How to get to the intensive care unit to the patient. Access of relatives to intensive care: what to do if you are not allowed to see your child? Video about the work of the intensive care unit

Image copyright Ria Novosti Image caption Doctors explain the ban on visiting children in intensive care by the danger of infections

The Ministry of Health of Russia had to again to remind that the law obliges doctors to allow relatives to visit patients in medical institutions including in intensive care.

The ministry's press secretary, Oleg Salagai, recalled that the ministry sent a corresponding letter to the regions last year.

"If there are violations, you need to contact the insurance company that issued the policy to you, the health authorities of the region, the control authorities," - wrote press secretary on Facebook.

This is how he reacted to the petition, which requires the Ministry of Health to publish not a "letter of request", but a decree that does not allow free interpretations. To date, a petition demanding to oblige hospitals not to prevent visiting loved ones in intensive care has collected more than 200,000 signatures.

The petition notes that patients, especially sick children, need psychological support, which they are deprived of due to the rules of medical institutions. The most popular comments on the petition describe cases in which sick children were deprived of communication with their parents.

Section 51 of Law 323 states that one of the parents or legal representative has the right to be with the child "while providing him medical care in stationary conditions during the entire treatment period.

Patients and employees of charitable organizations that help children say that in Russia it is really difficult to get into intensive care with a child, not to mention adults. At the same time, the situation in the regions is much worse than in Moscow.

Usually, doctors explain the ban by the fact that parents can bring the infection or become infected themselves, in some cases they interfere with treatment and distract medical staff.

There are not enough psychologists who could work with parents and children. Patients often refer to Western experience, where relatives are not forbidden to visit patients - except when the patient is receiving emergency care.

The BBC Russian service turned to experts and asked them to comment on how the law is being implemented locally, obliging parents to let their children into intensive care.

Nyuta Federmesser, President of the Vera Hospice Fund

Wherever parents are not allowed, there is a violation of federal law. The law on the health of citizens spelled out the right of the child to be with his parents in the hospital.

All internal regulations are fiction and the will of the chief doctors in the field. Sanitary standards are often violated by employees more than by parents, as employees, for example, go out to smoke in the same shoes they work in, and parents obediently bring a shift.

In hospital departments, it is nosocomial infection that is terrible, which is carried by dirty rags for cleaning, the lack of a culture of proper washing hands, gowns in which the medical staff moves from ward to ward, and disposable gloves that cease to be disposable after the nurse has moved to the next patient in the same gloves.

Many nurses say they wear gloves to protect themselves from hepatitis, not to protect the patient.

Parents are the most interested in quality care people. And they are the first aid to the staff in the case when children cry when it is time for dinner, washing or changing clothes. Parents must strictly observe only one rule - to leave the intensive care unit at the first request of the staff in the event of resuscitation or serious manipulations requiring the participation of two or more doctors.

Inadequate behavior of parents, which is often referred to by the heads of intensive care units when they do not let the mother see the child, is the result of separation from children.

Alexander Rabukhin, anesthesiologist with US experience

In the US, there is no such profession as a resuscitator. Severe patients are treated by a specialized doctor. If this surgical patient- then in surgery, if therapeutic - then in therapy, and so on. That is, there is no separate specialty "resuscitation", there are only blocks intensive care- ICU so-called.

AT certain time please can [visit]. Relatives come in, order pizza in unison, watch TV, eat pizza, wave to the hardware patient and leave. There is no such problem [ban on visits], because they generally treat it easier there, and doctors go without white coats. A sick person is also a person, and relatives are people, therefore human relations.

In Russia, a sick person is a person who has lost all rights in general. From the time you got to the hospital, the babysitter decides everything.

As for unsanitary conditions, to be honest, I have never seen any homeless people come to visit there.

And this applies not only to resuscitation, you just try to go to the hospital. It is much easier to get to any defense facility. In our country, 50% of the able-bodied population works in security, in my opinion. They need to protect something.

Now, if I, a doctor, come to some other hospital on business, if a pass is not ordered for me, I cannot get through. And in order to order a pass, you need to get inside, and so on, the circle is closed. It’s good at least they let you into the grocery store without a pass, but you say resuscitation.

What happens to a person in the intensive care unit

A person who is in intensive care may be conscious, or may be in a coma, including medication. With severe traumatic brain injury and increased intracranial pressure the patient is usually given barbiturates (that is, they are put into a state of barbituric coma) so that the brain finds resources for recovery - it takes too much energy to stay conscious.

Usually in the intensive care unit, patients lie without clothes. If a person is able to stand up, then they can give him a shirt. “In the intensive care unit, patients are connected to life support systems and tracking equipment (various monitors), - explains Elena Aleshchenko, head of the intensive care unit of the European Medical Center. - For medicines in one of the central blood vessels a catheter is placed. If the patient is not very heavy, then the catheter is placed in peripheral vein(for example, in a vein of the arm. - Note. ed.). If artificial ventilation of the lungs is required, then a tube is installed in the trachea, which is connected through a hose system to the apparatus. For feeding, a thin tube is inserted into the stomach - a probe. A catheter is inserted into the bladder to collect urine and record its amount. The patient can be tied to the bed with special soft ties so that he does not remove the catheters and sensors when excited.

