The intensive care unit is one of the most mysterious departments in the hospital. You can drive through the whole city and end up in front of closed door, and even if you insist, they will not let you into the department. “The condition is stable. You can't go inside. We provide all the care ourselves. Goodbye". All. What's going on behind that door? Why might they not let you into the department, although they are obliged to? Here are some reasons (and life situations).
The patient has just arrived
The patient was admitted by ambulance, surrounded by two doctors, three nurses, and a nurse. You need to transfer him from the gurney to the bed, connect pulse, pressure, and saturation sensors. Arrange venous access, collect blood and urine for analysis. Someone collects IVs and prepares drugs for administration. Someone assists the doctor - tracheal intubation is performed because the patient cannot breathe on his own.
At this time the doorbell rings. The intensive care workers have the keys, which means this is a relative. It’s impossible to let him in now, the doctor can’t talk to him, because helping the patient is more important. But relatives may insist on a visit, besides, they immediately want to know the diagnosis, receive information about the condition and “how long he will lie here,” although the person, let me remind you, has just been delivered and nothing is really known yet.
New patients arrived
This is the most common reason. The fact is that intensive care is not just a department. There is no strict visiting schedule. Or rather, he is. But if in the interval, say, from twelve to one, when it is allowed to visit patients, a seriously ill patient is admitted, no one, alas, will allow you to enter the ward. During patient admission, manipulations, etc., outsiders are prohibited from being present in the room.
Other patients in the ward
Yes, you need to remember that besides yours loved one There may be other patients in the ward. Lie down as you should in intensive care, without clothes. And not everyone will be pleased if strangers walk past them. In the USA - this country is often cited as an example when talking about organizing visits to intensive care units - there are separate rooms for patients, and there are even sleeping places for relatives. This is not the case in Russia - several people are in one room.
A patient is recovering from a planned operation
Moreover, some patients, being in an unpresentable state, do not even want to see their relatives. For example, after elective surgery The patient spends the first day in intensive care. Lying naked. His throat is sore after the artificial ventilation tube. I have a stomachache. The bed is stained with blood because the bandage is leaking a little. He is in pain, but now they have given him an injection and he is falling asleep. In two days he will be transferred to the general ward, soon he will be vigorously running along the corridor and discussing his health with his family, but now he only wants to sleep. And he doesn’t need any visits.
The patient’s relative is not ready to visit
Another situation. The man lies for a long time. The diagnosis is serious. A relative arrives and really wants to see you. They let him through. After talking, the relative leaves the room into the corridor, goes to the door, but before reaching it, he faints right into the arms of the nurse on duty. It’s good if he is not very tall and large, and there is a trestle bed nearby on which they can lay him down...
Unaccustomed people are frightened by foreign objects protruding from the patient: catheters, probes, drainages. The departments often smell bad and can make any visitor feel sick. Moreover, if doctors see a relative in a clearly unbalanced state, they are likely to be denied a visit.
If not objective reasons, preventing the visit, the relative will be allowed into the ward. Sometimes relatives help a lot - wash, treat, rearrange. This is real and necessary help because there is always not enough staff. They are always allowed to see patients. And such people always wait patiently outside the door if manipulation is being carried out in the hall and outsiders are not allowed to enter.
You need to be prepared to visit the intensive care unit. Do not be frightened by the sight of your relative or his roommates. Don't wrinkle your nose at unpleasant odor. Do not cry with pity - this can be done behind the door, but here, next to the patient, you should support him, not he you. Do not disturb the staff and leave the room upon request. If you are not allowed in, it is best to wait quietly outside the door until the doctor is free and you can ask him all the questions that interest you. Reanimation is a department emergency assistance, and in emergency situations there is not always time to talk.
Anastasia Larina
Photo istockphoto.com
Relatives of patients were allowed to enter the intensive care units of Moscow hospitals. The visiting procedure is described in the memo of the capital's health department. He spoke about the rules for admitting relatives to intensive care units on air on the MIR 24 TV channel. chief physician 67th city clinical hospital Moscow Andrey Skoda.
To visit a relative in the intensive care unit, you need a pass. Who prescribes it? Who and how decides what is permissible at the current moment in time? Is the degree of relationship between the patient and the visitor checked?
