Adult Intensive Care Units (ICU)

There are six sites with ICUs for adults across Island Health, located in Victoria (Victoria General Hospital and Royal Jubilee Hospital), Nanaimo, Duncan, the Comox Valley, and Campbell River.

The ICU cares for people who are very sick or recovering from serious illness, surgery, or injury. Our team provides close monitoring, advanced treatments, and ongoing support. We understand this can be a stressful time for families and communities, and we are here to guide you.

Important resources include:

Patient and Family Resources
Patient Communicator App
Learn about the ICU – My ICU Guide 

What to expect in the first hours and days

• Patients are connected to equipment that helps us watch their breathing, heart, and other vital signs.
• The first hours often include tests, assessments, and treatments to stabilize the patient.
• Machines, tubes, and monitors are common and help us provide safe care.
• Staff will update you regularly and explain what is happening in clear, simple language.

Who works in the ICU

The ICU is staffed by a large team of professionals who work together around the clock, including: 

• Physicians who specialize in critical care. 
• Nurses who provide continuous bedside care.
• Social workers who support patients, families, and communities.
• Respiratory therapists who support breathing and ventilation.
• Pharmacists, dietitians, and physiotherapists.

Everyone in the ICU works as a team to care for your loved one. Below is a comprehensive list of who is included in the team.

What happens day-to-day in the ICU

• Patients are monitored closely at all times. 
• The team meets throughout the day to review progress and adjust the care plan. 
• Tests, treatments, and medications may change as the patient improves. 
• Rest is important, so the environment may be quieter at certain times. 
• Staff may checking equipment, reviewing charts, or responding quickly this is all part of ICU care.

How families can participate and stay informed

• You are welcome to ask questions and share information about your loved one.
• The care team will provide regular updates and explain changes.
• You can support your loved one by being present and honouring their preferences and routines.
• Phones updates can be arranged if you cannot be at the hospital.
• We are committed to clear communication, cultural safety, and respectful partnership with families and communities.

Who is this service for?

• This service is for adults who are critically ill and need intensive care for their heart, lungs, or other vital organs.
• Patients are admitted when their condition is lifethreatening and requires continuous monitoring and advanced organ support.
• Most patients are referred by a specialist or another hospital department when they need a higher level of care.
• If you live in British Columbia and are enrolled in the Medical Services Plan (MSP), your ICU care is covered; patients from other provinces are covered through their own provincial health plans. Note, ICU care is provided whether or not you have coverage. If you do not have MSP or another Canadian health plan, you may be billed directly, and private insurance can help cover costs.

How to access and visit the ICU

Visiting hours are flexible, and visits are usually limited to immediate family or significant others. When you arrive, please check in at the Nursing Station or ask if you have questions. Mornings are often busy with assessments, care, and tests, so there may be delays. We ask that you avoid visiting between 7 a.m. to 9 a.m. and 7 p.m. to 9 p.m., as these are shift‑change times for staff.

Safety when you visit

If you are feeling unwell, please do not visit. Patients in the ICU are very sensitive to outside illness. All visitors must wash their hands before entering and wear any required protective equipment listed on the room door or as directed staff. The ICU is scent‑free, so please avoid perfumes, cologne, or scented products.

Respectful and safe visiting practices 

We aim to keep the ICU quiet and healing. Please keep noise low and limit conversations in patient care areas. Everyone has the right to feel safe, and abusive behaviour toward staff, patients, or visitors is not permitted. Some items, such as plants, balloons, or food, may not be allowed at the bedside. Your care team can guide you on what is appropriate. Please keep personal belongings with you, as the hospital cannot be responsible for lost or stolen items.

Visiting with children 

Children are welcome to visit, but please speak with your nurse first. Children must be able to follow infection‑control measures, including proper hand washing, and must remain under direct adult supervision at all times.

Family space 

Private family space may be available if you need a quiet place to talk, rest, or receive updates. Please ask your nurse if you would like access to a private room.

What family members can expect  

Families, loved ones, and community members are important partners in the ICU. We want to keep you informed in ways that feel clear, respectful, and comfortable for you. You can receive updates in person, by phone, or through video calls please let us know what works best for you.

Daily Rounds

• Rounds take place each morning and/or afternoon.
• You are welcome to join and listen to the team discuss the care plan.
• Start times may vary depending on activity in the unit.
• Staff will let you know when rounds are expected to begin.

Rounds give you a chance to hear directly from the team about progress and next steps.

Contacting the Unit

• You may call the ICU nursing desk at any time for an update.
• The bedside nurse will speak with you whenever possible.
• if the nurse is busy, your call will be returned as soon as they are able.

Your patience is appreciated, especially during busy times.

