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Sherry Russell BCBT BCETS

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Help for waiting in the ICU for a loved one
by Sherry Russell BCBT BCETS   
Rated "PG" by the Author.
Last edited: Wednesday, April 07, 2004
Posted: Wednesday, April 07, 2004

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Trying to comb through conflicting information, constantly changing information, and the endless unknown factors is frightening not to mention that it may be one of the most difficult times in your life.


Help for waiting in the ICU for a loved one

Sometimes modesty and dignity fly out the window when someone is brought into the ICU, adding to the all ready overwhelming situation.  This is an exhausting and stressful time for family members. Trying to comb through conflicting information, constantly changing information, and the endless unknown factors is frightening not to mention that it may be one of the most difficult times in your life.  Very few people are prepared for a crisis.  To be waiting for a loved one who is in the ICU may open up the floodgates to all kinds of emotions.  The perpetual roller coaster may include fear, anxiety, anger, feelings of isolation, exhaustion, frustration, impatience, loss of control, mistrust, and guilt.   You may even feel like you are in a novocain state feeling numb in autopilot mode.
 
When I worked in the ICU, I would first check the board for which families would be going to the “family rooms” that day and at what times. We had specific comfy rooms set aside for the families to wait in while the surgery was taking place. To this day, I have no idea how the 4 people I would take into a room would multiply into 25 right before my very eyes.  They would try to squeeze in the room to offer support and then clump together in various groups.  Some would be studying the situation, going over all the information, debating and second-guessing everything.  Others would be discussing topics not relating to the situation at hand.  All did their best to be and sound supportive to the initial family members as they each waited for the clock to tick another tock.   Time does seem to stop for the loved ones waiting for news – any news - good or bad.  

I would check with the nurse’s station for patient’s recovery information from the day before. It was amazing how much difference 24 hours would make in the recovery process.  When I wasn’t with family’s waiting in the family rooms or with the patients then I would cruise through the ICU lounge to see how people were doing in there.  Tremendous anxiety oozed from that room.  It was like looking at a foggy picture and thinking that by rubbing your eyes you could erase the blur. But alas, the anxiety would still be there.  Peaceful and fearless minds were elusive.

Can you imagine a group of people who do not know one another coming together to sit, sleep, eat, share phones, sleeping spaces, and tears without partitions to separate family from family, sadness from sadness and irritation from frustration.  Human nature is a strange thing and I witnessed many an outburst, intense anger almost coming to physical blows, caring tenderness, sharing of stories and all this with people who were strangers just hours or days before.  Some people were in the ICU lounge for a short period of time and others were there for weeks on end.  Even though privacy is utmost important in the hospital, it seemed each person in the lounge became privy to the other people’s life.  For some people it was like having a gossipy magazine invade their privacy including religion and broadcast it to all.  To othere, they could care less who knew what, all they desired was to know their loved one would be all right.

You witness people at their most vulnerable when they are washed in the fear of what may happen next.  Many people held it together until the operation was over and then they would see their loved one lying in a bed, bloated and wired up like a puppet.

Most of the Doctors I worked with didn’t have the time nor the patience to sit down with the families and explain exact details in lengthy conversations after the surgery.  It was a quick explanation of the facts. As I explained to many people, this Doctor (they are now frustrated with) held their loved one’s heart in his hands a short time earlier.  His skill is the issue more so than the bedside manner. More times than not, time is of the essence for this doctor.  There is another family desperately needing this same doctor to urgently caress their loved one’s heart.

The ICU is different from other hospital units.  The ICU has special equipment and highly skilled and intense nursing care.  The ICU team has special training in the knowledge and skills needed to care for critically ill people.  No matter, the ICU can be a foreboding place. There are three sides to be considered with the ICU, the patient, the family, and the ICU team.  All three are working together for the same end goal.  

It isn’t easy to have a loved one who is critically ill or injured in the ICU.  There are blinking lights, massive equipment, tubes coming and going, noises and the non stop hustle and bustle of doctors and nurses.  Every patient is different but the following information of what you can expect when you see your loved one, what you can do, how to care for yourself, communicating with the ICU team, and patient conditions may help.

What you can expect when you see your loved one:
 There will be many machines all attached to the person in some way.  Each bed in the ICU is equipped with sophisticated monitors to help the doctors and nurses watch the vital signs and to make decisions about the care for the patient.   If an alarm goes off, it doesn’t mean something is radically wrong, it could mean that the patient has moved in the bed setting off the alarm. 
 It is normal for the loved one to look pale, cold and swollen
 When the patient’s body temperature gradually increases to the normal body temperature, pain medication will be given and the swelling will go down in several days.
 When the patient first arrives in the ICU their heart, temperature, breathing, blood pressure and heart pressures are monitored constantly.
 The patient will need help breathing so an endotrachel tube will be coming from the mouth and connect to a respirator.  The patient will not be able to speak as long as this in place.  After the tube is removed the patient will receive oxygen through a facemask.  They will be able to talk but it is normal for the voice to be very hoarse at first.
 Chest tubes are placed during surgery to help the lungs expand and to drain fluid for the chest.  They will be removed when no longer needed.
 You will also see the intravenous tubes inserted to provide fluids, medicines, and to prevent dehydration. 
 There will be a catheter placed in the bladder. 
 You may find it undignified to find that you loved one may not be covered very well.  This is because of the need to see and feel the patient’s skin and to observe breathing, as well as to perform frequent examinations. 
 If they are alert, understand that they may not follow the conversation and may become disoriented.

