Intensive care: Patients' experiences site preview

Nursing care in ICU

In the intensive care unit people are constantly looked after and monitored by a highly specialised team, which includes consultants, physiotherapists, dieticians and nurses, each of them with specialist knowledge and skills. Specially trained nurses provide round-the-clock care and monitoring, and there is a high ratio of nurses to patients - each person in ICU is usually assigned his or her own 'named' nurse.

ICU nurses play a vital role in the patient’s care, including the following:

Taking regular blood tests
Changing the patient’s treatment in line with test results
Giving the patient the drugs and fluids that the doctors have prescribed
Recording the patient’s blood pressure, heart rate and oxygen levels
Clearing fluid and mucus from the patient’s chest using a suction tube
Turning the patient in his or her bed every few hours to prevent sores on the skin
Cleaning the patient’s teeth and moistening the mouth with a wet sponge
Washing the patient in bed
Changing the sheets
Changing a patient’s surgical stockings, which help circulation when he or she is inactive (lying still) for a long time
Putting drops in the patient’s eyes to make it easier to blink

Here people talk about the nursing care they received in ICU.

Most people spoke highly of all the staff in ICU and the care that they received, particularly from their named nurses, even if they couldn't always remember their names. For many the care was 'excellent' and the nurses were kind, encouraging, professional and calm. Several people discussed memorable experiences they'd had while in intensive care, such as celebrating birthdays, and one man recalled how the nurses arranged for him to leave ICU briefly and see his dogs, in the hope that this would help him recover.

She recalled how the nurses went out of their way to help her feel cared for and positive.

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Age at interview: 47

Sex: Female

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The nurses on Intensive Care were absolutely wonderful, very caring. Things that matter to you like they washed my hair, and the day after said, "You won't want your hair washing again because we did it yesterday." So I nodded. And they said, "You do want it washing?" And so I said, "Yes." So the nurse said to me, "Well, do you wash your hair every day?" And I said, "Yes." She said, "Well, if that's important to you and you do that every day at home, that's what we'll do here then."

And after that my hair was washed every day. And that was such a boost to me because that's what I would normally do. And it made me feel human having my hair washed and feeling clean. I was thoroughly washed every day. Some of the nurses went out of their way. I didn't sleep very well once I'd come out of the coma. I think I was frightened of the hallucinations really, and so I didn't sleep well. And I remember one of the nurses coming on duty and saying, "I've brought this stuff for you." And it was lavender wash stuff. And she said, "It says on it that it's helpful to sleep and it keeps you calm. And I thought about you because you've not slept very well." And I thought that was really kind, that she wasn't just washing me with whatever soap they had, but she'd actually gone out of her way.

Another of the nurses got some shampoo for me and said, "The stuff that we use in here isn't great. I've brought you some from home." Things like that made me feel they were not just nursing me, but they were becoming friends. And we actually had some good times. Once I'd come round I can remember being put in a side room because I'd developed MRSA. And so they brought me a television and radio in so that I wouldn't be lonely. And they put the radio on, the nurses, while they were doing whatever they were doing in my room, and turned it up really loud and we were all dancing. I mean I was sort of moving about on the bed and they were dancing round me while they were doing their work. And we were playing games like, you know, "Guess who made this record" and whatever. And I was writing my answers down, and I was putting my hand up and saying, "I know, I know" and writing the answers down. And they were shouting them out. And we had a bit of a party that afternoon. Other nurses kept coming in saying, "What's going on in here?" because we were so lively. And I thoroughly enjoyed that afternoon. So there were some positive aspects to being in Intensive Care. I felt that they'd become friends and that we were having fun. And because I was, I knew I was getting better at that point, I felt quite positive. And so that was a very good experience.

He had no clear memories of being ill in intensive care but enjoyed his stay.

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Age at interview: 71

Sex: Male

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And then we had a phone call from ICU saying that as you've been in for more than two days, we would like to do an interview with her and anyhow then they eventually come here and we had a chinwag and she asked, this was young [nurse's name], and her sidekick. I can't think of her name, then. And [laughs] they asked me questions, 'Do you remember this, do you remember that?'. I don't remember anything. I completely and utterly don't remember a thing.