There is no special pass for visiting patients in intensive care. We have already had quite a lot of experience visiting these patients, and we have been allowing patients to see them for a number of years. Now there is a specific order No. 451 of the Department of Health dated June 29, 2018. Now all relatives can freely visit their loved ones. To do this, you need to make an appropriate application to the hospital service and after that you can visit the patient who is in the intensive care unit. Of course, you need to know the degree of relationship. If a person is not on artificial ventilation and is available for contact, then he himself can say who this relative is. If it is not available, then the visitor must present a document, after which he can visit the intensive care unit.
How far in advance do I need to submit my application?
It can be day after day. There are absolutely no queues.
According to the rules, no more than two people can visit a patient. Is it at the same time or two people at a time during the day?
First of all, we focus on how comfortable it is for the patient. And, of course, visiting more than two relatives does not seem entirely appropriate to us. And it’s not very important to the patient either. If the patient would like to do it more often, then please do so. He can contact the head of the department or a doctor and invite his relatives.
Are there any compelling reasons for refusing to visit a patient?
Of course, there are failures. Well, for example, if a person is drunk, we will not let him into the intensive care unit. Or, if we do not know the degree of relationship. If a relative doesn’t want to see this or that person, we won’t let him in either. There are a fairly large number of such cases. But all these complex problems are solved quite quickly.
How is the issue of ethics resolved? After all, as a rule, intensive care wards are not single rooms. There might be two, three patients, some unconscious.
In every clinic, in ours for sure, each patient is separated by a screen. And therefore, when a relative of a patient is near his loved one, he is separated from other patients.
How many patients need these visits?
Of course, the need to visit relatives is very necessary, since the person is in difficult life situation, and the help of family and friends is necessary. This improves the treatment process.
How long can relatives enter the intensive care ward? For 15 minutes or an hour?
We do not regulate the issue of visiting, but usually it lasts 20-30 minutes maximum. And then the patient already says in advance that he would like to rest, he is tired, or he has some procedures. There are certain visiting rules here because patients become exhausted quickly. But when they see their loved ones, relatives, the healing process goes better.
In what condition must a patient be in order for a relative to be allowed in?
It can be in any condition. And if he is accessible, then he can talk to a relative. If the patient is not available for contact and is on artificial ventilation, we can also let relatives in so that they can see how the treatment is being carried out, talk with the attending physician, with the head of the department, and can ask questions that are necessary and related to the treatment. They can see with their own eyes what condition their relative is in.
American films show how a person lies unconscious in intensive care, and his relatives are next to him for hours, days. Is this impossible in reality?
No. This is not necessary. And the issues of sanitary and epidemiological conditions also do not go out of sight.
Are they allowed into the intensive care unit only wearing sterile clothing?
You must enter without outerwear- without the one you walk down the street in. It needs to be removed, there are all possibilities for this. You can undress and put on a disposable robe, shoe covers, a mask, or you can go without a mask.
Does this really prevent infection?
No. If a relative is sick, then I would not want him to visit the intensive care unit. But that's what a mask is for. But if a person is healthy, he can walk in absolutely without a mask and talk with his family.
Doesn't this create additional risk? After all, patients have very weakened immunity.
No it is not important factor which harms the patient.
In the West, relatives have been allowed into intensive care wards for 60 years. It was recently approved in Moscow. Why do you think?
I think that they simply didn’t pay much attention to this, on the one hand. On the other hand, I have been working in our clinic for more than 10 years, we almost never limited visits to relatives. We always tried to accommodate the patients’ relatives, because we understood perfectly well what they were going through, they would like to see, they would like to know what the prognosis is. We did this, we followed the relevant regulations, and relatives visited. There was even a film made about our hospital, called “Ambulance 24”. The film crew lived there in real time for six months. They themselves convinced themselves that this was indeed the case.
Not all hospitals in Russia are as well equipped as yours and Moscow hospitals in general. Is this the reason why visiting the sick may not be possible?
No, I don't think that's the issue. There is a certain rigidity of thinking among some leaders. That's why they don't allow it. I don’t even know what to be afraid of here. If you do everything as expected, provide assistance to the patient, then on the contrary, the relative becomes your ally in treating the person, we do one common thing.
