I spent part of the past two weeks with a friend (I’ll call him Steve) while he was in critical condition in the ICU of a local hospital. While I would like to explore some of the extreme difficulties of the events surrounding his condition and his prognosis, out of respect for Steve, his wife, and their family, I’ll limit this blog to what some might call the most insignificant and often ignored experiences of family and friends visiting critically ill patients: the waiting room experience.
Steve’s entire hospitalization was spent in the ICU. His wife, one of my closest and dearest friends; his children; and other family members spent countless hours in the ICU waiting room along with friends and family members of other critically ill patients. Many of Steve’s family members, friends, and other patients’ families commented on what little consideration goes into designing and maintaining waiting rooms for families who often spend several days and nights in the hospital during such critical, and in some cases, devastating times.
I was alarmed and outraged at the ICU waiting room at this institution. Blown light bulbs, old paint, and dirty flooring only seemed to make an already crushing experience even more distressing. I was surprised by the condition of an ICU waiting room at a time when hospitals strive to minimize infections and to improve customer service. The waiting room had three recliners, but only one worked properly. A nurse manager came to the waiting room one day with a screw driver to try to fix these chairs. Her effort was appreciated, but should a nurse manager’s job include furniture maintenance?
A nurse provided Steve’s wife with a pillow and blanket the first night she stayed in the hospital, and two days later, the same pillow and blanket were in the recliner where she had slept. The waiting room had a constant disturbing low-pitched hum emanating from the inconsistently working soda machine, the coffee machine, or the darkened fish tank.
The bathroom, although conveniently located a few feet from the waiting room, had a persistent odor of urine even after it was cleaned, and it was not cleaned the first two days of Steve’s hospitalization.
Unquestionably, critically ill patients are the primary concern of ICU staff; however, when building or refurbishing ICUs, family comfort should also be a major consideration especially for families whose loved ones are in such critical condition a family member remains in the hospital overnight, and in some cases, several days.
Caring and Empathy Must Extend Beyond the Doors of the ICU to Family Members Traumatized by Unexpected and Life-changing Events.
Administrators and providers should ensure that ICU waiting rooms provide family members with comfortable spaces, as much convenience as possible, efficient means of communicating with hospital personnel and with the outside world, and also ensure the waiting room conveys a genuine sense of caring and concern.
- Waiting rooms should provide a sense of comfort with neutral colors, clean walls, pictures or photos
- Waiting rooms should be well-lit with the ability to control lighting-electrical and natural-with shades or blinds or switches
- Disturbing noises, for instance, humming electrical devices or rattling trays should be eliminated or minimized
- If reclining chairs are provided, they should function properly
- Electrical outlets should be conveniently placed in view and not placed behind heavy pieces of furniture
- The waiting room should be kept clean with daily housekeeping services
- The bathroom should be strategically located close to the ICU and should be cleaned more than once a day since it is often a high traffic area
- Supplies including feminine products, toiletries, etc., should be made available to an immediate family member who traveled far, or due to the critical nature of their family member, did not have time to pack
- A pillow and a blanket should be generously provided without reservation to the family member who sleeps in the waiting area
- Hand cleansing stations and boxes of tissues should also be available to family members in the waiting room
- Nearby private meeting rooms should be available so nurses and physicians can speak with family members in private and not hold family meetings in the waiting room in the presence of other families. These rooms should be comfortable, intimate, and have phones available incase the provider needs to speak or conference with family members who are available only by phone.
- A microwave oven should be available to family members
- A small dining area with chairs and table (s) in the waiting rooming or a designated room close by should be available so that family members do not have to leave the waiting area to eat
- For sanitary reasons and for convenience, locker spaces should be available to avoid family members carrying all of their belongings in to the ICU when visiting their family member
- A patient navigator, advocate, or liaison who can attend to some of families’ nonclinical concerns and or facilitate communication with services such as family support, palliative care, etc., should be readily available to families, and staff should offer or at least inform families that such services are available
- Phone charging stations should be in the waiting room since families communicate via cell phones and text messaging, and must often contact employers, schools, businesses, etc.
- Families should be provided with access to hospital-guest Wi-Fi service
Lastly, I cannot recount how many people-nurses, nurse practitioners, physicians, physicians assistants, managers, etc.-walked passed my friend and her children standing in the hallway distressed, crying, and at times inconsolable while Steve underwent emergent procedures and in one case major surgery. Only two people stopped and asked if they could help or call someone on the family’s behalf. While walking down the hall, only one person asked me if I needed help when I could not find my way to a certain area of the hospital.
I am grateful for this experience on the other side of the ICU doors. I am now more aware of families’ experiences in ICU waiting rooms, and what visitors experience as they navigate their way through long hallways, lost, while dozens of people walking by who do not offer to help. I am thankful for the few who, despite their busy days, take the time to offer assistance to family and friends of patients. These individuals understand customer service.
Prior research indicates that limited attention to family comfort is a long-standing issue for ICU patients and families (Giannini, Miccinesi, Montani, & Leoncino, 2009). These researchers concluded that failure to address family comfort means failure in one of the five domains associated with family needs in critically ill patients: proximity, reassurance, information, and support. If you’re a healthcare administrator or provider, I ask you to please advocate for comfort, convenience, communication, and caring for families of critically ill patients. It’s easy to think that such seemingly minor things are not important, but with such critical and devastating events at hand, families recall how they were treated and often incorporate their experiences into the care provided to their loved one.
Related Research Articles
Ferri, M., Zygun, D. A., Harrison, A., & Stelfox, H. T. (2015). Evidence-based design in an intensive care unit: End-user perceptions. BMC Anesthesiology, 15(57). doi: 10.1186/s12871-015-0038-4 (Also available through Open Access at http://www.biomedcentral.com/1471-2253/15/57)
Giannini, A. Miccinesi, G., Montani, C., & Leoncino, S. (2009). Waiting rooms and facilities available to patients’ families and visitors in Italian pediatric ICUs: A national survey. Critical Care, 13(Supplement 1). doi:10.1186/cc7650 (Also available at Critical Care)