So the patient states he hates the hospital. They want to go home.
Of course they do!!! No one voluntarily comes to the ICU as a patient (at least the last time I checked).
So you take the time to explain to the patient, here is what you need to do. If you do more of this, this, and this it will be one step closer to you being discharged from the ICU and potentially discharged out of the hospital. (Now it of course is not that simple of a journey, but every small piece of effort does get them one step closer to home.)
They listen, the agree, you implore them to work hard. They nod and say of course.. ‘I want to get better’.
Then an hour later their complaining about what they have to do.
‘Do I have to do that.’
‘Can’t I lay back in bed?’
‘But it hurts to do that’
‘Can’t I just take my pills’
Case in point. Trauma pt is on his last leg of recovery. A passenger in an MVA. Rib fractures, VAP, bilateral pneumothorax’s, blah blah blah.. and trached.
He’s now off the ventilator, at the Trach Mask stage. No chest tubes. Minimal secretions from his trach. Not needing any suction. So we get him out of bed, into the bedside chair.
Go through the list of ‘things you need to do’. Which includes being in the chair! Being in the chair instead of laying in bed actually does have some medical benefits!
He nods appropriately. Yes I’ll stay in the chair! I want to be in the chair. I want to go home, etc, etc.
1 hr later…
Call light goes off…
‘Can I get back in bed now?’
And of course I ask why? Are you feeling short of breath? Having trouble breathing? Are you having chest pain? Are you feeling nauseated? What seems to be the problem
‘No. I just want to lay down. I want to sleep.’ (It’s 1pm)
And the beat goes on…