In ICU, patients are constantly looked after and monitored by a highly specialised team, which includes consultants, physiotherapists, dieticians and nurses, each with specialist knowledge and skills. Specially trained nurses provide round-the-clock care and monitoring, and there is a high ratio of nurses to patients - each person in ICU is usually assigned his or her own 'named' nurse.
Here relatives talk about their perceptions and experiences of nursing care in ICU.
Most people spoke highly of all the staff in ICU and the care the patient had received, one saying it had been fantastic 'from the most senior doctor down to the domestic staff'. Many praised the nurses in particular, who'd they'd seen day in, day out, during an extremely traumatic time in their lives. For many the nursing care had been 'excellent' and the nurses caring, patient and supportive. Several said they 'couldn't fault' the nursing care, and some felt it had been as good as any care the patient could have received in the private sector. Some also felt that nurses had been crucial in saving the patient's life.
- Age at interview:
- Managing director, engaged, no children. Ethnic background/nationality: White British.
We've sat and talked loads about how we can't thank them enough to be honest. And I don't think that you can, I don't think you can really. It's like, you know, both [my partner's] dad and I tried to sort of, we were taking big crates of Coke and chocolates and various things for them as much as we could, but it just seemed immaterial at the time. And it's now sort of thinking, what I was told by the doctors, it was so close for [my partner] that, I could be sat now, on my own still massively traumatised. And because of them, I'm totally convinced that the Intensive Care nurses in particular and also obviously the doctors largely saved [my partner's] life. And to sort of buy them a box of chocolates every day and a crate of Coke or something like that, well it just doesn't seem enough. Especially when you work in a world that is, purely commercial and you see what little, the very little things people do and what they expect to be rewarded for it, compared to what those guys do and the level of reward directly they get from their salaries and what they get from patients and relatives, it is nothing.
I mean I just assume that they must get so much reward hopefully from people like [my partner] popping in and other patients popping in and saying, 'Thank you very much'. Because, I suppose life can go various different ways, but if it had gone the wrong way... I mean I suppose just in keeping [my partner] going, they make such a massive impact on so many people. And I don't know, I'm sure they do recognise it, but I'm sure they must get sort of like, used to it I guess, like a trader gets used to selling shares or whatever. But, I hope to hell they don't. Because it's, I suppose most people you talk to will say their partner, their relative that was ill is such a brilliant person. But, [my partner] touches lots of people in really positive ways. And, I mean I was sending countless text messages every single day, and emails, communicating with so many people about how she was. And, it would have been shocking if anything negative had happened. And it was down to those guys that it didn't.
The only thing else that I could say is that I cannot speak highly enough about them at all. And I mean again some of them, well, only a couple actually, maybe their way is different. But, they were, I remember sitting there a lot and thinking, 'God, if I could have my office working as a team like this, like the group of nurses work as a team, the efficiency in my office would improve so much'. And also the ambience and things like that. It was just such a team spirit and such a team, working together just as a team should. It was fantastic.
Many people were pleased with the information they'd received from nurses, whether that had involved clarifying or explaining what doctors had told them earlier, giving information about ICU equipment or about the nursing care itself. Most felt nurses had answered all their questions, were easy to talk to and that they trusted them, one woman saying she'd felt quite dependent on them in the early stages.
- Age at interview:
- Social services employee, widowed with one child. Ethnic background/nationality: White British.
And while you were in Intensive Care was everything explained to you?
All the time. All the time. Yes. And the nurses there were really, really patient, because I ask things you see. I ask over and over again [laughs]. I am very, very inquisitive about things and they were really patient with me. They explained things all the time. They were really very good indeed.
What were your main concerns during the different stages on the general ward, on ITU, during his time in hospital, what were the most important things on your mind. Your concerns?
To be kept informed. That was mine. I - whether I have got - I just think I have got, I don't know, I find things easier to bear if I can understand exactly what is going on. I must have really aggravated all the nurses. Because every injection he had I said what is that one for, every tablet he took I said what is that one for. But everybody was really nice and explained it.
And answered all your questions?
