Chapter 2: Planning Care for Progressive Care Patients and Their Families

INTRODUCTION

It is important to be mindful of the unique needs of patients and their families as they transition from the intensive care or medical-surgical environment to a progressive care environment. Since lengths of stay in progressive care are typically short, preparation for the next anticipated level of care is initiated on arrival to the progressive care unit. Patient and family education is key to preparing for care transitions or potential discharge to home. It is also important to recognize anxiety that the patient may experience during transitions of care. If the patient is transferring from critical care to progressive care, the patient and family may feel nervous at the perceived decrease in level of nursing vigilance and technology. This can create questions on the part of the patient and family as to whether staff will be available to respond quickly to patient needs and changes in condition. Conversely, if a patient is transferred to the progressive care unit from a medical-surgical area because of declining physiologic status, anxiety on the part of the patient and family is related to the uncertainty of the patient’s condition. In either case, it is important to reassure the patient and family that the progressive care nurses have the skills and equipment needed to monitor and meet the needs of the patient.

The achievement of optimal clinical outcomes in the progressive care patient requires a coordinated approach to care delivery by interprofessional team members. Experts in nutrition, respiratory therapy, progressive care nursing and medicine, psychiatry, and social work, as well as other disciplines, work collaboratively to effectively and efficiently provide optimal care.

An interprofessional plan of care is a useful approach to facilitate the coordination of a patient’s care by the interprofessional team and optimize clinical outcomes. These interprofessional plans of care are increasingly being used to replace individual, discipline-specific plans of care. Each clinical condition presented in this text discusses the management of patient needs or problems with an integrated, interprofessional approach.

The following section provides an overview of interprofessional plans of care and their benefits. In addition, this chapter discusses patient management approaches to needs or problems during acute illnesses that are not diagnosis specific but common to a majority of progressive care patients, such as sleep deprivation, pressure injury, and patient and family education. Additional discussion of ...