Critical Care

• Check in at the nursing station upon arrival and whenever you have questions
• Turn down the volume: Minimize your conversations and cell phone use in patient care areas
• Scent-free zone: Refrain from wearing perfume
• Be respectful: Abusive behavior towards staff, patients and visitors is not permitted. We are committed to providing quality care that respects the dignity of all individuals
• Don’t leave belongings unattended: We are not responsible for lost or stolen items
• The doors to the units are locked and you will have to use the intercom to speak with the front desk to enter.
• Items which may be restricted at the bedside include electronic devices, flowers or plants, latex balloons, and food or drinks.

We actively include family members to help us create a healing environment for the patient.

Daily rounds: You are invited to join our interdisciplinary discussion every morning and/or afternoon in the intensive care units. Start times may vary. You may join in person or virtually.

Family conferences: Let us know if you would like to schedule a formal meeting to discuss your loved one’s health status and/or to ensure that medical decisions are in alignment with the patient’s wishes.

Patient updates: Our team is the best source of information and is available to speak with you upon request.

We are happy to answer your questions. It’s okay to ask:

• Ask us to explain any medical terms or words that you do not understand.
• Ask us about the risks, benefits and alternatives to any test or treatment.
• Ask us about the purpose and potential side effects of any medication.
• Ask us to assist you in communicating with your loved one.

Below is a brief description of the team members in our intensive care units:

Attending Doctor: This individual directs the care of critically ill patients. Every week, the attending doctor that works in the intensive care unit changes. Report is always given to the new attending doctor to ensure quality care is continued. Family meetings with the attending doctor can be set up when updates are needed or requested.

Resident Physician, House Medical Officers and Clinical Assistants: This group takes care of the medical plan, gives direction for treatment, and updates the attending doctor often. They also look after the patients in the intensive care units when the attending doctor is off-site.

Unit Manager: The manager directs and coordinates the delivery of high-quality nursing care for patients in the intensive care unit.

Clinical Resource Nurse (CRN): This individual promotes procedures, policies, practices, and standards of care in the intensive care unit.

Registered Nurse (RN): This position provides care to patients with life-threatening medical conditions. They advocate on your behalf and can be asked for updates or information about the plan of care.

Pharmacist: This team reviews all medication orders and the quality of medicines supplied to patients. They provide answers to your questions about side effects, interactions, and dosing.

Respiratory Therapist (RT): These individuals provide care to patients with breathing problems. They manage life support breathing equipment (ventilators) to help your loved one breathe better.

Health Care Aide (HCA): This group provides patient care and support with tasks such as bathing, dressing, and eating. They also ensure that medical supplies are readily available at the patient’s bedside.

Unit Clerk: This position performs clerical duties such as making copies and faxing documents. They also greet visitors, answer incoming calls, and route callers to the correct patient room.

Spiritual Health Practitioner: These individuals provide care to all whether you identify as spiritual, atheist, religious or agnostic. They are specifically trained to provide support for your emotional and spiritual well-being especially during times of difficulty and crisis. They also arrange ceremonies, smudge, sacraments, and rituals. To request the on-call practitioner, call 204-787-3884.

Dietitian: These professionals provide advice on the nutritional needs of critically ill patients. They help patients understand their needs and challenges, and design meal plans accordingly.

Speech Language Pathologist: These individuals provide therapy to patients with communication and swallowing disorders. They educate patients and family members on treatment plans, communication techniques, and strategies for coping with speech/language barriers.

Physiotherapist (PT): They provide education to helps patients improve their functional mobility by developing an exercise treatment plan which supports the recovery process.

Social worker: This team provides support to patients and families with issues that occur because of critical illness and hospitalization. They help patients and families access services, resources and programs related to their unique needs.

Occupational Therapist (OT): They provide therapeutic activities to help patients develop and maintain the skills needed for daily living and working.