Then they asked me if I wanted to or was I going to sue the hospital. What was I going to sue the hospital for? I was absolutely chuffed with the way I was looked after, the way they treated me. A matter of fact, other than just being in a little bit of pain, it was good. I really, really enjoyed myself there, you know. So I've got no complaints. The only complaint I've got is I ain't a got a clue of what happened. And I still don't know now, except what the good lady's [wife] told me.

Many people felt comfortable and secure in ICU because of the nursing care they received. Several people noted how they were treated 'like human beings', that the nurses became 'like friends', and were good at accommodating the many and differing needs of the individuals under their care. Some recalled that, despite the serious environment of ICU, they shared many moments of laughter and jokes with doctors and nurses.

He recalled how nurses joked with him yet were quiet and gentle with people who needed a...

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Age at interview: 60

Sex: Male

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Patient' Oh yeah, wonderful people. Yeah they had, if they'd had a couldn't-care-less attitude, it would have made it very, very hard, very, very hard.

Wife' It's hard being a patient, it's hard to nurse somebody all that time, and it's hard being patient for all that time, and being patient and keeping a sense of humour. And they would, [my husband] liked a lot of chat and interaction, and they realised that. And they would come in and there'd be some banter. And then they'd be at the next bed as quiet and gentle with somebody else because that's what they needed.

Patient' Yeah, yeah.

Wife' But [my husband] needed a lot of interaction, he needed to be kept going and he got that.

Patient' Oh yeah they used to

Wife' They'd joke.

Patient' They'd take the mickey out of me only 'cause they knew I'd take the mickey out of them. And I knew they could do it, I accepted it 'cause I'm taking it out of them, so somebody would come back at me again.

Wife' One nurse would threaten to take his tracheostomy

Patient' I was singing, yeah.

Wife' if he sang she'd say, "I'll take that off." And she'd take his cap off so that no sound came out, and he'd say, "You are wicked." [Laughs].

Patient' "You wait till I get better, I'm gonna come and get you".

Wife' [Laughs].

Patient' But no, as [wife's name] just pointed out, they are as attentive as the person needs. And it's, repeating what she just said, they'd leave me one minute and have a laugh and bit of a joke and then go to the next patient, who was seriously ill. In fact I had people say to me, "Cor, you know, you". I might say language, I don't mean bad language but the way he was talking, "Should he be talking to you like that?" I said, "Yeah". I said, "You wait till, you listen to how he talks to that fella next door who's really ill". And it's an entirely different person talking to that person, he's talking to him as he should and he's talking to me as I wanted him to talk to me, as a mate, not as a patient. I never wanted to be a patient, I was a mate you could have a laugh and joke with and take the mickey out of, you know.

He said that he was cared for by fantastic and caring nurses of every nationality.

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Age at interview: 63

Sex: Male

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And I can remember a great deal about it. And the wonderful thing about Intensive Care is that, in my experience, it was exactly as advertised. It was intensive and it was very, very caring. And intensive in that all the time there's a nurse at a station within reach so you're monitored with machines that have flashing lights and bells and all sorts of things like that, that warn the staff if anything goes wrong. And care in that every one I met in Intensive Care, and that was doctors, but mainly nurses of just about I should think every nationality on earth, they were wonderful. And I can only speak from my own experience but they were truly wonderful and made me feel quite welcome and good about it all.

I think probably the message is in all that I said somewhere, I'm not sure where but' Don't be afraid. These people are, they're the best. They wouldn't be in Intensive Care if they were not the best. And there's lots of them, you know, they don't have the same problems of staff shortage up there, or down there or wherever you are. And you couldn't get better treatment. I don't believe you could have better treatment. If there were anything that had struck me in Intensive Care as being below par I would have mentioned it and in my case I was probably very lucky. I was very lucky. That was not so, they were just fantastic, all of them. And it's because of the racial ethnic mix in our health service staffing, it's a jolly good place to take on board, to get to appreciate our common humanity.