Relatives and close friends spoke highly of nurses who they felt gave information and explanations about care or treatments clearly and honestly. Many also appreciated nurses who'd shown an interest in relatives as well as patients, especially when they'd seen how busy they'd been with patients. Some praised nurses who'd shown sensitivity and had treated the patient with dignity and respect. One man said that, whenever he hadn't been at his wife's bedside talking to her, a nurse would be there instead, talking to her while she was unconscious. Many noted how nurses had combed the patient's hair, cut their nails or carried out other care while the patient had been unconscious, sedated or too weak to do anything for themselves.
- Age at interview:
- Retired company director, married with two adult children. Ethnic background/nationality: White British.
The thing that struck me about this particular unit was that, despite all of this roller coaster business, high flying emotions, and the periods of depression that would hit you, was the quality of the staff on the unit. I think but for them, I and many of the other relatives with wives, husbands, children in the unit, would probably have gone under. They were quite remarkable as a team and as individuals. And their support, their willingness to talk, their willingness to support you and indeed prop you up at times, was quite remarkable. The doctors themselves were particularly good as well in that they were quite open and honest and explained what was going on, what they didn't know, what they knew they couldn't control. But the thing that struck me about it was the honesty and obvious integrity of the team there to do what they thought was best both for the patients and the relatives. They gave this support to all of us.
All the team in the unit are working in a goldfish bowl. I looked around when I was there and every bed had relatives around it and the staff were doing their duty, their work, their skilled work under the eyes of relatives who had nothing else to do because the patients were unconscious except to sit and watch them and perhaps talk to them. And these poor staff are working in a goldfish bowl all the time, and from what I saw there was an incredible amount of professionalism and care, what I would describe as good basic nursing care that you don't see a lot of these days. I mean within a few days of my wife being there I was almost assaulted by the nursing team to bring in her smellies. I had no idea what they meant until it was explained to me it was her perfumes and make up. And they gave me a list of what to bring in, and so I had to bring everything in. Anyway they wanted it because they wanted to look after her although she was totally unconscious. And they did, they washed her hair, did her nails. They did her eyes and they just did everything for her. And they made her look beautiful during this particularly difficult phase. And in the 49 nights she was there, there wasn't any indication whatsoever of any bed sores, nothing like that at all. There again that is a great testament to them, because she was absolutely supine all the time. Nevertheless there was good physiotherapy, good nursing care and so she came out of that experience in that sense whole and complete. I mean she wasn't physically whole and complete, she wasn't psychologically whole and complete, but from the care that she got she came out complete and I think that is a great testament to them, what they did, and the patience they showed and the absolute devotion. And it wasn't just for the wife, it was everybody. It was an extremely good unit.
Nurses had sometimes encouraged relatives and close friends to become involved in the patient's care, and this had helped them to feel they were doing something useful and positive.
- Age at interview:
- IT project manager, living with partner, no children. Ethnic background/nationality: White British.
In general I found the nurses very helpful and very kind -
In Intensive Care?
Yes, yes. And I think they were quite relaxed about us doing things like washing her face and all, obviously there were issues about germs and hygiene, but they were actually very good about us doing things like that, which I thought was good. Because, you know, you want to feel like you can kind of go in and do a few things for the person you're visiting, without feeling like you have to ask for everything that you're going to do. To the extent where we were able to sort of use the little sponges on sticks to moisten her mouth, and use the tube to suck the stuff out of her mouth for her, and things that otherwise you'd have to ask the nurse to do every few minutes.
You know, you could at least, sort of the only thing that, sort of things you couldn't do were things like when she needed to cough. And they had to put a tube down and that was really horrible to watch. But once I'd seen it once or twice I knew what it was. But it was, she went bright red and started sort of convulsing. And then the nurses would like, 'Oh, no, this is, you know, all we have to do is just put this tube down and it...' I know she hated that. But it had to be done. And it's just quite interesting to see the way someone has to be sort of kept going in those circumstances when their body just can't do anything for itself.
Sitting at the bedside all day, many people said they'd observed how hard working ICU nurses were, and how well they worked as a team as well as on their own. They'd also been impressed with nurses who'd shown commitment and friendliness, and felt this had been particularly important in an environment that sometimes felt depressing.
