Tan Tock Seng Hospital brings holistic occupational therapy into the ICU

Key Concepts

• ICU Delirium: A common complication in critically ill patients characterized by sudden confusion and disorientation, which can hinder recovery and lead to long-term cognitive impairment.
• Occupational Therapy (OT) in ICU: A specialized approach focusing on cognitive and emotional well-being, alongside physical rehabilitation, to improve patient recovery and function.
• Befrienders Programme: A volunteer initiative at Tan Tock Seng Hospital's Surgical Intensive Care Unit (SICU) that trains volunteers to provide emotional and cognitive support to patients.
• Early Mobilisation: A rehabilitation strategy involving early movement and activity for ICU patients to aid recovery.
• Sensory Overload: A state where patients in the ICU become overwhelmed by the unfamiliar environment and stimuli, leading to confusion and emotional distress.
• Cognitive Function: The ability to think, learn, remember, and solve problems, which can be significantly impacted by ICU delirium.
• Meaningful Activity: Engaging patients in activities that are relevant to their past routines and interests to promote engagement and improve mood.

Tan Tock Seng Hospital's Initiatives for ICU Patient Recovery

Tan Tock Seng Hospital (TTSH) is implementing innovative strategies to improve the recovery of critically ill patients in its Intensive Care Unit (ICU). These initiatives focus on mitigating the risks of ICU delirium and providing comprehensive support that extends beyond physical rehabilitation.

1. Occupational Therapy in the ICU

Main Topic: The integration of occupational therapists directly into the ICU setting.

Key Points:

• The primary aim is to combat ICU delirium, a frequent complication in critically ill patients who are in unfamiliar surroundings and under heavy sedation.
• ICU delirium can significantly impede patient recovery, potentially leading to cognitive impairments that may persist for years.
• Early management of delirium is crucial for optimizing long-term outcomes.
• Occupational therapists (OTs) are deployed to help mitigate these risks and reduce the likelihood of delirium.

Technical Terms:

• ICU Delirium: A state of sudden confusion and disorientation experienced by critically ill patients.
• Cognitive Impairment: A decline in mental abilities such as memory, thinking, and problem-solving.
• Sedation: The process of inducing a state of calm or sleep, often used in ICUs for patient comfort and to facilitate medical procedures.

Logical Connection: The deployment of OTs is a direct response to the identified problem of ICU delirium and its detrimental effects on patient recovery.

2. The Befrienders Programme

Main Topic: A volunteer-led initiative providing emotional and cognitive support in the SICU.

Key Points:

• Launched in November, this program trains volunteers to offer emotional and cognitive support to patients.
• Volunteers engage patients through activities like conversation, music, and other forms of engagement to improve their mood.
• The program aims to provide a "human touch" and awareness that complements the medical care provided by staff.

Examples/Real-World Applications:

• Volunteers engage in conversations, play music, and participate in activities like drawing with patients.
• One volunteer, Tae Kwon Chi, shared an experience where he spent nearly half an hour conversing with a post-eye surgery patient who was struggling with strain. This interaction was deeply meaningful for both the patient and the volunteer.
• Another impactful experience involved a patient with schizophrenia who was non-verbal. By engaging with the patient's family and discovering her interest in talking about her experiences with exercises, the volunteer was able to bring in relevant items, leading to increased engagement and calmness in the patient.

Step-by-Step Process (Volunteer Engagement):

1. Identification: Volunteers identify patients who may benefit from their support.
2. Approach: Volunteers approach patients, often starting by addressing them by name and identifying their preferred language.
3. Engagement: This involves talking, listening, and engaging in activities like playing music or drawing.
4. Observation: Volunteers observe patient responses and progress.
5. Reporting/Collaboration: Volunteers may share insights with the OT team to inform therapy.

