Who we are and what we are here to do
We are a small group of experienced nurses that work on CITU. Even though it may not always be the case, there will usually be one of us working on any given shift. If you wish to speak with one of us, just let the Nurse in Charge or the nurse looking after your relative know. If we are not available at that time, you can always leave a message to be forwarded on to us. We will get back to you as soon as possible.
The Cardiac Family Support Nurses are here to:
1. Help with any concerns or questions.
2. Contribute to continuity of care.
3. Aid understanding, especially during difficult times.
4. Ensure you have the correct information.
5. Ensure you have regular updates from medical staff and arrange meetings regularly.
6. Support family and friends as best we can.
This list is not exhaustive; if there is anything you feel we may be able to help with, please do not hesitate to contact us.
• The visiting times on CITU are more flexible than other wards within the hospital. We allow you to visit on the day of surgery if you so wish. However, there may be on occasion exceptional circumstances where visiting may be limited or even suspended for reasons such as COVID. If unsure, please contact the staff on CITU for the latest information regarding this.
• We ask that there are only two visitors per bed space at any one time. If more than two visit, you will be able to swap among yourselves.
• We have a protected meal time policy, so patients can eat in peace without interruption.
• Visiting is normally between 2:30pm and 8pm hours and we respectfully request that visiting is limited to 1 hour 30 minutes within this period. This is so that nurses looking after your relative can deliver care and see that your relative has adequate rest.
• However, if you are unable to visit during the allocated hours, it is possible, with prior arrangement, to visit at other times. To arrange this, speak to the Nurse in Charge or one of the Family Support Nurses.
• You will notice that when you visit CITU, you gain access to the unit via a buzzer system. This is to ensure privacy, dignity, security and safety within CITU. Any delay on our part in answering the buzzer is usually as a result of us delivering patient care. If you feel you have been waiting too long for a reply, please ring again.
• We apologise in advance if you are kept waiting and appreciate your patience and understanding.
Shift Patterns and Phone Numbers
| Shift | Times |
|---|---|
| Early | 7.30am - 3.30pm |
| Late | 12pm - 8pm |
| Long Day | 7.30pm - 8pm |
| Night | 7.30pm - 8am |
We are a 20 bedded unit divided into Cardiac Intensive Care 1 and Cardiac Intensive Care 2.
Cardiac Intensive Care 1
The bed numbers are 1 to 4 and 15 to 20. The direct line phone numbers are: 01253 957774 and 01253 957775. If you wish to speak with your relative, the mobile phone number is: 01253 957773.
Cardiac Intensive Care 2
The bed numbers are 5 to 14. The direct line phone numbers are: 01253 957771 and 01253 957772. If you wish to speak with your relative, the mobile phone number is: 01253 957770.
• Consultant Cardio-thoracic Anaesthetists and Surgeons.
• Cardio-thoracic Surgical and Anaesthetic Registrars.
• Matron.
• Advanced Nurse Practitioners.
• Band 6 and 7 Nurses (navy uniform) who either have a patient or take charge of a shift.
• Band 5 Staff Nurses (blue uniform).
• Health care assistants (HCAs) (light blue uniform).
• Ward clerks. • Housekeeper.
• Physiotherapists.
• Speech and Language Therapists (SALT).
• Pharmacists.
• Dietitians.
• Family Support Nurses (part of the CITU Nursing complement).
• Microbiologists.
• Infection Prevention and Control Team.
All the above people contribute to the care of your relative. Whilst your relative is in the operating theatre they are looked after by Consultant Cardio-thoracic Anaesthetists (who sometimes have anaesthetic trainees under their supervision). Consultant Cardiothoracic Surgeons operate with assistance from Registrars along with the rest of the theatre team.
After surgery, decisions concerning care are made between the on-call Anaesthetist, your relative’s Surgeon and the nurse at each bedside.
In general after planned heart or thoracic surgery a patient is admitted to CITU.
• As this is a Regional Cardiac Centre admissions can also arise from emergencies and other hospitals.
• After surgery your relative will be transferred to us and closely monitored during their recovery. An uneventful recovery is the norm and you may expect your relative to step down to the ward within 24 to 48 hours.
