Table 1 Psychological support based on positive suggestion intervention outline

Phase 1—Inform the patient about their ICU care and the nature of this treatment (daily)

 1. Information/environment—positive summary of medical course

  a. Introduce yourself and explain where patient is now

  b. Explain briefly what happened/provide treatment update

  c. Explain elements of treatment

   1. Ventilation aspects of treatment—simple phrases/explanations

   2. Procedural aspects—positive reframing/preframing based on each case

 2. Reduction of psychological stressors

  a. Non-verbal suggestion as appropriate—hand holding, etc.

Phase 2. Involvement of patient actively in the treatment process (once awake)

 3. Positive commands/regaining control

  a. Encourage patient to communicate with caregivers (even when they cannot speak) and to express their wishes/questions/requests

  b. Ask to move a hand, make a fist, wiggle toes; provide positive feedback. Engage nurse. Encourage participation with physical therapy to provide patient with greater functional independence once transferred out of the ICU

  c. Stimulate as many sensory channels as possible

  d. Offer choices to give patient the experience of being in control/having the opportunity to participate in treatment

 4. Optimistic future orientation/setting goals

  a. Based on values/hobbies once patient can speak/hobbies known. Encourage patient to describe a positive experience from the past (thereby giving patient the opportunity to experience it again)

  b. Set realistic aims together—today: get up; tomorrow: walk to the door, etc.

Phase 3. Debrief (once ready for discharge from ICU)

 5. Have patient explain how they saw:

  a. What happened to them

  b. What they understood about their condition

  c. How was being in the ICU for them

  d. Are there any questions? Anything to clarify?