The Impact of Compassionate Healthcare in ICU Units Report

This report provides an in-depth analysis of compassionate healthcare within Intensive Care Units (ICUs), drawing on observations from a trainee program at The Royal Melbourne Hospital. The report highlights the critical role of nursing in ICU settings, emphasizing the need for advanced skills, understanding, and dedication. It identifies challenges such as high nurse turnover, poor work culture leading to stress and understaffing, and the impact on patient recovery. The report advocates for a positive work environment, patient-centered care, and effective teamwork and collaboration as key elements of quality healthcare. It examines specific issues like heavy workloads, personnel shortages, technological demands, and lack of recognition, along with the implementation of practice changes to improve patient outcomes. The analysis includes a case study of a patient's experience, illustrating the impact of these factors on the delivery of compassionate care. The report concludes by emphasizing the importance of addressing these issues to enhance the quality and effectiveness of healthcare in ICU units.

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A compassionate healthcare in ICU units
The Name of the Student
The Name of the Course
The Name of the Professor
The Name of the School
The City and State where it is located
Date

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A compassionate healthcare in ICU units
Introduction
Working in a hospital is a serious business. Nursing takes an understanding, quick and
intelligent thinking, time, and total dedication to achieve the level of advanced skills required for
the job. It is a way of getting involved in a healthcare industry and handle patients on an
individual level. This is heavily based on a caring culture which can be termed as a professional
practice in an innovative environment aimed at improving patient and commu7nity health.
Having had a chance to work at The Royal Melbourne Hospital in the ICU ward for a period of
one year under a trainee program, l was privileged to get a clear picture of what happens behind
the closed doors and curtains of Intensive Care Units in hospitals. An ICU is a ward staffed,
equipped, and specifically designated to provide observation, care, and treatment to patients with
injuries, complications, trauma, invasive surgery, organ failure, accident victims, illness or
potentially life-threatening illness whose recovery is possible into the normal body or mental
functioning (Netter, 2014).
During the one year at The Royal Melbourne Hospital, there were a lot of gaps in the
healthcare service delivery to the ICU patients that took a lot of input to make improvements. I
observed that there was a high rate of nurses turnover which resulted always resulted in an
understaff challenges due to a high number of patients. This was due to a poor or negative
workplace culture that subjected the nurses to stress and pressure as nurses had to handle the
patients while juggling with high demands from the management. This had led to a poor
engagement of the nurses working without motivating that greatly affected the recovery of
patients from the ICU due to the poor health care services they were receiving. Over the year, the
hospital had a change in management that strongly invested in a positive work culture that

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transformed the whole healthcare to the patients to great standards (Brauchle and Wildbanner,
2018). Therefore, l strongly advocate for a positive work culture in the ICU units as the key to a
quality healthcare culture.
An overview of nursing in ICU wards
In the period of one year at the ICU ward, there were critical decisions, very stressful
conditions, and ethical dilemmas that were part and parcel of our daily duties and
responsibilities. ICU nursing focusses intensively on all the defined aspects of basic healthcare
nursing and support of life, and therefore combine the art of nursing with observation, intuitive
interpretation, insightfulness, and the reactions of the slightest imbalance in the patient’s
condition (Boev et al., 2015, pp.276-284). In the effort to provide a quality and compassionate
healthcare to ICU patients, we faced great challenges with a poor work culture that had a poorly
structured healthcare culture (Mealer et al., 2012, pp.292-299). I observed that a patient, for
instance, could have their medication given at late hours from the intended time, or their frequent
check-ups skipped with no one to make a follow-up or bother at all. The expert nurse could make
a routine check on the performance of the nurses and treatment of the frustrated patient’s ones or
twice a week with a couple of complaints from the patients which were never followed up by the
nurse in charge.
As a new recruit to the team, l took interest to examine the patients’ view over the
healthcare they received at the hospital. I had to stay late and extra shifts in order to connect with
the patients at the ICU unit. To achieve this l had to be attentive to their needs and preferences at
all the time l was called upon to provide care. There were those who claimed that had there been
a quality healthcare they could have taken lesser time to recover but since the services were
averagely given, it took long periods of time to get out of the hospital (Ziebland et al., 2012,