You said that on average a relative spends about half an hour in intensive care. And according to the new regulations, they must be allowed in 24 hours a day. Is this possible in practice?
Maybe. Here I will give an example when a patient comes to us as a result of an accident, man-made accident or mass admission. And, naturally, relatives and patients would like to know what is happening to him. If he is in a regular line department, then they can find out from him directly. And if he was admitted to intensive care, then the anxiety increases, so they can come, the hospital provides assistance 24 hours a day, and find out about their relative.
And if, say, a person had an accident, naturally his relatives immediately came to him in a large crowd.
This is the case when the patient receives assistance. Naturally, there should be no relatives at this moment. Because manipulations are being carried out, artificial ventilation. We are aimed primarily at salvation, but when it is provided, we are open to dialogue.
Help has been provided, the patient has already been transferred to the ward, in a stable condition, and it turns out that two people will go in and out of the ward?
I think yes. The two of them will come in together, and then they can talk about the patient. We won't let the whole crowd in. But the two closest relatives would be happy to do so.
And if there is no proven degree of relationship with the patient, this is just a young man of a girl, for example. Will she be allowed to visit him in the hospital?
You know, this is a very difficult question. If a young man is available for contact and he says that this is his girlfriend, then - please. But if he is not available for contact, then here we stand in defense of the patient’s rights. So this is the situation.
Photo by RIA Novosti
Through the eyes of a doctor
“On some issues, patients and doctors are two forces that cannot agree,” one doctor told our correspondent. Is it true?
Here's what the neurosurgeon said Alexey Kashcheev:
It all depends on the individual clinical situation and the time the patient will spend in intensive care. If something urgent happens to a person, such as a myocardial infarction, severe injury, road accident, exacerbation of the disease, then visiting the intensive care unit by relatives is not practiced. During the first few days, a lot of manipulations are performed with the patient. The presence of relatives interferes with doctors and nurses, sometimes very noticeably. The problem is that the relatives perceive everything that happens to the patient from their own point of view.
The situation through the eyes of a doctor: the person has been successfully operated on, he is in a coma. Monitor sensors are connected to it, the information is transmitted to the console of the resuscitator on duty. The dropper supplies the patient with medicine. Costs urinary catheter, sensors intracranial pressure and so on.
The situation through the eyes of a relative: the patient lies abandoned on the bed, no one needs him, no one is watching him, and he is covered in some tubes, he needs help!
This perception is not an isolated case, but a common occurrence, relatives are in a state of stress, they can be understood. But doctors can also understand that patients’ relatives are inclined to destructive behavior, very often they write meaningless complaints, making the work of resuscitators difficult. Complaints are not so bad; it happens that when relatives see their loved one “in some tubes,” they give an unpredictable reaction, even physical aggression.
In TV series, especially foreign ones, relatives always crowd into the intensive care unit; let’s leave this lyrical assumption to the conscience of the scriptwriters. IN foreign clinics, in which I have been, the situation with admission to intensive care for emergency patients is the same as ours. When carrying out intensive care, this is impractical and not in the interests of the patient.
It’s another matter if the stay in intensive care is prolonged and the situation turns from acute to chronic. Some patients remain in intensive care in a stable condition for weeks or months. It is advisable to allow relatives to visit such sick people. But for this it is necessary that in the intensive care unit chronic patients should be kept separately from emergency patients, but not every department has such an opportunity.
We've had it for a year now elderly woman in a vegetative state, she recently had a birthday, it was celebrated in the hospital, relatives brought a cake and decorated the bed with balloons. It is unknown to what extent the patient herself was aware of the situation, but there is no doubt that it was correct and good.
For patients after severe injuries, strokes, or severe disabling operations, the presence of relatives is not only useful, but also necessary. The sight of a loved one, the sounds of his voice, touches help the patient recover and speed up the rehabilitation process.
How to get?
There are no general rules; everything depends on the rules of a particular institution. The rules are different in city and federal hospitals. There is no need to argue with the staff. The timing of the visit was not chosen by chance. Believe me, this was not done to mock the relatives, but due to some necessity, the work schedule of the department.