Family Conferences

• You may request a meeting for a more in‑depth conversation.
• The care team may also suggest a conference when helpful.
• These meetings allow time to ask questions and review the care plan.
• They support shared understanding of the patient’s wishes and needs.

Family conferences help ensure decisions reflect the patient’s values and preferences.

During High‑Demand Periods

• Updates may take longer when the unit is very busy.
• Caring for all patients remains the team’s first priority.
• Staff will still do their best to work around your schedule.
• You will be kept informed as consistently as possible.

We appreciate your understanding during these times.

How you can help the care team and taking care of yourself

Supporting a loved one in the ICU 

• Your presence, voice, and reassurance can bring comfort.
• Even if the patient cannot respond, hearing familiar voices can help.
• The care team will guide you on what is safe and helpful at each stage.

If you wish to include cultural or spiritual practices, please let the team know so they can support them respectfully.

Talking with the patient

• Even if the patient cannot speak, familiar voices can be calming.
• Simple messages like “You’re safe” or “I’m here with you” can offer reassurance.
• Speaking slowly and gently may help reduce anxiety.

You may choose to share words, stories, songs, or teachings that are meaningful to your family or community.

Helping the patient stay oriented

• Patients may feel unsure of where they are.
• Gently reminding them of the date, time, and place can help.
• Familiar items such as a photo, music, or a meaningful object may provide comfort if allowed.

If cultural or spiritual items help with grounding or protection, please speak with the care team so they can help make space for them when possible.

Knowing what is safe

• The care team will explain what is safe at the bedside.
• This may include when it is okay to touch the patient and how to avoid disturbing equipment.
• Staff are available to answer questions and repeat information as needed.

You are welcome to ask for explanations in a different way if that is helpful.

Sharing information with the care team

• Families and communities have different ways of sharing information.
• Some choose one person to receive updates, while others share the role.
• Having a spokesperson helps keep information organized and consistent.

Writing down questions or key points can help during conversations with staff.

Taking care of yourself

• Supporting someone in the ICU can be emotionally and physically demanding.
• Caring for your own wellbeing helps you stay grounded and present.
• Rest, breaks, and reaching out to your support network are encouraged.

Looking after yourself helps you support your loved one more effectively.

Taking breaks

• Spending long hours in the ICU can be tiring.
• Stepping outside for fresh air, a meal, or a short walk can help you recharge.
• Staff will contact you if there are important changes.

Breaks allow you to return with more clarity and energy.

Managing stress

• It is natural to feel stress, worry, or uncertainty.
• Talking with friends, family, Elders, or support services can help.
• Writing down thoughts, deep breathing, or quiet moments can also support coping.

These practices can help you stay grounded during a difficult time.

Staying connected 

• Your support network can be a source of strength.
• Staying in touch through a call, text, or visit can help you feel less alone.
• Connection with family, friends, Elders, or community can provide comfort.

Reaching out for support is an important part of caring for yourself.

The ICU team

The ICU team works together to monitor the patient, provide treatments, and support recovery. Each team member brings specialized skills, and staff collaborate closely to ensure safe, coordinated, and effective care. Team members are available to answer questions and explain their role at any time. Below is a brief description of each role.

Critical Care Registered Nurses

ICU nurses have advanced training in caring for people who are critically ill. They spend the most time at the bedside. Their work includes:

• Checking vital signs and doing detailed assessments.
• Giving medications and treatments.
• Watching closely for any changes.
• Responding quickly when needed.
• Offering hands‑on care and emotional support.

They work closely with physicians and the rest of the care team.

Physicians

Physicians assess the patient’s condition and help guide the overall plan of care. They:

• Interpret test results.
• Make decisions about treatments.
• Prescribe and adjust medications.
• Oversee the use of specialized equipment.
• Work with the whole team to ensure safe, evidence‑based care.

Indigenous Liaison Nurses

Indigenous Liaison Nurses support patients and families by advocating for their needs, helping them understand medical information, and guiding them through their healing journey. They:

• Advocate for your needs and preferences.
• Help explain medical information in clear, respectful ways.
• Support cultural, spiritual, and traditional healing practices.
• Assist with questions and care planning.
• Help coordinate transitions between home, hospital, and community.

They are a resource for cultural safety and can help you navigate the healthcare system.

Nursing Unit Assistant

The Nurse Unit Assistant is often one of the first people you will interact with in the ICU.

• First point of contact who answers ICU phone calls.
• Helps guide you to your loved one’s location.
• Connects you with the appropriate nurse when calling from home.

They play an important role in supporting communication and helping you navigate the unit.

Social Workers

Social workers support patients, families, and communities by:

• Helping with emotional coping.
• Connecting you with financial, cultural, and community resources.
• Supporting difficult decisions.
• Assisting with planning for next steps in care.