Several people had felt ICU nurses had become 'like friends' and, because they'd spent so much time visiting the patient every day, they'd got to know many of them quite well. Some explained that, despite the serious environment of ICU, they'd shared laughter and jokes with nurses and many special moments. Some said nurses had often joked with the patient too, bolstering them, and the atmosphere had often been calm and peaceful.
- Age at interview:
- Husband: Part-time minister/social worker, full-time carer, married with one adult daughter. Ethnic background/nationality: White British. Daughter: Hostels officer, single, no children. Ethnic background/nationality: White British.
Husband' I mean basically the problem was then that the wound wasn't healing properly and they tried vac machines and maggots and you know you name it, they tried it to try and get this wound to heal and they were showing some'
Daughter' Who was it, the vascular nurse?
Daughter' She was absolutely fantastic' before mum went into Intensive Care, before she had to have any of the operations, she was amazing. She was so fantastic with people. She was excellent. And she would come and tell us everything. All the time. And she was - I think she was a real comfort to you both actually wasn't she?
Husband' Yes. I mean she was the main link to the whole vascular side of the thing anyway, but yes she was our main, sort of pillar of support.
Daughter' She was amazing, yes.
Husband' And the ward - the main ward sister.
Daughter' Who I didn't have much to do with did I?
Husband' But I mean, I think various members of the nursing staff in particular saw my wife as a friend in the end. I mean they would talk to her and she felt very supported by them and the doctors were fantastic as well. I mean the consultant herself was. But her team was very good and I mean it was highlighted for me by a later incident, which was to do with taking blood because my wife's got very poor veins and she is always, even at the peak she has been very difficult to get blood from. And of course when she was really ill, it was almost impossible. And the senior house officer on the team, I mean he would spend ages just finding a vein that he could use and he was just so patient about doing it. He was remarkable really. So the whole thing was like that and it was almost like a little family really wasn't it?
Some relatives talked positively about the reassurance and hope they'd been given by nurses, who'd encouraged them to never give up or had comforted them when they'd been distressed. Most had valued the support nurses had given them through such a difficult, uncertain time and some said that, if it hadn't been for this support, they might not have got through such a stressful crisis. One woman said that nurses had been her main source of support, information and advice over the four months her partner had been in ICU.
Some people said that, overall, they'd been happy with the nursing care in ICU but felt some nurses had been better than others, some more optimistic than others, and some had given more explanation and information than others. One woman said some nurses had been more welcoming than others when she and her family had visited ICU. A few people said they'd been disappointed in particular nurses, who they'd felt had been abrupt, slack or less hygiene conscious than other nurses. One couple had been particularly disappointed in a nurse who they felt had been dishonest with information and another who hadn't taken the hygiene measures they knew were essential to avoid cross infection.
- Age at interview:
- Father: Company director, married. They have three adult children. Ethnic background/nationality: White British. Mother: Retired NHS manager, married. They have three adult children. Ethnic background/nationality: White British.
Mother' Predominantly the nurses were brilliant. There were one or two who either seemed very brusque or very slack. And we actually had occasion to complain about one to the nurse-in-charge, who was actually lying about his condition. She said that he squeezed her hands. And he didn't. He wasn't squeezing hands. He wasn't cognisant in any shape or form at that stage. And quite why she had to embroider her findings and tell something that wasn't true, I don't know. As I've said, I had quite an extensive medical background, and I was reading her notes. And she hadn't written them up. She hadn't written any notes. And they were doing over twelve-hour shifts. By the time we finished talking to the nurse-in-charge her notes were all made up. So she had just recalled readings that she took at 10 o'clock that morning. And this was 11 o'clock at night. So I was very unhappy at this.
Father' But that was one particular nurse. The others were all excellent and we can't complain about them at all.
Mother' Well, there was one other that was a bit slack, obviously didn't want to be in the room. I don't know if she wanted to, they had a big ITU with about seven beds in it and then two side rooms, and maybe she wanted to be out with her colleagues rather than stuck in the room with the patient. But it just seemed that every two seconds she was off and away, and we were left looking after. And the other thing that worried me was that the patient in the other side room was MRSA-positive. And when this nurse went for a break, that nurse looked after both rooms. And there was no hand-washing. Yes, they wore gloves, but they'd go from one room to the other quite quickly. And in fact subsequently our son has been found to be MRSA-positive. And all I can say is, 'I'm not surprised'. And good as most of them were, one or two of them were lax and sloppy. And as a healthcare professional I wouldn't tolerate it. And expressing those things to the nurse-in-charge depended very much on which nurse was in charge, as to whether you got a tight response that said, 'Right, that will stop, that will cease' or whether it was sort of, 'Oh, leave it with me. I'll take care of it' you know, sort of, 'Don't worry about it'.