The body is treated with fluid to prevent bedsores daily. They treat their ears, wash their hair, cut their nails - everything is as in normal life, except that hygiene procedures performed by a medical worker. But if the patient is conscious, they may be allowed to do it on their own.

To prevent bedsores, patients are regularly turned in bed. This is done every two hours. According to the Ministry of Health, public hospitals There should be two patients per nurse. However, this is almost never the case: there are usually more patients and fewer nurses. “Most often, nurses are overloaded,” says Olga Germanenko, director charitable foundation"SMA families" (spinal muscular atrophy), Alina's mother, who was diagnosed with this disease. - But even if they are not overloaded, sisterly hands are still always lacking. And if one of the patients becomes destabilized, then he will receive more attention at the expense of another patient. This means that the other one will be turned later, fed later, etc.”

Why are relatives not allowed into intensive care?

According to the law, parents should also be allowed to see their children (it is generally allowed here cohabitation), and close to adults (Article 6 323-FZ). This possibility in pediatric ICUs (intensive care unit) is also mentioned in two letters from the Ministry of Health (07/09/2014 and 06/21/2013), for some reason duplicating what is approved in federal law. But nevertheless, there is a classic set of reasons why relatives are refused to be allowed into intensive care: special sanitary conditions, lack of space, too huge pressure on the staff, the fear that a relative will harm, will begin to “pull out the tubes”, “the patient is unconscious - what will you do there?”, “ internal rules hospitals are prohibited. It has long been clear that if the leadership wishes, none of these circumstances becomes an obstacle to the admission of relatives. All arguments and counterarguments are analyzed in detail in a study conducted by the Children's Palliative Foundation. For example, the story that you can bring terrible bacteria into the department does not look convincing, because the nosocomial flora has seen a lot of antibiotics, acquired resistance to them and has become much more dangerous than what you can bring from the street. Can a doctor be fired for violating hospital rules? "Not. Exists Labor Code. It is he, and not local hospital orders, that regulates the interaction between the employer and the employee,” explains Denis Protsenko, chief specialist in anesthesiology and resuscitation of the Moscow Health Department.

“Often doctors say: you create for us normal conditions, build spacious premises, then we will let them in, - says Karina Vartanova, director of the Children's Palliative Foundation. - But if you look at the departments where there is a permit, it turns out that this is not such a fundamental reason. If there is a management decision, then the conditions do not matter. The most important and difficult reason is mental attitudes, stereotypes, traditions. Neither doctors nor patients have an understanding that the main people in the hospital are the patient and his environment, so everything should be built around them.”

All uncomfortable moments that can actually interfere are removed by a clear formulation of the rules. “If you let everyone in at once, of course, it will be chaos,” says Denis Protsenko. - Therefore, in any case, you need to regulate. We in Pervaya Gradskaya start one by one, let us down and tell at the same time. If the relative is adequate, we leave him under the control of the nursing staff, we go for the next one. On the third or fourth day, you perfectly understand what kind of person this is, contact is established with him. Even then, you can leave them with the patient, because you have already explained everything to them about the tubes and devices for connecting the life support system.”

“Abroad, talk about admission to intensive care began about 60 years ago,” says Karina Vartanova. - So do not count on the fact that our healthcare will be inspired together and will do everything tomorrow. A forceful decision, an order, can spoil a lot. The decisions that are made in each hospital about whether or not to let in, as a rule, are a reflection of management's attitudes. There is a law. But the fact that it is not massively performed is an indicator that individual doctors, and the system as a whole are not yet ready.”

Why is the presence of relatives 24 hours a day impossible even in the most democratic intensive care units? In the morning, various manipulations and hygiene procedures are actively carried out in the department. At this time the presence stranger highly undesirable. During the rounds and during the transfer of the shift, relatives should also not be present: this will at least violate medical secrecy. At resuscitation relatives are asked to leave in any country in the world.

The resuscitator of one of the US university clinics, who wished not to give his name, says that their patient is left without visitors only in rare cases: "AT exceptional cases anyone’s access to the patient is limited - for example, if there is a danger to the patient’s life from visitors (usually these are situations of a criminal nature), if the patient is a prisoner and the state prohibits visits (for seriously ill patients, an exception is often made at the request of a doctor or nurse), if the patient has a suspected/confirmed diagnosis of a particularly dangerous infectious disease(Ebola virus, for example) and, of course, if the patient himself asks that no one be allowed in.”

Children in adult resuscitation they try not to let them in either here or abroad.

