ICU (Intensive Care Unit): Tips for Patients and Families
Medical Author: Maureen Welker, MSN, NPc, CCRN
The Intensive Care Unit (ICU) is a very “intense” area and can create a great deal of tension and stress for patients and families. Effective and appropriate communication is an important part of the healing process, not only for the patient, but also for the family.
The following are suggestions for family members on how to communicate with a loved one in the ICU:
- Speak in a calm, clear manner. Make short positive statements. Many family members assume because their loved one is on a ventilator they cannot hear and so they speak loudly. Don’t worry they can hear you.
- Acknowledge and recognize any discomfort your loved one may be experiencing. For example, you may tell them, “You’re are in the ICU and you have a tube to help you breath. This is just temporary and we will get the nurse to give you some medication to make you more comfortable, you are doing great and making progress.”
- Do not ask the patient questions that cannot be answered. Use a board so the patient can point to a word such as “pain,” this allows your loved one to make his need known. Most ICU’s have these boards available or will make one for you. It is not unusual for patients to be angry, frustrated, or not interested in communicating. Be patient with them and, the frustration level will decrease. Perhaps another method of communication will work better for them.
- Provide a small board for the patient to write on. Many patients can write just enough so you know what they want. The hospital should provide this, however, these boards can also be purchased at a drug store or art supply store.
- Offer short phrases that offer support and reassurance. For example, “Mom, its Maureen, I’m here with you and you are doing much better. Everyone is taking good care of you.”
- Simple hand gestures may work as well, such as thumbs up = “good”; and thumbs down = “pain” or “I need something.”
- Remind your loved one that “this is just temporary and they are making good progress.” Flood them with faith and hope.
- Hold your loved one’s hand or touch them gently (be sure to check with the ICU staff first). For example, rubbing lotion on their hands or feet may not be allowed.
- Orient your loved one to the surroundings, for example, the date and time of day. You may want to make a sign each day with the date on it and place it where they can easily see it (for example, on the wall at the foot of their bed). Describe what the different noises are to help ease any fear or anxiety they may have about them.
- Read your loved one’s favorite prayers, poems, books, stories, or bible verses.
- Music may be allowed in the ICU when appropriate. Again be sure to check with the ICU staff for guidance.
- Finally, just ask — the ICU staff may have the perfect suggestion for you to assist you in communicating with your loved one.
General suggestions that may be helpful to family members:
- Always check with the critical care staff before touching anything or saying anything to the patient. Stimulation can cause harm during critical periods of the recovery process.
- Ask the critical care staff to explain to you what the current status of your love one is, so you understand what is going on and why.
- Ask for suggestions on what would be helpful at this time for your loved one.
- Do not discuss any unpleasant matters in your love one’s room. If your love one’s condition is critical, discuss this or other problems outside the room. For example, do not discuss financial matters, or family disagreements, etc.
- If you are emotional and or upset leave the room. It may be helpful to request a Chaplin or social worker to help you to calm down and help you feel reassured, or sit quietly at the bedside. It may be harmful to your loved one to speak when you are angry or upset.
- Request your church Chaplin, the hospital Chaplin, or a social worker if you feel you need further support for yourself or for your loved one during the hospitalization.
- Consider setting up a family visitation schedule to spend time at the hospital as this prevents one person from becoming exhausted. For example:
Dad visits from 10:00 am to 12:00 pm
Maureen visits from 11:30 am to 2:00 pm
Kevin visits from 2:30 pm to 3:30 pm
It is important for family members to remember to be supportive of each other. Don’t forget to take care of yourself, eat, drink fluids and get rest!
- Consider setting up an information update on the family answering machine so family and friends can get frequent updates on your love one’s condition. Multiple phone calls to the Critical Care Unit staff can be time consuming and the staff wants to be at your loved one’s bedside.
- Have two designated family members that communicate with the physicians and nurses in regard to your loved one’s daily progress, and then those family members can update everyone else. You may want to keep a journal of information, questions, and answers. The critical care staff does not have time to answer the questions of multiple family members – they are very busy people and have your love one’s best interest at heart.
- Allow your loved one periods of rest, this is a critical part of the healing process.
- Just sit quietly at the bedside, speak only if your loved one wakes up. Offer support and comfort.
