Posts Tagged ‘ICU’


Thanksgiving in the ICU: Woven into the Tapestry of Traditions

November 25, 2015

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.) 


I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great joy. I work with people I care about and like so much that I look forward to spending a holiday with them. And at the end of the day I’ll be going home, where my family will be waiting for me, and I’ll hug my kids and count my blessings all over again.

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Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

November 2, 2015
Illustration by Denny Bond. All rights reserved.

Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the course of the essay the author finds that she must revise her opinion of cell phones. Time and the pressures of geographical distance are sometimes felt more urgently in the ICU.

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Patient Satisfaction and Nursing: Listening Matters, Whatever the Situation

August 7, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. Her last post on nursing and patient satisfaction surveys is here.

by runran/Flickr Creative Commons

by runran/Flickr Creative Commons

During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

Listening Carefully About Patients
“Her crit is dropping with each bowel movement, and she just won’t stop bleeding,” said my night shift colleague during the early moments of my shift.

As soon as she finished telling me the rest of my new patient’s care, I got on the phone for the ordered blood. Waiting for the first of many products to be delivered, I went to see her. As I poked around the hanging drips and fluids, checking dosages and orders, setting alarm limits, I heard my patient’s voice:

“Hello, hello? I’m so anxious. I just fell asleep for a moment and now I’ve woken up and I’m terrified. I think I need to be changed again, and I just don’t know what to do, and who are you?”

My colleague, busy with the details of resuscitation, hadn’t said much about my new patient’s anxiety. Anxiety, too often coded as neediness, is clinically important, especially in a patient with questionable stability, and doubly in a patient whose nurse must focus on speedy resuscitation more than handholding. I braced myself for what felt, just then, like an extra factor in an already challenging situation.

“Good morning,” I told her. “I’m Amanda, your nurse. I’ll be caring for you today, and my most important priority is getting blood into your body, because I’ve been told that you’re bleeding quite a bit. We want to stabilize your blood volume and stop your bleeding. We’ll do that with blood products in your IV.”

Listening Carefully To Patients
I start most of my shifts listening first, and then telling, setting a plan of care for the day together with my patients. But I didn’t like the slight bluish tint to this woman’s skin , or her heart’s steadily increasing beat. Her blood pressure was holding, but (applying Maslow’s hierarchy), I believed that she needed blood more urgently than she needed comfort (and antianxiety medication was out of the question—the resident would never agree to anything that might drop her pressure).

As I prepared to help my patient turn in the bed, she sent a million words in response: anxiety, questions, doubts of my actions and capabilities. With an eye constantly on the heart monitor, I gave the tersest of answers, my worries seemingly confirmed when I pulled back the covers and found a pool of bright blood.

Blood products came, and I pumped them into my patient’s flat veins. I was the only one in the room and I worked silently as she talked. And talked. If I had been a more experienced nurse, I would have welcomed her talking as a sign that her blood volume was sufficient enough to carry oxygen to her brain, and I would have engaged her more fully, both as a means of assessment and as a way to relieve her anxiety. But I was entirely wrapped up in the physical realm—stopping the bleeding and resuscitating the volume. Read the rest of this entry ?


AJN in March: Post-ICU Syndrome, Workplace Conflict Resolution, Prostate Cancer Options, More

February 27, 2015

AJN0315.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss.

New program for postintensive care syndrome (PICS). With increased ICU survival rates, we are seeing more complex cognitive, physical, and psychological sequelae. The authors of “Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors” share how they created and implemented an evidence-based collaborative care program for ICU survivors to reduce morbidities that can affect their quality of life. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Helping men with localized prostate cancer make informed decisions. The information men receive at diagnosis of prostate cancer can be overwhelming. “Early Localized Prostate Cancer” reviews the multiple treatment options available for men with newly diagnosed, low-risk, localized prostate cancer and explains how nurses can help these men make informed decisions. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). Read the rest of this entry ?


