Nurses

The coronavirus outbreak has meant that many Intensive Care Units are much, much busier than normal. Many Units will have had to completely reorganise how they provide care, so that they can increase the number of beds available, and also provide separate Units for patients who do and don't have coronavirus. All of this means that many more nurses are needed. Many Units have had to bring in ("redeploy") nurses from other areas who don't normally work in Intensive Care e.g. theatre or ward nurses. This may also include nurses who previously worked in Intensive Care, or have recently retired. These staff receive rapid training and support from Intensive Care staff, so that they can safely provide care. They will be carefully supervised by staff who normally work in Intensive Care 

What do nurses do in Intensive Care?

Looking after patients in Intensive Care can be a very busy and complicated job, ranging from providing personal care (eg bedbaths) to working with very complicated monitors and equipment. They work very closely with all the other members of the ICU team, including doctors, physiotherapists, dietitians, pharmacists,etc,etc. They are usually the first point of contact for family members and will keep them up to date with the patient's progress and answer any questions.

While patients are receiving support from the ventilator or breathing machine, they are usually looked after by one nurse. Patients who aren't attached to a ventilator or breathing machine may be looked after by a nurse who is also looking after one other patient. This may not always be possible during the coronavirus outbreak. 

Nursing care is provided 24 hours a day.A nurse is almost constantly at the patient's bedside. Wherever possible, we aim to ensure continuity of care, by trying to make sure that the same nurse looks after the same patient on her/his next shift. A more senior nurse (the nurse in charge) is also always available.

Handover  

The nurse will usually start the shift by hearing about the patient's progress since they came into Intensive Care and over the previous shift (handover). She or he will usually carry out a full assessment of the patient by checking their charts (including things like vital signs, blood results and medications), checking that all equipment is working as it should and carrying out a full body assessment (eg checking the patient's skin, including any wounds and dressings and listening to their chests).

Continual assessment

The nurse will constantly and carefully assess the patient's progress througout her/his shift.This is done by continually checking the monitors and recording the patient's vital signs (heart rate, blood pressure, etc),making sure that the patient is comfortable by continuously assessing their sedation (how sleepy they are) and pain levels. The nurse will continously assess how much support the patient needs from the ventilator or breathing machine and adjust it accordingly. Both the monitors and the ventilator or breathing machine have in built alarms so that the nurse will be made aware of any problems if she/he is temporarily concentrating on something else e.g. checking the patient's drug chart. All of this close attention means that any potential problems can be seen early and dealt with quickly.

The ward round

The doctors will carry out their own full patient assessment at the start of every shift and will discuss the patient's care with the nurse looking after him or her. A full ward round usually takes place during the day and involves all the members of the Intensive Care team (the medical staff, senior nursing staff, physiotherapists,etc,etc). Decisions about the patient's care are usually discussed at this time. The doctors will also work very closely with any specialists involved in the patient's care e.g. surgeons or heart specialists. A smaller ward round takes place at night, usually involving just the Intensive Care doctors and nurses. 

Personal care

Personal care includes things like giving bed baths, mouth care,skin care, moving patients in bed and doing gentle exercises to help keep the patient's joints from becoming stiff. Patients receive a bedbath (a complete body wash in bed) at least once a day and whenever else needed. Mouth care is provided every 2 to 3 hours, using soft moist sponges to clean and moisturise the mouth, and vaseline to stop the lips from cracking. The nurse will also change the position of the breathing tube in the patient's mouth to prevent it rubbing and creating a sore. Patients are moved in bed every 3 hours or so in order to prevent bed sores.We also use special pressure relieving mattresses to prevent this happening. Gentle exercises are performed several times throughout the day to help prevent the joints from becoming stiff. This involves lifting and moving the patient's arms and legs into different positions. 

Giving fluids and medications

When patients are connected to a ventilator or breathing machine, they are not able to drink normally. Fluids are therefore given directly into the bloodstream via drips or lines. The nurses carefully monitor and record how much fluid the patient receives along with the patient's vital signs (heart rate, blood pressure,etc), daily blood tests and how much urine they pass to make sure that he or she is receiving the right amount of fluids.

Medication can given in many different ways. It can be given into the bloodstream (intravenously), into the muscle using a needle (intramuscularly), or just under the skin using a needle (subcutaneously). Some medications are so strong that they can only be given into a large vein (intravenously) in the patient's neck or groin, where a richer blood supply helps to quickly dilute the medication. We can also give some medications down the tube that goes down the nose and into the stomach (the nasogastric tube) or in the form of plasters or patches. Others can be given in a device that delivers medication in a fine mist which is inhaled into the lungs (nebuliser).

Supporting patients

The Intensive Care Unit can be a very strange and sometimes frightening environment for patients, especially if they are starting to become more awake and more aware of their surroundings. Even when patients are unconscious (either due to their illness or the drugs we give them to keep them sleepy and comfortable), it is possible that they can feel and hear what is going on around them. For this reason,the nurses will tell the patient about everything they're doing and why. The nurses often form a close bond with the patients they're looking after, especially if they spend a long time in the Intensive Care Unit.

Keeping family members up to date

Visits from family members are not allowed during the coronavirus outbreak. We realise that this will be very upsetting for many patients and families. The staff will work very hard to make sure that families are kept up to date by phone. Many Intensive Care Units are using online or "virtual" visiting, which means that family members can see or speak with their loved ones, using mobile phones or tablets, if they are awake. The nurse is probably the person that family members will hear most from during their loved one's time in Intensive Care. She/he will have an in-depth understanding of the patient's progress and should be able to answer any questions.