Time in the ICU

If your loved one’s admission to the ICU was planned, you may have had the opportunity to discuss their wishes and values in advance. However, in the case of an unplanned admission, you may not have had that chance.

To learn more about making informed healthcare decisions, please refer here.

A substitute decision maker may be needed to make necessary legal decisions on behalf of the patient. This may or may not be the same person as the spokesperson. The health care team will keep both individuals, and any other representative the family identifies, fully informed of conditions and plans for treatment.

The substitute decision maker will:

• Inform the health care team if the patient has legally documented wishes about being put on life support
• Inform the health care team about the patient’s thoughts or wishes about being put on life support when no legal documentation exists
• Make decisions based on the patient’s best interests when the substitute decision maker has no knowledge of the patient’s wishes regarding life support If the patient signed a legal representation agreement naming a decision maker, this person will be required to sign consents on behalf of the patient.

If the patient hasn’t identified a substitute decision maker, the first person who qualifies, is willing and is available (in the following order) will be assigned the role: spouse, child, parent, sibling, anyone related by birth or adoption.

Essential care partners are people who matter most to your loved one in ICU. They can be a support person, caregiver, partner in care, or natural support. They can also be family members, partners, spouses, friends, and community health workers. Essential care partners are important members of the team.

Learn more about essential care partners here.

Designate a family spokesperson. The family will be asked to choose a spokesperson and to decide who may visit. The spokesperson will:

• Be the main person to communicate with the health care team about the patient’s condition and the plan of care.
• Coordinate visiting permission and information with extended family and friends.
• The spokesperson may or may not be the same person as the substitute decision maker.

The Indigenous Health Liaisons are here to support on your health care journey. To learn more see here.

The ICU provides care to those who are critically ill, and visiting can be a bit different than other areas in hospital.

Visitors to the intensive care unit are usually limited to immediate family or significant others. Visiting hours are flexible. Speak to a nurse about when best to visit.

In the ICU, patient care is complex, and certain procedures and assessments can take time to ensure the best possible care. Some tests require multiple steps, and treatments must be carefully monitored before decisions can be made. While we understand that waiting can be difficult, please know that every delay is in the interest of providing the safest and most effective care. We appreciate your patience and will update you as soon as we can. If you have any questions while you wait, please don’t hesitate to ask.

To ensure the provision of a safe workplace and health care environment, Fraser Health will not tolerate verbal, physical, psychological or sexual violence against any employee. Visitors have a responsibility to manage their own conduct, treat others with respect, and to preserve the dignity, safety and comfort of other patients/clients/residents, staff, physicians and volunteers. In situations where visitors exhibit behaviours which are disrespectful or violent, Managers or delegates are responsible for acting immediately to reduce risk and to protect the safety of others. If the behaviour does not meet these responsibilities, Fraser Health reserves the right to address the behaviour in a manner that preserves a safe workplace and safe health care environment.

What should I know about visiting my loved one in ICU?

Infection control and safety

Clean your hands before and after visiting your family member. This is essential to prevent the spread of infection. Alcohol-based hand sanitizers are available throughout the hospital.

Do not visit if you are sick. Patients in the intensive care unit are very ill and are more sensitive to outside illnesses. Their condition could worsen if they are in contact with germs.

Follow safety precautions, such as wearing gloves, gowns, or masks if your loved one is in isolation due to their condition.

Visiting with children

Talk to your nurse if you want to bring a child into ICU. Children must be able to follow all infection control measures, especially hand washing, and be always under direct adult supervision.

Family space

Private family space may be available by request. Talk to your nurse if you need access to a private space.

Language services

Interpreters and translation services are available.

Photos

To protect the privacy of other patients and families, speak to the nurse before taking any personal photos.

Each ICU in Fraser Health has visitation guidelines. Please see the different hospital’s ICUs below:

ICU visitor information

Abbotsford Regional Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Burnaby Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Chilliwack General Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Langley Memorial Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Ridge Meadows Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Royal Columbian Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

Surrey Memorial Hospital

• English
• Arabic
• Chinese Simplified
• Chinese Traditional
• Hindi
• Punjabi

Peace Arch Hospital

• English
• Chinese Simplified
• Chinese Traditional
• Punjabi

When someone you know is very ill, you might feel any number of things such as shock, anxiety, sadness, anger, restlessness, trouble concentrating, and other feelings. These are all expected and normal. One of the most important things you can do at this difficult time is take care of yourself. Your health and wellness are important.