Outerwear must be left in the wardrobe. Changeable shoes are needed; in some intensive care units the patient is given a robe to put on. If this is not possible, it is better to have a disposable robe. Avoid woolen fabrics in clothing; microbes feel comfortable in wool. Optimal clothing from synthetic materials. Some departments will not allow you to enter without a mask. But if you have the flu or an acute respiratory infection, sit down better at home, do not endanger your loved ones and other patients. What kind of visitors are allowed to see patients? Adequate.
Enemies or allies?
So, doctors set the rules based on their own medical reasons. An adult who is admitted to the intensive care unit urgently is one thing, but what if a child or a patient in need of palliative care is admitted to the intensive care unit? What if a patient dies in intensive care, and his relatives are allowed to see him for an hour a day? IN Lately a movement began in society aimed at resolving these issues, not so much medical as ethical.
A child in intensive care is a special case; separation from the mother is added to the pain and fear; specialists have long understood that this is not useful, including for treatment.
As for admission to the intensive care unit to see a child, on the one hand the federal law“On the Basics of Health Care” gives parents the opportunity to be with their children in medical institutions, but nothing is written there about intensive care units. It turns out that it is not prohibited, but not allowed either. In order for a mother to be with her child in intensive care, she needs to create conditions; this opportunity is not available in every department; if it is not there, then you need a desire to change the situation, and doctors do not always have this.
Director of the Children's Palliative Foundation Karina Vartanova:
There is a problem with admission to intensive care. It applies to patients in almost all intensive care units, both adults and children. But in relation to children, all this is especially acute and painful.
Last year, the Children's Palliative Foundation held great study, dedicated to this issue, it is published on our website under the title “Together or apart”.
We were not happy with the fact that any discussion of this problem always leads to conflict and confrontation, when doctors and patients’ relatives try to blame each other. Therefore, the goal of the study was to get an idea of the real reasons for the current situation, to find out why things are so difficult for us with the implementation of the federal law, which states that parents have the right to live together with their children in any inpatient institutions.
We wanted to understand what prevents parents from being admitted to the intensive care unit, what obstacles exist - infrastructural, organizational, ethical, and what opportunities exist for cooperation between medical personnel and relatives of patients in intensive care units.
The range of opinions presented in the study is, of course, very wide; the arguments “for” and “against” are very different. And it's clear that linear solution this problem does not exist, it is not enough just to open the doors intensive care units- requires serious preliminary work, in particular, the introduction of rules and standards for cohabitation, necessary both medical personnel, and to the parents of a sick child.
This year we are continuing to work in this direction, preparing a brochure for parents, which we plan to release in the fall. The authors - parents whose children spent a long time in intensive care units - talk about how to do so in order not only to achieve the right to be with their child, but also to be useful to both him and the department staff, how to communicate correctly, how to help, what to avoid.
The patient's relatives and doctors are not opposing sides, they should be allies, because they have one thing - to help a seriously ill patient.
What should I do to be admitted to intensive care?
Admission of loved ones to the intensive care unit is now regulated by the rights adopted in the department. The survey and Internet searches did not teach us any additional tricks.
- In intensive care units and intensive care units, where patients are admitted by emergency indications, visits are not provided.
- According to the law, a priest must be allowed into hospitals (in Article 19 of the bill “On the fundamentals of protecting the health of citizens in Russian Federation» the patient’s right to have access to a clergyman in a hospital institution is secured).
- In other cases, the visit must be agreed upon with the doctor, duty officer, attending physician or head of the department, who will issue you a pass.
- If the patient is conscious, it is good that he expresses his wishes - who exactly should be allowed to see him.
A person in intensive care seems to fall out of our world. You can’t come to him, you can’t talk to him, they take away his phone, clothes and personal belongings. The most that loved ones can count on is a note sent through a nurse. What if it's a person? What if it's a child? All you can do is wait for a call from the doctor and hope for the best.
Why are there such draconian rules in hospitals and how not to go crazy from the unknown? We answer the most FAQ about resuscitation.
