Intensive care: Patients' experiences
The general ward: care and environment
People are transferred from the intensive care unit to a general ward when medical staff decide that they no longer need such close observation and one-to-one care. For many people, this move is an important step in their progress from being critically ill to recovering. In the UK National Health Service (NHS), general hospital wards are very different from ICU, the biggest difference being fewer nurses to look after many more patients. Nurses can be called with a buzzer by the bed but may not come straight away and some people who have become used to intensive care find this difficult. Here people talk about what it was like for them when they left ICU and went onto a general ward. Their experiences range from those who found this move the most difficult aspect of being in hospital, to those who were happy to be out of intensive care and on to the next stage of their recovery.
Preparing for the move from ICU to a general ward
Many people we interviewed felt they were unprepared for the kind of care and busy atmosphere of a general ward and said that the move had made them feel anxious and insecure. Some people wished they hadn't been moved to a ward until they felt better able to cope and look after themselves. Many were worried because they were extremely weak physically, relatively immobile and often completely dependent on nurses for all their care. Some said that it sometimes seemed to them that nurses in the ward didn't understand how insecure they felt when they left ICU, and some nurses had unrealistic expectations about how much they could do for themselves (see 'Physical and emotional experiences'). Many also said that there were too few nurses to patients, one man saying he felt 'forgotten'. Some carers said they were shocked when they needed to help with aspects of personal care and hygiene on the general ward.
He felt safe, protected and cared for in ICU but isolated on the ward and was still very weak.
And they took me to the general ward, oh God what an experience that was. Ward, bed right down at the bottom, pushed me right down there in the corner, put my curtains round me. I thought, "Well this is it." I was safe, I was protected, I was looked after, and here I was in a bed in the corner with curtains around me, forgotten.
And I'm pausing here because it's so important because this is the salient part of the whole story.
What a shock it is to have woken up in Intensive Care, in Critical Care and to go to HDU. You come to terms with all that, you come to terms with all the care, you come to terms with the fact you can't move, you can't eat, you can't speak, you can't move your own bowels, you can't move your own bladder, you're completely reliant on machines. And then somebody makes a decision one day that they're going to come and take you in a bed, along a corridor and put you in a bed, in a corner of a ward, with the curtains round you. And it was completely and utterly unbelievable because I was still being tube fed, I was still catheterised, and I still couldn't move. And I was aware that I was one patient amongst many in a very, very, very busy surgical ward.
She had to clean up after her husband because nurses took so long to attend to him.
So I called the nurse and asked if we could help because he was sick and I tried to get him cleaned up but I couldn't. We had to wait a long time. a) It wasn't nice for [my husband]. b) It was awful for me. And I'm sure for the people in and around it was absolutely awful. So from that point of view that was very, very distressing. But they did, you know, they did look after him reasonably well, but they just don't have the facilities or the staff to do it.
"Before a patient is discharged from Intensive care or the High Dependency Unit s/he should be given another health check (short clinical assessment) to identify:
- any physical or psychological problems
- the likelihood of any problems developing in the future, and
- their current rehabilitation needs.
- If the health check shows that the patient could benefit from more structured support, s/he should be given a more detailed health check (called a comprehensive clinical assessment) to identify their rehabilitation needs.
In ICU, people received one-to-one care by specially trained nurses, but on a general ward several people said they were 'one patient among many' and some found this a difficult adjustment. One woman, with spina bifida since birth, recalled how her parents insisted she have her own nurse on the ward because she would need much more help than others. Some felt that the ward nurses were less trained than those in ICU. One woman was upset when nurses on the ward didn't know how to deal with equipment to drain her wound. Others described the wards as busy places, and said that nurses were sometimes so busy with other patients that they felt 'abandoned'. Yet others disliked having to 'buzz' the nurses for help and felt they were bothering or 'mithering' them.
He was concerned about the experience of nurses on the ward and said mistakes were made with his...
I know that in Intensive Care the people are extremely competent, extremely professional, just by their manner and how they go about things, it's not because it's Intensive Care, it's, through the experience of being there, the people are wonderful. It's not true in the ward. They made a mistake with me this last time which actually caused me to go into Intensive Care, on the ward. A drip was allowed to run out. Now that shouldn't have happened and things like that wouldn't happen in Intensive Care. I don't blame people for what happened because of the pressure people work under but it's worth bearing in mind.