What to do to get you into intensive care

“The very first step is to ask if it is possible to go to the intensive care unit,” says Olga Germanenko. A lot of people don't really ask. Most likely, it’s in their head that they can’t go to intensive care.” If you asked, and the doctor says that it’s impossible, that the department is closed, then you definitely shouldn’t make a fuss. “Conflict is always useless,” explains Karina Vartanova. “If you immediately start stomping your feet and shouting that I will rot you all here, I will complain, there will be no result.” And money doesn't solve the problem. “No matter how much we interview relatives, money does not change the situation at all,” says Karina Vartanova.

“It makes no sense to talk about admission with nurses or the doctor on duty. If the attending physician takes the position “not allowed”, you must behave calmly and confidently, try to negotiate, - says Olga Germanenko. - No need to threaten to appeal to the Ministry of Health. You calmly explain your position: “It will be easier for the child if I am there. I will help. Pipes don't scare me. You said that with the child - I can roughly imagine what I will see. I know the situation is difficult.' The doctor will not think that this is a hysterical mother who can pull out her tubes and yell at the nurses.

If you are denied at this level, where do you go next? “If the department is closed to relatives, communication with the head will not give anything,” says Denis Protsenko. - Therefore, you need to go to the deputy chief physician for medical work. If he does not give the opportunity to visit, then go to the head doctor. In fact, that's where it ends." Olga Germanenko adds: “You need to ask the head physician for a written explanation of the reasons why they are not letting you in, and with this explanation go to the local health authorities, insurance companies, the prosecutor’s office, supervisory authorities- anywhere. But imagine how long it will take. It's a bureaucracy."

However, Lida Moniava, so to speak, is reassuring: “When a child lies in bed for a long time, mothers are already being let in. In almost all intensive care units, a couple of weeks after hospitalization, they begin to let in, gradually increasing the duration of the visit.

Director of the Department of Public Health and Communications of the Ministry of Health Oleg Salagay contact his insurance, which, in theory, is responsible for the quality of medical care and respect for the rights of the patient. However, as it turned out, companies do not have experience in solving similar situations. Moreover, not everyone is ready to support relatives (“Resuscitation is not created for dates, here they are fighting for human life, as long as there is at least some hope left. And no one should distract either doctors or patients from this struggle, who need to mobilize everything their strength in order to survive,” the correspondent was told “ Posters Daily at one of the insurance companies). The responses of some companies are full of confusion due to supposedly conflicting legislation, but nonetheless, someone is ready to "respond quickly."

When there is objective reasons not to let a relative into the ICU? If you are frankly ill and can infect others, if you are in a state of alcoholic or drug intoxication - in these cases you will rightly not be allowed into the department, no matter how hard you try.

“If there is quarantine in the hospital, then no certificate will help you get to the department,” explains Denis Protsenko.

How to understand that everything is in order

“If you are not allowed into intensive care, you will never know if everything is being done for your relative,” says Olga Germanenko. - A doctor can just give little information, but actually do everything that is needed. And someone, on the contrary, will paint the smallest details of your relative's treatment - what they did, what they are going to do, but in fact the patient will receive less treatment. Perhaps you can ask discharge summary. But they won’t give it just like that - you need to say that you want to show it to a specific doctor.

It is generally accepted that the admission of relatives to the intensive care unit will complicate the life of the staff. However, in reality, this reduces the number of conflicts precisely on the basis of the quality of medical care. “Of course, parental presence is an additional quality control,” says Karina Vartanova. - If we take a situation when the child had no chance to survive (for example, he fell from the 12th floor), the parents were not allowed, and he died, then, of course, they will think that the doctors left something unfinished, overlooked. If they were allowed in, there would be no such thoughts, they would also thank the doctors for fighting to the end.”

“If you suspect that your relative is being treated poorly, invite a consultant,” suggests Denis Protsenko. “For a self-respecting, self-confident doctor, a second opinion is absolutely normal.”

"At rare diseases only narrow specialists know that some drugs cannot be prescribed, some can, but you need to control such and such indicators, so sometimes resuscitators themselves actually need consultants, explains Olga Germanenko. - True, the choice of a specialist must be approached carefully so that he does not talk down to local doctors and does not intimidate you: “You will be killed here. There are such stupid things here.

“When you tell your doctor that you want a second opinion, it often sounds something like this: you are treating the wrong way, we see that the condition is getting worse, so we want to bring a consultant who will teach you how to treat you properly,” says the psychiatrist, head of the Clinic of Psychiatry and psychotherapy at the European Medical Center Natalya Rivkina. - It is better to convey such an idea: it is very important for us to understand all the possibilities that exist. We are ready to use all our resources to help. We would like to ask you to get a second opinion. We know that you are our main doctor, we have no plan to go elsewhere. But it is important for us to understand that we are doing everything that is necessary. We have an idea who we would like to contact. Maybe you have other suggestions. This kind of conversation can be more comfortable for the doctor. You just need to rehearse, write down the wording. No need to go with the fear that you are breaking some rules. It is your right to get a second opinion.

