Recognising and Managing Fatigue
Date issued: April 2023
Review date: April 2025
Ref: D-381/TG/ward/Pencarrow and Penrose Intensive Care v2
PDF: Pencarrow and Penrose Intensive Care final August 2022.pdf [pdf] 215KB
When your loved one is admitted to Intensive, or Critical Care, it can be a very stressful time. Though some admissions are planned, most are not, and it is quite usual to feel worried and upset.
This booklet aims to provide practical information, and advice on what to expect.
We understand that the information you are given may be overwhelming or forgotten at such a difficult time. We hope that this booklet will act as a resource for you to take away and refer to later.
In today’s society, family dynamics can sometimes be diverse and at times complicated. The term `relative` is used throughout this booklet to simplify the text rather than to exclude individuals. This booklet is aimed at anyone the patient may consider to play a significant role in their life, whether that is a spouse, a relation, a long-term partner or very close friend.
Introduction
Approximately 200,000 patients are admitted to Intensive Care in the UK every year. For patients and relatives, this can be a frightening experience, and you may find it overwhelming at times.
What is Intensive Care?
Intensive Care Units (ICUs, also called Critical Care Units) are specialised areas within a hospital. They look after patients whose conditions can be life-threatening and need constant, close monitoring and support from highly trained staff, equipment and medication. There are many reasons why people may need care in ICU. These range from a planned admission for observation following a major operation to supporting the function of major organs such as the lungs, heart and kidneys following a sudden illness or accident.
ICUs in the UK are run and staffed by doctors and nurses who have undergone specialist training in intensive care.
The staffing levels are higher than the normal ward, one nurse will often look after one or two patients. As part of the medical team here is always at least one ICU Consultant on duty to ensure that patients have immediate access to a senior medical opinion.
A wide range of specialised equipment is used in the ICU that is not available on the normal hospital ward. This allows very close monitoring of vital body functions and temporary support of those functions that cannot be maintained by the patient themselves.
The length of time patients spend in ICU depends on how ill they are and may vary from a few days to a number of weeks.
What Happens on Admission?
When your relative is transferred to us we need to assess their immediate needs, stabilise their condition and make them comfortable. In order to do this, we may need to insert various devices and tubes and attach them to our equipment. This can take some time and may mean that you cannot visit your relative immediately.
We appreciate that you will be anxious to see your loved one and that it can be frustrating waiting for news. We aim to keep you informed of progress and will allow you to visit as soon as possible.
Please show respect and consideration towards patients and staff, including our reception staff, whilst you are visiting. We have a policy of “zero tolerance” to violence and abuse and anyone behaving inappropriately will be asked to leave the premises.
Visiting the ICU
The ICU is made up of 2 wards - Penrose and Pencarrow.
Visiting relatives on ICU is important for both relatives and patients, particularly as the patients get better. However, we recommend that as much as possible, visitors should be immediate family or very close friends.
Due to lack of space and safety for you and your relative we allow only two visitors at the bedside at any one time.
Whilst we would like to support your visiting needs as much as possible, our prime focus is on the care of your relative. For this reason, it may be necessary to interrupt your visit and ask you to leave your relative’s bedside temporarily while we carry out personal care, position changes or attend to more urgent needs. You will also be asked to leave during medical ward rounds in order to maintain patient confidentiality.
Entering the Unit
Reception staff will be able to assist you, they will notify your relatives nurse that you are here. If the reception team are not at the front desk, please use the intercom at the door of the unit.
If the unit is very busy, there may be a delay in answering the intercom. Please bear with us, and if no-one answers after a few minutes, ring again.
Infection Prevention and Control
Patients who are critically ill may have difficulty fighting infections. The staff will do all they can to make sure the patient is protected. You can help too, by sanitising or washing your hands when entering or leaving the Unit.
In line with Trust policy, visitors are reminded to consider their own health when visiting and not to come to the unit if they are unwell or becoming unwell. We advise you to telephone the nurse caring for your relative to ask for advice prior to visiting.
Unfortunately, fresh flowers are not permitted on the Unit as the water poses a risk to equipment and can harbour bacteria.
Please do not bring hot drinks and food onto the unit.
Children Visiting the ICU
Children are welcome to visit as long as their parents / guardians feel it would be beneficial. Some, but not all, children find the experience upsetting and we would ask you, as parents, to judge what your child would be happy with. If your child decides they want to go into the ICU, please check with staff before bringing them to the unit and talk to the child about it - prepare them for what they might see, including the machines, what they do and how the patient might look. Resources to help children who are visiting the ICU are available from reception on request.
