An intensive care unit (ICU) can often be an overwhelming place, both for the person who is in hospital and for their loved ones. It can, therefore, help to know a little about what to expect.
Medication
When you visit an ICU, many of the people in the ward may appear to be asleep because they are on painkilling medication (analgesics) and medication that can make them drowsy (sedatives). This medication is necessary if the person is unable to breathe on their own because artificial ventilation (when a machine is used to help you breathe) is very uncomfortable without it.
The doctors and nurses who work in intensive care will try to use the least amount of sedatives possible in order to maintain comfort. This means that the people who are being treated in ICUs will be partially awake for some of the time.
Unfamiliar appearances
The people being treated in ICUs are usually connected to intensive care equipment by a number of tubes, wires and cables. You should not be alarmed by this as the equipment is necessary to monitor the person’s condition. See Intensive care - treatment for an explanation of the equipment that is used to treat and monitor people in ICUs.
People who are in ICUs may appear to be slightly swollen. The swelling is caused by the person’s inability to move and the treatment that they are receiving. They may also have visible injuries, such as bruises or wounds. This can be upsetting to see, but the doctors and nurses will always make sure that the person is as comfortable as possible.
Unfamiliar sounds
In an ICU, there will usually be many unfamiliar noises, such as alarms and bleeps from the equipment. These help the nurses to monitor the patients. Most noises are nothing to worry about, but you should not be afraid to ask if you are unsure. The doctors and nurses who work in an ICU are highly skilled, and they will usually be very understanding.
Visiting
Visiting hours in an ICU are often very flexible, but there may be times when you have to wait, for example, if one of the people in the ward requires assistance from the intensive care doctors and nurses. The number of people who are allowed around a bed will usually be limited for the safety of the patient.
In an ICU, the levels of hygiene must always be kept very high, so you will need to use an alcohol hand rub before and after entering the unit. Dispensers are usually found at the entrance of the ICU and by every bed space.
If someone you care about is in an ICU, you may want to touch and comfort them, and this is usually encouraged. It is important to talk to the person you are visiting because they may be able to hear and recognise familiar voices, even if it appears that they cannot. You may want to tell your loved one about your day, or read them a book or newspaper.
You can bring in things to make the person more comfortable, but you should check with the intensive care doctors and nurses before doing so. Flowers are not usually allowed in an ICU because there is a risk that they could spread infection.
Decisions about treatment
If you are admitted to an ICU, and you are awake and able to communicate your wishes, you have the right to be fully informed and to make decisions about your treatment in partnership with the doctors and nurses who are treating you. They should support your choice of treatment wherever possible.
However, if you are heavily sedated, you may not be able to consent to a particular treatment or procedure. In this case, the intensive care doctors and nurses treating you will decide what is best. They will always explain what they are doing to a person in an ICU, even if it appears that the person cannot hear them.
Wherever possible, planned treatments and procedures will also be discussed with the family of the person who is in an ICU. However, this may not always be possible in an emergency, where treatment is needed immediately.
See the Health A-Z topic about Consent to treatment for more information about how and when consent is given.
Designated decision makers
Under the Mental Capacity Act (2005), someone who knows that they are going into intensive care may nominate someone to make decisions about planned treatment on their behalf. This person is known as a designated decision maker. If the person in the ICU is unconscious, the designated decision maker has the final say about any planned treatments or procedures.
However, a designated decision maker can only be nominated through:
- a lasting power of attorney: a legal document in which the person who is in hospital has granted someone the power to make decisions on their behalf
- being made a court appointed deputy: someone who is chosen to make decisions on behalf of the person in hospital by the Court of Protection - the legal body that oversees the operation of the Mental Capacity Act (2005)
Therefore, a person who is admitted to an ICU as an emergency measure is not able to nominate a designated decision maker.
See the Carers Direct information on the Mental Capacity Act (2005) for a more detailed explanation.
Advance decisions
If you know that you are going into intensive care, and there are certain treatments that you do not want to have, it is possible to pre-arrange a legally binding advance decision (previously known as an advance directive).
This means that the intensive care doctors and nurses will not be able to perform certain procedures, or treatments, even if you are unconscious. However, these documents must be very specific regarding what you do not want done in order for them to apply.
To make an advance decision, make your wishes clear in writing and have it signed by a witness. You need to include specific details about which treatments you do not want to have, and the specific circumstances in which they may apply.
See the Carers Direct information on Advance decisions for an explanation of how these can be used.