Some women praised the pampering and care they received from nurses - including nail-care and shaving legs and under-arms - which helped them feel better about themselves and how they looked.

She felt more positive after having her legs shaved by nurses and her eyebrows shaped by a beauty...

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Age at interview: 44

Sex: Female

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But when I was in Intensive Care and they used to say to me, "Do you want to see, shall we get the mirror, [participant's name]?" Because they used to come, they washed my hair, I could have that done every day if I wanted, and they'd dry it.

They, this sounds odd but they'd shave my legs, you know. They really, they'd come and they'd rub cream on my hands or on my feet.

While I was in there I had a period. And that was, because I couldn't do nothing, and that was when I first come round, and they were brilliant, you know. They never, you know, like I say it was very unpleasant for me, and to think that I had to rely on other people to see to things. But it just, you know, I think, after going through all that there, I think there isn't much now that I couldn't cope with.

It's made you a much stronger person?

In some ways, yes, and in other ways, no. But like I say, as a treat, I said to my mum at the time, I said, "Oh, you know, I must look a complete mess." My eyebrows, things, just silly, not really, no, it's not silly things, it's just things to make you feel better. And an auntie paid, I had a lady come in and do my eyebrows. You know, they asked if it was okay, and they said, "Yes" you know. Because it was more, the only time I had a male nurse was when I was first admitted. When I went into the room on my own I had just the ladies, the girl, you know. And they said, you know, "We know what it's like, [participant's name], you know, you don't want to be sat in here with hairy legs" you know. Silly little things. And they were brilliant.

Relatives of those who had been in intensive care also praised the nursing care in ICU, and talked positively about the reassurance and information staff had given. This carer became attached to the first named nurse who looked after his partner and he was worried when another nurse was going to replace her.

His fears were unfounded and he was reassured to find that all the nurses in ICU were excellent.

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Age at interview: 46

Sex: Male

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Partner' What I would say, one thing I would say about the ICU staff, the first nurse that we met came into the waiting room and told us [my partner] was in a bad way and we should go down and see her. She looked after [my partner] for more or less the first week after that and then all of a sudden she said "Well I won't be in now, I've come to the end of my rota sort of thing, I'm not in for three or four days," which terrified me. I thought, because we'd really put a lot of trust in this girl and she was fabulous, she really looked after her. And I was petrified that whoever came on wouldn't be as good or you know wasn't going to give her the same sort of care or attention or not let us be around as much. But after the first nurse came on, and there was a couple of male nurses as well who were equally as fabulous, and every one of them who came and looked after her was absolutely tremendous. So I didn't have any fear about, if you do get an attachment to a certain nurse, don't worry that another nurse is going to come that's as good because every one of the staff, we must've had a dozen different nurses over the time, and every one of them was absolutely fabulous, really made us feel confident that she was going to get through, whereas I know it's the doctor's job to give you the whole truth. But they were intent on telling us worst-case scenarios. The nurses all kept us up beat and every one of them was fabulous in the care that they gave.

Although the UK National Health Service (NHS) is often criticised, some people said that their own experiences of nursing care in intensive care were, in contrast, 'brilliant'.

He praised the hard work and care of the ICU nurses as well as the food and cleanliness.

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Age at interview: 54

Sex: Male

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They don't deserve the bad publicity, the NHS. I've said you can't knock it for what they've done, for what they try to do. I think the people that, you know, sort of knock them ought to sit back and, you know, see how hard they work. Because when you're laid in bed you can actually see what the staff have to do and cope with. But they must be dedicated to what they do, to want to do it. I mean there's a lot of people who would, could say to a patient, "Sod you" and that's it. No, there was, I mean you couldn't fault that at all, could you? The food was actually, you know, everyone used to knock hospital food, but it was really good nourishing stuff. It wasn't, you know, boiled cabbage and mashed potato, you know, good menus.

Clean, in fact I think they went into overkill with cleaning. Two or three times a day they was either hovering, mopping or wiping something. The Intensive Care was what it said. It was intensive care, it was one-to-one and you couldn't fault them. They were, what I saw of them, I mean obviously the first fortnight I was out of it, so they were just again figments in my imagination. But when they come out, you know, I've seen them again, seen them out, they're always friendly and that.