There's a certain age group of nurse, who've been nurses possibly for about twenty years, who've just had it and they don't, they're not good. They have no, they'd see the patient as enemy, for some reason, that's how I looked at it. They were someone to be dealt with as quickly and as abruptly and as curtly as possible. But then there's a whole new breed of nurse and a whole new breed of doctor and a whole new breed of consultant, too, that was my biggest relief. The consultants are now human beings, rather than golf club members, who want to get back to their private practices. They're completely different now, because I've suffered under their old school of consultant. But the ones I've had and the ones I've seen now are just wonderful. About thirty years younger than consultants I'd seen before.
Look on the whole, quite humanist all of them, that they look at it a holistic way which people hadn't been doing, it's taken a long time.
He adored some of the nurses but felt others were very busy and uncaring and, on one occasion,...
And the more tired I became, the smaller became my comfort zone. And my comfort zone certainly was not the chair at the side of my bed. That was a high-risk area to be in. I felt so vulnerable and threatened. Visiting time had finished. It was approaching the time for outgoing day staff and incoming night staff. And no matter how I pleaded, this was experienced on two occasions, I didn't get put in, back into bed until the evening shift had come on, when I had spent twelve hours in the chair at the side of my bed.
And on some occasions that occurred when it was not possible for the physios to get to me. So I had been chair-bound for twelve hours. And that is very, very frightening. Nobody there to give you reassurance. Your family has gone, those who were sort of giving positive support. And you realise that, you might, I realised that I didn't like necessarily all the nursing staff. There were some I really adore because I saw that the quality and the love and care shining from them. But I was ultra-dependent even on the people that I didn't like or took an instant dislike to. Some of which couldn't be substantiated. But that was feeling, and feelings are difficult to handle. And I realised I had to speak in a most genteel way, almost at times in a grovelling way, to get the attention of staff who would not normally show me the care that I felt that I needed.
He praised all the hospital staff but felt that nurses in ICU could give much more care and...
Patient' They moved me by, on the bed. It was quite
Wife' Different [laughs].
Patient' Dramatic really, yeah. It's like comparing going from a five star hotel to a bed and breakfast, because that's what you're getting in ICU, you're getting five star attention. And obviously when you get down on the wards, you're been used to one nurse sitting there, especially with my hands and everything. I couldn't talk, doing every command and, "Can I have a cup of tea please?" And, "Could I have a drink please? Could you give me a drink please? Could I have something to eat? Could you turn the paper over for me while I'm reading?" Whatever I, "Could you just put the television on me? Can you change the programme over in the television?" It's just like having a butler, well actually a couple of the men of a night time especially said, "When we look after you [my husband] of a night time, we're not nurses. We're butlers." 'Cause that is what they really were, they was just looking after...
Wife' Fetching and carrying.
Patient' Fetching and carrying that's what I meant, they were butlers. So going to another ward was different but they, this business I mean like they did tell me, you know, they told me, "[Participants' name], you know, it's gonna to be nothing like here." Most men when they, or ladies, patients when they go down there still most likely, perhaps a little but still, not unconscious but...
Patient'...unwell and not really with it whereas I was perfectly okay. And they said to me, "You're gonna notice the difference." And I said, "Yeah I know I will." But there's no comparison. There again the nurses on both wards I went to were terrific, the standard of nursing is very good but you can't compare it to ICU.
Wife' No, there's one patient-one nurse, and when you go to the ward it's four nurses, six nurses, twenty-four patients. So, you know, you do have to wait longer for things.
People described how difficult it could be to get their needs met on the general ward; some attributed this to a 'lack of co-ordination' on the ward itself. Others felt it was 'just the way it was' because of staff shortages in the UK National Health Service. Some were upset when they waited for things that never arrived, including meetings with medical staff, food and physiotherapy. Others said communication was poor between ICU staff and those on the ward, and occasionally - as when nurses on the ward were unaware of their medications or dietary restrictions - they felt this had affected their treatment and progress.
He felt there was a lack of continuity and co-ordination in the ward and never saw a counsellor...
