
That is why we can only put the nurses around the world in value: they possess the expert knowledge because they embrace and accompany every day. Nurses are the motor of the Humatization. It would be interesting to take into account their role and be more thankful, since without them a Health System (and a Society) falls.
Who needs more humanization? From my humble opinion, doctors. But this is not the same of saying that humanization is intrinsic to all nurses, because you know all sorts of people.
It seem obvious that everyone should improve, as in all fields of Knowledge. So many thanks to all who have always done their part, those who have been trying to improve for a few years and all those who are changing their realities to a more friendly and people-centered care model.
By Gabi Heras
Head picture from Enfermera en Apuros