How to help

“Doctors are forbidden to say that they do not have any drugs, consumables,” explains the deputy director children's hospice"House with a lighthouse" Lida Moniava. - And out of fear they can convince you that they have everything, although in reality it will not be so. If the doctor voices the needs, thank him very much. Relatives are not required to bring everything, but thanks to those doctors who are not afraid to speak.” The problem is that it is considered: if something is missing in the hospital, then the management does not know how to allocate resources. And relatives do not always understand the position of the doctor, so they can complain to the Department of Health or the Ministry of Health: “We have free medicine, but they force me to buy medicines, return the money, here are the checks.” Fearing such consequences, ICU staff may even use their own money to buy good drugs and expendable materials. Therefore, try to convince the doctor that you are ready to purchase everything you need, and you have no complaints about this.

Spinal surgeon Alexei Kashcheev also ask the attending physician whether it would be useful for the patient's current condition to hire an individual nurse.

How to behave in intensive care

If you are allowed into intensive care, it is important to remember that there are rules (in writing or spoken by a doctor), and they are designed so that doctors can do their job.

Even in those intensive care units where you can come even in outerwear, there is a rule: treat your hands with an antiseptic before visiting the patient. In other hospitals (including those in the West) they may be asked to wear shoe covers, a gown, not to wear woolen clothes and not to walk with loose hair. By the way, remember that visiting the intensive care unit, you expose yourself to certain risks. First of all, the risk of infection with local bacteria resistant to many antibiotics.

You must imagine where you are going and what you will see

If you have a tantrum, faint or feel sick, you will attract the attention of the intensive care unit staff, which is potentially dangerous. There are other subtle moments that Denis Protsenko talks about: “I know cases when a guy came to his girlfriend, saw her disfigured face and never returned. It happened the other way around: the girls could not cope with such a spectacle. In my experience, it is not uncommon for relatives who volunteer to help quickly disappear. Just imagine: you turn your husband on his side, and he has gases or a bowel movement. Patients vomit involuntary urination“Are you sure you will react normally to this?”

You can't cry in the ICU

“Usually, the first visits to the department by relatives are the most difficult,” says Elena Aleshchenko. “It is very difficult to prepare and not cry,” says Karina Vartanova. - It helps someone to take a deep breath, someone is better off crying on the sidelines, you need to talk to someone, someone should not even be touched. You can learn to be calm in the intensive care unit if you remember that the patient's condition largely depends on your calmness. Some hospitals employ clinical psychologists to help manage emotions.

Ask how you can help and don't be selfish

“A mother can change a diaper, turn it over, wash it, give a massage - all this is especially necessary for heavy children,” says Olga Germanenko. “It is clear that nurses, with the current workload, cannot do all this to the extent that is needed.”

Being in the intensive care unit around the clock is not only pointless, but also harmful

“You can visit us at any time, you can stay with the patient for 24 hours in a row,” says Elena Aleshchenko. Whether it is necessary is another matter. People then themselves understand that this is useless, that they are doing it more for themselves. When a person is in intensive care, he is sick, he also needs to rest. Olga Germanenko confirms this idea: “Sleeping in the intensive care unit special meaning no. In fact, no one will sit for more than four hours in a row (unless, of course, we are talking about a dying child). After all, everyone has their own things to do." A day in intensive care is hard not only physically, but also mentally: “What will happen to a relative after 24 hours in the intensive care unit? - says Denis Protsenko. - Corpses will be taken out several times past him, he will become a witness cardiopulmonary resuscitation, suddenly developed psychosis in another patient. I'm not sure that the relative will survive this calmly.

Negotiate with other relatives

“In one of the intensive care units where I ended up with my daughter, the children were in boxes for two,” says Olga Germanenko. - That is, if a nurse comes, and there are two more parents, then do not turn around. And her presence may be needed at any moment. So we agreed to come to different time. And the children were always supervised.

Respect the wishes of the patient

“When a person regains consciousness, the first question we ask him is: do you want to see relatives? There are situations when the answer is “no,” says Denis Protsenko. “Many clinics around the world have such programs for natural dying, when a patient and his family discuss how he will die,” says Natalia Rivkina. - This happens a month and a half before his death. The task is for a person to die with dignity and in the way he would like. There are parents who do not want their children to see the process of dying. There are wives who do not want their husbands to see the process of dying. Perhaps they will look ugly. There are those who want to be with their loved ones at the time of death. We must respect all these decisions. If a person wants to make the transition himself, this does not mean that he does not want to see loved ones. It means he wants to protect you. You shouldn't force your choice on him."

Respect other patients

“Speak to your child as quietly as possible, do not turn on loud music, do not use mobile phone in the department. If your child is conscious, then he can watch cartoons or listen to music using a tablet and headphones so as not to disturb others. Do not use strong-smelling perfume, ”writes Nadezhda Pashchenko in, published by the Children's Palliative Foundation,“ Together with Mom.

