What to Expect When a Loved One is Critically Ill

Admission of a loved one to an intensive care unit (ICU), a challenging and often unfamiliar environment, can create a great deal of tension and stress for patients and families. Effective and appropriate communication is an important part of the healing process, not only for the patient, but also for the family.

AACN supports including family members as partners in the care of acutely and critically ill patients. The information and links below are provided to assist families in understanding the ICU environment and the care that is delivered there.

What is the ICU?
 

Intensive care units (ICUs) are specially equipped hospital units that provide highly specialized care to patients who suffer from a serious injury or illness. The ICU staff includes doctors, nurses, respiratory therapists, clinical nurse specialists, pharmacists, physical therapists, nurse practitioners, physician assistants, dietitians, social workers and chaplains. There are over 6,000 ICUs in the United States, and different units may specialize in specific areas such as neonatal, pediatric and cardiac care.

Three factors differentiate intensive care units from other units in the hospital: 1) a very high nurse-to-patient ratio, 2) the availability of invasive monitoring, 3) the use of mechanical and pharmacological life sustaining therapies (mechanical ventilation, vasopressors, continuous dialysis).

Patients may be admitted to the ICU from an emergency room, operating room, another care area within the hospital or after being transferred from another hospital. Admission is based on a physician finding that close observation or specialized monitoring and/or therapy is necessary.

What Can I Expect in the ICU?
 

You can expect that the ICU staff will keep you informed of any major changes in the patient’s condition or procedures that are being performed. Patients in the ICU may have many doctors, who make rounds throughout the day. Members of the ICU team routinely meet with the patient and/or family to ensure that everyone has a common understanding of the health condition and the plan of care. During these meetings, it is a good time for family members to ask any questions of the healthcare team.

ICUs can vary in size. They may be small with four to six beds or they may be larger with twelve or more beds. You may have to press a buzzer and speak to a receptionist or a nurse on an intercom to gain entry to an ICU. Unless you are told otherwise, you should always check with a member of staff before entering.

You can expect to see machines and tubes in place. Patients in the ICU are connected to a heart monitor (EKG) and an oxygen monitor. Depending on the patient's condition, there may be many other types of equipment and monitors that the nurse can explain to you.

With so many monitors, the ICU can be a noisy place, especially during the day.  Alarms are set on the monitors and the breathing machines (ventilator). If the patient moves or coughs an alarm may sound. Know that most alarms do not signal an emergency.

Patients in ICU often require medication to keep them comfortable, which may diminish their level of responsiveness. The level of sedation will vary from person to person, depending on their condition. It is important to remember that although ICU patients may not be able to respond to a voice or touch, they may still be able to hear and feel. Visiting family members should talk to them, hold their hand and let them know they are loved.

When Are Patients Transferred Out of the ICU?
 

Some people may think that staying in the ICU for a longer period of time is better than moving to another hospital unit. However, the ICU is designed to care for critically ill patients. The transition out of the ICU usually means that the patient is improving and moving towards recovery. Once close observation and monitoring or specialized therapies are no longer required, the patient is transferred to the next level of care that meets his/her individual medical needs.

What is a Progressive Care Unit?
 

AACN recognizes progressive care as part of the continuum of critical care. Progressive care defines the care that is delivered to patients whose needs fall along the less acute end of that continuum. Progressive care patients do not require intensive care but need more care than that provided on a general ward. They may require frequent monitoring of vital signs and/or nursing interventions, but usually do not require invasive monitoring. Progressive care patients are moderately stable with less complexity, require moderate resources and require intermittent nursing vigilance or are stable with a high potential for becoming unstable and require increased intensity of care and vigilance.

Progressive care is how AACN collectively describes areas such as intermediate care units, direct observation units, stepdown units, telemetry units and transitional care units.

For more information see links below:

ICU Resources

Healthcare Resources

Complaint Resources

AACN Resources