When your senior loved one is in the ICU
August 31, 2015
Having a senior loved one hospitalized in an intensive care unit can be a frightening and stressful experience. In many cases the patient is often unable to communicate his or her wishes, and the responsibility can fall on the family caregiver to decide on a course of action. Here are some tips to help you through this often overwhelming process.
1. Ask questions. Check in with the doctors and nurses regularly to stay abreast of your loved one’s diagnosis, prognosis, and plan of care. In ICUs, the care team – often consisting of the attending physician, the nurse practitioner or physician’s assistant, the bedside nurse, and resident if it is a teaching hospital- usually makes “rounds” on all their patients at least once a day. Get an idea of who is on this team and when regular rounds should take place and try to be at the bedside at that time. Of course staff are always busy but don’t be afraid to ask for clarification if you don’t understand something. As their caregiver, the better you understand your loved one’s condition, the better equipped you will be to make decisions regarding their care.
2. Focus on the big picture. When patients are critically ill, the healing process can seem excruciatingly slow. Try not to stare at the monitor or obsess over tiny fluctuations in vital signs. Improvement is often measured in days, weeks, and sometimes months, not minutes and hours. Celebrate the small victories, but don’t let minor setbacks get you down.
3. Get some rest. Families and caregivers often feel obligated to stay at the bedside day and night, neglecting their own needs. You may be tempted to forego sleep, food, or even hygiene in favor of staying by your loved one’s side. Realistically, it’s not possible to keep that up for long before crashing. The best way you can help your loved one is by taking care of yourself, keeping a clear mind and not making decisions when overstressed or exhausted. This is especially true when your loved one is sedated or comatose and is not aware of your presence. Save your energy for when they can appreciate your company.
4. You can’t always trust “Dr. Google.” It’s great to educate yourself as much as possible and research your loved one’s condition, but remember to consider the source. Is your information coming from peer-reviewed, scientific journal articles, or internet forums where anyone with a computer can post their opinion? There is a vast quantity of information available on the web, and sifting through the detritus to get to the facts can be a monumental task. Remember, ICUs are specialized based on the patient’s diagnosis, and your loved one’s doctor has probably seen many similar cases. Trust her judgment unless it strikes you as dangerous or contrary to your loved one’s wishes.
5. Keep communication open and positive. We’ve all heard the saying “the squeaky wheel gets the grease,” but in reality this approach can often be counterproductive. Advocate for your loved one, ask questions, but remain polite and respectful. ICU nurses work long hours on their feet, providing care for the sickest of the sick, and your loved one is probably not their only patient. Be patient and try to keep things in perspective. Your loved one’s care team is there to help and will respond proactively when you communicate in a cooperative manner.
6. Don’t panic. The ICU can be a scary place. Monitors flash, machines alarm, and it’s nearly impossible for the layman to know what’s really an emergency and what’s not. Follow this golden rule: “If the nurse is not panicking, everything is probably okay.” In most ICUs there is a central monitor at the nurse’s station where staff can keep tabs on all the patient’s status from one place. Even if your loved one’s nurse is not in the room to see the monitor alarming, chances are someone can see their vital signs from the desk and would certainly rush in were it an actual emergency. Not all alarms are created equal: IV pumps beep to let the nurse know an infusion is finished, ventilators alarm when the patient coughs, and monitors flash when a patient’s heart rate goes above or below a certain threshold. If you’re concerned about something you see or hear in the room, again it’s important to ask questions.
7. Consider and respect your loved one’s wishes. Ideally, every family would lay out in writing what kind of interventions they would want in a worst case scenario. Unfortunately, calamity often strikes without warning, and families are left wondering what their loved one would have wanted. If the prognosis is poor, or your loved one is suffering without much hope of regaining their former quality of life, don’t feel guilty about looking into palliative care options. Of course very few of us want to be in the difficult position of needing to make critical decisions regarding next steps of care. In these circumstances, don’t let guilt or other emotions, especially about past conflict or strife with your loved one, influence your decision about their care. The most important thing to consider is what is best for the patient, their prior wishes and their quality of life.
We understand that the ICU can be a very intimidating stressful experience, much of which seems outside your control. Taking care of yourself, staying as objective as possible and communicating can help to remove some of the anxiety and helplessness that most of us feel when faced with this experience.
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