We ask you to use your own discretion and consider the risks of infection on a young immune system when deciding whether to bring a baby to visit.
Visiting Times
Visiting times are
12.00 - 2.00 pm and 4.00 pm - 7.00 pm
We have established a set rest period in the afternoon in order to help our patients sleep and recuperate as much as possible. This is 2-4pm
In exceptional circumstances, the Consultant may allow visiting outside the set times. This can be discussed with the nurse looking after the patient on the day and authorised by the Nurse in charge.
What to Expect
When you enter the Unit for the first time there is a lot to take in. The environment is noisy and can be overwhelming, and your relative may be connected to monitors, drips and machines. They may also be sedated.
Your Relative may Look Different.
Many patients have lines or drips to give medicines and monitor the patient’s condition. Patients often have a tube in their nose, which allows liquid food to be given. Some patients require a tube in their mouth or neck connected to a ventilator (breathing machine) to help them to breathe. Most patients also have a urinary catheter, and occasionally surgical drains.
Some of the machines that the patient is connected to have alarms that may sound to let staff know that something needs doing, for example if a drip needs to be changed. Usually, there is nothing to worry about – the staff will closely watch the patient at all times.
What Can I do to Help?
If your relative is in hospital for a long time, visiting can become hard. Days may go by with little change in the patient’s condition. There may be nothing for you to do but sit by their bedside and wait. It is common to feel ‘useless’ at this time, this is normal.
Helping the Patient
The nurses may ask you to bring in some of the patients’ personal belongings to help them recover, such as their favourite perfume or music. Talking to your relative or friend may also help. Keeping up a one-sided conversation can be difficult, but talking about shared experiences of holidays and good times can make you feel better too. You could also try reading a newspaper, magazine or book to them. Even if the patient is conscious, you may find it hard to communicate with them. If they can’t speak, they may be able to write, or spell out words by pointing to some letters, numbers and common words you have written on a piece of paper.
What Can I Bring my Relative?
Patients often appreciate their own personal items and toiletries such as:
• Small soft toothbrush and toothpaste
• Liquid soap or shower gel
• Comb or hairbrush
• Personal toiletries your relative may normally use
• Aerosol deodorants rather than roll-on varieties due to infection control
• Dentures, spectacles and hearing aids to make communication easier
• Razor, if electric please make sure it is fully charged
• Photographs and cards from well wishers
We try and keep the patient areas as clean and clear as possible. We have limited space for storage of large personal items so when possible, please take these items home.
Anything of value, especially money or jewellery, will be sent to the hospital safe, or given to you to take home.
Patient Diaries
The nurses will often start a patient diary a few days after admission which will document your relatives stay in the ICU. A diary can be very useful later on to help the person who is ill. They may have very confused memories of their time in the ICU or no memories of it at all and the diary can help them to understand what happened to them and fill in the gaps in their memory.
It can also help you and other family members and friends to write in the diary, to pass on your messages or to tell your relative news from home that they would like to hear. Please ask the nurse caring for your relative about their patient diary.
There is also a section for you to fill in with personal information such as the name your relative likes to be called, communication aids they normally use, such as glasses or hearing aids, and their likes and dislikes which will be useful to us in trying to maintain a normal day/night routine for them.
Delirium
It is common for patients who are critically ill to experience delirium. This may be because of their illness or medication. They may be agitated, confused, scared or paranoid. They may also have hallucinations and nightmares that seem very real to them. This can be extremely distressing for you and the patient but it will improve as they get better and begin to recover. More information on delirium can be found in the patient diary.
Talking to and Touching Your Relative
Nurses will often talk through what they are doing even if the patient is unconscious. This is because, even though they are heavily sedated, the patient may be aware of being touched, but they are unlikely to remember things as clearly as they would when fully conscious.
Although it may feel strange, talk to them normally to let them know you are there. They are more likely to recognise or respond to a familiar voice and will draw comfort from your presence.
Do not be afraid to touch your relative. Though the equipment and tubes may be unnerving, remember they are still the person you know underneath. You may wish to hold their hand; your nurse will show you how to do this safely.
Some relatives find it helpful to be more involved in caring for the patient when they’re recovering. You may be able to help by doing things such as brushing their teeth or massaging or moisturising their hands and feet. This will depend on how ill the patient is and won’t always be possible but if you want to help in this way, ask the staff.
Looking After Yourself
You can help the patient by taking care of yourself. You shouldn’t feel guilty for not being by their bedside 24 hours a day. You need to give yourself a break and this will also give the patient time to rest. The patient will be very well cared for and the staff will contact you straight away if they need to or if there is any change in their condition.