• There are occasions when recovery does not go to plan. This may be because patients are extremely ill prior to surgery, of the complexity of surgery itself, or other existing health issues.
• Complex cases may necessitate a longer stay from a few days or weeks to even several months.
• During longer stays other issues may arise. We will keep you up to date with these should they occur.
• Days may go by with no visible change in your relative’s condition. In such cases there may be little for you to do other than sit by their bedside and wait. Nurses will often talk through what they are doing to unconscious patients. This is because even though patients are heavily sedated they may be aware of being touched and so verbal reassurance is offered.
Alarms
At your relative’s bedside you will often hear alarms. Often there is merely a slight change in their condition that requires the attending nurse to alter some medication. Sometimes, the nurse will silence the alarm without any further action. They help us direct patient care and may not necessarily mean that something is wrong. Nevertheless, alarms can be a major source of anxiety for patients and relatives so if you ever have any questions please do ask a member of staff.
Helping the Patient
The nurses may ask you to bring in some of your relative’s personal belongings to help their recovery. This might be a favourite perfume, toiletries, a photograph of a pet or loved one, or music. Talking to your relative may also help. Keeping up a one-sided conversation can be difficult but talking about shared experiences of holidays and good times can make you feel better too. You could also try reading a newspaper, magazine or book to them.
Helping the Staff
You may find it helpful to be more involved in caring for your relative when they are recovering. You may be able to help in doing things such as brushing their teeth or massaging or moisturising their hands and feet. This will depend on how ill your relative is, and will not always be possible. However, if you want to help, please ask the staff. You can help the intensive care staff by nominating a family member or friend as the main contact. Staff can then update the main contact on the patient’s progress. They can in turn relay information to other family members and so save time for staff and relatives.
Patient Diaries
Often, you may find it helpful to keep a diary of what is happening. It can help you look back and see small improvements your relative has made. A diary can also be very useful to patients who may have been confused or have absent memories of their time in CITU. It may also help them understand what happened to them and fill in the gaps in their memory. It may also be useful for you to make notes, to help remind you, and write down any questions you may want to ask.
Preventing Infection
Patients who are critically ill are often immuno-compromised (this means they have difficulty fighting infections). This can lead to serious complications. Staff will do all they can to make sure your relative is protected and you may also be asked to wear protective equipment as a safety measure for the patient and yourself. You can help by using the antibacterial gels you see around the unit before you touch your relative and before you leave. Please ask other visitors to do the same.
Other things you can expect
There may be times when staff ask you to leave the patient’s bedside. This is because some medical procedures appear unpleasant and may upset you. There may also be occasions when things do not go according to plan and we may ask you to step outside so that we can carry out more invasive and possibly life saving procedures. This also gives the staff room needed to deliver optimal care for your relative.
Treatment
If your relative is ventilated (on a breathing machine), the nurses have to regularly clear the chest of mucus and fluid. They do this by putting a thinner tube into the breathing tube to suck out mucus. This is quite noisy and may cause the patient to cough or retch. When the patient is ready to have the breathing tube removed (extubation) we may ask you to return to the waiting room for a few minutes. This is because extubation may distress you. Fluids also given to patients to hydrate them may make them look swollen. This is not uncommon and will improve with recovery.
Behaviour and Delirium
Sometimes, your relative may behave out of character. This may be because of their illness or medication. They may be agitated, confused, scared or paranoid. Paranoia is a form of anxiety or fear that can make a person believe that others are plotting against or trying to hurt them.
They may also have hallucinations (see things that are not really there) and vivid nightmares.
Whilst in hospital, people are not in their normal surroundings, there are a lot of background noises and alarms. Various procedures and care given can also be intrusive and all these things can have a negative impact on your relative’s behaviour. The nursing staff are very aware of this and assess for ICU delirium on a regular basis. We appreciate that this can be extremely distressing for you and your relative but it will improve as they begin to recover.
If you are concerned that your relative is not him or herself, please talk to us about it.
You will find that our patients are commonly given sedatives, to protect themselves if they are delirious. The sedatives will be gradually reduced as your relative gets better; a process often referred to as weaning.
