Information for Patients and Families Admitted to the Adult Intensive Care Unit (ICU)

Our ICU health care team works in partnership with patients and their families. The following list provides a brief description of the team members in our ICU:  

ATTENDING DOCTOR - directs the care of the ICU patients. Every Monday, the attending doctor that works in the ICU for the week changes. Report is always given to the new attending doctor to ensure quality care is continued.  Family meetings with the attending doctor can be set up when updates are needed or requested.

RESIDENT PHYSICIAN, HOUSE MEDICAL OFFICIERS AND CLINICAL ASSISTANTS - takes care of the medical plan, gives direction for treatment, and updates the attending doctor often. They also manage the patients in the ICU when the attending doctor is off site.

UNIT MANAGER - directs and coordinates the delivery of high-quality nursing care for patients in the ICU. They provide support to the healthcare team, patients and families.

CLINICAL RESOURSE NURSE (CRN) - promotes procedures, policies, practices and standards of care in the ICU. They provide ongoing assistance to the healthcare team, patients and families.

REGISTERED NURSE (RN) - provides care to patients with life-threatening medical conditions. They advocate on your behalf and can be asked for updates and information about the plan of care.

PHARMACIST - reviews all medication orders and the quality of medicines supplied to patients. They provide answers to your questions about medications.

RESPIRATORY THERAPIST (RT) - provides care to patients with breathing problems. They manage life support breathing equipment (ventilators) to help your loved one breathe better.

HEALTH CARE AID (HCA) – provides patient care and support with tasks such as bathing, dressing, and eating. They also ensure that medical supplies are readily available at the patient's bedside.  

UNIT CLERK- performs clerical duties such as making copies and faxing documents. They also greet visitors, answer incoming calls, and route callers to the right department or patient room.  

SPIRITUAL HEALTH PRACTITIONER - provides spiritual and cultural care to people with different traditions, faiths, values and beliefs. They support patients and families in coping with spiritual distress.

DIETITIAN - provides advice on the nutritional needs of critically ill patients. They help patients understand their particular needs and challenges, and design meal plans accordingly.

OCCUPATIONAL THERAPIST (OT) – provides therapeutic activities to critically ill patients. They help patients develop and maintain the skills needed for daily living and working.

PHYSIOTHERAPIST (PT) - provides education which helps patients improve their functional mobility. They develop an exercise treatment plan which supports the recovery process.

SPEECH-LANGUAGE PATHOLOGIST (SLP) - provides therapy to patients with communication and swallowing disorders. They educate patients and family members on treatment plans, communication techniques, and strategies for coping with speech/language barriers.

SOCIAL WORKER - provides support to patients and families with issues that occur as a result of critical illness and hospitalization. They help patients and families obtain services related to their unique needs.  

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) – occurs when fluid builds up in the lungs. The fluid keeps your lungs from filling with enough air and deprives your organs of the oxygen they need to function.

ADVANCE CARE DIRECTIVE – a legal document that helps the healthcare team understand your choices for resuscitation and other treatments.

ARTERIAL LINE – a thin plastic tube placed into an artery and used to monitor blood pressure and blood gas.

ANTIBIOTICS – medications given to treat an infection.

BLADDER CATHETER – a soft tube that is placed in the bladder to drain urine.

BLOOD GAS – a sample of blood that lets us know how much oxygen and/or carbon dioxide is in the patient's blood.

BLOOD TRANSFUSIONS - what you should know about blood and blood transfusions.

CARDIAC MONITOR – a machine attached to the patient that provides information about heart rate, blood pressure, and oxygen levels.

CENTRAL LINE – a thin plastic tube placed into a large vein and used to give drugs and take blood samples.

CHERRY BLOSSOM – a visual cue which promotes end-of-life dignity, compassion and respect when a patient's death is imminent.

DAILY GOALS – a plan of care for the patient which may change each day.

DAILY ROUNDS – a multidisciplinary meeting which takes place every morning in the ICU.

DELIRIUM - a common and temporary state of confusion that may develop suddenly.

FALLS PREVENTION – safe patient handling and movement signs are some examples of what we do to reduce the risk for falls in the ICU.

GRIEF AND BEREAVEMENT – the process of understanding and working through the loss of a loved one.

INTUBATION – the process of inserting a tube, called an endotracheal tube , through the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness.

ISOLATION – specialized precautions including the use of gowns, gloves and masks by staff and visitors which prevent the spread of germs within the ICU.

LIFE SUPPORT – a breathing machine and medications used to sustain patients who are very sick.

MEDICATION RECONCILIATION – a process to make sure that all medications that are taken by the patient are assessed upon admission and discharge from the ICU.

ORGAN DONATION - the process of giving an organ or tissue to help someone who needs a transplant.

