Understanding the Patient-Unit
Which professionals work in the ICU?
^ HEAD OF INTENSIVE CARE DEPARTMENT
Experienced physician, specialized in anaesthesia and intensive care, who takes the ultimate responsibility of clinical and organizational decisions. He/she directs physicians' work and coordinates it with nursing procedures. He/she establishes work objectives and, collaborating with the nursing coordinator, he/she helps in reaching them through his/her leadership and by stimulating the ICU staff. He/she directly responds to the Hospital Direction.
^ INTENSIVE CARE UNIT MANAGER
Experienced physician, specialized in anaesthesia and intensive care, who follows day-by-day the clinical course of patients. He/she guides and coordinates physicians' work to guarantee the continuity and adequacy of treatments. Collaborating with the other staff physicians, he/she produces the ward internal guidelines and ensures their correct application.
^ NURSING COORDINATOR
Experienced nurse with managerial competences, responsible for ICU materials and resources, who coordinates all the nurses and other professional profiles. He/she contributes, as a guiding and motivating figure, to reach organizational and clinical objectives. He/she responds for his/her job to the Head of Intensive Care Department and to the Head of the nursing service. He cooperates in defining the clinical procedures such as guidelines and protocols.
Graduated medical doctor, specialized in anaesthesia and intensive care. His/her pivotal role is to perform lifesaving procedures whenever necessary (life-threatening conditions such as severe cardiac, respiratory, neurologic, metabolic dysfunction…), both in ICU and other hospital wards. He/she could also work on extra-hospital emergencies dealing with life-threatening conditions such as car accidents or cardiac arrests.
He/she is a health professional graduated in nursing, who carries out all the tasks related to prevention, cure and health preservation. Nursing activities include specific interventions both autonomous and complementary, intellectual and technical-scientific, managerial and educational. In the ICU the nurse plays a key role dealing with the patients continuous observation, therapies administration, prevention of complications and hygienic care.
^ TRAINEE INTENSIVIST
Graduated medical doctor, who is attending the school of specialization in anaesthesia and intensive care. The residents follow a training program designed by the University. During their training they visit different ICUs, becoming skilled in various intensive care fields. They have to directly experience a detailed set of clinical activities, always under the supervision and the responsibility of an attending physician (tutor), responsible both for their training and patients' safety.
^ MEDICAL STUDENT
In a University Hospital medical students are present in all the clinical wards. In the ICU some students are attending a training period connected with their degree thesis. They have not clinical responsibility but they perform support activity or research, according to their academic targets.
The nurse students have to attend different hospital wards. In the ICU every student has got a tutor who follows up his/her improvements. Each student follows the tutor's timetable, learning the specific job of a critical care nurse by experiencing it, according to their academic targets.
The office assistant collaborates in the achievement of all organizational and administrative duties according to the ICU Head's indications. He does not take part into patients' care.
^ ASSISTING HEALTH WORKERS
They are auxiliary personnel, having a supportive role during nursing activity such as delivering biological material to the lab, disinfecting/sterilizing clinical instruments, materials supplying. The social health operators help nurses with patient's hygienic care, administration of meals, mobilization/transfer. They are directed by the nurse coordinator.
^ CLEANING ENTERPRISE
Environmental cleaning plays a key role in preventing infections. This is particularly important because the ICU patient's body is in a weak condition, easily attacked by viruses, bacteria or fungi. Usually all the ICU areas are cleaned twice a day. A special cleaning program is sometime used if necessary, in the absence of patients and health workers.
Graduated psychologists, also qualified for the psychological profession, have a consultant role in ICU in order to improve the psychological well-being of patients, relatives and clinical staff, or to ameliorate the communication between them. Stressful events are common in the ICU; a psychological support may be beneficial for people involved both in a long period (chronic disease acceptance, prevention of health workers burn-out…) and facing sudden conditions that require hard decisions (therapy choice, organ donation).
^ RADIOLOGY TECHNICIAN
Health worker graduated in clinical radiology and radiotherapy, who has got specific competences on the use of radioactive sources (X-rays), thermic energy, ultrasounds, nuclear magnetic resonance. Often called to perform a check radiography (chest X-ray) at patients' bedside.
Health worker graduated in physiotherapy. He/she performs physiotherapy exercises for prevention, care and rehabilitation of patients with specific issues (neurological, orthopedic and respiratory problems). In collaboration with the physiatrist medical doctor, the physiotherapist evaluates the patient and elaborates a personalized rehabilitation program. He/she introduces the use of prosthesis and other auxiliary materials, training the patient on how to use them. He/she verifies the treatment efficacy in reaching the rehabilitation targets.
