Rehabilitation
During a patient’s critical care stay, we will ask the patient or a relative to fill in a "This is me" questionnaire that tells us about their life, routines, likes and dislikes prior to critical care.
This information will help us develop an individualised plan for their rehabilitation.
Goal setting
The rehabilitation team will work with the patient and their relatives to make rehabilitation goals, these may be short or long term.
Short term goals are those aimed to achieve before hospital discharge, while long term goals are identified in the period following discharge. For example, a short-term goal may be to stand up without assistance with a long-term goal to be able to take the dog for a walk.
Patient Diaries
Patient diaries are a simple but valuable tool in helping patients come to terms with their critical illness experience.
Patients who've had a stay in critical care may be kept sedated for some time while they're mechanically ventilated. After discharge from critical care, they often report having gaps in their memory from their illness or they may remember nightmares, hallucinations or feelings that people were trying to hurt them.
To help fill this memory gap and help patients to understand what has happened we complete a Patient Diary. It is usually written directly addressing the patient. Diary entries are completed by the critical care healthcare staff and relatives.
Relatives are encouraged to also write about what is happening at home as there may be important events there that the patient is missing.
The diary is given to the patient after discharge from critical care and is the patient’s property to take home and read at their own pace. The patient and relatives can also choose to read the diary during their Critical Care Follow up appointment with the support of our critical care team members.
The Rehab Team
We might see you on critical care if you are anxious or low in mood, especially if this means it is difficult to engage in rehabilitation.
Sometimes, we see people on the ward they move to after critical care. At this time, people can be struggling to make sense of what they have experienced and need the time and space to process this.
After discharge home, some people might struggle with distressing memories of their time in critical care. We have an outpatient clinical psychology service for people who could benefit from support with this. We can also help signpost to other relevant mental health services if these are most appropriate.
We will work to monitor and treat your health conditions to allow you to continue your recovery from critical illness.
If other specialist team inputs are required, we will liaise with them as part of multidisciplinary team effort.
Some patients may require procedures to assist them with their ongoing rehabilitation, which doctors on critical care will arrange or perform, one example is performing a tracheostomy.
A tracheostomy is performed under general anaesthesia, to make a hole in your throat and insert a tube, which is connected to a ventilator. You can find more information on a tracheostomy in our information leaflets library.
During critical illness a person’s nutritional needs can change daily. Dietitians monitor these changes and adapt nutritional plans to meet an individual’s needs.
This may be achieved through dietary advice, enteral feeding (feeding via a tube into the stomach or small bowel), or occasionally via parenteral nutrition (feeding into the vein).
Every day we will work with you and your relatives to help you achieve your rehabilitation goals. We will help to manage the activities of your day planning in periods of rest, so you don’t get too tired or overwhelmed.
We aim to optimise quality of life and functional independence by addressing physical, cognitive, psychological, and social needs.
It is common for patients with critical illness to experience delirium. Your occupational therapist will support you with managing delirium as well as providing education and information for yourself and relatives.
We will routinely assess you each day to monitor your breathing and help clear any secretions from your chest, which you may be unable to clear due to your critical illness. This may involve teaching you some breathing exercises to help reduce the risk of chest infections.
We will also assess your rehabilitation needs as soon as possible, even if you are still ventilated. This rehabilitation may involve sitting in a chair, walking or specific exercises to strengthen your muscles.
If you have been on a ventilator or have a tracheostomy, the muscles which support your breathing are likely to have become weaker.
Your physiotherapist will work closely with the doctors and the wider Multidisciplinary Team (MDT) to ensure this support is reduced gradually and at the appropriate time, ensuring the muscles which support your breathing do not become fatigued and your chest doesn't become overwhelmed with secretions.
We will support you with your communication and swallowing during and after your critical care admission.
If you have any difficulty with communication, we can help you to find other ways to communicate, for example using pen and paper or an electronic communication aid.
We perform swallowing assessments to see if you can start to drink and eat normally. We work with the Critical Care team to manage factors that make it more difficult to swallow and may provide exercises for your swallowing muscles.
You may have had an endotracheal tube; a tube that goes into your mouth, through your larynx (voice box) to your airway and connects to a ventilator or ‘breathing machine’. If this was in place for more than 48 hours, it is important that you are seen by a Speech and Language Therapist to assess whether the tube has had an impact on your voice and swallowing.
If you have required a tracheostomy during your critical care stay, a Speech and Language Therapist will be involved to support with your communication and swallowing.
The Critical Care Family Liaison nurses support families to integrate with patient rehabilitation. For example, we can facilitate visits off the unit to meet family members and their beloved pets.
If you require further advice or assistance, the family liaison can be contacted Monday to Friday, from 8am to 4pm, on 07584 331934.