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pp.219-249). For instance, on one of the evenings, a blood cancer was sharing her experience
that the worst time at the unit was during the night as the number of the nurses on night shift was
always very low in comparison to the patient’s number. She explained that getting attended to at
night could take a while as the available nurses struggled with fatigue whereby a single nurse
attended to more than four patients at the same time. At the facility, below are the challenges that
were faced in the effort of delivering a compassionate healthcare to the patients
Challenges that faced ICU wards
The entire year at the Royal Melbourne Hospital gave a clear overview of the challenges
faced by the staff that hindered a quality healthcare to the patients.
The nature of nursing work in the ICU unit
The ICU environment could sometime get very hectic and a noisy place that exposed the
nurses to all sorts of stimuli (Breau and Myriam, 2014, pp.16-24). Nursing in ICU was described
as a very demanding practice which posed high emotional and physical risks in providing care
for very ill patients fighting for their lives.
Heavy workload for ICU nurses
Nurses had a greater responsibility in conjunction with their patients more than other
departments at the hospital. This caused a lot of anxiety to the nurses with other different sources
as such the fear for failing to use various ever-advancing medical equipment well, the anxiety
that arises from fear of impossibility of not offering enough support to the patient and their
family in times they need it most, and the fear of not recognizing the symptoms and signs that
require urgent intervention as quick as possible to the patients. The greatest causes of torment for

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ICU nurses are psychological and the fact that they have to deal with dead bodies every day at
their work (Bogaert et al., 2013, pp.1515-1524).
The perception of futile care
For nurses, many situations ended up against their values and visions for care. There were
many incidences when nurses put in their best aggressive healthcare attention to patients but
unfortunately turn out to be non-beneficial when a patient, unfortunately, succumbs to death.
Such perceptions lead to great burnouts to most ICU nurses (Huynh et al., 2013, pp.1887-1894).
Personnel shortages and instability of experienced nursing staff
With the strict budget and the limiting number of nurses, it was difficult to deal with the
demands of a quality standard patient health care in ICUs. The absence of enough staff so that
the night shifts were comfortably scheduled, had created a compulsory overtime for the existing
staff that was unplanned thus we had to work two shifts in a row. This caused anxiety and
frustrations as the nurses had to continually readjust their private lives to cop up with their
duties.
Too short integration period for new nurses
The lack of nurses was very crucial. The hospital had to conduct a recruitment in order
fill in the gap in a hefty and short way such that the new team had no time for integration and full
orientation into their new roles. This raised psychological tension to the new nurses that felt
insecure after a limited integration period and minimal support to the delegated mandate of
taking care critically ill patients with complex needs (Crane, 2018). This resulted in a high
turnover of new nurses making the expert nurse to shoulder the whole responsibility of providing
companionate healthcare.

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Lack of recognition at work
Most ICU nurses suffered more from lack of recognition for heroic work that they did
than the actual stressful activities they undertook in complex needs of patients. Lack of gratitude
from patients and their family demoralizes the nurses and affects their self-esteem (Ahlin et al.,
2017, pp.177-185). This led to work dissatisfaction and thus caused poor healthcare to the
precedent patients.
Demands in technology
The intensity of nursing had highly advanced due to technology in ICUs. Nurses
experienced a lot of anxiety in using the ICU’s advanced technological equipment before they
become fully technologically competent (Hoonakker and Peter, 2018, pp.259-271). The nurses
were in most cases poorly prepared to handle these advancements in technology which made
them end up focusing on the dangers that could be brought by the wrong use of the equipment
instead of the quality healthcare standards for the patients.
Practice changes that influenced compassionate health care in ICUs
At the hospital, concern was raised from different parties due to the prolonged poor
healthcare services that needed to be thoroughly improved. The hospital management brought in
a team of experts to evaluate the situation and outline solutions towards improving the
healthcare. The team of experts outlined the problems with a negative work culture being the
major cause affecting the healthcare with a poor caring culture among other problems (Puri and
Nitin, 2018, p.71). The practices are briefly explained below.

