Critical Care and Life Support

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.

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. 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.

Bringing Items From Home

Familiar items from home are often comforting. Music, blankets, slippers, audiobooks, 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

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. You should expect to speak with the RN and doctor or doctors 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. 

Self Care

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. 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." 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

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. 

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's heart stops beating or 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 -  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.

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.