It is the middle of the night and the phone
rings. Your family member has been in a car
accident and is rushed to the hospital. He is
currently in the intensive care unit (ICU).
You race to the hospital and are met by the
intensive care doctor. All you hear is
“critical, unstable, and surgery.” Later, as
you sit out in the waiting room, you wonder, What
can I do to help my loved one through this?
This article contains key information on
assisting family members survive when a loved one is
in the intensive care unit. Communication, decision
making, multi-disciplinary meetings, pain/comfort,
and sleep are discussed. Hopefully, knowing
this information will help you and your loved one
have a positive experience and survive your time in
Thorough communication is the best tool that you
have when your loved one is in the ICU. You are
going to be overwhelmed with information from many
different people. Here are some tips to help you
understand everything that you are being told.
- Write everything down. During this
stressful time, it is difficult for you to
process all of the information you are given. If
you write everything down, you can read it at a
later time and absorb what you are reading.
- Have someone with you. If you have a second
set of ears to listen to what you are being
told, then you can discuss it afterwards to be
sure that you heard everything that was said.
- Nurses are excellent resources and can
assist you in many ways. If at all possible,
make sure that the nurse is present when having
discussions with the doctor. The nurse can help
to explain medical terminology or translate what
was discussed so that you can understand it
- Keep an open line of communication with your
nurse. Nurses are patient advocates and can help
make sure that the patient’s wishes are carried
out. Communicate openly and honestly with
your loved one’s nurse; let him or her know your
questions and thoughts. Nurses can better assist
you if they know what you are struggling with.
- The Internet is not always the best
resource. While looking up information on
the Internet may be helpful for you to better
understand certain things; the internet can be
overwhelming because it has so much extra
information on it. This extra information can
leave you confused and stressed; often the worst
case scenarios are included in your search
results. Listen to what the doctors are telling
you about your loved one. They are looking at
the entire picture, not just the specific
disease or injury.
The bottom line is that open communication with
all members of the healthcare team will help you to
better understand what is going on with your loved
Know your loved one’s wishes
loved one’s wishes about quality of life and
resuscitation is important all the time, but this
information is vital when they are in the intensive
care unit. When a patient is unstable and
there is no knowledge about their wishes, all heroic
measures are done. Heroic measures include putting a
breathing tube in the mouth, performing chest
compressions and giving the patient an electrical
shock when necessary This is true even if
there is no hope of survival. If you know
their wishes, let the healthcare team know early on.
It may save sorrow and heartbreak later on.
patients linger in ICU. They become weak and
lack the ability to breathe without the ventilator.
Some also lack the ability to swallow. The
healthcare team may ask for permission to place a
tracheostomy and/or a feeding tube. At this
time, you should ask the team these questions:
- What will be their quality of life?
- Is the tracheostomy and/or feeding tube permanent?
- What is the plan after these procedures? Is
the plan to try to wean and remove the ventilator or
to assist for placement in a convalescent home?
- Will my loved one be in a convalescent home until
end of life?
- What is the likelihood of a full recovery?
When you hear these answers, give permission based
on what your loved one’s wishes are.
Unfortunately the stress of the situation will
sometime overwhelm families, causing them to make
decisions based on guilt or their own beliefs.
Take time to really think, would he/she want to be
on a ventilator or in a convalescent home the rest
of his/her life? Remember, it is never too early to
have a living will, durable power of attorney, or a
discussion regarding your wishes regarding quality
of life. A durable power of attorney
designates someone that the patient has chosen to
make decisions for them when they are no longer able
to make decisions for themselves. Do this sooner
than later! Also, once you have had these
discussions with your loved one, be sure to stand up
for your loved one’s requests and make them known to
the health care team.
It is important to get frequent updates
on how your loved one is progressing while in the
intensive care unit. As discussed earlier,
communication between you and the healthcare team is
vital. However, families often complain about
receiving mixed messages from different healthcare
team members. This occurs frequently when
consulting physicians are asked by the family how
the patient is doing. They have the tendency
of reporting on how their specialized organ or
system is doing, not how the whole patient is.