You may have family and friends who are concerned about you and the patient, and they will want to know how things are. You may appreciate their concern, but it can be tiring if the phone is ringing all the time when you’re at home between visits to the hospital.
Passing on the information by e-mail, text message or in a group chat to several people at once can be easier. Or you could speak to one person regularly and they could pass the information on to others.
You may not feel like eating and you may have difficulty sleeping but do take time to eat regularly and rest when you can. If you become tired and ill, you won’t be able to care very well for the patient.
Communication with the ICU
The ICU team will keep you informed of your relative’s progress on at least a daily basis. The members of the team will always do their best to answer your questions accurately and promptly, but at busy times there may be a delay before one of us is available.
We will provide updates to next of kin and / or nominated family or friend.
During the day, we try to provide availability of a senior member of the medical team to speak to relatives who require a detailed update. Please ask the nurse at the bedside if you would like to talk to the doctor during this time, and we will do our best to ensure it happens. We hope you understand that due to clinical commitments, this may not always be possible.
Telephones
You may telephone to ask about your relative at any time. Please try to nominate one person to do this, who can then pass on information to others. This reduces the number of telephone calls, and hence interruptions, for the team caring for your relative. The nurse will set up a password to enable telephone updates with the nominated next of kin.
Mobile Telephones
For the purposes of maintaining confidentiality, the use of mobile phones by visitors is not permitted on the ICU. You may use it in the waiting rooms, or outside in the courtyard area, where the signal is often much better.
There are payphones available on Level 6 inside the main entrance to the hospital.
Photography
We respectfully ask you not to take photographs or use any sort of recording device within the ICU. This is to protect the confidentially of our patients.
Facilities on the Unit
The main waiting area has a chilled water dispenser and a visitor’s toilet. There are more extensive refreshment facilities in the main hospital, please see below.
Please help our domestic staff to keep the waiting areas clean and tidy by leaving them as you would wish to find them.
Please do not leave valuables unattended.
Smoking is not permitted anywhere within the hospital grounds.
Shops and Hospital Services
There are several shops and eating areas within the hospital. At the main entrance on level 6 there is a cash point, fruit and flower shop, newsagent/ convenience store, M&S food hall, and a second-hand book shop.
Other services on level 6 include:
• PALS: Patient Advice and Liaison Service
• Visitors’ toilets
• Bakery and coffee shop: open 24 hours
Restaurant
Level 7, Zone E; Serving hot and cold meals. Opening times every day 7.30 am to 8.00 pm. Out of hours there are vending machines supplying hot and cold snacks and drinks outside this restaurant.
Coffee Shop
Level 3 of the Terence Lewis Building (Zone C) below the ICU This coffee shop offers a selection of fresh salads, drinks, baguettes and healthy sweet options and is open 7am-4pm every day.
Parking
Derriford operates a pay on exit parking system, with pay points at the exits from the hospital building.
Relatives of patients who are on ICU are entitled to free parking – please ask the ICU receptionists for a car parking permit. However only 2 permits per patient can be issued.
Public Transport
Bus timetables are available outside the porters’ lodge in the main entrance on level 6 and at the individual bus stops outside.
There is a park and ride scheme from Tavistock Road opposite ‘The George’ public house where the number 7 bus provides a direct route to the hospital.
Accommodation
The Lodge is a charity-owned establishment near the hospital offering bed and breakfast at reasonable prices to relatives. It is situated a few minutes’ walk from the hospital.
To make a booking contact reception:
Tel: 01752 315900/315930
Hours: Mon – Fri 9am - 9pm Sat - Sun 9am - 7pm
Chapel and Multi Faith Room
The hospital has a Chapel and a Multi Faith room, with appropriate wash facilities, located on level 7. These facilities provide a tranquil place for quiet reflection or prayer. They are open day and night and cater for persons of all faiths.
Pastoral care and support are available to patients and their relatives, regardless of faith or beliefs. If requested, a chaplain will visit your relative.
Communication and Interpreter Services
If you find communication difficult because you are non-English speaking or hearing impaired, please tell the bedside nurse and we will arrange an interpreter for you.
How Long Will My Relative Need Intensive Care?
The course of critical illness is unpredictable, and your relative’s condition may fluctuate widely. Staff will keep you informed of all important changes. The outcome of serious illness and the effectiveness of the treatments we use can often be uncertain as each person responds differently. Length of stay can vary from as little as twenty-four hours to several weeks.
As long as treatments are continuing to be beneficial, we will continue to support your relative with the necessary treatments and care to aid their recovery.