And I said, "Well if you're the Dietician, I'm low on potassium and I want bananas." "Oh." She says, "Bananas isn't my department, that's the Ordering Department, you've got to get onto the Ordering Department." And I never got the bananas. The only time I got bananas was when a friend brought me some. And things were like that. You'd gone from this hugely protective Critical Care to this sort of hit and miss uncoordinated service. There was nothing wrong with the individual care, you know when somebody came to empty your urine bag, they did it properly, they didn't spill the urine all over the floor. When they came to do your blood pressure they did that properly, but were they really asking me, as a patient, how did I feel? Once in a blue moon the Sister would come and sort of bounce past and say, "How are you today?" And you say, "Well I'm alright." You know, what more can I say?
One of the things that is quite interesting and something that I'm a little bit loathed to say, but I have to say it. One occasion when I've just, when I was going through the awkward period of going to the general ward and I was very frustrated behind these curtains because it was an emergency department and I had, in the time I was in there I think I had six people in the next bed to me, and two of them were stabbings, people who'd been stabbed. And when I was going through that period I was seen by part of the Follow Up Team who did an assessment on me and said I was depressed and I had to see the counsellor. I had to see the Psychiatric Services, they were going to arrange it. And I didn't necessarily agree with that because I wanted to know more about it, I was worried about it, and nothing was ever done from that day to this. And one of the things that I feel very, very concerned about is that I have all this wonderful care and I don't think I have ever seen anybody with, what I call, psychiatric mental health expertise, and how can that happen?
She was disappointed when she didn't receive some of the things she'd asked for or was expecting.
And how often did the doctors come round in intensive care?
Oh, every day, the doctors came round. They were very good. Yeah, I've got no compunctions - you know, at all about - I'd give them all good credit. It was the nursing, I think that - I mean one sister, she came to do something, and I hadn't had a cup of tea. I think the trolley had been and gone or something, while they were seeing to me - and I said to the sister, "Oh I could really drink a nice cup of tea". She said, "I don't do tea". And that put me in my place.
Where was this, in the general ward?
Yeah. You didn't get a lot of - I mean how long did it take to make a cup of tea? And they said, "Try a bit of toast", and the toast never came. They went away and did something else. You know, they're not - their minds are elsewhere,
Being left unattended for varying lengths of time when they needed to go to the toilet or be washed or cleaned could be hard to cope with on the general ward and some said they felt themselves 'go downhill'. One woman said she felt isolated and disappointed when she had to have a catheter re-inserted. For others it was the 'little things' that were overlooked - 'that little extra bit of kindness' - which made the difference between feeling 'treated' and feeling 'cared for'. Some of these people thought that all hospitals should have a High Dependency Unit to bridge the gap between intensive care and the ward (see 'High Dependency Units (HDUs)').
He was still too weak to move or lift things when he was transferred to a ward and would have...
For the first couple of days, it took a long time, we were both in tears constantly, and that's one thing we put forward to the hospital is that really to come out of an Intensive Care unit there should be a unit available for that transition period, just so you get used to not having the dependency of the nurses.
Patient' The staff were very willing and very pleasant, but didn't seem to know my limitations as it were. And you're in a new environment, your bed isn't the same, your equipment isn't the same in terms of what you had around you. One of the symptoms was that my body couldn't regulate it's own temperature so I'd go from being very hot to very cold and vice versa. Up in Intensive Care, they knew that and they had fans around me and additional blankets.
On this the second ward, they didn't have that equipment or that knowledge of my symptoms and I think what summed it up for me on the first evening was, the nurse came round to pass out my medication and it was just put on my tray table and I couldn't pick it up. And I didn't know whether I should take it then, I should take it before I went to sleep or whatever. But it was just literally doled out, put on the table. I could talk at the time but not very strongly and had [my wife] not been there, I'm not sure how I would have communicated with the nurse to find out. And it was [my wife] that had to give me the tablets.
To the credit of the nurses on the ward, after a couple of days they realised what I could and couldn't do, so they would feed me my breakfast etcetera.
One man, who had sickle cell anaemia and chest pains when he went into hospital, said that his family questioned whether the standards of care on the ward had actually triggered his pneumonia in the first place and led him to intensive care.
His family wondered how he'd got pneumonia and MRSA when he was in hospital, and was surprised to...
But one thing - I'll be honest with you, the one thing that really, like, not shocking to me, but I wouldn't have expected it - was while I was - I came from ITU and I was placed back in the general ward. And I just overheard a conversation between a doctor and a nurse, regarding me and it was like, the doctor was explaining to one of the nurses what he requires, what needs to be sorted out, and I was just shocked because he said, "Be careful with that one". So, now, if he's saying be careful with me, then what is he doing with the other patients? Does that make sense?