Health worker graduated in Dietetics who suggests the best strategies for the correct nutrition. Often, in the ICU, this last cannot be achieved by natural means with foods by mouth, chewed and swallowed. In such cases, it is necessary to use an "artificial" nutrition which can be performed by the "enteral" way, with nutrients absorbed by the gut, or by "parenteral" way with nutrients infused directly into the veins. In such cases, the administration of nutrients is prescribed by the physician responsible for the patient's care.
ICU physicians collaborate with a large number of specialists. ICU hospitalized patients are in fact in life-threatening conditions with diseases involving many organs and systems and therefore require specific skills for their care.
He has got a degree in Medicine and Surgery and is specialized in diseases of the cardiovascular system. He deals with diseases of the heart and blood vessels (arteries and veins).
He has got a degree in Medicine and Surgery and is specialized in Neurology. He deals with diseases of the brain, spinal cord and peripheral nerves.
He has got a degree in Medicine and Surgery and is specialized in Gastroenterology. He deals with diseases of the digestive tract, i.e. esophagus, stomach and intestine.
He has got a degree in Medicine and Surgery and is specialized in Pulmonology. He deals with diseases of the respiratory system.
He has got a degree in Medicine and Surgery and is specialized in nephrology. He deals with diseases of the kidneys.
^ INFECTIOUS DISEASES SPECIALIST
He has got a degree in Medicine and Surgery and is specialized in infectious diseases. He deals with diseases caused by pathogens such as viruses, bacteria and fungi.
He has got a degree in Medicine and Surgery and is specialized in Endocrinology. He deals with diseases of the organs that produce hormones such as the pancreas or thyroid.
He has got a degree in Medicine and Surgery and is specialized in Haematology. He deals with diseases of the blood. It 's also responsible for the transfusion of blood components, i.e. red blood cells, plasma or platelets.
He has got a degree in Medicine and is specialized in Psychiatry. He deals with mental illness.
He has got a degree in Medicine and Surgery and is specialized in Diagnostic Imaging. His professional skills guarantee a proper evaluation of the Imaging diagnostic tests to provide valuable information to understand the origin of the diseases. In addition, he can carry out clinical activities such as radiotherapy or interventional radiology.
^ MEDICAL LABORATORY
He has got a degree in Medicine and Surgery and is specialized in Laboratory Medicine. He deals with the interpretation of blood tests to provide valuable guidance to clinicians, i.e. the physicians who directly takes care of the patient.
He has got a degree in Medicine and Surgery and is specialized in Physical Medicine. He deals with diseases of the muscles and bones. In addition, he prepares the physical therapy program for motor rehabilitation.
^ HEART SURGEON
He has got a degree in Medicine and Surgery and is specialized in Cardiac Surgery. He deals with diseases of the heart that require surgery to heal.
He has got a degree in Medicine and Surgery and is specialized in Neurosurgery. He deals with diseases of the brain, spinal cord and peripheral nerves that require surgery to heal.
^ GENERAL SURGEON
He hasgot a degree in Medicine and Surgery and is specialized in general surgery or abdominal surgery. He deals with diseases requiring abdominal surgery.
^ THORACIC SURGEON
He has got a degree in Medicine and Surgery and is specialized in thoracic surgery. He deals with diseases that require thoracic surgery (for example the lungs).
He has got a degree in Medicine and Surgery and is specialized in urology. He deals with diseases of the urinary tract (ureters, bladder, urethra, prostate).
He has got a degree in Medicine and Surgery and is specialized in general surgery or surgery of the digestive system. Endoscopy means "To look into"; as a matter of facts through flexible tools equipped with cameras it's possible to see and work inside the digestive tract (esophagus, stomach, small intestine, large intestine) passing through natural orifices (mouth or anus).
^ VASCULAR SURGEON
He has got a degree in Medicine and Surgery and is specialized in Vascular Surgery. He deals with diseases of the blood vessels (arteries and veins).
^ ENT SURGEON
He has got a degree in Medicine and Surgery and is specialized in Otolaryngology. He deals with diseases of the ears, nose and throat. In the ICU he/she is sometimes called to make tracheostomy procedures in difficult cases.
^ ORTHOPEDIC SURGEON
He has got a degree in Medicine and Surgery and is specialized in orthopedics. He takes care of bone diseases, whether they are due to medical conditions (for example, osteoporosis) or trauma (for example, fracture).
He/she has got a degree in Medicine and Surgery and is specialized in Forensic Medicine. In the intensive care his/her intervention (or the intervention of a surrogate such as a doctor of the Health Department) is necessary to take part to the committee for the diagnosis of brain death, composed by an intensivist, a neurologist and a forensic.