The ICU is a busy place filled with all types of noise. Patients do not get much sleep, and sleep deprivation along with narcotic drugs can contribute to confusion in the intensive care unit, called “ICU psychosis,” which is due to the critical care environment and illness itself. Many elderly patients become confused just being removed from their homes and placed into a different environment, or in the dark of night, even when they are not particularly ill. As the patient continues heal from the illness or injury, medications are typically decreased. Normal sleep patterns gradually return and the patient recovers from the confusion of ICU psychosis. The act of communication will aid the patient in the process of returning to normal orientation. You will find the hospital staff very helpful in offering suggestions that will be beneficial to your loved one as the healing process continues. Various types and levels of communication will be of benefit at different stages of the recovery process.
IMAGES PROVIDED BY:
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care June 22, 2017
© 2005-2018 WebMD, LLC. All rights reserved.
Improving access to rehabilitation services for ICU patients
Historically, success in critical care medicine was gauged using patient survival rates, with significant focus placed on early identification and stabilization of the patient’s primary diagnosis. Underlying this approach was a long-standing belief that patients could wait to receive physical and occupational therapy until recovery, usually after being discharged from the intensive care unit (ICU). However, although patient survival rates following ICU admission have improved, it’s become apparent that many of these patients have profound weakness along with new challenges to their brains and emotional states.
Physical consequences include ICU-acquired weakness that occurs in 25 to 80 percent of patients on mechanical ventilation for more than four days and in 50 to 75 percent of patients with sepsis. Cognitive impairment occurs in 30 to 80 percent of ICU patients and includes problems with memory, processing, planning, problem-solving and visual-spatial awareness. From 10 to 50 percent of ICU patients have symptoms of post-traumatic stress disorder (PTSD), which can persist for eight years. Experts who gathered at a 2010 meeting of the Society of Critical Care Medicine named the combination of difficulties that survivors experience post-intensive care syndrome (PICS).
The idea that many ICU patients would benefit from rehabilitation services as early as 24 to 48 hours after admission, even while they are very ill, is gaining acceptance. Multiple studies have confirmed that early therapy interventions are both safe and feasible. Early mobility programs have been shown to reduce ICU and hospital lengths of stay and thus decrease the cost of care. Access to rehabilitation services also can help increase strength, improve functional status, and decrease delirium, depression and anxiety.
Recognizing these benefits, staff from Physical Medicine and Rehabilitation (PM&R), in partnership with staff from Critical Care Integrated Medical Practice (CC-IMP), at Mayo Clinic’s campus in Minnesota, sought to develop a new care model to guide practitioners in determining how and when to integrate rehabilitation services into care plans for ICU patients.
Before this care model was revised, assessment of Mayo Clinic Hospital — Rochester ICU patients’ need for rehabilitation services was performed by providers (including M.D.s, P.A.s, C.N.P.s, R.N.s) who were not involved in providing that physical medicine and rehabilitation care. These providers screened patients for the appropriateness of therapy (right time, right patient, right provider) and placed an electronic consultation request for review by physical therapists (PTs) and occupational therapists (OTs) who were located in a different area of the hospital.
The goal of the staff charged with updating the ICU care model for rehabilitation services was to optimize timing of PT and OT consultations. The team also sought to reduce the time that elapsed between the provider screening and PT-OT consultation.
2017 care plan goals and implementation
Defining the process for embedded therapy in a combined medical-surgical ICU
The new model of care is being used at a 21-bed mixed medical/surgical/transplant ICU at Mayo Clinic Hospital — Rochester, Methodist Campus. The plan embeds three PTs, two OTs and one rehabilitation technician to provide coverage seven days a week. The therapists attend the charge nurse handoff meeting at 7 a.m. each day and screen every patient for appropriateness of therapy.
“This model greatly improves communication between care team members, reduces the time required to obtain consultation from rehabilitation staff, and facilitates nurse-driven patient mobilization and self-care,” says Patrick J. Cornelius, P.T., D.P.T., CCS, acute hospitalist clinical lead in physical therapy and team leader for the care model update.
Beyond adding rehabilitation staff on-site within the ICU, the plan also includes:
- A new orientation process for the embedded therapy staff
- Updates to the therapy ICU manual
- OT dysphagia training
The embedded therapy staff also attended a national continuing education conference in preparation, and a newly developed ICU PT-OT training course was offered to all PM&R staff across the Mayo Clinic enterprise.