Do not conflict with doctors and nurses

“The work of the ICU staff is quite difficult, very intensive, energy-consuming,” Yulia Logunova writes in the same brochure. - This must be understood. And in no case should you conflict with someone, even if you see a negative attitude, it’s better to keep silent, it’s better to take a break in communicating with this person. And if the conversation turns to raised voices, the following phrase always works: I thought that you and I had one goal - to save my child, to help him, so let's act together. I have not had a single case when it did not work and did not transfer the conversation to another plane.

How to talk to a doctor

Firstly, it is advisable to talk with the attending physician, and not with the person on duty, who changes every day. He will definitely have more information. That is why in those intensive care units in which the time for visiting and communicating with the doctor is limited, it falls on uncomfortable hours - from 14.00 to 16.00: at 15.45 the shift of the attending physician ends, and until 14.00 he will most likely be busy with patients. It is not worth discussing treatment and prognosis with nurses. “Nurses carry out doctor's orders,” writes Nadezhda Pashchenko in the booklet Together with Mom. “It’s pointless to ask them about what exactly they give your child, since the nurse cannot say anything about the child’s condition and the essence of medical prescriptions without the doctor’s permission.”

Abroad and paid medical centers you can get information by phone: when you draw up the paperwork, you will approve the code word for this. In public hospitals, in rare cases, doctors can give their mobile.

“In a situation where someone close is in intensive care, especially when it is associated with a sudden onset of the disease, relatives may be in a state of acute reaction to stress. In these states people
experiencing confusion, difficulty concentrating, forgetfulness - it is difficult for them to get together, ask right question- explains Natalya Rivkina. - But doctors may simply not physically have time to build a dialogue with relatives who have such difficulties. I encourage family members to write down questions throughout the day to prepare for their appointment with the doctor.

If you ask "How is he/she?", the doctor may give two responses: "Everything is good" or "Everything is bad." This is unproductive. Therefore, it is necessary to formulate clearer questions: what is the patient's condition at this moment, what symptoms does he have, what are his plans for treatment. Unfortunately, in Russia there is still a paternalistic approach to communication with the patient and relatives. It is believed that they do not need to have information about the treatment. “You are not a doctor”, “You still will not understand anything.” Relatives should always be aware that by law they must be informed about the treatment being carried out. They have the right to insist on it.

Doctors react very nervously when frightened relatives come and say: “What are you doing? We read on the internet that this drug kills.” It is better to ask this question like this: “Tell me, please, what side effects have you seen from this medicine?” If the doctor does not want to answer this question, ask: “What do you think about this side effect? That way you don't attack or criticize. Any criticism causes resistance in people.

A common question in intensive care, especially if we are talking about cancer patients: “Is that all?” or “How long does he/she have to live?” This is a question that has no answer. A properly trained doctor will answer it. A doctor who has no time will say, "God only knows." Therefore, I always teach relatives to ask this question in this way: “What is the worst and best prognosis?” or “What is the minimum and maximum duration life can be according to the statistics of such states?

Sometimes I insist that people leave and rest. No matter how wild and cynical it may be. If it is obvious that they cannot do anything for the patient now, they will not be allowed in one hundred percent, they cannot make any decisions, influence the process, then you can be distracted. Many people are sure that at this moment they should grieve. Going out to drink tea with friends in a cafe is to break the whole logic of the universe. They are so fixated on the mountain that they reject any resources that could support them. When it comes to a child, any mother will say, “How can I afford this?” or "I'll sit there and think about the baby." Sit and think. At least you will do it in a cafe, and not in the intensive care corridor.

Very often, in situations where one of the relatives is in intensive care, people become isolated and stop sharing their experiences. They try so hard to protect each other that at some point they just lose each other. People should speak openly. This is a very important step for the future. Children are a special category. Unfortunately, very often they hide from children that one of the parents is in intensive care. This situation is very bad for their future. Proven fact: the later children learn the truth, the higher the risk of severe post-stress disorders. If we want to protect a child, we must talk to him. This should be done by relatives, not a psychologist. But it is better that they get professional support first. Communicate in a comfortable environment. It should be understood that children of 4-6 years old are much more adequate to the issues of death and dying than adults. They at this time have a fairly clear philosophy regarding what death and dying are. Later, many different stigmas and myths are superimposed on this, and we are already starting to relate to this in a different way. There is another problem: adults try not to show their emotions, while children feel and experience this experience as a rejection.

It is also important to understand that different members families different variants adaptation to stress and different need in support. We react the way we react. This is a very individual thing. There is no one correct reaction for such an event. There are people who need to be stroked on the head, and there are people who get together and say: "Everything will be fine." Now imagine that they are husband and wife. The wife understands that a catastrophe is happening, and the husband is sure that you need to clench your teeth and not cry. As a result, when the wife starts crying, he says, "Stop crying." And she is sure that he is soulless. We often see family conflicts related to this. In this case, the woman becomes isolated, and it seems to the man that she simply does not want to fight. Or vice versa. And it is very important to explain to family members that everyone needs different support in such a situation, and to encourage them to give each other the support that everyone needs.