He appreciated the staff working in ICU and the difficulties of imparting bad news to patients...

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Age at interview: 46

Sex: Male

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I've no complaints about the hospital, the nurses, the doctors, they were all great. I just hope other hospitals are same as the hospital, which I should think they are all over, intensive care people are so dedicated the whole way through, they're all dedicated. They have to be to do that job. I couldn't do that job.

What they go through on Intensive Care, telling people he's died or they, full families of them and they're all oh, I used to say to them, I've had a talk to them since, but it does get to them, even though they're professional nurses when somebody dies on there, who they've been looking to. And they know the family, you know because they know all, they knew all our, they knew all my family, kids you know and they've seen them every day and talked to them and been nice to them you know, and all for them to tell them that I'm dying, well it must be horrible because they've got close. They got close to [my wife], in fact they still talk to them you know, all the nurses in, so it must, I couldn't do the job but they were so, I can't speak highly enough of them, lovely people.

Many people were grateful to all the staff who had cared for them and had helped them to survive and recover. One woman, whose husband was admitted to ICU after an accident, recalled how one of the nurses talked sternly to him while he was sedated but succeeded in stopping him pulling out vital equipment. Others noted that the care they received was as good as any they'd had in the private sector.

The care he received couldn't have been better and he praised staff working at every level of the...

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Age at interview: 71

Sex: Male

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I don't think they could have done any more in the hospital, I think although I wasn't eating very well, I saw the menu's and they was excellent, they came round many times during the day, you know with three good meals, tea in the morning, afternoon and evening. And what can I say for the staff, right down to the cleaners, everybody, they was absolutely marvellous.

I don't think I could have expected any more if I'd been the king, I really don't. I was amazed, every thing you wanted you got. You got things you didn't really want but, you got the nurse coming round and you say oh no not again, you know, you got to that stage. And I know they was doing their job but you felt, oh have I got to go through this again, yes, there's your tablets, they stood there while you took them. And they came round to do your heart, your pulse, and all everything around your arm and on your finger or in your ear now or under your tongue. And I said that was being done at an hourly rate for at least three days. But there you are, yes I thought the support was one hundred percent, right the way down from top to bottom.

And people criticise the National Health Service but [laughs] it won't be me criticising them I'm telling you that, I mean I've been in to Bupa as well so, I mean yes, the service in Bupa is excellent, to have your own room and everything else but I don't suppose the medical side could be any better.

Some people said it was important for them to get on well with the named nurses because they were completely dependent on them for their care. A few said they felt 'like children' because they needed nurses to do everything for them. They compared the care they received to that of a mother looking after a child. Others noted that they were happy both with the overall care they received and the honesty with which information or news was imparted. One carer said the doctors were more cautious when imparting news compared with the nurses, who were usually 'upbeat' and optimistic (see the 'Information' section).

Several people said that, although the majority of nurses in ICU were good, a few were unhelpful, unkind or unfriendly.

She felt that her care was inconsistent because some nurses helped her with daily activities...

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Age at interview: 44

Sex: Female

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Like I say, I remember waking up and seeing, and I had a male nurse there. And I wasn't all that struck on him [laughs]. Sometimes they always seemed a bit harsh, you know, when really all, I don't know. There was some that, I found that some would say, "Right, [participant's name], come on, you know, even if you have a flannel and just wash your face." And I remember thinking, "I can't even lift up a flannel to wash my face." And then, or they'd say, "Come on [participant's name]." I couldn't even pick up a cup, so they would bring me it in a baby's beaker with a straw, for me to drink. And they'd say, "Come on. You've . . ." Certain ones would say, "Come on. You've got to do it." And I think, and I'd sit and cry and say, "I can't do it."

And then another one would come in and automatically say, "Come on, [participant's name]" and would help me. I always, and I have told them this, when I went for my follow-up in Intensive Care, I've told them the continuity of like the care plan, there's none there. I found that, perhaps with what my job was/is, I don't know yet, there's no continuity there.