Implementation of the revised care plan began on Jan. 3, 2017, and data collection will continue through June 30, 2017. Thus far, the overall response from ICU staff members has been favorable.
“I cannot overstate the value of the PM&R group to our critical care practice!” says anesthesiologist and critical care specialist Jeffrey B. Jensen, M.D., medical director of the Thoracic/Vascular Intensive Care Unit at Mayo Clinic Hospital — Rochester, Saint Marys Campus. “I have witnessed significant progress in many chronically critically ill patients, including increased strength, faster mechanical weaning, decreased delirium and increased sleep without adding additional medications to mimic sleep. In years past, many of these patients would have languished far longer.”
“Despite the progress made in blood transfusion restrictions, new ventilation strategies and expensive medication regimens, I believe this practice of integrating physical therapy in a structured format will demonstrate more significant returns moving forward,” adds Dr. Jensen.
Clinical resource nurse Andrea Y. Lehnertz, M.S.N., R.N., offers these observations about the care model’s impact: “Any day walking through the 10-3 ICU is a testament to the success of this project. Vented patients are in chairs and ambulating, and patients deemed too cognitively impaired to get out of bed do so with the help of PT-OT. As our patients’ cognition clears, they become interactive in their care.”
Beyond the ICU
A multidisciplinary group is currently working to improve awareness about PICS while also testing multiple prevention and treatment strategies. The project team has made various education tools about PICS available to patients, family members and Mayo providers. A survivor support group also has formed with assistance from the Society of Critical Care Medicine Thrive Initiative.
Knowing that someone you love is very ill and in need of the special care provided by the hospital’s Intensive Care Unit (ICU) is naturally very worrying. You are likely to feel confused and upset, and anxious to help in any way you can.
The information provided here is designed to explain a little about the ICU, what to expect when you visit your loved-one, and answer some of the questions most often asked by friends and relatives.
What should I expect when visiting in ICU?
Visiting in ICU for the first time can be very confronting.
A major operation, accident or illness will have resulted in your loved-one being admitted to ICU. This is because their body has ceased to function properly and they need special help to avoid serious long-term effects or even death.
The patient may well be connected to a number of machines and drips and will often look very different from how they normally look. The fluids given to the patient to keep them hydrated may make them look bloated and bruising can be caused by tubes and injections. This is normal and will improve as the patient recovers.
Sometimes they will be given strong pain-killing drugs or sedatives to help the healing process begin.
When a patient is first admitted to an ICU, it is normal for you to feel helpless, and desperate to know everything you can about their chances of recovery.
If you have questions about what is being done, do ask the staff in the ICU.
They will answer your questions as best they can, but they will not want to give you false hope. The staff will be happy to explain what they are doing and they will be able to update you as time goes on.
What are all those machines and alarms?
Most patients in ICU will be connected to machines or drips of some sort. It is important for you to know that an alarm going off in ICU does not immediately translate to a problem or emergency. Many of the machines have alarms that sound to let staff know that something needs doing, for example if a drip needs to be changed. Usually, there is nothing to worry about – the staff will closely watch the patient at all times.
If the patient is on a breathing machine (ventilator), the nurses have to regularly clear the chest of mucus and fluid. They do this by putting a thinner tube into the breathing tube to suck up the mucus. This is quite noisy and may cause the patient to cough or retch.
There may be times when staff will ask you to leave the patientʼs bedside. This is because some of the necessary medical procedures are not pleasant and may upset you. It also gives the staff room to do their job.
What can I do to help the patient?
It is natural to feel helpless and anxious. Days may go by with no change in the patientʼs condition. There may be nothing for you to do but sit by their bedside and wait. But even that is a positive contribution. Research has shown that patients show positive effects including reduced blood pressure and heart rate when visited by a loved one. Simply by sitting by the patient’s bed and holding their hand, you will give the patient and yourself much comfort.
Just hearing your voice can be a help. Keeping up a one-sided conversation can be difficult, but talking about happy memories and good times can make you feel better too. You could also try reading a book or newspaper to them.