Depending on how ill they were, the drugs needed and how long they were sedated for, the weaning process can take hours or it can take days or even weeks. During the weaning process your relative may be drowsy and confused, particularly in the night. At times we may need to implement our restraint policy. This is to protect them and prevent them from injuring themselves when they are confused and agitated.
The leaflet entitled ‘Delirium; A guide for families and patients’ explains how your relative may be confused after their surgery.
Looking after yourself and other things to consider
You can help your relative by taking care of yourself. You should not feel guilty about not being at their bedside 24 hours a day. You need to give yourself a break and this will also give the patient time to rest. Your relative will be very well cared for and the staff will contact you straight away if they need to or there is any change in their condition.
Your family and friends will be concerned about you and the patient and they will want to know how things are. You may appreciate their concern, but it can be tiring if the phone is ringing all the time when you’re at home between visits to the hospital. Passing on information by email or text message to several people at once can be easier. Alternatively, you can speak to one person regularly and they can pass the information on to others.
We also respectfully request that only one or two designated people ring us concerning the patient as too much time spent on the phone can take the nurse away from patient care. You may also feel like not eating and have difficulty in sleeping. It is, however, important that you take the time to eat regularly and rest.
If you become tired or ill you won’t be able to care very well for your relative. If your relative is very ill and/ or been with us a long time you may be able to get help with your car parking costs. Likewise, if they are extremely ill and may not survive, and you are unable to leave hospital, we may help you with meal costs. In extenuating circumstances, we may also arrange overnight accommodation for you at the hospital. Please note, this is only available to relatives of a patient that is extremely ill or unlikely to survive.
Once your relative is more stable and making progress, help with meals and overnight accommodation will no longer be available.
However, please feel free to ask a member of staff for further information if you feel we can help you.
If the patient is your partner, you may suddenly feel very alone. Accept offers of help from family and friends. You will have less time to do things like shopping and may need help with childcare. Often, in times of worry and stress, people turn to their partner for support.
The Family Support Nurses are here to help and even though we may not know all the answers we may be able to point you in the direction of others who may be able to help. Regardless of your religious beliefs, you may like to seek the support of a spiritual advisor.
You can speak to our hospital chaplain who can put you in touch with a minister of your denomination or religion. You can ask us to contact a member of the chaplaincy team for you or you can contact them yourselves.
You may also feel drained physically and emotionally. If you feel unwell or are concerned about physical symptoms, go and see your GP for help and advice. Make sure that your bills are being paid and if you need access to your partners account contact the bank to explain the situation. You may be able to get temporary control of the account while your partner is not able to deal with matters.
If money becomes a problem, contact the Citizens Advice Bureau for information on any financial help and benefits that are available to you.
Once your relative is out of danger, you may have a reaction following the stress you have experienced. If you feel guilty worried or depressed you can get help and information from the organisations listed at the end of this booklet. If you need more support you can also arrange to see your GP and they may be able to organise counselling.
You may need to consider whether a child should visit their parents or close relative in an intensive care environment. As a rule we do not allow children under the age of 12 to visit. This is for infection prevention; to protect your children as well as the patient. However, in extenuating circumstances this may be waived. Please check with staff before bringing children to the unit.
If a child is allowed to visit prepare them for what they might see. This includes the machines, what they do and how their relative may look. We offer an activity booklet for children to help with their understanding of the Intensive Care environment. Their relative may also be at the stage of recovery where they can be wheeled to a coffee shop within the hospital so that the environment is better for the child.
What you explain will depend on their age and why their relative has had a prolonged stay in CITU. You can help a child deal with the situation by:
• Trying to keep to their routine as much as possible;
• Telling the school and any other relevant groups that the child’s parent or relative is in CITU;
• Explaining the situation and being honest if you don’t know what is going to happen. If you are not sure, try saying something that they can understand that will help the child feel secure and reassured, for example, ‘Daddy is very ill but the doctors are doing everything they can to help him’ and encourage them to keep a diary. It could include a brief description of each day and any souvenirs such as pictures they may want to include.
• This helps the child understand what is happening and makes it easier for them to talk to the parent about what happened in their life while the parent was in hospital.
Once the patient is out of intensive care the child may need help dealing with what has happened. This can be a gradual process and may take several months.
