Critical Care Information
The Critical Care environment is fast-paced, noisy and stressful. Staff and doctors come and go, interacting with your family member as needed. Often despite their best attempts, communication can be confusing or lacking in sufficient detail. Medical terms used are often unfamiliar. Being under stress and/or sleep-deprived can make understanding all the information given to you overwhelming.
- Choose one (1) spokesperson/contact person for your family.
- It is OK to ask questions -- more than once if needed.
- There are no wrong or "stupid" questions.
- Use the access code for privacy.
- Have family and friends go through the spokesperson for information.
Choosing a spokesperson
We know how important communication with the healthcare team is, and we try to make every effort to keep the lines of communication open, and to relay accurate, timely information.
Our policy is to have a spokesperson or contact person to whom to relay all information. For privacy reasons, please be very careful when selecting a spokesperson for your family. Please DO NOT share the access code to the unit with other family or friends, to maintain your loved one's comfort and privacy.
Communicating with a loved one
Keep your voice at a normal tone. Realize that your family member may not be able to respond -- either because of breathing tube being in place, decreased awareness from medications or his or her physical condition. Continue to speak with your family member even if he/she is disoriented/confused or unresponsive. If the patient is able to, you may have him/her write a note or nod yes or no to simple direct questions if unable to speak.
Touching is generally considered comforting and encouraged. The nursing staff will monitor the patient's response and let you know if this is somehow interfering with rest of the patient's care.
Familiarize yourself with our visitation policy. Visits should last no more than 20 minutes at a time and only two (2) persons at a time. There may be special patient circumstances where the staff may request a family member to stay with the patient for longer periods to help comfort, relax the patient or keep watch for the patient's safety -- preventing a fall, etc. The patient's need for rest, quiet time and privacy are paramount to the healing process.
Your rest and proper nutrition is important also. So be sure to allow yourself adequate rest periods and maintain your food intake.
Bringing items from home
Familiar items from home are often comforting. They may help orient some patients as well as provide a sense of security and promote relaxation. Music tapes, blankets, slippers, books on tape, videos, recordings of loved ones' voices, etc., may all be helpful in reducing stress for the patient. Please check with the nurse prior to bringing any items into a patient's room.
Asking the nurse for help
The nurse spends many hours at the patient's bedside. Therefore he or she observes your family member's response to treatments and assesses his or her comfort level. Please feel free to ask the nurse any questions you may have regarding the care of your loved one.
Ask the doctor
Because of the stress of having a loved one in Critical Care, you may not be able to remember or think as clearly as usual. Therefore, we encourage you to write down questions as you think of them and ask the appropriate staff member or doctor when you see them.
At least daily, you should expect to speak with the RN and doctor or doctors taking care of your family member. Because of the nature of critical care, if your family member experiences an acute change or event any time, the staff and/or doctor will contact the primary contact person as needed at that time. Should it be necessary, a Patient Care Conference (PCC) may be arranged to allow more direct and lengthy discussion with most all doctors and/or disciplines involved in your loved one's care as appropriate.
You are vitally important to the healing process of your family member. We are learning more each day regarding the importance of positive reinforcement and encouragement from close friends and family. You have been with this person before and hopefully long after this hospitalization. We recognize your unique role in the life of our patient. Coping with the critical illness of a loved one requires strength of mind, body and spirit. You may experience a multitude of feelings while your loved one is in the Intensive Care Unit (ICU) or Coronary Care Unit (CCU). These feelings are normal:
- Loss of control
Take care of yourself. This includes proper rest, sleep, food and exercise. Do not feel you must be here every minute of the day and night. We are here caring for your family member and can notify you of any significant changes. Allow other family members and friends to help you. Allowing family and friends to help gives them a sense of helpfulness as well.
Patients have "good" and "bad" days. This is similar to riding a roller coaster. Try to stay positive -- celebrate the success and view the setbacks as "just a bump along the road to recovery." Stay positive around your loved one! Your faith, values, beliefs and resources are your best sources of strength during difficult times.
We encourage you to keep a pen or pencil and notebook available. You can use the notebook as a diary for feelings, thoughts to later be shared with the patient. But also use it to write down questions as you think of them -- so you can ask the nurse or doctor. Also keep the names and numbers of important contacts -- doctors, cooperative care staff (CCP), chaplain, contact numbers for family and friends, etc.
If you have any questions regarding the care you or your loved one is receiving in ICU/CCU, please ask your nurse.