What to do:
 Your visits are highly important. Let the patient know you are there even if they are not alert.  Talk to them.  Use their name frequently and have eye contact.
 Wash your hands and if you are ill you will need to wear a mask.  Ask at the nurse’s station for a mask.
 Step away from the bedside to allow doctors and nurses to provide care.
 Do not touch any of the equipment.
 Do not be afraid to touch the patient. 
 Remember the machines, lights, noises are all there to support the patient or to help the intensive care team to monitor the patient. 
 Ask questions about anything or any equipment that you are not clear about
 Control your emotions.  Make sure you are calm before entering and try to be cheerful. Let your loved one know you are there to help them.
 Keep your conversations of subjects that are not upsetting to the patient.  Even if the patient is unconscious, take an upsetting subject out of the room.
 If you need help with concerns about insurance, money, obtaining housing if needed, coordinating home care and supportive counseling ask for a social worker. 

 Make sure you have all the patient’s personal belongings including dentures, contact lenses, glasses, wallets and clothing.  There is no room in the ICU for personal belongings and it is best family member’s keep these things until needed.
 Do not send flowers until the patient has been moved to a regular patient floor.
 The people available to you include doctors, nurses, social workers, patient representatives, respiratory therapists, chaplains and case managers.
 Be honest with your loved one.  Be positive and supportive but be honest.
 Listen when the patient wants to talk.  Don’t hush them up because you don’t want to hear what they are saying.  They may have real concerns and you need to accept the importance of those concerns.
 You may need to get help to make decisions for your loved one.
 Learn to communicate effectively within the system.  Ask questions but realize there are some questions that cannot be answered.  Conditions change quickly in ICU. This can be frustrating but you aren’t being “put off” so to speak, they simply may not have an answer. 
 Make sure you take care of yourself. 

Suggestions for taking care of yourself:
 Eat right.
 Get adequate rest.
 Take your medications.
 Take care of your personal and business affairs.
 Take breaks from the waiting area by going for walks.  Always let the lounge know where you are before leaving.
 Talk with others about your feelings.
 Watch television, read, or exercise for relaxation and helping with stress.
 Read all the materials given to you by the staff.  Knowledge will help your anxiety.

How to communicate within the ICU team:
 Make sure you introduce yourself.  Let them know your relationship to the patient.
 Have a list of contact numbers for the team in case you leave the hospital. Make sure the ICU lounge knows where you are at all times.
 Make sure you have all the correct numbers for the hospital and units you may need to call.
 If you are not the main person, let the team know who is the selected family spokesperson.  This person should be able to speak for all of you and can deliver information without filtering it.
 Make sure the team understands the patient’s wishes, if known, in regards to life-support equipment and other difficult decisions.  This is tough but you must relate the patient’s wishes – not your own.
 Provide as much information as possible about the patient to the team.
 Write down any questions you may have when you think of them and keep your questions and concerns handy for when you meet with the doctor.  Write down the information given so that you may share it with the other family members.
 Ask specifically what you can do to help.

Patient Conditions terms are the following:
 Critical means vital signs are unstable.  The level of consciousness may vary.  Indications are unfavorable.
 Serious means vital signs may be unstable and may not be within normal limits.  Level of consciousness may vary.  Patent is acutely ill.  Indicators are questionable.
 Fair means vital signs are stable and with in normal limits.  Level of consciousness may vary.  Indications are favorable.
 Good means vital signs are stable and within normal limits.  Patient is conscious and comfortable.  Indicators are excellent.
 Undetermined means the patient is in the evaluation process.
 Stable means the vital signs are stable. 

Your emotional support along with the decisions you may have to make for your loved one are all ways you are part of the ICU team.  No matter how overwhelmed you may feel, you are helping your loved one by being an effective family and team member and sharing as well as relaying information. 

A tender touch from a loved one’s hand delivered in the ICU along with sweet words of support can work miracles. Remember the more you understand what is going on the less likely you will be to be afraid.

 

Web Site: The Bright Side - Wings of Support


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Reviewed by Karen Lynn Vidra, The Texas Tornado
good advice you have here, sherry. this should help a lot of people who are facing this very thing right now; such a stressful time such as it is! i have been there, more than once; NOT fun! (NOT me, but my mom and also my grandma; they've been in i.c.u. more than once; both have since passed on, unfortunately, but i remember the fear and helplessness i felt while waiting at the hospital!)

(((HUGS))) and much love, your friend in tx., karen lynn. :(
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