Elsevier

Critical Care Clinics

Volume 16, Issue 4, 1 October 2000, Pages 723-734
Critical Care Clinics

ICU BEDSIDE ENVIRONMENT: A Nursing Perspective

https://doi.org/10.1016/S0749-0704(05)70143-3Get rights and content

By its very nature the ICU environment is a strange place with its noises, equipment, constant activity, and bright lights. The demands of the critically ill patients in this environment often keep the care providers from recognizing the hostility of the environment from the patient's perspective. Patients are often scared, confused, and uncomfortable, and the ICU environment does little to provide comfort. Despite studies that have indicated the need for a more healing environment for critically ill patients, little has changed in how ICUs are designed today.

There are other factors that will drive changes in the ICU bedside environment of the future, including significant advances in monitoring capabilities, the addition of new members to the health care team, the types of information and communications that will be needed, and the increased need for flexibility to accommodate sicker patients. These factors combined with the need for a more healing environment in the ICU have pushed critical care practitioners, administrators, and architects to work together on creating the ideal ICU. But what will the ideal ICU bedside environment be in the future?

This article presents the work done by practitioners on the need for a healing environment in the ICU. A discussion of the current issues in the ICU environment leads to a projection of what the ICU bedside environment might look like in 2010. The need for a change is clear, but it is a little unclear what will make the ICU a better place from the patient's and the practitioner's perspectives. The proposed ICU environment of the future must be able to meet the demands of the critically ill patient for high tech care and balance those environmental concerns with the equally important needs for a high touch, healing environment.

Section snippets

THE EARLY ICU ENVIRONMENT

Intensive care units emerged in the late 1950s as architecturally discrete areas for treating unstable patients. Although these early areas were just general care units with a few beds designated as special care beds, it was recognized that the nursing care for the patients in these beds would be of higher intensity. Few units at that time boasted new complex technology, but rather used the sphygmomanometers, chest tubes, tracheostomy tubes, catheters (the “old stuff”) in a new location.8 The

ICU AS A STRESSFUL ENVIRONMENT

It has often been said that the ICU is a stressful place in which to work and a hostile environment for patients. The environmental stressors that have been reported in the literature as affecting ICU patients center around the physical and psychological comfort of the patient, staff interaction with the patient, the physical environment of the ICU, family, the illness, and the fear of death.2 In addition to these are the inability to communicate, the drugs used to sedate patients, the

THE BEDSIDE ENVIRONMENT OF THE FUTURE

Understanding the current state of the ICU environment is critical to creating the ICU of the future. The major goals of the ICU environment of the future will be to accommodate even sicker patients, make use of available technologies, increase the flexibility of the ICU environment, and incorporate a more healing environment into the ICU. There are multiple ways to accomplish these goals, and it should be recognized that the concept of creating flexibility in the critical care unit is not

TAKING THE HOSTILITY OUT OF THE ICU BEDSIDE ENVIRONMENT

In addition to accommodating the high technology of the future and the care providers who will use that technology to improve the outcomes of the critically ill patients, a healing environment must be created. The maximum flexibility in the ICU bedside environment will be obtained when all of the environmental controls for the patient room are serving an individual patient room.11 Thermostats, light switches, sound systems, window blinds, and so forth should be controlled separately for each

CONCLUSION

Here is a little glimpse into the ICU of the future.

The nurse presses her communication (COMM) badge to alert the multidisciplinary team that the patient who had been admitted during the night with respiratory failure and pneumonia, Mr. Wheeze, and his wife who was staying in the ICU room with him were awake. The team came to the unit and entered Mr. Wheeze's room. The artificially created views from the windows that surrounded Mr. Wheeze's bed were of a beautiful, sunny fall day. The music, a

THE ICU BEDSIDE ENVIRONMENT OF THE FUTURE IS BEING CONSTRUCTED TODAY

Research has demonstrated that the environment in the ICU is a stressor for most patients and staff. These studies will be used to design a better ICU for critically ill patients. The concept of the universal bed to care for the patient throughout the acute illness seems to be the most flexible idea for the delivery of critical care in the future. All components of the bedside environment will be very different in 2010. It is believed that the total number of patients requiring critical care

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Address reprint requests to Connie A. Jastremski, MS, MBA, RN, ANP-CS, FCCM, Director of Nursing, Rome Memorial Hospital, 1500 N. James Street, Rome, NY 13440

*

SUNY Health Science Center, Upstate Medical University, College of Nursing, Syracuse; and Rome Memorial Hospital, Rome, New York

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