Intensive Care Units (ICUs) are intimidating places to visit. The aim of these pages is to provide information on a range of issues and questions often asked by ICU visitors.
Intensive Care Units (ICUs) are intimidating places to visit. With the knowledge that your loved one is seriously ill, coming into an ICU may be overwhelming for you. Strange sights, smells and sounds may confront you when you enter this new place and this may make it difficult to make sense of this information. But you are not alone. The staff of intensive care are there to support you in many ways, including explanations, time, consideration and counseling. Different ICUs have different visiting policies, which have been developed to suit the local environment and you need to familiarise yourself with these.
Why are there restrictions?
Every ICU has a specific visiting policy, which has been developed to suit the local conditions. Visiting may be restricted because of:
- Limited space at a patient’s bedside;
- The need to carry out life saving procedures and every day care;
- Transporting the patient to other departments for test and scans;
- The patient’s condition doesn’t allow for visitors.
What are the usual visiting hours?
There are no universal visiting hours for ICU. Generally when a patient is very unstable most ICUs allow fairly open visiting for the immediate family. Once the patient’s condition has stabilised it is important for both the patient and family to get plenty of rest. Under most circumstances visiting is restricted to set times of the day.
Why do I have to wash my hands?
Intensive care patients are very vulnerable to infections. The staff of the ICU routinely washes their hands between patients to reduce the transmission of infections. It is important that visitors wash their hands to reduce the transfer of infections as well.
What you will see and hear?
This is a difficult question to answer. When you are visiting for the first time ask the member of staff who is escorting you into the Unit to tell you what you will see or hear. You will probably see a lot of activity, depending on the time of day. As well the level of activity can generate a lot of noise. Some ICUs are large open rooms with patients in individual bed spaces. Some older ICUs have restricted space and may seem overcrowded. Newer ICUs tend to have bed spaces with half or full walls separating patient bed spaces.
The person you are visiting may be connected to:
- A patient monitor that may look like a computer or television screen. A patient monitor collects information of a patient’s vital signs and displays them as a graph. You will see a number of leads from the patient to the monitor. It is not a life support machine.
- If they are having breathing difficulties they may be connected to a ventilator. A ventilator or breathing machine supports a patient’s breathing.
- Intravenous (IV) fluids via an IV cannulae or central line. There may be one or more intravenous lines using control pumps.
- Other equipment such as a dialysis machine.
Why should mobile phones be turned OFF?
Mobile phones may interfere with the electrical equipment used in the ICU.
Benefits of visiting – patient
In todays modern ICU’s most patients are awake to some degree. However, even if they are awake, the patient is often unable to understand where they are or what is happening to them and by visiting your loved one you can reassure them. Research has shown that patient’s 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.
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.
Benefits of visiting – yourself
Visiting a loved one in an ICU may not be nearly so frightening as not visiting and imagining what is going on. When visiting you will be able to see for yourself and ask the questions you feel are important. It is a good idea to select a member of the immediate family to be the spokesperson. This spokesperson can be the link for the extended family and friends of the patient. This will save the next of kin having to answer too many phone calls. The staff are restricted by privacy legislation and cannot discuss the details of a patient’s condition and treatment over the phone. They can only say general things about the patient’s condition, such as stable or unstable.
Who should visit?
When a patient is first admitted to the ICU and their condition is uncertain it is usually best to confine visitors to the immediate family. That is husband, wife, children, parents, siblings and grandparents. This does not necessarily mean close friends cannot visit. Some ICUs may have a strict policy in regard to visitors so this is a question you need to ask. The staff of the ICU have dealt with many different types of families and cultures and are usually able to customise a visiting schedule that works for you. We would suggest that the family of the patient should endeavor to discuss any issues and consider what is best for the patient. The social worker may be able to assist you in negotiating through any problems.
Who should not visit?
If you are receiving treatment, which reduces your immunity to infection, extended visits into ICU may not be wise. Similarly, if you have an active infectious illness, which may be spread by social contact such as coughing, it is probably best to restrict your visiting. Visitors who are causing a disturbance to either the patient, other patients or visitors will be asked to leave the unit. This would include visitors behaving in either a physical or verbally abusive manner, persons who are under the influence of alcohol or other drugs or persons interfering in the treatment of patients.
Looking after yourself
The admission of a loved one to an ICU is a stressful experience that affects different people in different ways. You may find that you are coping initially but as time goes by dealing with the critical illness as well as chores of daily life becomes more difficult. It is very important to acknowledge this and take steps to take care of yourself. This includes getting rest when you can, eating regularly and sharing the burden. Keeping to a regular schedule and relying on other friends and family will generally help. If you are experiencing problems please discuss them with the staff, your family doctor or the social worker. Initial refusal of social work assistance is not a barrier to asking for help at a later date.
It is not uncommon for a relative to experience a delayed reaction once the acute illness as resolved. These reactions vary widely.
Should I bring the children in?
Under most circumstances the children of a patient are allowed to visit. A child’s imagination is very active so if they can see what is going on most of their fears can be allayed. They should not however be forced to visit. For the safety of the child and patient there are usually conditions attached to children visiting the ICU. Firstly the child/ren should be the sibling, grandchild or child of the patient. Secondly, they must be closely supervised at all times. For example babies and toddlers should be in a pram or carried. Older children should be supported by another relative and allowed to leave when they feel they need to. Most teenagers will cope as well as adults do but this should not be assumed. With all children it is important that an explanation of what is happening be given and that appropriate support always be available. It is considered inappropriate for children to be on the beds of patients or to be fed or changed in the ICU. Most hospitals will have facilities for these activities. If an ICU does not allow children to visit there are usually unit specific reasons for this. It would be unwise to bring a very new baby or a sick child into an ICU, or to have them visit an infectious patient.
Most ICUs will have either a designated social worker or access to a hospital-based social worker. The social worker will be able to help you in a number of ways. Primarily a social worker has had experience in dealing with the relatives of patients with acute serious illness and will be able to help you to cope with the feelings and frustrations you may be experiencing. They will be able to assist you with family, work or social security issues.
Most hospitals have a contact list for the ministers of religions and will be able to enlist their help if required. Alternatively, if you have a specific religious minister who is willing to visit, this is generally not a problem. Some hospitals employ pastoral care workers for support and have a non-denominational chapel that is available for reflection or prayer.
NSW Health has an interpreter service, which is available for both patients and families. These interpreters are specifically trained to interpret medical terms into a second language. If English is not your first language and you are having trouble understanding the doctors and nurses you should ask for help from the interpreter service. This is especially important when the doctors are explaining the details of your loved ones condition or if you are being asked to give consent for procedures. Under these circumstances it is considered inappropriate to use a member of the family to be the interpreter. Unfortunately this Service is limited, so planning in advance is a good idea.