Talk to your loved one: Speak calmly and in a clear voice. Even when unconscious, your loved one has a sense of your presence and reassurance. If your loved one is alert but unable to speak, phrase questions that can be answered with a nod, shake of the head or hand gestures. If your loved one is able to write or use a smartphone or tablet, you can assist with that. We have some communication tools that may be useful for expressing basic needs. The bedside nurse will be able to help.

Choose a family spokesperson: This is the person we will contact to provide updates and help make care decisions.

Provide us with a complete list of current medications: Please include any prescribed and over-the-counter medications, and all dietary supplements like vitamins, minerals, and herbal health products.

Participate in patient care: Orient your loved one to the surroundings. You can talk about the noises you hear and the people you see. Describe the kind of activity around you. Ask your nurse about opportunities to get involved with daily care activities. Examples include assistance with entertainment (music, television and reading), meals, oral care, baths, pillow repositioning and applying lotion to the skin of your loved ones.

Take care of yourself: It is important that you take time to eat, drink fluids and rest. Ask us for information about our family rooms and quiet areas, and for directions to the cafeteria.

Talk to us: You know your loved one the best. Let us know if you sense any change in their condition that requires our attention.

Let us know if you would like to learn more about:

• Advance care directives: A legal document that helps our care team understand your choices for resuscitation and other treatments.
• Delirium: A common state of confusion that is usually temporary but may develop suddenly in a critical care patient.
• Grief and bereavement: The process of understanding and working through the loss of a loved one.
• Organ donation: The process of giving an organ or tissue to help someone that needs a transplant.

Acute Respiratory Distress Syndrome (ARDS): Occurs when lungs are injured causing inflammation and fluid to build up in the lungs. The fluid keeps lungs from filling with enough air and deprives organs of the oxygen they need to function.

Advance care directive: A legal document that helps our care team understand your choices for resuscitation and other treatments. Learn more.

Arterial line: A thin plastic tube placed into an artery and used to monitor blood pressure and blood gas.

Antibiotics: Medications given to treat an infection.

Bladder catheter: A soft tube that is placed in the bladder to drain urine.

Blood gas: A sample of blood that lets us know how much oxygen and/or carbon dioxide is in the patient’s blood.

Blood transfusion: A blood transfusion is a way of adding blood to your body after an illness or injury. If your body is missing one or more of the components that make up healthy blood, a transfusion can help supply what your body is missing.

Cardiac monitor: A machine attached to the patient that provides information about heart rate, blood pressure, and oxygen levels.

Central line: A thin plastic tube placed into a large vein and used to give drugs and take blood samples.

Cherry blossom: A visual cue which promotes end-of-life dignity, compassion, and respect when a patient’s death is imminent.

Daily goals: A plan of care for the patient which may change each day.

Daily rounds: A multidisciplinary meeting which takes place every morning in the intensive care unit.

Delirium: A common and temporary state of confusion that may develop suddenly.

Falls prevention: Safe patient handling and movement techniques to reduce the risk of falls.

Grief and bereavement: The process of understanding and working through the loss of a loved one.

Intubation: The process of inserting a tube, called an endotracheal tube, through the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness.

Isolation: Specialized precautions including the use of gowns, gloves and masks by staff and visitors which prevent the spread of germs within the intensive care unit.

Life support: A breathing machine and medications used to sustain patients who are very sick.

Medication reconciliation: A process to make sure that all medications that are taken by the patient are assessed upon admission and discharge from the intensive care unit.

Organ donation: The process of giving an organ or tissue to help someone who needs a transplant.

Palliative care: An approach to care which focuses on comfort and quality of life for people of all ages affected by life-threatening illness. Palliative approach can be incorporated into a lifesaving treatment plan.

Pneumonia: An infection in one or both lungs caused by bacteria, viruses, or fungi. The infection causes inflammation, making it difficult to breathe.

Sepsis: A life-threatening condition that arises from the body’s response to an overwhelming infection. Sepsis can cause organ failure, shock (low blood pressure) and even death.

Ventilator: A machine that is used to help patients breathe when they are too sick to breathe on their own.