1. Will he die?
Don't stress yourself out and don't panic. Yes, your loved one has health problems. Yes, this is serious. And yet, if someone is in intensive care, this does not mean that he is on the verge of death. A person can be put there even for a couple of hours - for example, after. As soon as doctors are convinced that his life is not in danger, the patient will be transferred to a hospital.
The prognosis depends on the severity of the patient’s condition, age and concomitant diseases, from doctors, from the clinic and many, many other factors. And, of course, from luck.
2. What's going on there?
Doctors need access to equipment, and nurses need to be able to wash the patient - that’s why they usually lie naked in the department. Many people find this inconvenient and humiliating.
Maria Borisova told the story of her elderly mother on Facebook: “They immediately said: “Undress naked, take off everything, socks and panties inclusive.” Mom was lying in the large corridor, where there was walking great amount people, talking loudly, laughing. A small detail: in order to relieve yourself, you must get up naked from your bed in front of a large number of people who are walking back and forth, sit on a bedpan on a stool that stands next to the bed, and relieve yourself in public.”
Lying under one sheet can be not only embarrassing, but also cold. And dangerous for already weakened health. There are diapers and disposable underwear, but these are additional costs. And the money in public hospitals There's always not enough. Therefore, it is easier to keep patients naked. If a person is able to walk, he may be given a shirt.
Bedridden patients are treated daily with liquid to prevent bedsores, and are turned over every two hours. The body is also kept clean. Hair and nails are cut. If the patient is conscious, he can do this himself.
Life support systems and tracking devices are connected to the patient in intensive care. They can also tie him to the bed so that in his delirium he does not pull out all the sensors and harm himself.
3. Why am I not allowed to see him?
By law, doctors cannot refuse to admit you to intensive care without a serious reason. If a child under 15 years of age is admitted there, the parents have the right to go to the hospital with him. But this is in official papers, but in practice everything is different. Hospital staff have a “classic” set of reasons for not letting relatives in: special sanitary conditions, infections, lack of space, inappropriate behavior.
Whether this is right or wrong is a complex question. On the one hand, in the West you can visit a patient almost immediately after surgery. This gives peace of mind to both the relatives and the patient. On the other hand, in the West the conditions are suitable for this: air purification systems, bacterial filters, spacious rooms. And who can guarantee that he won’t faint when he sees a loved one unconscious and covered in equipment? Or won’t he rush to pull out IVs and tubes? This is also not uncommon.
In general, whether you insist on visiting or not is up to you. If the staff flatly refuses to let you in, refer to Federal Law No. 323 and contact the clinic management.
Follow all visiting rules: wear a robe, mask and shoe covers. Tie up your hair and bring hand sanitizer.
4. How can I help?
You can buy missing medicines, care products (“duck”, for example), or special food. You can hire a caregiver or pay for an outside consultation. Ask your doctor if this is necessary.
And ask the patient himself if he needs anything. Children often ask to bring their favorite toys, adults - a tablet or books, older people - even a TV.
5. How to behave in intensive care?
As calm as possible. Don't disturb the staff. Your loved one may be unconscious or acting strangely. It may look or smell unusual. Tubes and wires may be sticking out of him, and wounded, seriously ill people may be lying in the same room with him. Be prepared for anything.
The patient largely depends on his mood, and the mood depends on you - your loved ones. Don't cry, don't get hysterical, don't wring your hands and don't curse fate. Talk to him as if he were healthy. Don't discuss the illness until he brings it up. It’s better to discuss the most ordinary, everyday things: how things are at home, what news your friends have, what’s happening in the world.
If a person is in a coma, you also need to communicate with him. Many patients actually hear and understand everything that is happening, so they also need to be supported, stroked on the arm and told last news. Research shows it speeds up recovery.
If a patient asks to meet with a priest, doctors are required to let him into the room. This right is ensured by Article 19 of the bill “On the fundamentals of protecting the health of citizens in the Russian Federation.”
- Take off your clothes. We are transferring you to intensive care.When I first heard this phrase, the ground literally went out from under my feet. To say that I was scared is to say nothing!!! I was TERRIFIED! Reanimation then seemed to me like a place where people die... It turned out to be quite the opposite. Lives are saved there.
Good morning my name is Evgenia enia . This year I spent more than 3 months in the hospital, more than 2 weeks of which were in intensive care.