Some ways you can take care of yourself are:

• Eat regularly
• Take time to sleep
• Go for a walk or a stretch
• Allow yourself to ask for help
• Get others to help you with meals and tasks
• Don’t help too much
• Accept support from others

Having a loved one in ICU can be extremely exhausting mentally, emotionally, and physically for family members and essential care partners. Taking care of yourself and taking breaks away from ICU is very important. It is good to visit your loved one in the ICU, but it is also important you take some time away from the ICU to take care of yourself.

Here are some tools for coping with serious illness.

Ask to speak to one of our social workers if you need support with any of the following related to the patient in the hospital:

• Housing
• Accommodations
• Finances
• Legal matters
• Support
• If you wish for spiritual support, we can ask one of our spiritual health professionals to visit.

What is delirium?

Delirium refers to a state of confusion that can affect a person's ability to think clearly and understand their surroundings. People experiencing delirium may:

• Struggle to think clearly
• Have difficulty focusing or paying attention
• Find it hard to comprehend what’s happening around them
• See or hear things that aren’t there, which seem very real to them

Delirium often causes feelings of fear, anger, loneliness, and even shame in patients.

How common is delirium?

Delirium is quite common in ICU patients. About 2 out of 3 patients in the ICU experience delirium, increasing to 7 out of 10 for patients on a ventilator.

What causes delirium?

Experts believe delirium results from changes in brain function and can be triggered by:

• Reduced oxygen supply to the brain
• The brain’s inability to properly use oxygen
• Chemical changes in the brain
• Certain medications
• Infections
• Severe pain
• Serious medical conditions
• Alcohol, sedatives, or pain medications
• Withdrawal from substances such as alcohol or nicotine

What does delirium look like?

• Restlessness or withdrawal
• Forgetfulness and trouble thinking clearly
• Confusion about place or time
• Memory gaps
• Sleep disturbances
• Hallucinations (pleasant or frightening)
• Mood changes

How do we care for people with delirium?

• Treat underlying illnesses
• Monitor for delirium signs daily
• Encourage early movement
• Provide reassurance about safety
• Use medications if necessary
• Utilize whiteboards for orientation

How can you help your loved one?

• Visit and reassure them
• Hold their hand (if they like being touched)
• Remind them of the date and time
• Speak softly and simply
• Bring familiar items from home
• Read or play their favorite music
• Track their progress with a diary

How can I take part in care and give comfort?

• Help with personal care tasks (as instructed by the nurse)
• Provide spiritual and emotional support
• Bring in familiar scents, textures, and soundsh

When a person you care about is in the ICU, it can be a very stressful. The environment is unfamiliar, there is a lot of equipment, and the person’s health is uncertain. It can be very helpful to keep a diary of what is happening each day. It can help you look back and see the small changes that have happened in your loved one. And later it can help your loved one understand what happened to them as their memories of the time might be very confusing or scary or they may have no memories of their time in ICU.

Diary as a place for questions

This diary is to give you a space to write down your questions and the answers you are given.

From our experience, some of your initial questions might include:

• Why are they not awake?
• I am upset by the way they look. Why do they look different?
• What is wrong with them?
• What treatments and care are they receiving?
• What are the tubes and machines for?
• When will they be able to breathe on their own?

Some questions related to ongoing care might include the following:

• Are they better today?
• Are they in distress?
• Are they in pain?
• Can they hear me when I speak to them?

Some questions related to the recovery of the person you care for might include:

• How long will they be in the ICU?
• Will they get better?
• What are the chances that they recover?
• Will they have any problems after they get better?

Some questions related to what to expect regarding the lines of communication in ICU might include the following:

• How and when will we know what is going to happen?
• Can I be sure I will be told if something happens?
• Can I call to find out how they are doing?
• Will I be informed regularly of changes and, if so, how?
• In a decision-making situation, what is expected of me?

Diary as a record

The diary is also a place for you to record the ICU experience of the person you care about. People who have been sedated and on life support in ICU need time afterwards to think about their ICU experience.

It is common for people who have been cared for in ICU to have bad dreams and bad memories of what happened. These memories might even be frightening. It is also common for them to have trouble sorting out what was a dream, and reality.

Because of this, people who have been in ICU might need help later to understand their experience. A diary is a tool that has been shown to help.

A diary can help a person can make sense of their dreams and memories by connecting them to your diary entries. Studies have shown that being able to make these connections helps to reduce any anxiety or depression that a person who has been in ICU may later face.