At times, it may be helpful to mention the patient’s stay in hospital so the child knows they can talk about it. Let them ask questions, and ask them how they felt at that time. If the child is very young they may find it easier to show their feelings by drawing pictures or acting out what happened.
Remember that children can ask very blunt questions, so if your relative doesn’t feel strong enough to cope with this, ask another family member or friend to talk to the child about their experiences and feelings.
Transferring to the ward
Most patients are usually transferred to the ward within 24 to 48 hours of their surgery. However, there are occasions when your relative’s stay has been extended. When your relative no longer needs intensive or critical care they will be transferred to wards 38, 39 or the Lancashire Suite.
The decision for transfer is made as a result of feedback concerning patient recovery from various members of the multi-disciplinary team. The final decision for transfer to the ward is made between the on call Consultant Anaesthetist and the patient’s Consultant Surgeon in conjunction with other members of the multi-disciplinary team. Being transferred to the ward is a positive move and a step closer to home.
Even though most patients see this as a positive move, some may also feel very apprehensive about ‘stepping down’ to the ward. This is not unusual in itself as patients have had a lot of support and now have to re-learn a lot of daily skills and build up strength and confidence before they return home. The Family Support Nurses are here to help allay any fears, as are other members of the multi-disciplinary team. Please talk to us about how you are feeling.
Once discharged, the Cardiac Rehabilitation Team may be able to help you with any questions or concerns. Their number is 01253 955326.
When a patient becomes too ill and does not survive
Despite the best efforts of intensive care staff sometimes the patient is too ill to survive. As a person’s health deteriorates, we will explain to you that there has been a change in their condition and that they could be in the last few hours or days of their life. You may also notice changes in their condition, in their breathing pattern, behaviour and how they may look as their circulation slows down.
Our main aim at this stage is to provide comfort and dignity for your relative. We like to be as supportive as possible without being intrusive. If you feel at any time that the needs of your relative are not being met, please let us know.
We want to get this right as it is important for us to ensure we are doing all that we can for them and for you. A person has died when the heart stops beating or when the brain stem has died. If the doctors believe the patient’s brain stem has died they have a set of tests they must follow to confirm this. If your loved one has died, we will give you a booklet (Information for Bereaved Relatives and Friends) which has all the information you need regarding what happens next.
Under certain circumstances a doctor is legally obliged to inform the Coroner of the death and they may decide that a post mortem is required. You do not have to wait till this is concluded to continue with funeral arrangements. It may also help you to talk to a bereavement councillor. They can offer both support and understanding for adults and children.
When a patient is unlikely to recover or has died their next of kin and family members may be approached to discuss organ and tissue donation. Knowing your relative’s wishes regarding organ and tissue donation can help in making the right decision for your family. If this is something you want to discuss or look into please speak to one of the nurses. We will contact the organ and tissue donation teams on your behalf should you so wish.
If you are unhappy with the care being given to a patient
The staff normally do all they can to keep relatives informed about what treatment is given and why. Where possible they will let the patient and relatives know what treatment options they have. If there is anything you don’t understand or want to know about, please ask the staff. You can also speak to the Nurse in Charge, any of the Family Support Nurses, the Advanced Nurse Practitioner or the Matron. Arrangements can also be made for you to speak to any of the Consultants, Anaesthetists and Registrars who are looking after your relative. If you are unhappy with the care being given please speak to us about it.
We really do want to help and alleviate any concerns at this stressful time.
However, if you feel you are not able to deal with this through the cardiac intensive care staff you can contact a member of the hospitals patient relations team who will help you to find the answers you need. Their number is 01253 955588/9.
Chaplaincy Team
01253 953876
01253 956299
01253 953876
Cardiac Rehabilitation Team
01253 955326 SWAN
End of Life and Bereavement Care Team
01253 952456
e-mail bfwh.swanteam@nhs.net
ICU Steps
www.icusteps.org
Citizens Advice Bureau (CAB)
Citizens Advice Bureau Blackpool
01253 308400
www.blackpoolcab.org.uk
Citizens Advice Bureau UK
03444 111 444
www.citizensadvice.org.uk
Cruse Bereavement Care
01772 686668
www.cruisebereavementcare.org.uk
Samaritans
01253 622218 116 123 (free to call)
www.samaritans.org