So that kind of thing I am shocked about and it is disturbing, but I don't know, I think I'll just let that one go.
Some people were concerned about language barriers between patients and staff.
Some of the nurses couldn't understand what she was saying because English was their second...
How can you sit on the commode with the diarrhoea and no pan in the bottom? My daughter-in-law brought my own toilet rolls. They went missing, and then they didn't bring any toilet rolls. It was a bit of a distressing experience. I don't think I want to go through it again. Intensive care was wonderful - but not back in the ward. Didn't like it. Very upsetting. I was glad to get home, although really I could have done with a few more days, though once I came home, I still had the diarrhoea - severely - my daughter-in-law, she stayed with me.
But these foreign nurses, to my mind they're not proper, they're not nurses. They do a job. Let's be fair. They're doing their best, but they can't understand you. They don't know what you are speaking about. It's a shame. It is a shame. So I hope I don't have to go back anymore [laughs]. Please God, I don't go back anymore.
Some people felt that the ward environment hindered their recovery. Many said that the lights prevented them from sleeping properly as well as noise from other patients and their visitors, including arguments.
She was glad to get back home because she found the noise from other patients, their visitors and...
And the night staff - they start laughing and talking, noisy, at 11 o'clock at night, which I think is not on.
And the light's still on in the ward at 11 o'clock at night - well that's - silly things like that but it makes all the difference. Nurses come on, and they're all laughing, talking. People want to go to sleep. I was so glad to get into my bed and have a proper sleep. You don't get sleep in the ward - it's a well known fact. Someone's always poorly. I was poorly. My light was going on at one and two in the morning. I was apologising to everybody all the time. I'm sorry, I was upset. I didn't want to upset anyone. I never had a phone, or a TV. Girls were on the phone at 12 o'clock at night, on their phone. You can hear every word they say. Things like that can disturb you. So I was glad to get home, I really was.
One man said that his partner noted many instances of poor hygiene and cleanliness on the ward.
His partner noticed that nurses often didn't wash their hands or wear gloves when they attended...
This was on the general ward?
Yes, this was on the general ward. She noticed that on some of the wards there was a nurses' station with cups and sweets etc that are eaten throughout their shift. Like the cups had been used, so obviously the nurse had had a cup of tea or something, then she'd put it down and go and see a patient, then come back to the cup of tea, she's not wearing no gloves, you know. That's how it goes on.
Again, "No, no gloves from, on many occasions from patient to patient, nor the washing of hands." She did notice it a lot, she noticed it a few times when I was in ICU, where they come up and change like the catheter and the bag with no gloves, and then go and see somebody else.
Improvement and recovery
For some people moving to a general ward was associated with making progress and seen as an important step in the right direction. They quickly accepted that there were fewer nurses to patients, and a few said they were more comfortable with getting less attention. Several noted that, although the care was more personal and 'intensive' in ICU, they understood the constraints on the ward, on the UK National Health Service more generally, and accepted that the wards would be 'busy, short-staffed and under-resourced'. Overall, they were satisfied with their care and focussed on recovering. Some, who'd found ICU lonely, were pleased to be able to look around and talk to other patients on the ward. Others said they were satisfied with and grateful for all the care and treatments they were given while they were on the ward.
She found the care on the ward excellent and felt like she needed to do more for herself once she...
He praised the care and treatment he had and felt he was very well looked after.
Was this all on the NHS or did you also have private healthcare?
No, all on the NHS and people knock the NHS but I've got nothing but, you know, the highest praise of them because I couldn't have been better looked after even if it'd cost me hundreds of thousands. Yeah.
Have you felt that you've had all the support that you've needed or are there areas where you felt there could have been improvements?
Oh no, no it couldn't have been any better at all and I really mean that. The support I've had and the help I've had, you know, and the treatment I've received couldn't have been better anywhere really.
Outreach services aim to enhance the care of ICU patients on the wards and make the transition easier. Outreach nurses also aim to avert re-admissions to ICU from the wards and to share their nursing skills with other staff in the hospital. A few people recalled being visited by outreach nurses.
Last reviewed August 2018
Last updated November 2012.