When a loved one is seriously ill, the Critical Care environment can be confusing and stressful. Being under stress, tired and dealing with unfamiliar situations and medical terms can make understanding all the information given to you overwhelming.

Remember to:

• Choose one spokesperson or contact person for your family.
• 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 make every effort to keep the lines of communication open.

Our policy is to have you choose a spokesperson or contact person for your family member who is a patient. We will relay all information to that contact person. 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 your family member may not be able to respond or speak. Continue to talk to your family member even if he or she is disoriented, confused or unresponsive. If your loved one is able, you may have him or her write a note, or nod yes or no to simple, direct questions.

Touching is generally considered comforting and is encouraged. The nursing staff will monitor the patient's response and let you know if this is somehow interfering or distressing.

Visitation

Familiarize yourself with our visitation policy. Visits should last no more than 20 minutes at a time with only two people present. There may be special circumstances where the staff asks a family member to stay for longer periods to comfort the patient or to keep watch for safety reasons like preventing a fall. Rest, quiet time and privacy are important to the healing process.

Your health is important also. Be sure to rest and eat right.

Bringing Items From Home

Familiar items from home are often comforting. 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 before bringing any items into a patient's room.

Asking the Nurse for Help

The nurse spends many hours observing your family member's response to treatments and assessing 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

We encourage you to write down questions as you think of them to ask the appropriate staff member or doctor. It's easy to forget details with the stress of a loved one in critical care.

You should expect to speak with the RN and doctor or doctors taking care of your family member on a daily basis. If there is an acute change or event at any time, the staff or doctor will contact the primary contact person/spokesperson for your family. Should it be necessary, a Patient Care Conference (PCC) may be arranged for more direct and thorough discussion. Most all doctors and/or disciplines involved in your loved one's care (as appropriate) will participate.

Self Care

You are vitally important to the healing process of your loved one. We recognize your unique role. Positive reinforcement and encouragement from close friends and family make a positive difference. 

You may experience many feelings while your loved one is in the Intensive Care Unit (ICU) or Coronary Care Unit (CCU). These feelings are normal:

• Fear
• Depression
• Helplessness
• Frustration
• 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 usefulness.

Patients have "good" and "bad" days. Try to stay positive - celebrate the successes and view the setbacks as "just a bump along the road to recovery." 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 and thoughts to later be shared with the patient. Also use it to write down questions. Keep the names and numbers of important contacts - doctors, cooperative care staff (CCP), chaplain, 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.

Life Support

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, 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 face 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. It includes, but is not limited to: cardiopulmonary resuscitation (CPR), 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 pass away 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) if 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 pass away 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 nutrition (eating) and hydration (drinking). This 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 - 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.

Palliative Care

Some hospitals have a specially designed unit for patients/families who have decided on comfort care measures only. We have specially trained staff focused on meeting the needs of the patients/families at this unique time in their lives. Palliative Care Teams are comprised of RNs, a social worker and a chaplain and may be consulted to help in the decision-making process, if appropriate.