Having a permanent resident in intensive care: the rewards and challenges.

BACKGROUND Intensive care units are generally structured and staffed to care for short-term critically ill patients. This is in contrast to the increasing incidence of patients who require long-term (i.e. greater than 6 months) intensive care in the contemporary health care context. AIM The aim of this paper is to share our experience of caring for a long-term ventilated patient in intensive care, including providing a summary of strategies and considerations that proved effective in our setting. PROCESS Dealing with the initial reactions of the staff, patient and family was the first focus of care, with strategies developed to manage the psychological as well as practical challenges. Core to subsequent strategies was the early formation of a multi-disciplinary case management team. Ongoing challenges included integrating rehabilitation care into the intensive care, developing effective multi-dimensional communication strategies, facilitating appropriate involvement of the patient and her family, operationalising trips outside the intensive care environment and adapting the model of nursing care to suit the context. CONCLUSION Elements essential for the effective care of a long-term patient within the intensive care setting included the development and maintenance of an open and honest relationship with the patient and family, regular multi-disciplinary case management meetings and effective communication strategies throughout the health care team. Importantly, clinical leaders should remain open to considering new ideas and strategies that facilitate effective care for a patient whose primary focus is different to the majority of intensive care patients.