You can ask any member of the ICU team to connect you with a social worker.

Health Care Assistant

Health Care Assistants (HCAs) are key members of the care team who support patients with daily needs.

• Assist patients with personal care such as bathing, dressing and mobility.
• Help promote comfort, safety and dignity.
• Work with nurses to support overall patient care in the unit.

They play an important role in providing hands-on care and supporting patient well-being.

Respiratory Therapists

Respiratory Therapists (RTs) are experts in breathing and lung health. They:

• Manage ventilators and other breathing equipment.
• Provide treatments.
• Perform breathing tests.
• Monitor the patient’s respiratory status.

They play a key role when a patient needs help with ventilation or oxygen therapy.

Pharmacists

Pharmacists ensure medications are safe and appropriate. They:

• Review all medication orders.
• Check for interactions.
• Adjust treatments based on the patient’s condition.
• Daily monitoring and involvement in patient care rounds to ensure the optimal use of medications.
• Provide guidance on medication choices and administration.

Physiotherapists

Physiotherapists help patients maintain or regain movement, strength, and lung function. They:

• Assess mobility.
• Create individualized movement plans.
• Help with sitting, standing, or walking when safe.
• Use techniques to improve breathing.
• Help prevent complications from long periods of bed rest.

Occupational Therapists

Occupational Therapists support patients in maintaining or rebuilding everyday abilities. They:

• Assist with early mobilization.
• Support thinking, memory, and orientation.
• Help with positioning and comfort.
• Use strategies to reduce delirium.
• Plan for discharge and safe transitions.

Speech Language Pathologist (SLP)

SLPs support patients who have:

• New difficulties with speech.
• Changes in language abilities.
• Challenges with swallowing.
• Other communication concerns.

They assess these issues and provide therapy to help patients regain skills or adapt to changes.

Dietitians

Dietitians assess the patient’s  nutrition needs. They:

• Create and adjust nutrition plans.
• Support healing through food or other forms of nourishment.
• Explain options and answer questions .

Dietitians help ensure the patient receives the nourishment their body needs to heal.

Housekeeping

Housekeeping staff are essential in maintaining a clean and safe environment. They:

• Keep rooms and common areas clean and safe.
• Help prevent the spread of infection.
• Complete deep cleaning between admissions.

Their work helps protect everyone’s safety and wellbeing.

Students / Learners

Learn from experienced staff in areas like medicine, nursing, pharmacy and respiratory therapy. They:

• Always work under close supervision.
• Help with care while ensuring safety and quality.
• Can step back if you prefer fewer people at the bedside.

Students / Learners are part of the learning environment and your comfort and cultural needs will be respected.

Patient decision making

• Sometimes a patient is too sick to share their wishes.
• A substitute decision maker may be needed to make health‑care decision.
• This person may be different from the family spokesperson.
• The care team will keep all identified representatives informed.

This helps ensure decisions reflect what the patient would want.

Role of a Substitute Decision Maker

• Speaks for the patient when they cannot speak for themselves.
• Shares any legal documents or known wishes about treatment.
• If no documents exist, shares the patient’s values, beliefs, or past conversations.
• If nothing is known, makes decisions based on the patient’s best interests.

The goal is to honour the patient’s wishes as closely as possible.

• If a legal representation agreement exists, that person will make decisions.
• If not, provincial law guides who is asked first (spouse, adult child, parent, sibling, or another close relative).
• The team will explain the process and answer questions.

This ensures decisions are made by someone who knows the patient well.

Qualifications for a substitute decision maker

• Must be at least 19 years old.
• Must have been in contact with the patient in the past 12 months.
• Must not have unresolved conflict with the patient.
• Must be able to understand information and make care decisions.
• Must be willing to act according to the patient’s wishes or best interests.

If no one qualifies, the Public Guardian and Trustee may appoint someone.

Advance Care Planning

Advance care planning helps ensure that treatment aligns with the patient’s values and wishes. 

• The doctor will discuss the patient’s condition and any limits to treatment.
• If life support is not helping and the illness cannot be reversed, the team will meet with you.
• These conversations can be difficult, and support is available.
• If treatment is withdrawn, the team will help you plan how to say goodbye.

The patient’s comfort, dignity, and cultural needs remain the highest priority.

Organ and Tissue Donation

• If the patient will not survive, BC Transplant may offer the option of donation.
• Donation can help others and may bring meaning during a time of loss.
• A coordinator can answer any questions you may have.

Families are supported in making the decision that feels right for them.

Delirium in the ICU

Delirium is a short‑term change in thinking that can happen during serious illness. A person may seem confused, restless, very sleepy, or have trouble focusing. These changes can come and go. Although it can be hard to see, delirium is common in the ICU and usually improves as the patient heals.

