Intensive care: experiences of family & friends

The ward environment and nursing care

Patients are transferred from the intensive care unit (ICU) to a general ward when medical staff decide they no longer need such close observation and one-to-one care. For both patients and relatives this move is an important step in the ill person's progress from being critically ill to recovering. In the UK National Health Service (NHS) general hospital wards are very different from intensive care, the biggest difference being fewer nurses to look after many more patients. Instead of each patient having one dedicated nurse as they did in ICU, each nurse in a general ward may be responsible for caring for up to nine patients. Nurses can be called with a buzzer by the bed but may not be able to come straight away. Both patients and their relatives can find this difficult if they have become used to intensive care. 

Here people talk about the general ward environment and nursing care. Experiences ranged from those who found this an extremely difficult part of the patient's time in hospital to those who were glad the ill person was moved from intensive care on to the next stage of recovery.

The ward environment
The transfer from ICU to a ward had been a big and often worrying move for both patients and relatives. For many patients the move followed days, even weeks, of being unconscious either as a result of an illness or injury or because they had needed artificial respiration. During these early stages of recovery patients were usually extremely weak and unable to do very much for themselves. They had lost skills and confidence and often could not walk, feed themselves or even reach for the buzzer to call a nurse. Some people felt that the patient hadn't been prepared for the busy atmosphere of the ward and had wished they hadn't been moved until they'd felt better able to cope and look after themselves. They worried about leaving them on the ward when they were so weak and immobile and consequently completely dependent on nurses for all their care (see our section on Intensive care for patients).

"Before a patient is discharged from critical care, s/he should have another health check (short clinical assessment) to identify any physical or psychological problems. If the health check shows that the patient could benefit from more structured support, s/he should then have a more detailed health check (comprehensive clinical assessment) to identify his or her current rehabilitation needs. The healthcare team should talk to each patient about their rehabilitation goals and rehabilitation programme, both of which should take into account the results of the health checks and be tailored to their individual needs." (NICE CG83 2009)

Many people said their relative, partner or close friend had found the ward busier and noisier than ICU. Some patients had found it difficult to sleep and relatives had worried that this would hamper their recovery. Some said they'd found it worrying when the patient had moved to a ward that didn't specialise in the patient's condition. This was especially the case when patients had head injuries or conditions affecting their brains. They were extremely anxious about leaving the patient unsupervised when they had not fully recovered and could easily fall and injure themselves. These relatives felt the ill person still needed 24-hour care. Some other patients, who were ready to be transferred to rehabilitation units where they would receive more intense, specialist support, had to spend some time in a general ward before a bed became available (see 'Hospital discharge and rehabilitation'). 

Many relatives felt frustrated because the ill person wasn't receiving the support they felt he or she needed in order to recover, and that this was hindering their progress. Several, who worried that there was such a marked difference between the ICU and the general ward, felt that all hospitals should have High Dependency Units (HDUs), where patients would receive less care and support than in ICU but more than on a ward.

Nursing care
In ICU, patients receive one-to-one care by specially trained nurses but on a general ward many more patients are cared for by fewer nurses. Some people said they'd been anxious about leaving the patient when they were on a ward because nurses wouldn't be able to attend to the ill person whenever they needed something. Visiting on the ward, compared to ICU, is more restricted and many found this difficult, especially when the patient had been extremely weak and immobile, often too weak to press the buzzer to call nurses, feed themselves or go to the toilet. In some cases, where patients had been so weak they hadn't been able to move or feed themselves, relatives had asked if they could come in and help, fearing that the patient wouldn't eat at all if nurses hadn't got the time to feed patients individually. Some, who'd had long distances to travel, also said they'd been allowed some flexibility in terms of visiting. 

