2.THE SOCIAL WORKER IN INTENSIVE CARE UNIT [

Role Of Social Worker In ICU

Mr. Prakash LoboMedico social worker

MSW Department

Overview

• What is ICU and Team of ICU

• Medical Diagnosis in ICU

• Emotions in ICU

• Care giver Burden and Experiences

• Role of Social Worker in ICU

Intensive Care Unit [ICU]

Intensive care units are places in the hospitals

where the most seriously ill patients are cared

by specially staffed, specialty equipped,

separate section of a hospital dedicated to the

observation, care and treatment of patients

with the life threatening illness, injuries or

complications form which recovery is possible.

It is also named as critical care unit/ Intensive

therapy unit.

Medical Diagnosis

• Sepsis• Pneumonia• Pulmonary Edema• HAP – Hospital Acquired Pneumonia• CAP – Community Acquired Pneumonia• VAP – Ventilator Acquired Pneumonia• ARDS – Acute Respiratory Distress Syndrome• Septic Shock• CVA –Cerebrovascular Accident• Weaning difficulty• MODS – Multiple organ Disorder/Failure• COPD – Chronic Obstructive Pulmonary Disease

Continue…

• OP poisoning• RTA• Stroke/MCA Infarcts• GB Syndrome• Meningitis• CKD/AKI• Burns

Caring Team for Patient in ICU

• Intensivists• Critical Care Nurses• Mentors• Dietician• Social Worker• Physical assistants / Nursing Aid• Hospital Chaplain• Ward Incharge / Executives

Emotions In ICU

• Extreme anxiety or irritability• Difficulty in Concentrating• Crying or tearfulness• Restless and agitation• Loss of interest in activities• Negative feeling such as sadness,

hopelessness, helplessness, or guilt• Difficulty in sleeping (especially returning

to sleep)• Fatigue or exhaustion• Changes in appetite or eating habits• Suicidal Ideation

Care taker burden

• Dependent• Not able to go for work• Role changes• Loss appetite• Loss Sleeplessness• Fear of losing close one• Fear unfinished business• Stress

FAMILY MEMBERS EXPERIENCES

• Shock• Sadness• Depression• Anxiety• Fear• Helplessness• Denial• Numb and Blank• Guilty

Role of ICU Social Worker?

The primary role is addressing Psycho-Social factors and focusing on Emotional support.

• Providing psycho education and medical adherence (updating self knowledge).

• Helping the patient & family to accept the nature of illness (Reality orientation)

• Enhancing communication among patient, their families and the medical tem members.

• Collaborating with multidisciplinary team to evaluate patient's medical or physical condition to assess client needs ( giving and receiving feedback).

• Addressing emotions to maintain emotional wellbeing (Empathy).

• Focusing on death and dying (Dr. Elisabeth Kübler-Ross)- shock

& denial, anger, bargaining, depression, acceptance.

• Reducing family distress & facilitating end of life decision making.

• Improving quality of life for very sick & dying patients in the ICU & in their Families (Unfinished Business).

• Involving support groups for family members to assist them in understanding & to cope with stressful experience.

• Referring patient & family to community resources to assist in recovery from physical & mental illness & to provide access to services such as financial assistance, legal aid, housing, job placement or education.

(Resource Mobilization & Rehabilitation Plan)

• Planning discharge from care facility to home and follow up care.

• Conducting social research to advance knowledge in the social work field.

Social Worker Interventions in dealing with the emotions of families of critically ill patients.

COUNSELING TEAM

• The treating Consultants• Medico-social workers COUNSELING

• Counseling becomes essential when a person is so depressed by grief that their normal coping processes are disabled.

• Grief counseling facilitates expression of emotions.

COUNSELING in Intensive Care Unit

• Assessing grieving stage• Allow to ventilate concerns and needs• Provide emotional support• Identify family issues/conflicts• Motivating to continue treatment.• Legal assistance to RTA patients• Arrange frequent sections with doctors if needed• Arrange family meetings• Facilitate to take decisions• Prepare to accept the loss of a loved one• Co-ordinate with nurses and consultants• Give feedback• Recording and Documentation

What is Grief?

“Grief is a natural reaction to the loss of someone important to you. Grief is also the name for the healing process that a person goes through after someone close has died. The grieving process takes time, and the healing usually happens gradually.”

The five stages: Shock – “Speechless”Denial -“This did not happen. He is not dead, just went away.”

Anger - “Why did this have to happen? I hate him! he left me!”

Bargaining - “I promise I’ll be good if he will come back.”

Guilt – “I should have gone for second opinion” “I Should have brought her early to hospital”

Acceptance - “Father is gone but it is ok.”

What are the Five Stages of Grief

Grief Counseling Goals

• To increase the reality of the loss.• To help the bereaved deal with both experienced &

latent affect. (PTSD)• To help the bereaved to overcome from loss.• To encourage the bereaved to make a healthy

emotional withdrawal from the deceased & reinvest energy into other relationships

Specific Ways to Cope with Grief/ Loss

• Asking them if they want to talk about their Grief. ( Counseling)

• Just sit with them, you don’t have to say anything to comfort others (Listening)

• Allowing them to cry and be sad (Ventilation)• Don’t minimize their feelings • Show you care by words and actions• Helping with practical needs• Information on Taking care of Self Physically (rest well, eat

and limit alcohol use)

Challenges

• Knowing one’s own limits

• Setting up the boundaries

• Burn out

TO CONCLUDE…………...

Social Worker can be a lifeline! They will not only guide to the information and resources patients & their families need during ICU stay – they will also be a safe place to go to get the support you need to care for Your family, physically, Financially and emotionally.

Thank You!