PALLIATIVE CARE – an approach to care which focuses on comfort and quality of life for people of all ages affected by life-threatening illness. Palliative approach can be incorporated into a lifesaving treatment plan.-

PNEUMONIA – is an infection in one or both lungs. Bacteria, viruses, and fungi cause it. The infection causes inflammation, making it difficult to breathe.

SEPSIS – a life-threatening condition that arises from the body's response to an overwhelming infection. Sepsis can cause organ failure, shock (low blood pressure) and even death.

VENTILATOR – a machine that is used to help patients breathe when they are too sick to breathe on their own.

VTE PROPHYLAXIS – drug and nondrug treatments to reduce the risk of developing deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

A-B-C-D-E-F of ICU CARE:  represents a bundle of quality care initiatives that we do to support patient recovery. The ABCDEF are listed below:

• AWAKE – ICU patients often need medication to keep them calm for treatments to work well. Our team adjusts these medications (Daily Awakening Trial) to ensure that patients are awake or lightly asleep, and remain calm.

• BREATHING – ICU patients often need breathing support from a ventilator. Our team performs a daily breathing test (Spontaneous Breathing Trial) which tells us when the patient is ready to breathe on their own or if a breathing tube is still required.

• CHOICE OF SEDATION – The choice of medication is checked often in the ICU. Our team re-assesses daily goals for sedation and analgesia to ensure adequate pain control, and prevent/treat delirium.

• DELIRIUM – ICU patients often experience delirium, which is confusion that develops during an illness. It can be caused by illness, medications, pain and other factors such as noise and interruption of sleep. We look for what may be causing the delirium and treat the underlying cause(s).

• EARLY MOBILITY – Movement and exercise are important for a patient's recovery. Our team performs a variety of safe patient care activities including range of motion exercises, sitting up in a chair or using a bed bike.

• FAMILY – Families are considered essential members of our healthcare team. Your voice is important and helps ensure that medical decisions are in alignment with the patient's wishes.

During the COVID-19 pandemic, in-person visitation may change in response to public health and safety guidelines. However, Virtual Visitation through videoconferencing is available in all ICUs at all times (see the “How do I set up for videoconferencing?” tab). 

Safety Measures upon Arrival:

• Every person will be screened for COVID 19 prior to entry. The total number of visitors allowed will be determined in accordance with Public Health and Safety Guidelines.
• Don't visit when you are sick. Patients in the ICU are very ill and more sensitive to outside illness.
• Check- in at the Nursing Station. Upon arrival and whenever you have questions.
• ALL VISITORS must follow hand hygiene, social distancing, personal protective equipment (PPE) requirements and hospital policies.
  • Hand Hygiene Videos
  • PPE Videos

• The ICU is a scent-free zone. Please refrain from wearing artificial scents.
• Turn down the volume. Minimize your conversations in patient care areas. 
• Abusive behavior towards staff, patients and visitors is not permitted. We are committed to provide quality care that respects the dignity of all individuals.
• Items which may be restricted at bedside include electronic devices, flowers or plants, balloons, food and/or drinks.  Ask your nurse for more information about restricted items.
• Don't leave belongings unattended. We are not responsible for lost or stolen items.

Patients and their families are important members of the healthcare team. We are committed to providing you with information about your loved one, and there are several opportunities for families to communicate with the ICU medical team. This communication can occur in person, by telephone (teleconference) or by video (videoconference). Let us know what works for you and your family. 

Daily Rounds: You are invited to join our interdisciplinary discussion every morning and/or afternoon in the ICU.  Start times may vary depending on what's happening in the ICU.

Patient Updates: You can call the ICU nursing desk at any time and ask to speak with the bedside nurse caring for your loved one.  If the bedside nurse is unable to speak with you at the moment, we will call you back with an update as soon as we are able. 

Family Conferences: Let us know if you would like to schedule a formal meeting to discuss your loved one's status and/or to ensure that medical decisions are in alignment with the patient's wishes. Alternatively, the care team may contact you directly to arrange a family meeting. 

Family Conferences provide opportunities to ask us questions:

• Ask us to explain any medical terms or words that you do not understand.
• Ask us about the risks, benefits and alternatives to any test or treatment.
• Ask us about the purpose and potential side effects of any medication.
• Ask us to assist you in communicating with your loved one.

During this pandemic we anticipate having more patients in the hospital than normal. As a result, updates could be delayed because caring for all patients is our primary responsibility. We appreciate your patience if a delay in communication happens. Our ICU team will do our best to work around your schedule.

Please note: These communication methods do not guarantee privacy and confidentiality. Please use them at your discretion and complete the written permission request from your loved one's unit to consent to use.

