Communication

Good communication is essential to the smooth running of the Critical Care Unit. This includes communication between staff, patient, visiting professionals, and relatives.

Patient communication

Critically ill patients may still be able to hear bedside conversations despite sedation or apparent unconsciousness. All procedures should be explained to the patient in simple terms before starting, even if they appear to be unconscious. The patient who is not competent to consent to treatment may still appreciate verbal discussion or explanation.

Multidisciplinary team communication

The multidisciplinary approach to critical care involves medical and nonmedical staff in decision-making. Ward rounds are a forum for such interdisciplinary communication, and the specialist leading the round should ensure all present are both truly involved and understand the day’s plan. The plan for the day is more likely to succeed if those effecting the plan are involved in setting it. All changes from the plan, whether due to unforeseen emergencies or failure of the patient to respond, should be fully discussed and documented.

Communication with visiting teams

The critical care staff should be responsible for the day-to-day care of critically ill patients, including coordinating the input from various non-Critical Care Unit professionals. The admitting team should be involved in major strategy decisions and should be accompanied to the bedside or relatives’ area by a member of the critical care medical staff. They should be encouraged to write a clear note of their thoughts and proposed management plans in the patient records.

Communication with relatives

Relatives are often overwhelmed by the environment of a Critical Care Unit, are worried about the patient, and are easily confused by the information given. Most communication should be face to face, avoiding lengthy discussions on the telephone. Where several people are imparting information, differences in emphasis or content serve to confuse.

• All communication with relatives should be fully documented.

• It is essential the bedside nurse is present when relatives are spoken to since there are often questions and concerns which crop up later that may be directed to that nurse. Relatives have greater contact with the nurses and often build up a relationship with them.

• Where admitting teams need to communicate with relatives about a specific aspect of the illness, the bedside nurse and, ideally, a member of the Critical Care Unit medical staff, should be present.

• Most interviews with relatives should be away from the bedside although it is often helpful to impart simple information at the bedside, particularly to demonstrate particular issues. Again, it must be remembered that the patient may hear the conversation.

• While it is preferable to interview all relatives together, this is not always practical. Information changes when delivered second-hand so it may be better to communicate directly with various relatives separately in these circumstances.