In Intensive Care?

Yes. You had that one nurse for twelve hours, yes. But you might one day, like I say, one would do one thing, and the next day you'd have a different one that would do everything for you, feed you say, you know. That I found really hard.

She was happy with her care but advises nurses to remember that patients are intelligent people...

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Age at interview: 38

Sex: Female

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From the first time I was in pain, the next, it wasn't the first time, the second night I was pain, from then on I had, everybody basically was there. I mean it was a bit of a shock to me that I'm thinking who are these doctors? I don't know these people, why are they here? But they explained why and they kept me very well informed. The doctor who I had I can't, the surgeon who I had I can't fault him. He kept me very well informed. He made sure you know, he made sure I knew exactly what was going on. He made me very comfortable, he made you know, he was very, very attentive, very good. The teams were very good so I can't really say that I needed anymore, counselling.

The only advice I would really give is probably to nurses in there is that we may be temporarily, you know, invalids but that doesn't mean that you don't have a brain and I think they should be aware of that. We don't, before we became ill and, you know, incapacitated, it didn't mean we were stupid. We're still not stupid because we're lying here and unable to move. That's the only thing but oh, I don't know. For me I just needed that time away.

For many, the amount of equipment and constant attention and monitoring in intensive care contrasted dramatically with their experiences of the general ward (see 'The general ward' care and environment'). A few people were disappointed with their care because they felt that the ICU nurses spent more time checking equipment than talking with them and learning about them as individuals.

She felt that nurses were desensitised and uncaring when they put monitoring technical equipment...

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Age at interview: 55

Sex: Female

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And if there was anything at all I could do to prevent that feeling of being so, you're completely, you have no control over anything, any of your bodily functions, where you are, what you do, what's said to you. You're so completely out of control. If I could just try and get staff who deal with the patients not to be so desensitised to them, and try and remember that this could be them one day. This could be them. And I am sure that they would have, if it had been someone their age, if it had been one of their colleagues, if it had been a handsome bloke in his thirties or twenties, if it had been a gorgeous girl in her twenties, they would have had a completely different experience to mine.

Intensive Care, you've got highly specialist nurses. They're highly trained, everything that they do, all of your things are monitored and fed into a computer, and they have to respond to the computer and so on. And they're actually becoming dehumanised. And I can understand how that occurs and not everybody can be total perfection.

But to some extent, what they need to do is to supplement that. Some of the people who nurse in Intensive, it must take a particular type of person and personality because things need to be more precise, more technical. And you can't be all things to all people. So your physical needs are very well taken care of. Of that, you know, I haven't got any anxiety as far as the Intensive Care Unit at my hospital is concerned.

And I don't think in a way that you're going to be able to alter the behaviour of the nursing staff there to a huge degree. You can nudge them and say, "Have a go. Try." So I think this is an area where they need to look far more at nursing assistants. And some of the nursing assistants in there were really quite rude. They'd actually supposed to be sitting watching you, they'd sit on a seat. But they'd sit within a foot of you and turn their back on you because they were wanting to watch what wonderful emergency activity was going on in the room that had taken the nurse away.

And that's what I found that they didn't, they'd also become, I don't know what they'd become. They weren't nurses. They weren't cleaners. They were some kind of orderlies, that could actually have picked up on some of the niceness, the caringness that was needed, that was lacking.

A few people noted that the overall care they received was extremely good but they often didn't see the same nurse or doctor twice. Sometimes, this made it difficult to build a trusting relationship.

What is a care bundle?
Care bundles were developed to help achieve standardised health care and best practice. Care bundles are a collection of interventions (usually three to five) that have been recommended as best practices, based on evidence, in the treatment and management of a particular condition. By putting these interventions into a bundle, it is hoped that this will produce a standard approach to delivering core elements of care which will reduce risks for patients. What is in each bundle will vary and it is not intended to be a comprehensive list of all care that should be provided, but should form the basic level of care that should be expected and must be adhered to for every patient, every time. All the tasks are necessary and must all occur in a specified period and place.

Last reviewed August 2018.

Last updated November 2012.