Who's Who in Critical Care?

Staff in Critical Care

Critical Care is a complex hospital unit where a big Multi-Disciplinary Team, including the roles listed below, support patients. Below is a brief overview of the different roles of staff in Critical Care. This may differ slightly from unit to unit however the basic information should be the same and we hope be helpful for you to know who to speak with if you have any questions or concerns.

Nurses

Nurses working in Critical Care undergo extensive additional training and are highly skilled in this speciality area. Patients on Critical Care are nursed on a one-to-one basis due to the high level of knowledge and skills that the care of the patient may require. This includes close assessment and monitoring of their condition to quickly identify any problems and then taking measures to correct these issues. This knowledge and technical skill allow them to safely care for the patient and the complex medical devices used in the area.

The nursing staff are highly visible and accessible to those who have loved ones on Critical Care and are often the first point of contact families have within the Critical Care area. The nurses may ask questions about you/your loved one to help understand what they were like before their admission, how well they were and what their preferences are. The Multi-Disciplinary Team will use this information to help plan their care, and will act as an advocate for the patient and their families to help represent their wishes to the rest of the Multi-Disciplinary Team. The nursing team welcome discussion with patients and loved ones, and can explain many of the therapies and interventions you may see in the Critical Care area. They can also direct you towards any additional support you may need.

You may also see students alongside the nurses who are an important part of preparing the next generation and are gaining essential skills and experience.

The Critical Care Outreach Team are a group of advanced (or trainee advanced) practitioners who are highly specialised in the care of critically unwell patients outside of the Critical Care Unit. In addition, the team provide a follow up service to support all patients that have recovered from critical illness and transitioned to ward-based care.

Please see the Critical Care Outreach Team section of our website for more details.

Intensivists

Intensivists are Consultant Doctors that provide specialist care for critically ill patients and lead the Multi-Disciplinary Team on Critical Care. In the UK, Intensive Care medicine has its own dedicated training pathway. Intensivists have overall responsibility for the patients and lead the Multi-Disciplinary Team ward round. During these ward rounds, the team discuss and review the events from the last 24 hours and this informs the day’s decision making and each patient’s treatment plan. Intensivists are also likely to be the professionals contacting each patients loved one, to update you on their progress whilst admitted to Critical Care.

Pharmacists

Patients in Critical Care will often be prescribed a wide range of drugs, usually at varying doses. Pharmacists take part in the daily ward round and advise on whether medications can be changed to better support the patient in their treatment and recovery. They also work closely with dietitians about nutrition and feeding needs of the patient.

Dieticians

Dieticians in Critical Care have specialist training to understand how to manage the complex nutritional needs of patients in Critical Care. Critically ill patients can experience malnutrition, changes in eating patterns, poor or excessive appetite, or an inability to eat. This impacts on recovery and rehabilitation. The Dietitian identifies patients who are malnourished or at nutritional risk and will make nutritional treatment plans based on the patient’s weight, specific requirements and the nature of their illness to support their recovery.

Physiotherapists

Physiotherapists have two main functions in Critical Care: managing respiratory (breathing) needs and physical rehabilitation.

Physiotherapists will help patients in breathing independently by helping keep their chests clear of mucus to prevent lung infections. They will assess patients in critical care for breathing or coughing difficulties, using techniques to help bring up secretions (mucus) from their chest to help make breathing easier. They are also core members of the team of clinicians that support patients with a tracheostomy (a tube through the neck and into the windpipe to help breathing) and help make the plan to remove the tracheostomy tube when it is no longer needed.

Physiotherapists also support each patient’s physical recovery. Patients admitted to Critical Care commonly experience muscle weakness. Rehabilitation is an important part of the Physiotherapist’s role and, with help from the rest of the Multi-Disciplinary Team, they aim to restore pre-admission movement as soon as practically possible. Once a patient is well enough, Physiotherapists support rehabilitation by encouraging them to sit, stand and walk.

Occupational Therapists

Occupational Therapists (OTs) promote a patient’s ability to complete their daily routines and meaningful activities. Occupational Therapists work with individuals on a Critical Care to help them to regain their independence using techniques and equipment to support them as they recover. The Occupational Therapy Team are currently working with a reduced service, and so services may be different at each Critical Care site across CTM UHB.

They can work with the wider Multi-Disciplinary Team to promote and continue independent personal care on Critical Care, complete upper and lower limb assessments and provide techniques for stretching, exercises and positioning.

Speech and Language Therapists

Speech and Language Therapists (SALT) have specialist training in problems with the nose, windpipe, lungs and swallowing tube. The Speech and Language Team are currently working with a reduced service and so services may be different at each Critical Care site across CTM UHB.

Patients who have been put on a breathing machine on Critical Care can often have difficulty communicating, eating and drinking. Speech Therapists provide assessment, intervention and advice to support patients in returning to talking, eating and drinking. They are also core members of the team that support patients with tracheostomy, and aim to re-introduce speaking, eating and drinking as soon as is safe.

Clinical Psychologists

Clinical Psychologists working in Critical Care are specially trained in the treatment and management of common psychological responses following critical illness. Each Critical Care has a different level of psychological staff and so their role varies. There are also Assistant Psychologists working in Critical Care who are not clinically qualified, but work under the supervision of a Clinical Psychologist to support patients with their experiences of being critically unwell.

Psychology staff can provide support with mood, anxiety and ICU Delirium on Critical Care and wards. They also support staff wellbeing and work as part of a Family Support Service to offer psychological support to loved ones of individuals on Critical Care.

They work as part of the Multi-Disciplinary Team to help long-term patients with goal planning and can provide joint sessions with other Critical Care staff. Clinical Psychologists also form part of the ICU Rehab & Recovery Follow Up Clinic Team to assess for any common psychological problems after being discharged from Critical Care such as anxiety, depression and PTSD. If problems are identified, patients or their relatives can access the in-house Critical Care Psychology Service for 1:1 psychological therapy.