Every day, we come to work ready to tackle the sickest and most complex patients in the hospital. We are competent, we are certified, and we are conscientious practitioners. We are educated to notice even the smallest changes in our patients. However, do we notice what our patients notice? Not every patient is unconscious or sedated. Some patients are in bed noticing things we could not possibly see. What are those things and what can we do to help our patients feel less anxious? How can we help improve their outcomes and speed up their recovery?

* The next time you are in a patient room, stop and listen. What do you hear? Typical sounds are from machines in the room, alarms both inside and outside the room, and noises outside the room, including, perhaps, other patients and hospital staff. What are the staff talking about? Are they quietly giving report? Consulting with other practitioners? Talking about the upcoming weekend? You may be surprised at what you hear. The effects of sound on sleep deprivation and its impact have been well documented in the literature. Knowing this, we need to do what we can to decrease noise stimulation in the environment.

* Look around the room. Is it day or night? If you did not already know the time, could you tell by looking around the room? Blinds on windows need to be open for orientation. Lights can be turned down at night to simulate a normal nighttime routine. Is there a clock in the room that informs a patient if it is morning or night? It is easy enough to become confused as to the day and time without having obstacles in the way.

* What do you see? Is the room clutter-free and neat? A patient may wonder if you cannot organize a room that you might not be able to organize their care. Is the room clean? Are the garbage cans overflowing with trash? We need to create a safe environment, and that may include one that looks organized.

* Who do you see? Only people the patient does not know? Are the patient's loved ones there? The benefits of more flexible visitation in intensive care units are well documented in the literature. However, most critical care units still adhere to strict visiting hours. Your unit might want to ask who benefits from restricted visitation. Is it the patient? Is it every patient? Is it the health care team?

* Where are you when it is visiting time? Are you in the room to answer questions and to give an update to family members? Or do you take this opportunity to run an errand or disappear from view? Research tells us that the main thing family members want, other than for their loved one to receive good care, is to receive information on their loved one's condition. If you are not there, you cannot do this.

Perhaps, these things do not seem important to you when you are titrating drugs and trying to maintain an airway. But they are important to the person on the bed and to those family members who come to visit. I know this because, recently, I had a loved one in the intensive care unit. These were some of the things she observed and spoke to me about.

Linda Baas1 wrote about patient- and family-centered care in the January/February editorial of Dimensions of Critical Care Nursing. It is time we start practicing this model of care. This model of care is designed to benefit patients and families, but you will find that you benefit as well.

Ruthie Robinson, PhD, RN, FAEN, CNS, CEN

Interim Chief Nurse Officer

Nursing Administration

Christus-St Elizabeth Hospital

Beaumont, Texas

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