Studies also show that a diary helps the essential care partners, family and friends who were part of the ICU experience have fewer symptoms of Post Traumatic Stress Disorder (PTSD).

We suggest you use this diary to write in each day about your loved one’s health. We also suggest that you use this diary to describe activities and situations each day that they might have memories of.

Sepsis is a serious illness that happens when your loved one’s body has an extreme reaction to an infection. Instead of just fighting the infection, their body starts to hurt its own tissues and organs. This can cause their organs to stop working properly and can be life-threatening if not treated quickly. Explore the resources below on Sepsis.

Resources about sepsis

Post-sepsis syndrome

When a loved one is in ICU, communication can be difficult, and this can feel frightening or frustrating. Several factors may affect their ability to talk, including:

• Fatigue
• Delirium
• Hearing or vision impairments
• Oxygen therapy or mechanical ventilation

Even if your loved one is sedated or unresponsive, they may still hear you. Speaking to them can be comforting, even if they don’t remember it later. Share updates about the outside world, familiar voices, memories, or holiday stories to help them feel connected and less alone.

As they become more awake, communication may still be challenging. We’re here to help. Here are some ways you can support better communication:

• Bring in and label their hearing aids and glasses
• Ask simple questions with “Yes,” “No,” or “I don’t know” answers
• Communication boards that can be printed off and used with your loved one
• A free app to help with communication: Vocable
• If your loved one has delirium here are some things you can say to make them feel safe:

• These sentences provide security and information about the location:
• You are in hospital and being cared for in the intensive care unit.
• Physicians, nurses and I/we are at your side.
• You are safe here.
• Everyone you may hear or see here is looking after you.
• The whole family knows that you are here, and we will come and look after you.
• You can be sure that everything is fine at home, we will take care of it.
• These sentences help understand the sounds and physical sensations:
• You may hear unfamiliar noises, for example this beeping. All sounds are normal and here so that doctors and nurses can take good care of you.
• You can't move normally yet because your body still needs time to recover. You can just lie still. I am with you.
• You get help in breathing by a supporting ventilator machine. You will notice this by the unfamiliar feeling in your mouth.
• You may feel like you are breathing through a straw. That is okay, I know it is hard. Try to slow down your breathing, I am here to help you. The tube you feel in your mouth is helping you breath.
• You may feel something on your wrists to stop you from accidentally pulling the cables and tubes that are helping you heal.
• If your sick relative is very restless, the following sentences can be helpful:
• Your body still needs to rest and recover. That's why you're here, because this is the best place for you to recover.
• I will stay with you until you feel calmer.
• You can see that everyone here is trying to help you.
• I can see that you are worried or perhaps experiencing something strange. You can be sure that everything is all right here and that you are in good hands.
• These sentences help the patient to better organise their thoughts:
• Sometimes you may be confused and see things that are not really here. Everyone is here to help you. You are safe.
• You may have had dreams that felt real. It might be difficult to tell what is real and what is a dream. When I squeeze your hand (squeeze their hand), you can be sure it's real and I am here with you.
• You might find it hard to concentrate or focus. That is okay. Your head will become clear again.
• We're all thinking about you, even when we're at home or you're asleep and dreaming.
• Today is (day of the week) and it is around (say time of day). You are in the ICU at (hospital name). You are here because (say reason). I am here with you.

The ICU team provides the best care possible, but sometimes, despite every effort, a loved one may not survive.

Understanding what happens

A person is considered to have died when their heart stops beating or when their brain permanently stops working (called brain death). If doctors believe your loved one is brain dead, they will perform thorough and detailed tests to confirm this. They will explain the results to you and answer any questions you may have.

Coping with loss

Losing a loved one is one of the hardest experiences anyone can face. You don’t have to go through it alone. Talking to a bereavement counselor or joining a support group can help you process your feelings and find support during this difficult time. Many of these resources offer guidance for both adults and children.

• Managing Grief and Loss: When Someone Dies
• Grief Counselling and Support Services (Fraser Health)
• Suggested Books on Bereavement for All Ages
• British Columbia After a Death Checklist

In some cases, families may be asked to consider organ or tissue donation.

• If your loved one shared their wishes about organ donation, their decisions can guide you.
• If their wishes aren’t known, you may need to make this decision as a family.

This can be a deeply personal and difficult choice. Whatever decision you make, it will be respected by the healthcare team.

If organ or tissue donation is a possibility, a donor coordinator will guide you through the process, answer your questions, and support you every step of the way. The ICU staff is also available to provide information and assistance.