Trauma-Resilient Care In the ICU: Practical Social Work Strategies from Those with Lived Experience

Background and Purpose

More than five million people enter U.S. Intensive Care Units (ICU) each year. Most experience trauma that potentially leads to Post-Intensive Care Syndrome, a constellation of symptoms including PTSD, cognitive impairment, and physical disabilities. Theoretically, clinical training and relationship building skills make social workers ideally positioned to support such patients both in and after the ICU, but current social work research, policy, and practice falls short. In order to respond to this need, social workers who work with critically ill patients require relevant trauma-resilient strategies developed and utilized collaboratively by those with lived ICU experience and practitioners and researchers who understand this space.

Methods

This paper was developed using community-based participatory research. Approximately 10 team members meet regularly to discuss what they refer to in their mission statement as “the continuum of critical care, survival, and healing.” This group first met in 2023 in response to a critical care physician looking to learn from those with lived ICU experience. Three years later, this team of experts with lived experience, clinicians, and academically trained researchers continue to meet regularly to learn from one another, consult on community projects, and discuss and implement research ideas. The current paper grew out of members’ conversations about the impact of the ICU on overall healing and practical strategies that might reduce trauma and distress in the ICU. Team members brainstormed suggestions from when they were hospitalized and discussed ideas that they gathered from written materials and other ICU survivors.

Findings

These conversations generated various trauma-resilient strategies. These interventions are organized into five sense-based categories: sight, sound, smell, taste, and touch and a sixth general trauma-resiliency care category that includes practical actions that social workers could use to reduce distress and trauma in the ICU.

Strategies include: provide an eye mask and ear plugs for sleeping, quieting alarms when possible, replicate pleasant smells from the patient’s home in the hospital room, prepare patients for unpleasant flavors, apply a patient’s favorite lotion and lip balm, explain all procedures and identify hospital workers to patients and families, and prepare the patient and family members for potentially distressing events (e.g., breathing trials).

Conclusion and Implications

Most people will experience critical illness in their lifetime and require care. The ICU is a scary place for many people, where treatment of the physical body often supersedes seemingly “less important” psychosocial-emotional-social assessments and interventions – which research shows are also vital. Given all the barriers and pain ICU patients experience, this paper is primarily a source of practical information to reduce ICU-related trauma and its likely consequences (e.g., PICS). More broadly, it serves as a clarion call for social workers to become the bridge-builders and leaders who can integrate, teach, and improve upon evidence-based trauma-resilient care in the ICU for the common good. With increasing and unjust funding cuts to healthcare and policy changes that leave the most vulnerable behind, this kind of social work research, service, and leadership is needed now more than ever.