The purpose of life support is to support or augment failing body organs. Examples include ventilators for the lungs; dialysis machines for the kidneys; electric shock for the failing heart; and tube feedings for the patient unable to eat. In general, life support is a temporary measure simply meant to help a patient recover from an injury, surgery or serious illness. However, in some situations, life support takes on a "life of its own." Instead of being a means to support the patient while he or she heals or adapts to an altered function, it becomes the lifeline for the patient.
When patients are no longer able to make healthcare decisions, one of the most challenging decisions a healthcare surrogate or family member(s) might be faced with is whether or not to introduce or continue life support of their loved one. Decisions regarding life support are highly personal and should be based on honoring the wishes of the individual patient as communicated by the patient, if competent to do so, or if not, then as expressed in an Advance Directive and/or as communicated to the medical staff by the patient's healthcare surrogate, the patient's next of kin, if no healthcare surrogate has been named by the patient, or by a legal guardian.
Generally, there are three levels of care to consider.
- Full Support: This includes the use of any and all appropriate treatments to preserve life and increase the patient's chances of a full recovery. This includes, but is not limited to: CPR (Cardiopulmonary Resuscitation), defibrillation and chest compressions if the patient suffers cardiac arrest (the heart stops beating) or respiratory arrest (the patient stops breathing.)
- Conditional Support and Allow Natural Death: This allows patients, if competent, or if not, healthcare surrogates, next of kin, or legal guardians to determine with the advice of the patient's physician(s) which interventions to utilize to restore or maintain function as the patient's needs change. Other measures can and will be done as deemed appropriate unless the patient suffers a cardiac or respiratory arrest in which case no CPR or chest compressions will be performed and the patient will be allowed to die naturally.
- Comfort Support and Allow Natural Death: This allows patients, if competent, or if not, healthcare surrogates, next of kin or legal guardians to determine with the advice of the patient's physician(s) that therapeutic measures will be used to alleviate suffering and maximize the comfort and dignity of the patient. As with the Conditional Support, no CPR or chest compressions will be performed if the patient suffers cardiac arrest or respiratory arrest. The focus is on providing care needed to enhance comfort, dignity and a sense of wellbeing. Examples of comfort support measures may be morphine or other pain management and oxygen PRN. Healthcare providers will allow the patient to die naturally while providing comfort and support to both patient and family.
The following are words you may hear during treatment for your loved one:
- CPR -- Cardiopulmonary Resuscitation.
- BLS/ACLS -- Procedures used by trained individuals to attempt to restart someone's heart and/or breathing. This can include artificial breathing, chest compressions and electrical shocks (defibrillation).
- Defibrillation -- Electrical shocks sent through the chest wall to the heart.
- Vasopressors -- A group of drugs used to raise a patient's blood pressure, which necessitates close monitoring by staff.
- Tube feeding -- A means of artificial (eating) nutrition and hydration (drinking). Can be done by placing a tube through the nose or throat, or surgically through the stomach or abdomen.
- Intravenous (IV) feeding -- Can take the form of Total Parenteral Nutrition (TPN) and/or IV fluids. Artificial nutrition and hydration can be very valuable and life saving, but in dying patients, can have harmful side effects and can actually prolong suffering.
- Mechanical ventilation (MV) -- Breathing done by the assistance of a ventilator (breathing machine). This is done by inserting a breathing tube through the patient's nose or mouth. A tracheotomy may be performed to allow for prolonged MV with less discomfort for the patient. MV is a form of life support.
- Dialysis -- Artificial means to clean and remove excess fluids and waste products from the blood. This can replace or supplement the work of the kidney.
- Pacemaker -- Is a device that can be temporary or permanent, which supplies electrical current to the heart to stimulate it to beat.
- Implantable Cardioverter Defibrillator (ICD) -- A device used to shock a patient's heart back into a regular or life-sustaining rhythm.
If your family member has an advance directive, please be sure staff is aware and have copies of any documentation on the chart. If no legal documents are available, then as a family (if the patient is unable to decide for him/herself) you should discuss any known preferences of the patient.
Unfortunately, many people fail to formalize their wishes by means of advance directives. We have specially trained critical care doctors/intensivists who can help you make informed decisions.
Our hospital has a specially designed unit for patients/families who have decided on comfort care measures only. 2 South has specially trained staff focused on meeting the needs of the patients/families at this unique time in their lives. We have a Palliative Care Team comprised of two RNs, a social worker and a chaplain who may be consulted to help in the decision-making process to facilitate with the transition to 2 South, if appropriate.