Sadly, in spite of all the efforts of the staff and medical knowledge, some patients will deteriorate and die. This will rarely be a sudden and unexpected event and we will spend time discussing this with you in a sensitive way, aiming to provide realistic and honest information about your relative’s condition and progress in a way which you will understand.
Bereavement
At this very difficult time, the nursing and medical team will do all they can to prepare relatives and support them. Religious support is always available to those who wish it.
If you have not been offered one already, please ask for a bereavement booklet which will guide you through some of the practicalities following a death, or call the bereavement office on 01752 439492
Organ and Tissue Donation
Organ and tissue donation is the gift of organs and/or tissues donated after death to help someone who needs a transplant. Hospital staff are committed to doing everything possible to save lives and organ and/or tissue donation is only considered after all attempts to save life have failed.
Many people have made decisions in their lifetime about donation and it is important for the hospital staff caring for your relative/friend to find out what these wishes are. To be able to explore if a patient had expressed a wish to donate, hospital staff will discuss organ and/or tissue donation with you as the patient’s relatives.
If you would like more information on organ and tissue donation we also have a Specialist Nurse in Organ Donation available 24 hours a day who will provide information, advice and support.
Your nurse can call them for you.
Leaving the ICU
When your relative is better and no longer requires the specialist skills of the intensive care team, they will be transferred to a ward or a specialist rehabilitation unit. Here your relative will not have a nurse at the beside and there will be less equipment, because it is no longer necessary. Your relative will return to a more normal atmosphere.
This transition period can be a worrying time. It is common for both you and your relative to feel vulnerable or apprehensive, but this is natural and should be seen as a positive step towards recovery. Patients from ICU are seen by the Acute Care Team who provide support to the nurses and doctors on the ward by offering specialist advice and acting as a link with the intensive care team.
Rehabilitation
Rehabilitation starts in the ICU as early as possible and is key to recovery. When your relative is discharged to a ward, the rehabilitation team will follow up with them to ensure they have continuity of care and continue making progress.
Give Us Your Views
We hope that your experience of the ICU will be a positive one, but we are always looking for ways to improve our services. You can help us to decide those changes.
A Relatives’ Questionnaire is available from the reception. We really appreciate any suggestions you may have to improve facilities so we can continue to provide the best standard of care for our patients and their families. Please ask for one if you would like to feedback on your experience.
Following discharge from hospital your relative may receive a letter with a feedback questionnaire and an invitation to return to a follow up clinic where they can discuss any aspect of their treatment with one of the ICU doctors or nurses.
Complaints
The ICU Team aims to provide a high-quality service; however, we appreciate that sometimes problems do arise. If you have any issues or concerns, please speak to a member of staff; regardless of how busy we may seem, we are always happy to help resolve any issues.
If you feel that the problem is not being dealt with appropriately, please ask to speak to the Nurse in Charge.
If we are still unable to resolve things, you may wish to discuss your concerns with the Patient Advice and Liaison Service (PALS). PALS is a confidential service where you can get advice and support, and if necessary, information on the Trust’s complaints procedure.
How to Contact PALS
Telephone: 01752 439884
PALS@nhs.net
Patient Advice & Liaison Office (PALS)
Patient Services
Derriford Hospital
Plymouth, PL6 8DH
Other support and information
If money becomes a problem, contact Citizens Advice for information on any financial help and benefits that are available to you.
Cruse
A national charity offering support to anyone who has been bereaved. Trained Cruse volunteers can visit you at home, text or talk to you over the telephone.
0844 477 9400 www.crusebereavementcare.org.uk
Winstons Wish
https://www.winstonswish.org/
Freephone Helpline on 08088 020 021 for expert advice and guidance on bereavement support for a grieving child or young person after the death of a loved one.
Headway
The National Head Injuries Association provides information, support and services to people with brain injury and their family and carers.Tel.No. 0115 924 0800. Help line 0808 800 2244
www.headway.org.uk E-mail: enquiries@headway.org.uk
ICU Steps
ICU steps was founded in 2005 by ex-patients, their relatives and ICU staff to support patients and their families through the long road to recovery from critical illness.
https://icusteps.org/
Samaritans
A help line is open 24hours a day for anyone in need of emotional support. Tel. No. 0845 790 9090
E-mail: jo@samaritans.org.
Spinal injuries Association – SIA
Providing information and advice for people with spinal cord injuries Tel. No. 0800 980 0501
www.spinal.co.uk E-mail sia@spinal.co.uk
UK Transplant
Providing information and useful links on organ and tissue transplant.
www.uktransplant.org.uk
