Medical Author: Maureen Welker, MSN, NPc, CCRN
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
The Intensive Care Unit (ICU) is a very "intense" area and 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.
The following are suggestions for family members on how to communicate with a loved one in the ICU:
- Speak in a calm, clear manner. Make short positive statements. Many family members assume because their loved one is on a ventilator they cannot hear and so they speak loudly, don't worry they can hear you.
- Acknowledge and recognize any discomfort your loved one may be experiencing. For example, you may tell them, "You're are in the ICU and you have a tube to help you breath. This is just temporary and we will get the nurse to give you some medication to make you more comfortable, you are doing great and making progress."
- Do not ask the patient questions that cannot be answered. Use a board so the patient can point to a word such as "pain," this allows your loved one to make his need known. Most ICU's have these boards available or will make one for you. It is not unusual for patients to be angry, frustrated, or not be interested in communicating. Be patient with them, the frustration level will decrease and perhaps another method of communication will work better for them.
- Provide a small board for the patient to write on. Many patients can write just enough so you know what they want. The hospital should provide this, however, these boards can also be purchased at a drug store or art supply store.
- Offer short phrases that offer support and reassurance. For example, "Mom, its Maureen, I'm here with you and you are doing much better. Everyone is taking good care of you."
- Simple hand gestures may work as well, such as thumbs up = "good"; and thumbs down = "pain" or "I need something."
- Remind your loved one that "this is just temporary and they are making good progress." Flood them with faith and hope.
- Hold your loved one's hand or touch them gently (be sure to check with the ICU staff first). For example, rubbing lotion on their hands or feet may not be allowed.
- Orient your loved one to the surroundings, for example, the date and time of day. You may want to make a sign each day with the date on it and place it where they can easily see it (for example, on the wall at the foot of their bed). Describe what the different noises are to help ease any fear or anxiety they may have about them.
- Read your loved one's favorite prayers, poems, books, stories, or bible verses.
- Music may be allowed in the ICU when appropriate. Again be sure to check with the ICU staff for guidance.
- Finally, just ask — the ICU staff may have the perfect suggestion for you to assist you in communicating with your loved one.
General suggestions that may be helpful to family members:
- Always check with the critical care staff before touching anything or saying anything to the patient. Stimulation can cause harm during critical periods of the recovery process.
- Ask the critical care staff to explain to you what the current status of your love one is, so you understand what is going on and why.
- Ask for suggestions on what would be helpful at this time for your loved one.
- Do not discuss any unpleasant matters in your love one's room. If your love one's condition is critical, discuss this or other problems outside the room. For example, do not discuss financial matters, or family disagreements, etc.
- If you are emotional and or upset either leave the room. It may be helpful to request a Chaplin or social worker to help you to calm down and help you feel reassured, or sit quietly at the bedside. It may only be harmful to your loved one to speak when you are angry or upset.
- Request your church Chaplin, the hospital Chaplin, or a social worker if you feel you need further support for yourself or for your loved one during the hospitalization.
- Consider setting up a family visitation schedule to spend time at the hospital, this prevents one person from becoming exhausted. For example:
Dad visits from 10:00 am to 12:00 pm
Maureen visits from 11:30 am to 2:00 pm
Kevin visits from 2:30 pm to 3:30 pm
It is important for family members to remember to be supportive of each other. Don't forget to take care of yourself, eat, drink fluids and get rest!
- Consider setting up an information update on the family answering machine so family and friends can get frequent updates on your love one's condition. Multiple phone calls to the Critical Care Unit staff can be time consuming and the staff wants to be at your loved one's bedside.
- Have two designated family members that communicate with the physicians and nurses in regard to your loved one's daily progress, and then those family members can update everyone else. You may want to keep a journal of information, questions, and answers. The critical care staff does not have time to answer the questions of multiple family members - they are very busy people and have your love one's best interest at heart.
- Allow your loved one periods of rest, this is a critical part of the healing process.
- Just sit quietly at the bedside, speak only if your loved one wakes up. Offer support and comfort.
The ICU is a busy place filled with all types of noise. Patients do not get much sleep, and sleep deprivation along with narcotic drugs can contribute to confusion in the intensive care unit, called "ICU psychosis," due to the critical care environment and illness itself. Many elderly patients become confused just being removed from their homes into a different environment, or in the dark of night, even when they are not particularly ill. As the patient continues heal from the illness or injury, medications are typically decreased. Normal sleep patterns gradually return and the patient recovers from the confusion of ICU psychosis. The act of communication will aid the patient in the process of returning to normal orientation. You will find the hospital staff very helpful in offering suggestions that will be beneficial to your loved one as the healing process continues. Various types and levels of communication will be of benefit at different stages of the recovery process.