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Positive work environment
The team of experts highly advocated for a positive work environment which included
making changes in management and leadership, work processes, workforce deployment, and
organizational cultures (Nants et al., 2017, pp.91-98). The team found out that the following
standards that are essential for establishing and sustaining a healthy work environment were
missing in action; effective communication skills, effective decision making that highly values
the welfare of nurses, true collaboration that is maintained continuously, an appropriate staffing
that matches the skills to the patient needs, a meaningful recognition and value of the nurses and
their duties, and an authentic leadership. The absence of an effective positive work environment
was greatly affecting the performance of nurses leading to poor healthcare culture.
Patient-centered care
As part of the team, the role of patients can greatly influence the degree of quality care
they receive (Hack et al., 2017, pp.14-20). The team of experts proposed that the nurses partner
with the patients with their family and friends in an informed decision making, improve patient
knowledge, understanding and valuing patient’s needs and preference, and advice on self-
management skills. The team highlighted that the patients who are engaged in their decision on
care and self-management have higher chances of for better outcomes unlike those who are not.
Patient self-management has been shown to be in association with improvements in the quality
of life, decreased utilization of services, health status, and highly improved physical status.
Patient-centeredness gradually became being recognized as an essential professional evolution
that held promising improvements in the quality and safety of healthcare in the ICU wards.

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Teamwork and collaboration
Teamwork and collaboration were strongly emphasized. The experts found out that
nearly 60% of the sentinel operations had failed due to poor communication. With poor or lack
of teamwork and collaboration, there were consequences that came along with it since
information could be misunderstood, lost, or wrong in relation to the context. Teamwork skills
are considered to be nontechnical and entail, adaptability, leadership, performance monitoring,
and flexibility (Krueger et al., 2017, pp.321-327). Teamwork and collaboration have greatly
helped to improve the healthcare offered today in ICU wards.
Evidence of analysis of findings analysis from observations from ICU patients
Within the one year of work at The Royal Melbourne hospital, there was a 70-year-old
patient who was the patient suffering from cardiovascular diseases at the time l started working
at the hospital. Three months later she was discharged due to slight improvements and her family
demanded that she could be taken care of from home. In the course of the year, however, her
condition became chronic therefore she was re-admitted to the ICU ward where l was stationed.
This time the hospital had allocated one nurse per two patient and she happened to be among one
of my patients l had to provide care for. The patient had a lot to talk about what had changed at
the ward in comparison to the last time she had been admitted.
The patient narrated how they used to be attended to poorly with a limited number of
nurses who did not care and love their work as the current situation was, she explained how
frustrated the nurses seemed to be during her first time at the hospital. After one week of her re-
admission, she said she could conclude that she can trust on the services of compassionate
healthcare being offered in regard to her recovery and other patients at large (Arvaniti et al.,

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2017, pp.437-448). She pointed out that one of her family friends had recommended her to the
hospital as she had been to the ICU ward and was provided with a quality healthcare that had led
to her first recovery and her discharge. She, in fact, claimed her friend had been allocated a
single nurse to take care of her in a quiet private ward while spending more time with the nurse
with a close monitoring of her condition, involving her together with her family in every medical
decision that was made at the ward.
Moreover, the cardiovascular patient was also grateful with the increased amount of visit
time for family and friends the hospital had put in place, the ward had also extra spaces for one
family member per patient that could stay at the hospital at with their loved ones. The patients
could interact with the nurses nearly the entire time whereby their needs and preferences were
keenly attended to. Additionally, she acknowledged the positive workplace culture, the patient-
centered compassionate care culture, and the patient-safety traditions that had been set in place in
relation to the previous state of affairs concerning patients’ healthcare.
After a month of her stay at the ICU, she was discharged to her residence whereby she
send thank you cards to the hospital’s ICU department and to the central management for the
effective changes they had put in place. In addition, she posted compliments on the hospital’s
feedback portal (https://www.thermh.org.au/patients-visitors/coming-hospital/contacting-us-
compliment-complaint-or-suggestion) with her full identity revealed. This was an indication of
confidence and satisfaction with the healthcare services at the Intensive Care Unit. (Crunden,
2010, pp.18-24) attests to such satisfaction of the post-ICU patients who are said to express their
gratitude for the services or raise complains in case the healthcare services are below their
expectations and standards. The scholar explains how the post-ICU period is crucial as it may
cause anguish in case the healthcare services did not impact towards healing of the patient. He