When people do not allow themselves to cry and kind of squeeze their emotions, this is called dissociation. Many relatives described this to me: in intensive care, they seem to see themselves from the outside, and they are horrified by the fact that they do not experience any emotions - no love, no fear, no tenderness. They are like robots doing what needs to be done. And it scares them. It is important to explain to them that it is absolutely normal reaction. But we must remember that these people have a higher risk of delayed reactions. Expect that after 3-4 weeks you will have disturbed sleep, there will be anxiety attacks, maybe even panic.

Where to look for information

“I always strongly advise relatives and patients to go to the official websites of clinics,” says Natalya Rivkina. - But if you speak English, it's much easier for you. For example, the Mayo Clinic website has great text across the board. There are very few such texts in Russian. I ask relatives not to enter the Russian-language patient forums. Sometimes there you can get misleading information that is not always related to reality.

Basic information in English about what happens in the intensive care unit can be found here:.

What to expect

“Within a few days after the patient is in intensive care, the doctor will tell you how long the person will stay in the ICU,” says Denis Protsenko.

After resuscitation, as soon as the need for intensive observation is no longer necessary and the patient can breathe on his own, he will most likely be transferred to a regular ward. If it is known for sure that a person needs artificial lung ventilation (ALV) for life, but in general he does not require the help of resuscitators, he can be discharged home with ventilator. You can buy it only at your own expense or at the expense of philanthropists (from the state

Sooner or later, people are faced with a situation where one of their relatives or friends is in the intensive care unit. At the same time, everyone, without exception, wants to get into the intensive care unit, but often doctors do not let relatives of the patients there. Meanwhile, relatives want to cheer up, care for or just see a loved one human. They are genuinely confused why you can’t be in intensive care, and in the event of an imminent death, say goodbye to him. In no case should we assume that doctors are soulless people, they, of course, understand all the lamentations relatives, but in this matter it is better to rely on common sense, and not on emotions . The concept of resuscitation This is a rather serious topic, because it is in the intensive care unit that all the vital functions of the body are restored.

Why not

Intensive care units are as sterile as operating rooms, there is no place for strangers. Doctors all the time have to help patients - they resuscitate, they intubate, and then visitors get in the way, and sometimes they give “advice”. Also, any visitor can bring nothing, no microflora that is harmful to him, which, unfortunately, can be deadly for human who has been here since open wounds after operation. Only extremely serious patients are in intensive care, and any virus or bacteria brought from outside can only aggravate the already difficult condition of the patient. Another reason for observing the regime in this department, and the answer, why it is impossible, what happens can serve, so that the patient himself turns out to be a carrier of a serious infection, and then his visit for relatives fraught with unpleasant consequences.

The reaction of relatives when visiting is unpredictable

Many doctors also note that loved ones human who was in critical condition after transferred operations when visiting, they cannot cope with the surging emotions and, as a rule, behave not quite adequately. There was a case when man who underwent the most difficult operation after car accident, required tracheal intubation. They put him on the tube larynx for artificial lung ventilation. When the doctors let the visitor into the ward, it seemed to him that a tube IVL placed in larynx, prevents his dear and close person from breathing, and he tried to “ease” the latter’s suffering by pulling out larynx tubes artificial lung ventilation. It is even scary to imagine how the “help” of a relative could end, fortunately, the professionalism of doctors working in the intensive care unit cannot be overestimated.

In rare cases, resuscitators make exceptions and allow one of the close relatives to see the patient. But when you see your own human and all hung t cuttings, yes with a ventilator in larynx, often, unable to bear such a spectacle, they faint. Visitors after what you see, you have to hastily pump out the same doctors, and in other cases even put it on the next bed. And believe me, they don’t have time for this, every nurse in the intensive care unit overworks.

Just to survive

In the intensive care unit, patients lie in the same room, without distinction by gender. They usually take off their clothes, this is due to the fact that doctors in the struggle for the life of the patient have not yet had to deal with locks and buttons on their clothes, and many of the visitors take this as a mockery or negligent attitude. Most often, patients end up in the intensive care unit in an unsightly state, and believe me, no one cares about that here, the main thing is to survive. But for the psyche of the average visitor, it becomes a horror, relatives just not ready to accept what they see. After holding operations, when human is in a serious condition, a drain can be installed, the tubes of which protrude terribly from the abdomen. And add to this a catheter in bladder, gastric tube, endotracheal tube in larynx, often open postoperative wounds.