So... Reanimation. Or in other words “intensive care unit”. Those who actually need " intensive therapy", not available in the regular branch.
There are completely different ones available medications, equipment and unlimited access to the laboratory (for analyses) and personnel.
There's a completely different world there. Everything is much cleaner, stricter, tougher... and more serious. They don’t lie there with simple diagnoses or for examination because “something stabbed in the side.” If you are in intensive care, it means there is a threat to life and everything is very serious.
But first things first.
They bring you to the intensive care unit naked. At all. Wedding ring And pectoral cross will also need to be removed. You cannot take anything with you... Phones, books or any other entertainment - all this remains in the department. The sister will carefully collect your things in a large bag and put special valuables in the safe. But this is already without you. If they told you that they are transferring to intensive care, then they will take you without delay... with a breeze. The maximum you can do is undress.
Upon entering the intensive care unit, you will immediately be surrounded by wires. Installation included subclavian catheter(for ordinary droppers), often with a tee, so that several jars can drip at once, spinal anesthesia(infusions into the spine) for pain relief and more, sensors on the chest to determine the heart rate (I don’t remember what they are called), a cuff on the arm (to measure pressure) and a urinary catheter (a bunch of things... because about getting up and walking Naturally, there is no speech to the toilet with such a set of wires). And this is just the “basic package”. In the case of more serious or simply specific problems, there are another two dozen different devices that can be connected to you.
Devices are a quiet horror of intensive care!!! They squeak all the time! Quietly, but confidently, constantly. On different tones and frets. With different tempo-rhythm and volume. Someone is telling someone off heartbeat, someone signals about the pressure, someone simply sings some song unknown to me without shutting up... And so 24 hours a day! And if one beeper is turned off, it means another one will be connected soon! This constant soundtrack literally drives you crazy.
The rooms in our department were for four people. Men and women, old, young, heavy and not so heavy - all together.
- There is no room for embarrassment here.- they told me for the first time. And I remembered it.
There is a nurse in each ward. She is indoors almost constantly. And she is always busy with something. She doesn't sit still for a minute. Either he changes someone’s IVs, then he takes some tests, then he fills out some documents, then he straightens the beds, then he turns over attendants so that they do not develop bedsores. Every morning, all patients must be washed with special hygiene products and the bed changed.
The staff in the intensive care unit is specific... These people, both doctors and nurses, seem tough and even almost heartless. They talk in official numbers and diagnoses, and the dialogue is conducted in the style of “twice two makes four.” At first, such a lack of humanity was depressing, but then I realized that it was just a mask... Once I burst into tears, even the manager came to calm me down. Department. Just humanly... All their callousness is nothing more than a defensive reaction, so as not to go crazy in this horror.
The worst thing in intensive care is the patients! Someone is moaning, someone is screaming, someone is delirious, someone is vomiting, someone is wheezing, someone is getting an enema, and someone is just quietly dying on the next bed. You fall asleep to the quiet moans of your neighbor's grandmother, and when you open your eyes, she is already being taken away, covered with a sheet... and this happens all the time, around you, in close proximity. And this is very scary...
Every new patient causes a big commotion. Doctors flock to him from all over the department, entangle him with IV wires, and perform various procedures. For some, a capillary in the nose, for others, gastric lavage, and for others, intubation. All this is nearby, here, with you... All this is in a hurry, because minutes are counting, because another patient was brought in next and he also needs to be saved, now, at this minute... and there is no way to press pause! And all this at any time of the day or night... With bright lighting and musical accompaniment from a dozen instruments beeping in different ways...
And visitors are not allowed into the intensive care unit. And you lie in a complete information vacuum, entangled in wires, with a wild headache (despite all the painkillers) from beeping devices, surrounded by moaning and delirious people, and counting the minutes until you will be released from this hell...
But when you see how the person on the bed opposite, who just yesterday was unable to breathe on his own, has the tube removed from his throat, and the next day he is transferred to a regular ward, you understand what all this is for...
They really do everything to save lives... Although without unnecessary curtsies.
This year I was in intensive care 6 times! But even 1 time is too much!!!
Never go there.
If you have questions, please ask them in the comments!