VTE prophylaxis: Drug and nondrug treatments to reduce the risk of developing deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

A-B-C-D-E-F of ICU CARE: A bundle of quality care initiatives that we do to support patient recovery. The ABCDEF are listed below:

• AWAKE: Patients often need medication to keep them calm for treatments to work well. Our team adjusts these medications (Daily Awakening Trial) to ensure that patients are awake or lightly asleep and remain calm.
• BREATHING: Patients often need breathing support from a ventilator. Our team performs a daily breathing test (Spontaneous Breathing Trial) which tells us when the patient is ready to breathe on their own or if a breathing tube is still required.
• CHOICE OF SEDATION: The choice of medication is checked often. Our team re-assesses daily goals for sedation and analgesia to ensure adequate pain control and prevent/treat delirium.
• DELIRIUM: Confusion that can be caused by illness, medications, pain and other factors such as noise and interruption of sleep. We look for what may be causing the delirium and treat the underlying cause(s).
• EARLY MOBILITY: Movement and exercise are important for a patient’s recovery. Our team performs a variety of safe patient care activities including range of motion exercises, sitting up in a chair or using a bed bike.
• FAMILY: Families are considered essential members of our care team. Your voice is important and helps ensure that medical decisions are in alignment with the patient’s wishes.

The following may be helpful in coping with this very difficult situation:

• Acknowledge how you are feeling: Allow yourself time to feel difficult feelings. Some people find it helpful to journal how they are feeling or talk to someone they trust.
• Remind yourself there is no “normal” way to feel in this situation; the situation is highly abnormal and goes against our instincts of how we expect to be able to care for our loved ones.
• Focus on what you can control: You cannot control what is happening to your loved one or whether you can visit them, and you may feel helpless and powerless. You can control your routine at home, what you eat, and who you talk to. Trying to maintain consistent routine, exercise, and eating well will give you more energy to deal with your emotions and the current situation.
• Reach out to your supports: Family members, friends, or spiritual leaders. If unable to connect in person, connect through phone, FaceTime, or Zoom.
• Be kind to yourself: It is okay and expected that some days you may not feel able to do much at all. Remind yourself that what you are going through would be extremely difficult for anyone. What would you say or do to help someone else in this situation? Try to apply this to yourself.
• Write down helpful statements: Examples might include, “My loved one is being cared for by expert hands”, “Not visiting my loved one is helping to keep them safe”, “My loved one would understand why I cannot visit”, “Taking time for myself will allow me to be a better caregiver.”
• Ask for help: There are a lot of little things that your friends and family can do to help and support you. Consider asking for help with practical tasks like pet care or with yard and garden care. Make a list of groceries for the next time someone offers to help you. It can be difficult to ask for or accept help, but friends and family members will likely be happy to feel useful and helpful to you during this time.
• Take a break: If you can visit your loved one in-person, consider time away from the bedside for self-care. Even short breaks can be beneficial (a quick walk around the hospital, getting fresh air outside, deep breaths or listening to music).
• If you would like additional support, there are several options:
  • AbilitiCBT (no-cost therapy to be available shortly though the Provincial Government)
  • Anxiety Disorders Association of Manitoba – COVID-19 support line 204-925-0040
  • Manitoba Psychological Society – Find a clinical psychologist
  • Comprehensive list of COVID-19 coping resources
  • Support for grief and loss
  • Focusing on our mental health during COVID-19
• If your thoughts or emotions become unbearable, you feel unable to care for yourself or others who rely on you, or have thoughts of hurting yourself or someone else, call:
  • Klinic Crisis Line 204-786-8686 or 1-888-322-3019
  • Mobile Crisis Service 204-940-1781
  • Manitoba Suicide Line 1-877-435-7170
  • Kids Help Phone 1-800-668-6868
  • Manitoba Farm, Rural & Northern Support Services 1-866-367-3276
  • First Nations and Inuit Hope for Wellness Helpline 1-855-242-3310