Different Perspectives on the Baseline Status of Critically Ill Patients.

Abstract

Do you sometimes find that a family member’s view of a patient’s baseline health is more positive than your own? Hope et al found that surrogate decision makers’ ratings of preillness patient frailty were less accurate for predicting patients’ outcomes than were frailty scores assigned by objective researchers. One plausible explanation is that emotional attachment and a gradual adaptation to diminishing capacity led those who knew the patients best, their decision makers, to underestimate patients’ physiological and functional decline.Understanding baseline patient frailty can help us assess the risk for poor outcomes; how patients emerge after a critical illness depends in part on the state they were in when they entered it. As nurses, we can ask questions such as “What was a typical day like for him?” or “What could she do independently and what did she need help with?” to aid in our understanding of a patient’s baseline functional status. At the same time, we can support families who struggle to comprehend adverse outcomes because they fear loss and maintain a powerful awareness of the patient as a person. Our ability to assess patient frailty accurately while holding space for families with different perspectives is essential to the care we provide during critical illness.