For example, if you ask a cardiologist how the
patient who has had abdominal surgery is doing, he
will probably respond to only how the heart is
progressing. This is not out of malice or any
intention of misleading you. It is because
many times they are only looking at their specific
piece of the puzzle.
family meetings help to prevent these mixed
messages. At these meetings, all the
consulting doctors, the patient’s primary doctor,
nurses, social workers, clergy, and other team
members are in the room with the family.
Instead of hearing one doctor’s views on the
patient’s status, the family hears from everyone and
leaves with a better understanding of how the
patient currently is and the expected outcome.
Come with your list of questions and write down the
answers. Many times, the questions are
answered, but families forget because of the stress
of the situation. Do not be afraid to ask for
explanations if you do not understand the “medical
jargon.” At the conclusion of the family
meeting, repeat back what you heard so that the team
can make sure that you understand and are aware of
what the next steps will be.
Lying in a bed for 90 - 100% of the day can be very
uncomfortable. Add in the different tubes,
drains, procedures, exams, and the injuries which
lead to the ICU just compounds the discomfort and
pain. It is common for patients to receive
scheduled or continuous pain and sedation
medications while in the ICU. If your loved one
appears or indicates they are uncomfortable, speak
up. You know him/her better than anyone else.
Be their voice.
Many times when being weaned from
the ventilator, these medications are decreased so
the patient is more awake and able to participate in
this process. This can be uncomfortable.
It is very important to collaborate with the
healthcare team to maintain comfort while allowing
this weaning process to occur.
importance of sleep while your loved one is in the
ICU cannot be stressed enough. Unless he/she
is very unstable, you should make a point to sleep
every night (in your own bed if at all possible).
You cannot support your loved one if exhausted.
Let the nurse know you are going home for the night
and to call you if there are any changes. Remember,
the intensive care patient to nurse ratio is
normally 2 patients to every 1 nurse. Your
family member will have close observation and
excellent nursing care. This is the safest
place in the hospital for your loved one. Don’t be a
It is completely okay for you to go home
and allow your loved one to rest. Even though they
are the patient, if they are awake, they may feel as
if they have to entertain you while you are visiting
them. They may feel the need to talk to you and to
put on a happy face; when you leave, you are giving
the patient permission to rest.
When your loved one has stabilized and
transferred out of the ICU, many times they will
need you more than when in ICU. Yes your loved
one is stable, but many times they need you to
oversee their care. They are getting better, but
still may be weak and mentally foggy. It is
important to be there when the medical team does
rounds and makes the plan of care for the day. Ask
questions and be the voice your loved one needs at
While patient survival of the ICU is
not always possible, we hope that this list of
helpful hints will assist you and your family during
your time in the ICU. The dedicated staff of the ICU
works diligently to save patient lives and assist
family members through difficult times. Stress and
anxiety can prevent families from hearing all of the
information they are given. Be sure to ask questions
and get a good understanding of what is going on
with your patient before making any life altering
decisions. As the family member, you are the voice
of the patient; you need to make decisions based on
what the patient would do if they were able to
communicate their wishes.
Susan Montminy, MSN,
RN has been a nurse practicing in the State of
Connecticut for the past 30 years. She has
spent approximately 20 years of her career in the
Medical/Surgical Intensive Care Unit at St. Francis
Hospital and Medical Center in Hartford,
Connecticut. The last two years of her career
has been as a nurse educator for the Intermediate
Meredith Dodge, MSN, RN has been a
nurse practicing in the State of Connecticut for the
past 12 years. She has spent the last 10 years of
her career in the Medical Surgical Intensive Care
Unit at St. Francis Hospital and Medical Center in
Hartford Connecticut. The last year of her career
has been as a nurse educator for the Medical
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