Photo used with permission. Credit Leah Merrill. 2020
Walking alongside families in Intensive Care
#Intensivecarenurse#Insightfulnursing#Anxiety#Stress#Copingstrategies#Lifesupport#Ventilation#Shock#ICU#criticalcondition#Breathing#Heartrhythm#Bloodpressure
Planned and Unplanned Admissions to the ICU
Having someone you love admitted to an Intensive Care Unit (ICU) is scary, whether it is planned or not. A patient can have a planned admission to an ICU for close observation after a major heart or brain surgery. Unplanned admissions are often patients who have been involved in something they could not have foreseen, such as a vehicle accident, difficulty breathing from a pneumonia, severe bleeding from a knife wound, or a new diabetic with a high blood sugar. Everyone who is admitted to an ICU is there because they need careful monitoring of their heart rhythm, breathing, and blood pressure.
If you don’t work in healthcare or even if you do, the Intensive Care Unit can be scary and confusing. It is like walking into a foreign country and trying to understand a new language, while being asked to make quick and difficult decisions.
Who am I?
I am a registered nurse who worked in a medical and surgical Intensive Care Unit for fourteen years. I am now the business owner of InsightfulNursing.com, and freelance nurse health writer. I love having the opportunity to share my nursing expertise with all of you. I’ve looked after patients as young as a few months old in the ICU, patients in their nineties, and every age in between. I’ve also been where you are right now; sitting on the other side of the ICU door waiting to speak with the doctor and to spend time with my loved one.
What can I do for you?
Would you let me sit with you in the ICU waiting room and listen to your questions and hear your pain? I use my intensive care blogposts to explain in clear and simple terms what the physician is telling you; sounds and alarms you are hearing; different rhythms on the cardiac monitor you are seeing; to define lab values and describe procedures. If you let me, I will be an empathic and understanding voice during this anxious time in your life.
Being in an ICU is different from the scripted emergency room scenes you watch on television. In your living room, you are an observer; in the ICU you are a participant. There are smells and noises you’ve never seen or heard before. The lights are bright, people are moving quickly, and you can’t press pause to get snacks and a glass of wine.
Confusion
Your mind is both empty and full at the same time. How can this be happening? It can’t be real. Of course you must do everything. What do you mean my dad is not doing well? How could my mom have a stroke at forty-five years old? My child’s brain is swelling from a fall from the monkey bars? They were all safe before I answered my phone or the police came to my door.
Anxiety
Your mind is whirling and you cannot retain what the doctor is saying; but that doesn’t matter anyway because you don’t understand the words they are using. The doctor wants to put in a central line and is preparing for intubation. Or your loved one is going into shock and needs a massive blood transfusion. They use words like frailty score, and mechanical ventilation, and PH.
Not only are you struggling to understand, you can hardly breathe.
How our bodies react to stress and anxiety
When we are anxious and under stress, our bodies put out a hormone called cortisol. This hormone gives us extra strength and energy to either stand and fight; or turn tail and run. However, since neither is a viable option, you
start to shake
breathe fast
your fingertips and toes become numb
you lose your balance if you are standing
your voice shakes
As your intensive care nurse, may I suggest six coping strategies to alleviate some of your stress and anxiety in these first few moments of shock and confusion?
Six Coping strategies Suggested by an ICU Nurse
As an ICU nurse, part of my job was to help families cope during this time of extreme stress. Here are my top six suggestions:
1. Take a deep breath
Take a few deep, slow breaths to calm your mind and your heart. This will enable you to listen to the physician speaking to you.
2. Write down what the doctor says
Use your phone or grab a piece of paper and pen to write down what the doctor says to you. This way you can read it back to yourself, and also accurately recount to family and friends what you heard.
3. Keep a list of words or phrases you don’t understand
Start a dictionary list of medical terminology or phrases that have no meaning to you, then ask the nurse to explain them. Medical professionals forget how much of their terminology is medical jargon. You can use this list to refer back to during the days you spend in the ICU with your family member.
4. Ask the nurse to remain behind after a family meeting
The ICU nurse is your best resource because not only do they know the condition of your family member, but they can also translate into lay terms what the physician told you during a family meeting. If they are too busy to stay, ask them to come back when they have time.
5. Ask to speak with a social worker
All ICU’s have social workers that will sit beside you and listen to you speak about your family member's condition. They can also help you navigate some of the practical needs such as where to spend the night if you’re from out of town, and how to find the cafeteria and public washrooms.
6. Ask for spiritual care
ICU’s can be scary places for both you and your family member. If you or your family member wish for spiritual care, ask the ICU staff to call someone from the Spiritual Care department. There is always someone available during business hours, and also on-call after hours.
ICU’s are confusing and stressful places, especially when the prognosis and outcome of your family member is uncertain. As a former ICU nurse with many years of experience, I would like to help you navigate your way through the intensive care unity with my blogposts.
Please leave comments about topics you would like addressed; and stay tuned for the next blog on what happens when your family member is struggling to breathe.
Keywords: Life support, intensive care, intubation, anxiety, stress, central line, pain, fear, prognosis, medical ICU, surgical ICU, frailty, shock, patient, laboratory, critical care, planned admission, major surgery
References
Cay M, Ucar C, Senol D, Cevirgen F, Ozbag D, Altay Z, Yildiz S. (2018). Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores. North Clin Istanb. 2018 May 29;5(4):295-301.
CDC. Coping with Stress. (2023). Centers for Disease Control and Prevention
Please leave comments about topics you would like addressed; and stay tuned for the next blog on what happens when your family member is struggling to breathe.
Disclaimer: Anything written on this blog can be used for informational purposes only and should not be substituted for medical advice.