Not goodbye

Asking an intensive care doctor to meet your loved one human, you should think not only about yourself, but also about those people who share this room with your relative. After all, neither he nor his relatives will like the fact that complete strangers will see him in such an unattractive form. In addition, you should trust the doctors and understand that the intensive care unit is not a place for dates. Here they fight for the life of the patient until there is even the slightest hope of survival. And it will be better if visitors do not distract either the medical staff or the patient after any complications from this hardest and most important struggle for life with their endless questions.
Why then close, it seems that a person after operations, or for any other reason who has ended up in the intensive care unit, urgently needs to talk or ask for something from relatives. Yes, he does not want anything, because of his difficult condition. After all, if the patient was taken to the intensive care unit, then he is most likely in a coma, or connected to specialized equipment, and because of the tube in larynx he can't talk.
As soon as the patient's condition improves, he will be transferred from intensive care unit to a regular room. Then the time will come for dates, and it will be possible to thank the doctors for the fact that they won this fight.
Unfortunately, there are cases when it is no longer possible to help the patient, he has almost a few minutes left to live, for example, when human oncological disease, or kidney failure. In such cases, patients are not kept in intensive care units, they try to human He left this life peacefully, within the walls of his own home.
It is best to adhere to the opinion that if a person is placed in intensive care units, then he urgently and urgently needs highly qualified help, without which he simply cannot survive. Here, doctors will fight for his life to the end, and not always the presence of relatives can help the patient, but on the contrary, only harm him.

Access to stable patients

The very word resuscitation means "revitalization of the body", re-revival. When a person is in critical condition after operations or after accident, visitors will not be allowed to see it. It doesn't mean when, some patients afteroperations sent to the intensive care unit to recover from anesthesia. Does it make sense to visit here? It seems not, because in a few hours these patients will be transferred to the general ward for further treatment.

To small patients who have recovered vital important features organism, but they are still on a ventilator, also do not let any visitors through. Often, mothers or other relatives simply do not understand the importance inserted in larynx the child's ventilator tube, some of them even try to pull it out completely, for fear of damaging larynx, or because it seems to them that the child wants to say something, while not consulting resuscitators.

However, if Small child, who is in intensive care, nevertheless came to a stable state and is conscious, in order to improve the general emotional background of the child, a short visit to his mother is allowed.

In any case, whatever age group and gravity was not sick, you should not be self-willed in his ward, since often relatives themselves, out of ignorance, cause tangible harm to their loved one.

Some life situations are better never to get into, some questions are better never to try to find the answer. But if it so happened that you have to be interested in whether the wife has the right to go to intensive care, it is necessary to obtain extremely objective information. This will help to be fully prepared in case of a conflict situation.

How do you get into intensive care?

To the intensive care unit:

Patients are transferred if sharp deterioration them general condition, occurrence real threat life.
You can get right from the emergency room, with an unsatisfactory condition and the need for qualified emergency care.
There are representatives of all races and nationalities, regardless of gender, age and religion. One thing unites them - the severity of the condition.
Try not to let any stranger.

Outsiders, in this case, everyone is considered except patients and medical personnel. After all, for effective work and no outsider is needed to help, or not? Are there any changes for the better after visiting relatives? Dynamics, as a rule, only worsens and there is an explanation for this.

How can a visit to intensive care end?

Patient in intensive care:

He lies in a common ward, with many others.
"Stuffed" with tubes that help him breathe or drain fluid from his peritoneum and lungs.
Often lives only at the expense of devices connected to it.
It is a sad sight.
Has reduced immunity.

Now imagine, “compassionate relatives” came:

Brought the infection from outside.
Got some equipment.
In a fit of hysteria, a probe or catheter was pulled out.
horrified appearance sick and decided that the end was near.
They interfered with the work of the resuscitation team, which, due to the pandemonium, did not have time to help the patient in the next bed.

Of course, these are just the fears of doctors and in some places they are seriously exaggerated. But phobias do not form from scratch, everything listed somewhere and once has already happened, no one wants a repetition.

Why can't they let me into intensive care?

To be guided only by the letter of the law, in such a matter, is not entirely reasonable. Purely from the point of view of the law, the wife has the right to visit her husband in intensive care. But if the doctors prevent this, for some reason, calling the police squad is not an option. Law enforcement officers will not scatter resuscitators and accompany the wife to the intensive care unit, this is understandable.

Admission issues, as a rule, are managed by the head physician. It is to this person that you must apply for permission to visit your husband.

Doctors can quite reasonably ban the visit, the reason for this may be:

Extremely serious condition sick.
Exceeding the epidemiological threshold in the region for any infection.
Change sanitary conditions in the department.

As a rule, physicians are guided by their own considerations regarding the patient's condition and further prognosis. All arguments, in this case, are nothing more than a formality. Therefore, sometimes a “heart-to-heart talk” is useful, and not another bickering.

Scandals won't help if medical workers they will go on principle and decide not to let them into the intensive care unit, it will not work to break through such a “barrier” on their own. But yes, legally speaking, a wife has a right to visit her lawful husband. If there are no medical contraindications to this.

The rights of a civil wife

The institution of civil marriage in our country is practically not developed. Purely theoretically, it is precisely the marriage that is registered after going to the registry office, as opposed to church marriage, that should be called civil. In our country, a similar concept is called banal cohabitation.

If young people live together for a long time, this does not give any additional rights to a common-law wife. Of course, in the event of a division of property or any other conflict, if you manage to prove the fact of joint management of the economy, you can claim your share. But this is only through the court, on the basis of its decisions, and not by any other right.