You will need internet access, and a computer or hand-held device to participate in videoconferences with your loved one and/or the ICU medical team. FaceTime™ is available on all Apple™ products. Zoom™ can be used on all computers and hand held devices.  Directions on how to set up and use these programs are listed below: 

Getting Started with FaceTime™

FaceTime™ allows you to make audio or videoconference with calls over a cellular network or WIFI wi-fi with Apple™ products. To begin, open the application on your device (or conduct a search to find it) and enter the telephone number of the person you are trying to call. If the person's contact information is in your phone, you can call them directly from your “contacts.” Please note: FaceTime™ users must have a valid Apple™ ID and need to sign in the first time.

Getting Started with Zoom™ Videoconferencing

Zoom™ works with all devices and has a Web Client for desktop computers. It allows two or more users to communicate for up to 40 minutes (more parties can be added for shorter periods of time). All parties need to have this application on their devices and need to be logged in.

Steps for setting up Zoom™ on your device: https://zoom.us/feature/messaging

1. Install the Zoom™ application on your device from the Apple™ App Store or Google™ Play Store.
2. To join the Zoom™ meeting by phone, call any one of the numbers provided to you by the meeting's organizer, and enter the "Meeting ID" and "Password" when prompted.
3. To join the Zoom™ meeting online, click on the link provided by the meeting's organizer, and choose "audio" or "video" participation.
4. Creating a "free account" is not necessary to participate in Zoom™ meetings, but this option will allow you to organize (i.e. "host") and invite others to join a meeting.
5. If you want to "host" a meeting, use the icons at the bottom of the chat screen to invite participants. You can use the "Schedule" button to pick a time that you want to meet, and then generate a meeting event using a calendar invite or email invitation. You may also need to share a "meeting room number" (a random, 9-digit code created by the application). There are options for video chat "on" and "off" - choose your preference.

More resources are available on the Zoom™ website or YouTube™ to help you get the most out of Zoom™'s features.

Choose a family spokesperson. This is the person we will contact to provide updates and help make care decisions.  If your loved one is not able to speak for themselves, family may be asked to participate in goals of care discussions.

Provide us with a complete list of current medications. Please include prescribed and over-the-counter drugs as well as dietary supplements like vitamins, minerals, and herbal health products.

Take care of yourself. It is important that you take time to eat, drink fluids and rest.  Let us know if you would like to speak with a spiritual health practitioner or a social worker on our team and we will have them contact you.

Support and Care for your loved one.  There are multiple ways you can care for your loved one while they are in the ICU (see the “Caring for my loved one in the ICU” tab).

Follow all posted precaution signs. You may be asked to wear a gown, gloves, and mask to protect patients, families, visitors, and healthcare workers from the spread of germs that cause sickness.

Help us prevent infection.  Wash your hands with soap and water or hand sanitizer gel frequently, before and after contact with your loved one, and every time you enter and exit the ICU.

Help us protect patient privacy.  Please do not discuss patient health information with others and/or post what you see/hear on social media. Photographs, audio and video recording are not allowed.

Offer suggestions. You know your loved one the best. Let us know if you sense any change in their condition that requires our attention.

Tell us about your experience. You are an important member of our healthcare team. Your feedback is important and will be used to improve the quality of our critical care services. You are encouraged to:

• Complete our online satisfaction survey and/or request a paper copy of the survey from one of our team members.   
• Join our Patient and Family Advisory Council (PFAC).  
• Contact the unit manager or patient relations office when appropriate.

Having a loved one in ICU is a stressful time. Often communication is disrupted because of illness, sedation or delirium. Even when unconscious your loved one has a sense of your presence and reassurance. Here are some ways to encourage communication and help your loved one with being orientated.

• Speak calmly and in a clear voice.
• Speak in positive statements that are comforting and supportive. This is more calming than asking questions about pain and discomfort.
• If your loved one is alert but unable to speak because of a breathing tube, phrase questions that can be answered with a nod or shake of the head. Try simple hand gestures such as thumbs up or down. If your loved one is able to write or use a smartphone or tablet, you can assist with that.
• ICU has some communication tools that may be useful for expressing basic needs. The bedside nurse will be able to help.
• Photos of family, friends and pets are good for orientation plus they make great conversation starters.
• Remember that laughter is positive.

Ways to Participate in Care

• Feel free to hold your loved one's hand or offer a gentle touch.
• Orient your loved one to the surroundings. You can talk about the noises you hear and the people you see. Describe the kind of activity around you. This helps ease fear and anxiety.
• Read a book or a newspaper out loud. Bring in some music and headphones for your loved one. Watch TV together.
• Get involved with the ICU team by attending rounds and asking questions. The bedside nurse is a good resource so ask how you can participate.
• You can comb your loved one's hair or give a hand massage with lotion.
• You can also participate in your loved one's care by doing exercises with them as prescribed by the health care team. 

