In the first article on this subject I looked at which intensive care is which; what you can expect when you and your child first arrive on one of the units and I briefly introduced to you the main people you will come across during your first hour on the ward. In the second article I described the equipment that you are likely to find around your child’s bed and in this third and final article in the series I intend to look at the routine you can expect from a standard day on intensive care and what you as a parent can assist with.
Obviously, the first thing to say is there is no such thing as a standard day and every child’s pathway is unique. But having worked for a varying amount of time in every, bar one, intensive care in London and popped over to work and live for a while in Australia I feel able to inform you of the usual practises across the board. (You will find further notes on my reasoning in article one).
Again this article is not referenced as is my usual practise, but written from experience. However, this does not mean that I don’t love learning. I love receiving comments, so feel free to share you experiences with me either publicly or personally.
A day in the life of intensive care
7.45 am:The nursing day staff arrive on the unit for handover with the nurse in charge
8am: The new bedside nurse for the day arrives for hand over at the bedside. Depending on the unit you may be asked to leave for this, but it is usual practise that this is not necessary. It really depends on the size of the unit and whether you will be able to overhear what is being said at the bedside next to you. If one parent has to leave then everyone does so as to be fair.
8.30am: Having done her checks the bedside nurse will seem more relaxed and happy to talk.
9am: The doctors will come for a ‘ward round’. This has been allocated a time of 9am but this will probably change slightly every day you are on the unit. Depending on the consultant these will sometimes be quick rounds and other times they will seem to last hours. You will probably be asked to leave at these times when the ward round approaches as there are a lot of people talking loudly about different patients, regardless of where they are on the unit, and if you hear then it breaks confidentiality regulations.
The rest of the morning: Your child will be assessed by their registrar for the day, the physio, and their drug charts will be reviewed by at least one type of pharmacist. The bedside nurse will also go on a breakfast break.
Lunchtime: Certain drugs will be given throughout the day and the times of these are often 10am, 12pm, 2pm and 6pm as well as hours in-between. These are often double checked by two nurses, but not always, it depends on the training level of the nurse and the drug itself. When doing medication it is best not to distract your child’s nurse with questions as this, though rare, can lead to errors being made.
Your bedside nurse will get another longer break at lunchtime where your child will again be under the care of another nurse. You may like to take your lunch at a different time to the bedside nurse, but it is important to go. Sick parents are no good to sick children and in fact aren’t even allowed to visit due to the risk of spreading infection. The atmosphere in hospital is often very dehydrating, so I recommend drinking more than you usually would.
Mothers who wish to breastfeed need to drink 2 litres of water a day and express every three hours, including overnight. Every drop is gold, so don’t feel disheartened. It is hard to produce milk when stressed, but if you chose sleep over expressing don’t be surprised if your milk dries up altogether. Regular expressing can keep this from happening and keep the mother even more proud of herself! Medics agree that, for young babies, breast milk is the milk of choice when feeding is started again and without it there is a delay to avoid the gut being pushed with formulae feeds. As a result there is even often milk banks of rigorously checked breast milk for mothers who are unable to breast feed and there is no shame in asking about this if you would rather this option. They also usually always welcome donations too!
1pm-2pm: The physio will usually pay a second visit to check your child’s lungs again and perhaps to do passive limb exercise, or even to support them in sitting in the chair for a few hours, or with a walk if they are progressing towards leaving the intensive care.
The afternoon: This is usually more relaxed and there is often time to hold your baby or young child. The nurse will ensure the lines and tubes are placed in a safe manner. Having been woken up after a few days your child may already be extubated (no more ventilator and breathing tube) and ready for some toast, or toys from the play specialist or activity leader. If your child is stable enough they may be bathed and their sheets changed. This is also usually a more relaxed time with time to change dressings. Be aware though the current research points towards not changing dressings as frequently as was previous practise years ago.
5pm- 6pm: Around this time there will be another smaller ward round which you may have to leave for, but not always as the report of the day is usually given by the bedside nurse and there is no need for a loud discussion. After this the bedside nurse will go for a small break and her last of the day.
Early evening: The lights will start to be turned down and the nurse will become focused on finishing her notes and reports before the night staff come on.
7.45pm: The night nurses arrive for handover with the nurse in charge
8pm: The bedside nurse for the night arrives and takes handover. The day nurse leaves at 8.15pm and the night nurse does her checks.
9pm: The doctors’ hand-over about this time, having started at about 9am, and two new doctors start for the night shift, usually under the same consultant who works 24 hours a day for the week on call. The consultant will visit probably twice over night, but obviously try to sleep too; unlike the registrars who remain awake with the bedside nurses all night.
Overnight: If a physio is needed then the on-call one will be called, if drugs are needed they will be given, perhaps with the assistance of the on-call pharmacist. If lines are needed they will be inserted. The aim is to allow the children to rest as much as possible overnight in a calm environment with minimal handling. But intensive care is very much 24 hour care and everything that needs to be done will be done. On the ward the children are constantly cared for too, but it is usually safe to put most care off til the morning. The bedside nurse will get breaks amounting to about 1.5 hours overnight and at least an hour of that will be in one go.
6am- 7.30am: The lights start going on, children that are stable start being washed and x-rays that need doing are taken so they are ready before handover. Blood tests are also taken (usually from lines as your child sleeps) and the bedside nurse gets ready to handover to the day staff. It is common for parents to choose to arrive on the ward at 7am so they can find out how the night has been from the night staff and also to see their child before they may be asked to leave during handover. Which is then a good time to get breakfast or showered. I note here that parents can visit any time day or night, but getting good amounts of rest is always recommended even if it is a near impossible feat!
As a nurse I say ‘they will need you more when they wake up’ as a parent the voice in my head says ‘bugger off, i’ll do what I like!’
There will be plenty of opportunity for you to help:
~You can sing/ play music or read to your child as they sleep or stir.
~ You can help with their cares. Eye, mouth and nappy care is usually done every 4 hours. Baths and sheet changes are also done every day if your child is stable enough.
~ You can help feed your child either through bottle or breast feeds, or more commonly down the nasogastric tube, having been taught to do so by the nurses.
~ You can help clear their secretions with a tissue, or even the suction machine if the nurses deem it appropriate.
~You can even just chose to sit on a chair and hold your child’s hand until they are well enough to leave.
In rare circumstances you may be asked to step away from your child becomes your presence is making them unstable. This is because they start to fight so they can get up and go home with you! It is a compliment of their love that they can hear you through the medication and even asleep your touch may increase their blood pressure. This situation wont last forever. There is chairs at the bedside so you can see what is happening and be present, but not disturb them.
I hope you have found this article interesting. I hope that any stay your child has in intensive care is short and finishes with a positive outcome and I hope you feel able to share your experiences in the comment boxes below; for in turn then you will be supporting someone yourself.
- What to expect from intensive care (paediatric, neonatal, cardiac) (niccilouise.wordpress.com)
- Neonatal Song Lowers Heart Rate, Improves Suckling (medicaldaily.com)
- NICU Nursing: Salary & Job Description (nicunursing.wordpress.com)
- From mice to humans, comfort is being carried by mom (esciencenews.com)
- Why Do Babies Calm Down When They Are Carried? (asianscientist.com)