Some people felt that nurses on the ward had unrealistic expectations about how much patients could do for themselves. They suspected that these nurses knew little about what these patients had been through in intensive care but that they had been prepared to give more support once they'd realised how weak and debilitated the patient had been. Many said that, at first, nurses would leave food and drinks on the patient's table, not realising that, at that stage, the patient hadn't been strong enough to lift a cup or cutlery or to feed themselves. Clearly some nurses had been better and more helpful than others. One man said his wife was unable to do anything for herself on the ward and had felt isolated but that after he had been able to talk to the doctors about her situation, things improved. 

Some people said the patient had sometimes waited what seemed an extremely long time for things they'd asked for or needed. A few people said the patient had occasionally missed out on meals. Some said they'd often had to go and look for nurses because the patient had needed something but there'd been no one at hand to help.

Some felt that the ward nurses, who were less highly trained than those in ICU, were too busy to provide adequate support to patients who were so debilitated. A few people felt that, because staff had been so busy on general wards, there hadn't been enough time for them to be properly briefed about each new patient.

Some people felt there was a lack of communication between nurses on the ward working different shifts, and one woman felt that several of the problems her husband experienced were due to this.

Some people felt extremely disappointed in the care on the ward, having got used to the nursing care in ICU. Some had been able to pull strings to ensure better care. For instance one or two people who'd known health professionals working at the hospital had contacted them and managed to get the patient transferred. One woman's husband was on a ward before being transferred to a specialist hospital. She rang her brother who worked at the hospital and asked him to speak to doctors so her husband could be transferred as soon as possible. Two people said they transferred their partners to a private hospital, where nurses would have more time for each patient. Both felt that the patient could have benefited from more psychological support at this time as well as physiotherapy.

For some relatives and close friends the patient's transfer to a ward had been especially difficult, not only because the ill person had been extremely weak but also because he or she had been confused or hallucinating. Some of these patients had wanted to discharge themselves or for their relatives to take them home. A few people said the patient had become very depressed on the ward. Others felt that patients had felt isolated because of the restricted visiting. One man became so depressed he made his wife take him home that very evening. Doctors discharge people only when they feel they are not at any risk of deteriorating. Some people, though, choose to leave hospital without being formally discharged. This is not usually recommended because a person may have complications or problems at home. This could hinder recovery or lead to new problems and, sometimes, re-admission to hospital. 

Some relatives were keen for the patient to be discharged because they felt they would recover better at home (see 'Supporting and caring for the ill person at home'). 

Outreach Services
Outreach services aim to enhance the care of ICU patients on the wards and make the transition easier. Outreach nurses also aim to reduce the risk of re-admission to ICU from the wards and to share their specialised nursing skills with other staff in the hospital.

“Many hospitals now have an outreach team of intensive care trained nurses and doctors who follow up intensive care patients on the ward and address any specific issues they can help with. This ensures that there is as seamless a transfer of care as possible.” (The Intensive Care Society)

A few people recalled being visited by outreach nurses. One man praised the support he and his partner had received from outreach nurses before his partner had been admitted to ICU and wished they'd seen them again afterwards. Other people hadn't recalled seeing outreach nurses and one woman felt that the one she had seen had been unsympathetic. One man said he would have valued having a specific person on the ward who he could contact to ask questions and discuss his wife's progress. 

Making steady progress
For some people the patient's move to a general ward was associated with making progress and seen as an important step in the right direction. Some relatives and close friends said they'd quickly accepted that there were fewer nurses to patients and recognised the benefits for the patient in having to do more for themselves. Several noted that, although the care was more personal and 'intensive' in ICU, they understood the constraints on the ward and on the UK National Health Service more generally, and accepted that the wards were bound to be busier, have fewer nurses per patient and were often 'under-resourced'. But, overall, these people said they'd been satisfied with the care and had focussed on the patient's recovery, some saying they'd felt grateful for all the care and treatments the patient had received.

One man felt that some of the nurses had been very supportive when his wife was on a ward and said they'd given them both lots of useful information. A few recalled how friendly the nurses had been and felt that the care had been appropriate now that the patient could do a bit more for themselves.

Last reviewed August 2018.

Last updated May 2015.


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