Noise in the ICU: Terminology, Health Effects, Reduction Strategies, and What We Don’t Know

May 16, 2014

By Jacob Molyneux, AJN senior editor

Noise isolation headphones to use in loud environments

via Wikimedia Commons

I woke up this morning, as I do every morning now, to the sound of pile driving at a large construction site a block and half away on the Gowanus Canal. It shakes the earth and reminds me of the forges of evil Sauron in one of the Lord of the Rings movies. I once had a dog lose a good bit of hair when there was a pile driver for several months in the lot behind another apartment in Brooklyn.

The negative physical and emotional effects of excessive noise get an occasional mention lately in health reporting, but in New York City or along the remotest forest lane, the forces of quiet can seem to be in rapid retreat before an army of leaf blowers, all-terrain vehicles, diabolically amped-up motorcycles, huge TV sets, garbage trucks, helicopters, and the like.

Lest I sound like a total crank (I do have useful noise-cancelling headphones plus an Android app that offers such choices as white noise, brown noise, burbling creek, steady rain, crickets, and soothing wave sounds), there’s a reason for the preamble. Florence Nightingale herself called unnecessary noise “the most cruel absence of care which can be inflicted either on sick or well,” as is pointed out by the University of Washington researchers who wrote the latest installment of our column Critical Analysis, Critical Care.

“Noise in the ICU” looks at current research about the health effects of noise in the ICU, provides useful definitions of the terminology used when talking about sound levels, and considers strategies for reducing noise, as well as what still needs more study. The article will be free for a month (until June 15), so give it a look and see if it gets you thinking. After all, to quote the article again, “Studies have found that sound levels in the ICU continue to exceed WHO recommendations.”

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When the Preceptor’s Attitude Is a New Nurse’s Biggest Challenge

March 12, 2014

FirstPreceptorIllustrationHere’s the start of “My First Preceptor,” the Reflections essay in the March issue of AJN.

“Manage your day,” she told me, not for the first time, as if it had been my fault that one patient crashed yesterday just as my second one returned from surgery with a new set of orders. I could not be in two places at once, keeping track of two critical patients, making sure each one received the care she needed at the moment she needed it.

A new critical care nurse has a lot to worry about. It’s easy to feel overwhelmed, even when you’re actually doing a pretty good job. A preceptor can play a crucial role in helping a new nurse find her or his footing. As one might expect, however, some good nurses are not good preceptors. In this essay, the author describes her struggles to deal with the time pressures of her new job, along with her preceptor’s constant admonitions and disapproval.

This fraught nurse–preceptor relationship reaches a crisis point against a backdrop of life and death struggles. I won’t try to summarize what happens in the essay, since different readers may interpret it differently, depending on experience and temperament. But it’s definitely worth a read.—Jacob Molyneux, senior editor

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Preventing Delirium, The Luxury of Time, Things We Get Right, More: Nursing Blog Roundup

March 7, 2014

By Jacob Molyneux, senior editor

Here are a few recent posts of interest at various nursing blogs:

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

In the throes of nursing school: An intriguing little pastiche of a poem (does it qualify as a ‘found word’ poem?) can be found at a newish blog, adrienne, {student} nurse, in a short post called anatomy of a bath. In another post, she makes the following observations: “In nursing school, you are not driving the train…You absolutely must keep telling yourself that there is nothing wrong with you.”

Preventing delirium in the ICU: At the INQRI blog (the blog of the Interdisciplinary Nursing Quality Research Institute), a post summarizes some recent research on implementing a “bundle” of practices to increase mobility and reduce sedation in the ICU, all in order to prevent patient delirium, which is known to have many short- and long-term negative effects.

The luxury of time. At Love and Ladybits, the author gets a tantalizing glimpse of the quality of care she’d be able to provide if she had more time to spend with each patient. Of course, this “alternative reality” can’t last, but perhaps it can serve as a touchstone of sorts during more hectic times.

The past is present. At Head Nurse, there’s a somewhat rueful post about an unexpected encounter, years later, with the author’s least favorite nursing professor (“Everybody has one of those instructors–the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia”). Read the rest of this entry ?


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