BACCN News

Update on NICE guidance CG83 Rehabilitation afterCritical Illness

In 2009 the Nation Institute for Health and Clinical Excel-lence (NICE) published their guideline on Rehabilitationafter Critical Illness. Over one hundred thousand peoplespend some time in a critical care unit every year in theUK (NICE, 2009). Until recently there was little understand-ing of the longer term consequences of having a criticalillness or what actually happens to patients once they aredischarged. Even less thought was given to the consequencesfor families of the patients. Therefore the recognition of thephysical and non-physical consequences of critical illnessand the production of the NICE CG83 to guide manage-ment of patients was very welcome. NHS Evidence waslaunched in 2009 and bought together 34 specialist electroniclibraries formally administered by the National Library forHealth. The BACCN has ensured that critical care nursingis represented on the appropriate section of NHS Evidence,this being NHS Evidence-surgery, anaesthesia, peri-operativeand critical care. Part of the remit of NHS Evidence was toprovide an annual, detailed update of literature publishedsince the original release of the NICE guidelines. It is veryimportant to identify what factors contribute to physical andnon-physical problems for patients following critical illnessand what can be done to prevent or manage these problems.BACCN were invited to take part in the update. A total of 29articles were selected for review and these were distributed toa team of reviewers. Four articles were reviewed with directrelevance to nursing and the full update can be foundhttp://www.library.nhs.uk/THEATRES/ViewResource.aspx?resID=345330 Not surprisingly duration of seda-tion, duration of ventilation and length of stay on ICU

were associated with depression following critical illness(Davydow et al., 2008). This review concentrated on patientswith a diagnosis of Acute Lung Injury (ALI) or Acute Res-piratory Distress Syndrome (ARDS). It is uncertain whetherthe results of the review are specific to ALI/ARDS or criticalillness in general but the findings show that Post TraumaticStress Disorder (PTSD) remains high at 1 year post ALI/ARDSand can still be present at 8 years. The presence of depressionand PTSD were associated with lower quality of life. Findingmeans of reducing length of stay through the use of bestpractice is an important issue for all critical care practitioners.Wikehult et al. (2008) studied burn injured patients and foundfear is associated with Post Traumatic Stress Disorder (PTSD).Nurses should minimise moments of fear and pay extraattention to verbal and non-verbal cues of fear. Fear in thisstudy was mainly associated with not making it. Althoughthe authors make explicit the limitations of research I wouldsuggest the relationship between fear and PTSD is importantin the prevention of PTSD. How many times have any of uswalked into an ICU and seen terror in patients’ eyes. This aninteresting article which has limitations but also has impor-tant implications for nurses and other practitioners regardingminimisation of frightening experiences during ICU stay.

Hofhuis et al. (2008) specifically studied the perceptionsof patients regarding nursing care. Three important factorsemerged in relation to supporting patients:

• Providing patients with information and explanation• Placing the patient in a central position i.e. seeing them

as a human being.• Personal approach by nurses

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BACCN News

This study should remind nurses of the importance of infor-mation giving and seeing the patient as a human being. Thesefundamental elements of support may get forgotten about inthe hi-tech environment of the ICU.

Patient diaries have become a popular method of recordingevents for patients whilst in ICU. Engstrom et al. (2009) con-ducted a study regarding the use of patient diaries and thefindings of this study highlight that the reading of diaries byformer patients is not without emotional and psychologicalconsequences. Nurses need to be aware of this when imple-menting diaries and perhaps they should always be used inconjunction with ICU follow up.

The updated literature for NHS Evidence reminds us thatas nurses, and other practitioners, our actions and the way weprovide support for patients has a profound effect on theirrehabilitation.

REFERENCESDavydow DS, Desai SV, Needham DM, Bienvenu OJ. (2008). Psychiatric

morbidity in survivors of the acute respiratory distress syndrome: asystematic review. Psychosomatic Medicine; 70: 512–519.

Engstrom A, Grip K, Harmen M. (2009). Experiences of intensive care unitdiaries: ‘‘touching a tender wound’’. Nursing in Critical Care; 14: 61–67.

Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Rommes JH, Bakker K.(2008). Experiences of critically ill patients in the ICU. Intensive andCritical Care Nursing; 24: 300–313.

National Institute for Health and Clinical Excellence. (2009). Rehabilitationafter Critical Illness. London: National Institute for Health and ClinicalExcellence.

Wikehult B, Hedland M, Marsenic M, Nyman S, Willebrand M. (2008).Evaluation of negative emotional care experiences in burn care. Journalof Clinical Nursing; 17: 1923–1929.

Vanessa GibsonProfessional Advisor

National Board

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