The intensive care unit is different from other wards both visually and in the care that it provides. Patients will have single rooms and are usually cared for by a designated nurse for each shift. We usually have a one nurse to one or two patient ratio depending on the clinical demands of the patient. They will have a thorough knowledge of their individual patient and are supported by other members of the nursing team. They will usually be able to answer questions at the bedside and liaise with the medical team when needed.
Each bed space will have a range of monitors, pumps and other machines. It can appear quite an alien environment and there will often be multiple lines and drips to the patient. Many of the machines and pumps have alarms set at a low threshold that sound to let staff know that something needs doing or that it has detected a change. We understand this can be frightening but please be assured that most alarm sounds are information giving and to maximise patient safety. The bedside nurse can explain to you what our machines do so please feel free to ask.
Patients in the ICU are often are sedated primarily for comfort and safety. Very few patients will be under full general anaesthesia and so patients may be able to hear even if they cannot respond. Members of staff talk to the patients and tell them what is happening, so please feel free to talk to or hold the hand of your loved one.
Ventilators are breathing machines, often called ‘life support machines’, that support a patient’s breathing via a tube, usually in their mouth. The tube passes between the patient’s vocal cords, which prevents them from being able to speak while the tube is in place. Patients who are on a ventilator often need some level of sedation to allow them to tolerate the tube.
When a long period of ventilator dependency or breathing problems is anticipated the medical team may discuss with you the placement of a tracheostomy. A tracheostomy is a breathing tube which is inserted directly through the front of the neck, done under a general anaesthetic. They are generally considered to be more comfortable than a breathing tube through the mouth and a patient can often be awake with one in. Our specialist speech pathologists can then assist the patient with talking and swallowing safely as their condition improves. Sometimes patients leave ICU with a tracheostomy and they are cared for by the hospital Tracheostomy Team on the wards.
We recognise that this is a very stressful time for all involved and do our utmost to ensure clear communication with patients and their families. The nurses and doctors can provide bedside updates but these can be difficult to plan due to work load demands. We will always make time and more formal conversations can be organised with the specialists and social workers. The bedside nurses can assist in arranging these.
If you require interpreting services to aid in communication with hospital staff our social workers can help arrange this. We aim to provide an interpreter in person but sometimes this is not always possible and so teleconferencing services are used.
End of Life
Unfortunately we cannot always predict the course of an illness and there may be rapid changes in a patient’s condition. Sadly recovery is not always possible and a patient may not survive. In these circumstances we do our utmost to ensure comfort and dignity.
When a person dies in a situation where they may become an organ and/or tissue donor, the possibility of donation is raised with the family to consider. The Australian Organ Donor Register is checked to find out whether the person had registered their decision regarding organ and tissue donation and the family is given time and support to discuss and reach a decision. The quality of care for every patient at the end of his or her life, and the wishes of their family, is always the foremost consideration of all those involved.