How can we improve patient comfort in intensive care units?

Every year, approximately 30,000 Danes experience being admitted to one of the country's intensive care units due to critical illness.
Often, patients are unable to speak because they are on a ventilator, because they are under the influence of pain-relieving medication or because of the disease itself.

»We know that being in such a high-tech ward and being on a ventilator can be very uncomfortable. You experience pain, but it can also be uncomfortable because there is a lot of noise around you, or because you don't quite understand what is going on. And you may be afraid of dying,« says Anne Højager Nielsen, Associate Professor at the Department of Clinical Medicine at Aarhus University and at the Department of Surgery and Intensive Care at Gødstrup Regional Hospital.

With support from Independent Research Fund Denmark, she will lead a research project that will investigate the importance of comfort for patients, relatives and healthcare professionals in intensive care units.

The experience gained should make it possible to develop a measurement tool that can help determine whether a patient is comfortable when the patient is not able to tell it her- or himself.

In collaboration with clinicians and patients, an intervention will be developed to seek to improve patients' comfort while they are in an intensive care unit.

What is comfort?

The starting point of the research is to find out what it really means to experience comfort when you are admitted to an intensive care unit.

»This is something that nurses work a lot on, for example by optimising the way the patient lies in bed or by staying close so that the patient can experience presence and security. What we lack is an updated understanding of what it means to experience comfort when lying in the intensive care unit. This is a kind of basic research in intensive care nursing,« explains Anne Højager Nielsen.

The project group will seek the understanding of comfort partly in scientific literature and partly by asking patients, relatives and staff in the intensive care unit. Part of the work will take place as individual interviews and focus group interviews to ensure a deep insight.
Based on this, a tool for measuring comfort will be developed, and a concept will be developed for an intervention targeted the intensive care units.

»We will be conducting a large randomised controlled trial in the Danish intensive care units. We hope to be able to engage somewhere between 900 and 1,000 patients, as well as their relatives and health care professionals. But that lies a few years into the future,« says Anne Højager Nielsen about the project, which will extend over five years in order to include all aspects.

Can benefit the weakest in society

Anne Højager Nielsen hopes that the implementation of the project can lead to other interventions aimed at patients in intensive care in a systematic way. She also sees a gain for society's weakest.

»It is important to know about intensive care patients that they are often people who are already more ill than the background population in Denmark. This project can benefit everyone, including the sickest, the weakest and those without a social network,« she emphasises.

Today, long-term effects can often occur after admission to an intensive care unit. If comfort can be increased and the long-term effects can be reduced, it can further benefit society, which may mean that you can get back into the labour market faster or have less need for help to recover.

In addition to Anne Højager Nielsen, the research group includes two other Danish researchers: Marie Oxenbøll Collet, Senior Researcher at the University of Copenhagen and Rigshospitalet, and Lene Lehmkuhl, Assistant Professor at the University of Southern Denmark and development nurse at the intensive care unit at Odense University Hospital Svendborg Hospital.

In addition, two foreign researchers are included in the form of Associate Professor Sepideh Olausson from the University of Gothenburg, who has previously researched patients' experiences of being in an intensive care unit. And Céline Gélinas, Professor at McGill University in Montreal, Canada. She has previously helped develop a method to measure whether intensive care patients are in pain when they cannot tell it themselves.

Finally, two PhD students will be hired, and the researchers will also be dependent on the help of a number of professionals, such as nurses and biostatisticians.