Learn about what to expect in ICU, visitation policies, support for you and your loved one and decision making.
For more information about what to expect when a loved one is admitted to our ICU, please refer to the Patient and Family Handbook here.
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Making decisions
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.
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Support for Indigenous Peoples
The Indigenous Health Liaisons are here to support on your health care journey. To learn more see here.
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Visitation in the ICU
The ICU/HAU 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.
What should I know about visiting my loved one in ICU/HAU?
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/HAU. 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.
Family spokesperson
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.
Each ICU in Fraser Health has visitation guidelines. Please see the different hospital’s ICUs below:
ICU Visitor Information ICU visitor information
Abbotsford Regional Hospital
Burnaby Hospital
Chilliwack General Hospital
Langley Memorial Hospital
Ridge Meadows Hospital
Royal Columbian Hospital
Surrey Memorial Hospital
Peace Arch Hospital
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Taking care of yourself while your loved one is in ICU
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.
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Delirium in ICU
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
- 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 sounds
Additional resources on delirium
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ICU Diaries
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.
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Sepsis
Sepsis is a serious illness that happens when your body has an extreme reaction to an infection. Instead of just fighting the infection, your body starts to hurt its own tissues and organs. This can cause your organs to stop working properly and can be life-threatening if not treated quickly. Explore the resources below on Sepsis.
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Communication in ICU
When a loved one is in intensive care, communication can be challenging, which may feel frightening or frustrating. Several factors can make it difficult to talk with them, including:
- Oxygen therapy or mechanical ventilation, which can make speaking hard or impossible
- Fatigue
- Delirium
- Vision or hearing impairments
Your loved one still may be able to hear you even if they are sedated and not awake. The nurses will speak to your loved one and you can too which can be reassuring for them, even if they don’t remember. Tell them what is going on outside, the weather, what is happening in the lives of people they know, talk about previous shared memories together and holiday memories. This can help them feel relaxed and not alone.
When your loved one is more awake there still may be difficulties communicating. We are here to support you through these difficulties. There are steps you can take to improve your ability to connect with your loved one:
- Bring in and label hearing aids and glasses (this is important)
- Ask simple “Yes/No/I don’t know” questions
- Click here to explore helpful resources available to assist with communication
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If your loved one doesn’t survive
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.
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Organ and tissue donation
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.