A common-law wife may not be allowed into intensive care or even a regular hospital department, she will not be provided with the personal information of a common-law spouse. But in any area draw up a power of attorney, include a person in the list of trusted persons, or perform other manipulation that will seriously expand the capabilities of a loved one with whom relations are not legalized.

Can a legal wife visit her husband in intensive care?

Presence of a stamp in the passport gives the wife the legal right to visit her husband in intensive care. But the decision on admission will still be made by the head physician, who has the right to refuse:

due to the severity of the patient's condition.
To protect the patient from exposure to infection.
In connection with possible violation sanitary conditions in the department.
For patient safety reasons.
To maintain positive momentum.

Visitors may calm down a bit when they see that close person still alive and fighting for life. But for the patient, this is guaranteed to be stressful, which will complicate the already very difficult struggle.

Information about whether the wife has the right to go to intensive care is not always applicable. Speech, as a rule, goes on for days or even hours, and it is completely pointless to seek a court order or frighten the head of the police. It is better to listen to the recommendations and go to the world.

Video about the work of the intensive care unit

In this video report, Alexander Nikonov will tell you how resuscitation works in Voronezh and whether they have the right to let patients' wives in:

Medical staff working in the intensive care unit are seriously concerned about the likelihood of various complications after surgery caused by infection. Each medical institution is trying to solve the issue of the emergence and spread of hospital-acquired (nasocomial) infections, making every effort to avoid this. Responsibility for postoperative complications lie with the employees of this institution. To reduce this likelihood, most hospitals have introduced strict ban to visit relatives of people lying in the intensive care unit for recovery after a serious surgical intervention.

In a number of hospitals for children, such a ban has been introduced even for visiting patients by their own parents. This is a violation of the right of the child not to be separated from the mother. Guided by the safety of a sick child, doctors and medical personnel have been violating the Russian Constitution and a whole list of laws for many years.

By doing this in relation to adult patients, they violate only the first paragraph of Article 6 of Law No. 323-FZ "On protecting the health of citizens." It indicates the requirement to comply with the norms of ethics, respect and humanity on the part of hospital employees. And also the article says that during the construction medical institution, the premises in it must be designed so as to comply not only hygiene standards but also to ensure the comfort of patients. It also states that "the priority of the interests of the patient can be realized by creating conditions that ensure the possibility of visiting the patient by relatives and caring for him in a medical facility, taking into account the patient's condition."

But in reality, hospital staff may not let loved ones into the intensive care unit even to say goodbye to the dying. Doctors refer to article 27 of the above law, which refers to the need to comply with the internal regulations of the hospital. Thus, permission to let in or not let in relatives is given exclusively by the administration of the hospital. In accordance with this, in many, but not all, intensive care units, the entrance of people close to patients is strictly prohibited.

For a long time there were no serious objections to the established practice. This meant that thousands of people could not exercise their right to be near a dying person.

According to one of the experts, a lawyer on medical problems: “In accordance with the current legislation, relatives are right. In case of refusal of admission to the patient, you must first receive a written refusal from the head of the TMO of the hospital, and already contact the prosecutor's office with it. In this case, the administration's references to Art. 27 FZ-323 are unreasonable, since the care of a relative for a patient does not in any way violate the internal regulations of the hospital, only specific inadequate citizens can violate them - they should then close their admission, it will be legal.

The Ministry of Health of Russia confirmed the right of relatives to visit patients

On March 14, the media reported that "the ban on visiting children is a direct violation of Federal Law No. 323. And the ban on visiting adults in the hospital violates the provisions of the Constitution on freedom of movement." In this regard, both the Prosecutor's Office of the Russian Federation and Roszdravnadzor had the opportunity to call for the elimination of this law-breaking practice, and people who personally encountered such a ban have the right to challenge it in court.

But, despite these laws allowing relatives to be in intensive care, many medical workers did not allow this, citing such reasons: firstly, because of the danger of viruses; secondly, because of fears of a possible abnormal reaction of loved ones.

The current situation has become so serious that in March of this year, the Change dot org website began collecting signatures under an appeal to the Russian Ministry of Health.

The result of this struggle was that the Ministry of Health recognized the right of relatives to visit people lying in intensive care units of medical institutions.

Oleg Salagay, head of the Department of Public Health and Communications of the Ministry of Health, said: “Every patient, including those in intensive care, has the right to visit his relatives. A letter with a recommendation to ensure the implementation of this legislative norm was sent by the Ministry of Health to all regions back in 2015.”

Salagai stressed: “if there are violations, you need to contact the insurers who issued the policy to you, as well as the regional health authorities and control authorities.”

“As for adult patients, the legislation has secured the right to visit relatives while they are in medical organizations, and in relation to children - both visits and joint stay of relatives with them for the entire period of treatment, including being in the anesthesiology and intensive care unit, ”said Salagay.