- Age at interview:
- ICU consultant, living with partner and two children. Ethnic background/nationality: White British.
Perhaps with my insight into Intensive Care it is to ensure that the wrong things weren't being done. For example one physio didn't like me asking politely if she would take her watch off because it is an infection risk. By definition, if you are wearing a watch you cannot be washing your hands properly as the bugs grow under the watch.
On another occasion, a nurse had rolled and turned one patient and went straight to my father without washing her hands. Again, she didn't particularly like being asked to wash her hands first. There is a big emphasis on infection control and I think they both knew they were wrong. I tried to do it diplomatically but, at the end of the day, I don't care about their sensitivity if my father gets an infection as a result. So I think I was being more vigilant from a medical perspective. These are relatively isolated incidents. By and large what they did was very good. My mother also picked up on the vast difference in the quality of the nurses looking after my father. She noted at the beginning of the shift that one or two would really clean everything, surface tops, equipment, etc whereas others wouldn't clean at all. She was saying why are some people ultra-clean and others not? Again she is absolutely right.
When someone is critically ill in intensive care, one relative or close friend is designated to phone ICU and pass on updates to other people. When away from the hospital, many people had relied on nurses to ring them if there'd been any change in the patient's condition. Some said they'd often phoned ICU to get a quick update before going to hospital or phoning other relatives. A few said there'd occasionally been a bit of confusion in who the designated person had been and, when they'd phoned ICU for an update, had found it difficult to get information from nurses. One woman said her father had been so distressed when her mother had been critically ill that he withdrew and gave them very little information. When she'd phoned ICU for information, some nurses had been helpful but others had refused to give information to anyone who hadn't been the designated person.
- Age at interview:
- Retired GP, married with three adult children. Ethnic background/nationality: White British.
I did have a problem establishing that I was the person they should tell things to. So sometimes I would ring up early in the morning. Because my husband I think would probably have telephoned me just before he went to bed, and so I wanted to know before he telephoned me what the news was this morning. And sometimes the nurse would give me an answer that was meaningless. And I'd have to rather bully her and say, 'I am the person who is supposed to be told things.' And of course because that was the case that they only would tell one person, I was responsible for telling everybody else. And there were some nurses who would give a rather gloomy picture of what was happening, and others who would be very optimistic. And I wasn't really sure whether this was altogether to do with difference in her condition or whether it was to do with their own temperament in a way, their inclination to be one thing or the other. But they were all very nice. I mean I was very impressed by the idea that you have a nurse who is totally devoted to one patient for the whole time.
A few people said that, although they felt the nursing care had been good, they'd rarely seen the same nurse twice. One woman wondered whether this was deliberate so nurses wouldn't get too attached to particular patients.
Some people said they'd felt sad and emotional saying goodbye to the nurses, especially when they'd been visiting ICU for several weeks, seen nurses every day and felt like they'd got to know them. Many felt they built a bond with the nurses, having shared such a traumatic time with them. A few said they could never repay them for what they'd done and, though they'd bought them gifts when the patient had been discharged, these had felt small and trivial compared to what the nurses had done for them.
The nurses will do things for the patient include the following:
- Taking regular blood tests
- Changing the treatment in line with test results
- Giving the drugs and fluids that the doctors have prescribed
- Recording the patient’s blood pressure, heart rate and oxygen levels
- Clearing fluid and mucus from the patient’s chest using a suction tube
- Turning the patient in bed every few hours to prevent sores on the skin
- Cleaning the patient’s teeth and moistening his or her mouth with a wet sponge
- Washing the patient in bed
- Changing the sheets
- Changing the patient’s surgical stockings, which help circulation when s/he is inactive (lying still) for a long time
- Putting drops in the patients eyes to make it easier for them to blink
Last reviewed May 2015.
Last updated May 2015.