A word of caution, however. Too many visitors, visiting for extended periods and lots of stimulation are not beneficial for the patient during this critical phase of their illness. This is especially important for patients with brain injuries. Rest is as much a part of the patient’s treatment as any of the medical and nursing treatments. It is important that you ask about the most appropriate visiting strategy for your loved one. This strategy may change as the patient’s condition improves.
It is important for visitors to ICU to be conscious of hygiene to prevent vulnerable patients from contracting infection. Be sure to wash your hands and use the anti-bacterial creams or sprays in dispensers around the unit before going near a patient.
I’ve heard of ICU diaries. What are they?
Often, relatives find it helpful to keep a diary of what is happening. It can help you to look back and see small improvements the patient has made. A diary can also be very useful later on to help the person who is ill. They may have very confused memories of their time in the ICU or no memories of it at all. A diary can help them to understand what happened to them and fill in the gaps in their memory.
I’ve heard that patients have nightmares in ICU. Is that true?
Illness or medication can cause patients to become confused, severely agitated and fearful. Sometimes, they may believe people (including the staff or even family) are plotting against them or trying to hurt them. They may have hallucinations and nightmares that seem very real to them.
This behaviour in a loved-one can be extremely distressing for you to witness and for the patient to experience. But you must be reassured that this is not uncommon in ICU and will improve as the patient’s condition improves.
If the patient in the ICU has been given sedatives, the sedatives will be gradually reduced as the patient gets better. Depending on how ill they were, the drugs they needed and how long they were sedated for, the weaning process can take hours or it can take days. During this process, the patient will be drowsy and confused, particularly in the early stages, but itʼs a necessary step and an important part of recovery.
Should children be allowed to visit a loved-one in ICU?
You should discuss with staff before bringing children to the unit and talk to the child about it. If the child decides they want to go into the ICU, prepare them for what they might see, including the machines, what they do and how the patient might look.
What you can tell the child will depend on their age but you can help the situation by:
- trying to keep to the child’s routine as much as possible;
- informing the school of the circumstances;
- explaining the situation and being honest if you donʼt know what is going to happen –try to say something they can understand that will help the child feel secure and reassured, for example, ʻ……… is very ill but the doctors are doing everything they can to helpʼ;
- encouraging the child to keep a diary with pictures etc. This will make it easier for them to talk later about what happened in their life while the patient was in hospital.
Once the patient is out of the ICU, the child may need help dealing with what happened. This can be a gradual process and can take several months. At times, it may be helpful to mention the patientʼs stay in hospital so the child knows they can talk about it. Let them ask questions, and ask them how they felt at that time. If the child is very young, they may find it easier to show their feelings by drawing pictures or acting out what happened.
How do I go about raising any concerns I may have about patient care?
Communication is important between ICU staff and family. The staff normally do all they can to keep relatives informed about treatment options and recommendations. If there is anything you donʼt understand or want to know more about, ask the staff.
There are several steps that may resolve any concerns about patient care:
- Speak to the nurse who is looking after your relative or to the primary care nurse looking after your relative. Ask them to follow-up with the ICU medical team.
- Ask to speak to the medical team – this may take more than one meeting if you would like to consider the information provided, discuss it with your family and meet with them again
- Ask to speak to the social worker who may advocate for families, or even just improve communication between families and the ICU team
- If you are still dissatisfied – every hospital has a patient advocacy /complaints service. This service is intended to improve communication between families and the hospital and may be of value if every other opportunity to resolve the differences has been attempted.
What about how I’m feeling? (A question we know you’ll be reluctant to ask, so we’ll ask it for you!)
When someone you love is in ICU it is very natural to experience a myriad of emotions – fear, anxiety, guilt, exhaustion, confusion, helplessness. If the patient is your partner with whom you usually share troubles, you may feel alone and overwhelmed.
You can help the patient by taking care of yourself. You shouldn’t feel guilty for not being by their bedside 24 hours a day. You need to give yourself (and the patient) a break – to eat and rest, even if you don’t feel like it – and this will also give the patient time to rest. The experienced staff are there and will contact you straight away if they need to or if there is any change in the patient’s condition.
You should accept that your family and friends will be concerned about you as well as the patient. Let them help by accepting offers of practical assistance such as cooking, transportation, shopping or childcare.