It can be extremely stressful to have a loved one sick in hospital or ICU. As a family member in this situation, you may experience a range of emotions, including grief, guilt, anxiety, stress, sadness and anger. This may be more distressing if you cannot be with your loved one. The following may be helpful in coping with this very difficult situation:

• Acknowledge how you are feeling, allow yourself time to feel difficult feelings. Some people find it helpful to journal how they are feeling or talk to someone they trust.
• Remind yourself – there is no "normal" way to feel in this situation; the situation is highly abnormal and goes against our instincts of how we expect to be able to care for our loved ones.
• Focus on what you can control. You cannot control what is happening to your loved one or whether you can visit them, and you may feel helpless and powerless. You can control your routine at home, what you eat, and who you talk to. Trying to maintain consistent routine, exercise, and eating well will give you more energy to deal with your emotions and the current situation.
• Reach out to supports you already have - other family members, friends, spiritual leaders. If unable to connect in person, connect through phone, FaceTime, Zoom, etc.
• Practice self-compassion (be kind to yourself). It is okay and expected that some days you may not feel able to do much at all. Remind yourself that what you are going through would be extremely difficult for anyone. What would you say or do to help someone else in this situation?  Try to apply this to yourself.
• Coping thoughts may be helpful to manage feelings you have about your loved one being alone. Writing down/reminding yourself of some key statements can be helpful to get through difficult moments or days. Examples (depending on the situation) might include, "My loved one is being cared for by expert hands", "Not visiting my loved one is helping to keep them safe", "My loved one would understand why I cannot visit", "Taking time for myself will allow me to be a better caregiver."
• There are a lot of little things that your friends and family can do to help and support you. Consider asking for help with practical tasks like pet care or with yard and garden care. Make a list of groceries for the next time someone offers to help you. It can be difficult to ask for or accept help, but friends and family members will likely be happy to feel useful and helpful to you during this time.
• If you are able to visit your loved one in the ICU, consider time away from the bedside for self-care.  Even short breaks can be beneficial - Examples may be taking a quick walk around the hospital, getting fresh air outside, or taking some time in the car (or on the bus or walk) before and/or after visiting to take some deep breaths or listen to something (music, a podcast) you enjoy. 
• If you are unable to visit in person, use technology as able to see and communicate with your family member and their healthcare team.
• If you would like additional support, there are several options:
  
  • AbilitiCBT (no-cost therapy to be available shortly though the Provincial Government) – https://www.gov.mb.ca/covid19/bewell/index.html
  • Anxiety Disorders Association of Manitoba COVID-19 support line - 204-925-0040 http://www.adam.mb.ca/blog/adam-s-new-support-line-info
  • Manitoba Psychological Society - find a clinical psychologist www.mps.ca/find-psychologist/
  • Comprehensive list of COVID-19 coping resources https://mps.ca/wp-content/uploads/2020/03/COVID-19-resources-for-the-general-public.pdf
  • http://www.mygrief.ca (online resource/support for grief and loss)
  • Speak to your family doctor
  • Referral by physician to Department of Clinical Health Psychology https://wrha.mb.ca/psychology/
  • Focusing On Our Mental Health During COVID-19 https://www.pmh-mb.ca/let-s-focus-on-our-mental-health

• If your thoughts or emotions become unbearable, you feel unable to care for yourself or others who rely on you, or have thoughts of hurting yourself or someone else, you need to access crisis support. Please call:
  
  • Klinic Crisis Line 204-786-8686 or 1-888-322-3019
  • Mobile Crisis Service, 204-940-1781
  • Manitoba Suicide Line 1-877-435-7170 (1-877-HELP170)
  • Kids Help Phone 1-800-668-6868
  • Manitoba Farm, Rural & Northern Support Services 1-866-367-3276, supportline.ca
  • First Nations and Inuit Hope for Wellness Helpline 1-855-242-3310

If you or your family members would like access to any of these services please let your care team know.

Spiritual Health Practitioners provide compassionate listening and cultural care to people from all backgrounds, all faiths or no faith, respecting all values and beliefs.

Social Workers provide counseling and help patients and families obtain services related to their unique needs.

Clinical Psychologists are trained to assess and diagnose difficulties in thinking, feeling and behaviour as well to help people overcome or manage these difficulties using a variety of treatments or psychotherapies.

Indigenous Health Services: The WRHA provides First Nations, Inuit and Metis communities with language interpretation, patient advocacy, discharge planning and spiritual/cultural care. Indigenous Health Centralized Support is available from 8 AM to 6 PM, 7 days a week. Call (204) 940-8800 or toll-free 1-877-840-8880. (https://wrha.mb.ca/indigenous-health/)

Language Access Support Services: The WRHA provides in-person and over-the-phone interpreter services in several languages and dialects. These services are available 24 hours a day, 7 days a week. Let us know your language needs.

Health Links - Info Santé is a provincial telephone health information service. Registered Nurses are available to speak with you 24 hours a day, 7 days a week. Call (204) 788-8200 or toll-free 1-888-315-9257.