Patient Care Vignette
Mr. Jordan, a 64-year-old male with underlying lung disease, was admitted to the Intensive Care Unit (ICU) with the flu. He required respiratory support from a mechanical ventilator. For the first few days he was sedated and not able to interact with the ICU care team or his family. As he improved, the sedation was decreased, and he became more awake. Although he still required multiple medical interventions and was still quite ill, the care team began to encourage participation with physical therapy and sitting in a chair every day. He was then helped to walk using a walker, all while still attached to the ventilator. The care team provided a variety of communication devices for him to interact with his family since he was unable to talk. After several more days of intense medical therapy, he was removed from the life-support machines and could finally talk with his family. He was then transferred to the inpatient rehabilitation ward for 3 weeks of therapy to help him recover and return home.
During his time in the ICU and in rehab, Mr. Jordan’s family noticed that he seemed depressed and withdrawn. He seemed anxious, especially when he was attached to the life-support machines. They thought he was concerned about possibly dying. The care team thought he was trying to “put on a good face” for the family when they visited, but otherwise he was difficult to engage in recovery efforts. The family said he did not attend church but asked for a visit from the hospital chaplain. The chaplain visited regularly and met with the patient and his family, both in the ICU and on the rehabilitation ward. Mr. Jordan developed a supportive relationship with the chaplain, and thought about returning to his church once he was discharged home. When he finally returned home, Mr. Jordan was encouraged by his family to attend church and include a spiritual component throughout his ongoing recovery.
ROLE OF THE CHAPLAIN AND SPIRITUAL SERVICES IN THE ICU
Most major medical centers have a dedicated chaplaincy (pastoral care) service. The chaplains are non-denominational and will meet with patients and families of many religious faiths. If there is not a hospital chaplain, often there are volunteer chaplains within the community who will provide spiritual services at the hospital. Patients and families can ask their pastor/priest/spiritual guide to come to the hospital and provide support. The “why” questions can be distressful for patient and family alike (i.e., Why did this happen to me? Why has this occurred now?). The care team does not have answers to the “why” questions, and neither does the chaplain. However, the chaplain can help the patient and family explore these questions during their journey through critical illness and during recovery (Fig. 9-1). For patients with a faith-based existence, pastoral care within the ICU is an extension of their usual life ...