Critical care units present particular challenges for meeting patients and families. Expert clinicians must learn how to “meet” and come to know patients who are often sedated and paralyzed or less than alert. Gadow1,2 developed the concept of existential advocacy even with silent patients. By existential advocacy, she means the kind of patient advocacy that respects the concerns and identity of the person.

In 2 studies of nursing practice in critical care units, my colleagues and I found that nurses have many practical strategies for knowing the silent patient.3,4 For example, nurses request personal information about patients and pictures of patients in their usual circumstances from families and friends.5,6 “Knowing a patient,” “following the body’s lead,” “preserving personhood,” and “describing [to the patient] what happened during the period of sedation or unconsciousness” were described as strategies for meeting and recognizing the silent patient as...

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