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claims further that this may result in psychological consequences thus he acknowledged the
importance of a good caring culture at the ICU wards to the patients even after they are
discharged.
As a nurse in the ICU, l experienced a number of similar cases with happy patients who
narrated their testimonies from time to time at the ward with a lot of recognition from the rest of
the departments at the hospital (Cahoon et al., 2018, pp.127-139). The reputation had gradually
improved with the compassionate healthcare that had been facilitated majorly by the positive
workplace culture that had been invoked. The nurses had set their team goals where every
member’s contribution was highly appreciated, the procedures were clearly defined, evaluation
and decision making of the team was done with a lot of consideration, consultations, and
inclusivity of the members, respect, responsibility, collaboration, and effective communication
were highly observed at the hospital leading evidenced improvements of the caring culture at the
hospital.
Analysis of current caring culture
The analysis of the caring culture at the ward could be compared before and after the
improvements were made drawing clear differences between the previous negative workplace
and the current positive workplace culture using the Manley model (Manley et al., 2011).
Negative workplace culture
Absence of enabling factors
At the time l started working at the hospital, the service delivery of a compassionate care
was poor which was highly attributed to the negative workplace culture in place. For instance,
the nurses at the ICU ward worked with no clear roles or dedicated responsibilities for each

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individual. There was very minimal support from the human resource management that could
provide an enabling approach for the nurses to perform their tasks. The lack of transparency in
management and decision making processes greatly contributed sluggishness of the nurses in
their daily activities.
Absence of essential attributes
In addition, there was lack of teamwork, collaboration, and participation of nurses as a
team in delivering services with poor communication across departments that highly promoted
the negative culture at work (Pipe et al., 2012, pp.11-12). There was no evaluation or audit done
for accessing the credibility of performance as the nurses had no vision to drive their motives and
any attempt to invoke hard work from any individual member was received with a lot of negative
attitudes, resistance, and intimidation from the rest of the team.
Consequences
This had led to patients’ dissatisfaction, complains, and preference to seek healthcare
from other hospitals for better services. The standards were evidently low as complaints in the
suggestion boxes were never received with consideration but neglected without any commitment
to work on the areas affecting the patients. The entire state of the hospital environment always
led to the frustration of not only patients but also we, as the nursing team (Lanham et al., 2013,
pp.194-202).

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Positive workplace culture
Enabling factors
Along the course of working at the hospital, there came radical changes that were brought
about by the new management in place. The new team brought in place a strong transformational
leadership that facilitated utilization of nurses’ skills. The roles were clearly defined for each
member with open channels of support from the human resource in delegating a compassionate
healthcare to the patients. The organization showed its readiness to evoke change, analyze
decisions from the members with weekly meetings, evaluation of staff members among open
communication structures being set in place.
Essential attributes
The new team organized for teamwork, support, involvement, and team building events
where the importance of working together was the theme for the events and the outcomes that the
nurses could realize if they worked in a strong collaboration manner. Training and seminars for
the staff were organized to refresh their roles and effective healthcare attributes at the wards.
Rewards were promised to the nurses to encourage creativity and innovation from the staff. The
new management also formulated formal systems that could enable continuous evaluation of
nurses’ performance and a shared governance.
Consequences
These changes resulted to an empowered, motivated, a committed team of nurses that
were ready to work towards the defined goals and objectives which were based on patient-care
culture, compassionate caring culture, and a continual improvement of the workplace culture for
both the patients and nurses. As a result, there was the general change of attitude evidenced from