What Delirium looks like

Delirium can affect how a patient thinks, behaves, and interacts with their surroundings. 

• Delirium is a temporary change in thinking and awareness.
• It may look like confusion, restlessness, sleepiness, or trouble focusing. symptoms can come and go and may be upsetting to see.
• Delirium is common in the ICU and usually reversible.

The team monitors closely and works to treat the causes.

Why delirium happens

• Caused by infection, medications, pain, dehydration, or lack of sleep.
• Bright lights, noise, and interruptions can add to confusion.
• The team works to identify and treat the causes.

Delirium is monitored closely and managed with care.

How families and loved ones can help

• Your presence can be calming and grounding.
• Speak softly and offer gentle reassurance.
• Remind the patient of the date, time, and place.
• Familiar items like photos, music, or meaningful objects may help if allowed.

Simple, gentle communication can reduce confusion.

What care is provided

• Adjusting medications.
• Supporting regular sleep–wake cycles.
• Managing pain and hydration.
• Encouraging safe movement.
• Reducing noise and overstimulation.

The care plan changes as symptoms improve or shift.

Supporting memory and recovery

• The ICU can feel overwhelming, and memories may be unclear.
• Many families keep a simple daily diary of events.
• A diary helps track changes and supports communication.
• Patients often find it helpful later, especially after delirium or sedation.

A diary can help the patient understand their experience once they are healing.

ICU Diaries

• Create a timeline of what happened during the ICU stay.
• Help patients make sense of confusing or missing memories.
• Offer reassurance about what occurred during their illness.

Diaries can be an important part of emotional recovery.

Contributions to Recovery

• Families and loved ones can write short notes about visits or progress.
• Messages of encouragement can be meaningful.
• Entries help the patient reconnect with their own story.

These contributions support healing and strengthen connection.

Leaving the ICU

Leaving the ICU can happen for different reasons, and the transition can bring many emotions for families and loved ones. When specialized ICU care is no longer needed and you are ready to be transferred, the care team will make the necessary arrangements and guide you through the next steps.

When a patient is improving

When a patient no longer requires intensive monitoring or life‑support treatments, they may move to another hospital unit. The new environment is typically quieter, with fewer machines and alarms. Care will focus on continued treatment, mobility, nutrition, and rehabilitation. The ICU team provides a detailed handover to the receiving unit to support a smooth and safe transition.

Support during transitions

Whether a patient is recovering or nearing the end of life, transitions out of the ICU can be emotionally complex. The ICU team is available to support you. They can help with questions about next steps, provide emotional support, and connect you with community or hospital resources.

Families and significant others often find it helpful to take things one step at a time, ask for clarification when needed, and lean on their support networks. The ICU team remains committed to ensuring that care is compassionate, respectful, and centred on the patient’s needs and values.

Supports after being discharged from the ICU

Recovery after an ICU stay can take time. Patients, families, and communities may need support as healing continues. The focus after leaving the ICU is on rebuilding strength, understanding changes, and accessing the right resources.

Understanding Recovery After Critical Illness

Many patients experience physical, emotional, or thinking‑related changes after an ICU stay.

• These may include weakness, tiredness, memory gaps, trouble concentrating, or mood changes.
• These effects are part of post‑intensive care syndrome (PICS), which is common after critical illness.
• Most people improve gradually with rest, rehabilitation, and support.

These changes are part of healing and usually get better over time.

Community and family support

Recovery is often easier with support. Community resources such as home health, mental health services, caregiver supports, and rehabilitation programs may be available depending on the patient’s needs. Families and significant others may also benefit from support groups or counselling to help navigate the emotional impact of critical illness.

Rehabilitation and Mobility

• Physiotherapists and occupational therapists may continue to support mobility and strength.
• They may help with breathing exercises and daily activities.
• Early and ongoing rehabilitation helps prevent complications and supports long‑term recovery

Rehabilitation helps patients regain strength and independence.

Cognitive and Emotional Healing

• Some patients feel confused or have limited memories of their ICU stay.
• Tools like ICU diaries, counselling, and follow‑up visits can help make sense of the experience.
• Emotional healing may take time, especially after delirium or long sedation.

Support is available to help patients understand and process their experience.

Follow up Care and Planning

Before discharge from the hospital, the care team will review medications, equipment needs and follow‑up appointments. Families are encouraged to keep a list of questions and bring it to follow‑up visits.

• Recovery can be unpredictable, with good days and harder days.
• Focusing on small improvements can help.
• Asking for help when needed is an important part of healing

The ICU team is here to guide you and connect you with resources for long‑term recovery.