Key Arguments/Perspectives:

• Nor Laila Binte Takup: Emphasizes that while the medical team focuses on physical rehabilitation and early mobilization, OTs address cognitive function and emotional well-being, which are critical for full recovery. She highlights that sensory overload in the ICU can take a toll on patients' emotions, and OTs help them become more aware of their surroundings, aiding their recovery.
• Tae Kwon Chi: Expresses his personal interest in ICU patients and the fulfillment he derives from providing comfort and engagement. He acknowledges the challenges of communicating with critically ill patients but finds ways to overcome them through patience and personalized interaction.

Technical Terms:

• Sensory Overload: An overwhelming of the senses by excessive stimuli.
• Non-verbal Communication: Communication without the use of spoken words, relying on gestures, facial expressions, and other cues.

Logical Connection: The Befrienders Programme serves as a crucial support system, working in tandem with the occupational therapy interventions to provide holistic care.

3. The Role of Occupational Therapists and Volunteers

Main Topic: The synergistic relationship between occupational therapists and volunteers in patient care.

Key Points:

• Occupational Therapists (OTs): Focus on identifying meaningful activities for patients by understanding their past routines, interests, and hobbies. This information is then shared with volunteers.
• Volunteers: Utilize the insights provided by OTs to engage patients in these meaningful activities, offering human touch, interaction, and awareness.
• Training for Volunteers: Volunteers receive training on how to communicate with non-verbal patients, approach them supportively, and provide reassurance. This training is essential to prevent volunteers from feeling overwhelmed and to ensure effective interaction.

Data/Research Findings (Implied): The hospital's approach is based on the understanding that cognitive function and emotional well-being are directly linked to a patient's potential for full recovery.

Notable Quotes:

• Nor Laila Binte Takup: "For the occupational therapists, right, we do assist in terms of getting some of the patient at more in terms of how to target meaningful activity. So things like getting to know what still pass routine. But these like to do in terms of interests and these can be actually shut than us as a source to befriend us to follow up on and ease of therapy. So heavy that befriend a human touch interaction and awareness on how to actually teach the right we on how to engage patients. I think that is really meaningful. And it's something that not all of us every the data they can do."
• Tae Kwon Chi: "It was this woman who just had their eye surgery recently and no doubt a voice, a very staff. She can still many strain gage me in composition with her for close to half an hour that makes it very meaningful and fulfilling."

Logical Connection: The OT's role in identifying patient interests and the volunteer's role in implementing these through engagement create a structured yet personalized approach to patient care, bridging the gap between medical treatment and emotional support.

4. Challenges and Overcoming Them

Main Topic: The difficulties encountered in interacting with critically ill patients and strategies to overcome them.

Key Points:

• Challenges:
  • Communicating with patients who are non-verbal or have limited responsiveness.
  • Identifying the patient's preferred language.
  • The potential for patients to be in a state of delirium, making interaction difficult.
• Overcoming Challenges:
  • Patient-Centric Approach: Identifying the patient's name and preferred language.
  • Patience and Persistence: Continuing to engage even when responses are limited.
  • Training: Volunteers are trained in non-verbal communication techniques and supportive approaches.
  • Collaboration: OTs provide insights that help volunteers tailor their interactions.

Technical Terms:

• Hyperactive Delirium: A state of delirium characterized by agitation, restlessness, and confusion.
• Hypoactive Delirium: A state of delirium characterized by lethargy, drowsiness, and reduced responsiveness.

Logical Connection: The challenges highlight the complexity of ICU care and underscore the importance of specialized training and a collaborative approach involving both medical professionals and trained volunteers.

Conclusion/Synthesis

Tan Tock Seng Hospital's innovative approach to ICU patient care, by integrating occupational therapists and a dedicated volunteer program, demonstrates a commitment to holistic recovery. The initiatives directly address the pervasive issue of ICU delirium by focusing on cognitive function and emotional well-being, complementing traditional physical rehabilitation. The Befrienders Programme, in particular, leverages trained volunteers to provide crucial human connection and personalized engagement, transforming the patient experience and contributing significantly to their long-term recovery. This multi-faceted strategy underscores the understanding that healing in critical care involves not just medical intervention but also emotional and cognitive support.