If you are reluctant or unable to share your feelings and worries with them, it is important that you get help and give yourself the chance to talk about how you are feeling. Remember, confronting serious illness and the experience of ICU is an immense challenge for the patient and for you. Even after the patient comes home, you may have a reaction to the stress that you have been under once the patient is out of danger.
If you feel guilty, worried or depressed, you can get help and information from:
Lifeline – 24 hour counselling: 13 1114
Beyond Blue: 1300 224 636
Veterans counselling service: 1800 011 046
Victims of crime 24 hours: 1800 000 055
Road trauma support: 1300 367 797
Brain Link: 1800 677 579
A visit to your GP may also be helpful at this time.
April 10-14 is National Cancer Registrars Week. Are you taking care of or know any patients who are battling the big C?
Despite the advanced technology and modern treatment plans, we, as nurses, should still value the proven benefits of prayers in healing our patients. We should take care of their faith and spiritual health as much as we care for their physical and mental needs.
Here are some of the most powerful healing prayers for cancer you can share.
A healing petition
May God heal me, body and soul. May my pain cease, may my strength increase, may my fears be released, May blessings, love, and joy surround me. Amen.
Prayer for easing pain
Father, with you nothing is impossible. You are God of all flesh; we love you and we are confident that no situation is too hard for you. We come to you on behalf of this dear one seeking healing from cancer. God, Jesus Christ has fully paid the price by the stripes He took; we therefore are asking that the devourer gets off from this child of yours in Jesus Mighty Name, Amen.
Prayer for healing
Father God, we humbly pray for all those who are fighting cancer. Give them the hope and courage they need each day. Comfort them in their pain and bless them with healing. Strengthen their family, friends, and caregivers. In Jesus’ name, Amen.
Prayer for cancer fighters
Heavenly Father, Give all cancer fighters comfort when they are in pain. Lay your healing hand on all and remove every cancer cell so that they may be healed! Amen
Prayer for physicians and nurses
Lord Jesus Christ, we call upon your blessed name and we pray for your merciful heart to surround these with love, strength, and courage and we ask Your hands to touch them with the power of healing. May they be directed to the right treatment in Your blessed name as we ask You Lord to represent the physicians, nurses, and medical care aids and administer them in Your spirits. May every cancerous cell be cast out and replaced with good ones. May every spot of this deadly cell be wiped out by Your powerful hands.
Prayer through St. Jude
God of healing mercy, in Jesus your Son you stretch out your hand in compassion, restoring the sinner, healing the sick, and lifting up those bowed down. Embrace us now in your loving care, particularly those afflicted with cancer, for whom this intention is offered. May the Spirit of Jesus bring us all health in soul and body, that with joy and thanksgiving we may praise you for your goodness, through the same Jesus Christ our Lord. Amen.
See Also: 20 Short But Effective Prayers for Surgery
Prayer through Saint Peregrine
O great St. Peregrine, you have been called “The Mighty,” “The Wonder-Worker,” because of the numerous miracles which you have obtained from God for those who have had recourse to you.
For so many years you bore in your own flesh this cancerous disease that destroys the very fibre of our being, and who had recourse to the source of all grace when the power of man could do no more. You were favoured with the vision of Jesus coming down from His Cross to heal your affliction. Ask of God and Our Lady, the cure of the sick whom we entrust to you.
(Pause here and silently recall the names of the sick for whom you are praying)
Aided in this way by your powerful intercession, we shall sing to God, now and for all eternity, a song of gratitude for His great goodness and mercy.
Through Saint Agatha
Oh St. Agatha, who withstood the unwelcome advances from unwanted suitors, and suffered pain and torture for her devotion to Our Lord, we celebrate your faith, dignity, and martyrdom. Protect us against rape and other violations, guard us against breast cancer and other afflictions of women, and inspire us to overcome adversity. Oh St. Agatha, virgin and martyr, mercifully grant that we who venerate your sacrifice, may receive your intercession. Amen.
Prayer for strength
Lord, at the moment nothing seems to be able to help the loss I feel.
My heart is broken and my spirit mourns. All I know is that Your grace is sufficient. This day, this hour Moment by moment I choose to lean on You, For when I am at my weakest Your strength is strongest. I pour out my grief to You And praise You that on one glorious day When all suffering is extinguished and love has conquered We shall walk together again.
See Also: 35 Nurse’s Prayers That Will Inspire Your Soul
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