Posts Tagged ‘ICU’


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 ?


Not Compatible With Nursing

February 5, 2014

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

photo 1-1

Photo by the author

“His family knows this is not a survivable injury, right?”

This question, posed to me in the doorway of my patient’s room by a trauma surgeon I regard as brilliant, caught me off guard.

“No,” I said. “They don’t know that.”

He frowned at me, mumbled something about false hopes, then moved away to continue his rounds.

This wasn’t the only physician who’d expressed a strong opinion regarding my patient’s mortality—a consultant had deemed his injuries “not compatible with life.” But I’d been caring for this man, as a 1:1 assignment because of his high acuity, for every shift for weeks. It seemed obvious to me that my patient’s continued presence in the ICU—and his relative stability on that particular day—directly opposed the dire predictions. The man’s family did not see his situation as hopeless, and neither did I.

And yet days after the surgeon uttered those words, my patient suffered a complication and became so unstable that for hours he teetered between life and death. The resuscitation effort was massive—and no one mentioned survivability. No one behaved like there was even a shred of futility in bringing to bear the full force of medical interventions. I never left his bedside, determined that, if my patient were to die, it would not be for a lack of vigilance and intervention on the part of his nurse. Read the rest of this entry ?


Why Don’t We Pay Attention to Oral Care in the ICU?

October 16, 2013

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

“Although meticulous oral care has been shown to reduce the risk of ventilator-associated pneumonia (VAP), oral care practices among critical care nurses remain inconsistent, with mouth care often perceived as a comfort measure rather than as a critical component of infection control.”

scanning electron micrograph of Pseudomonas aeruginosa bacteria, one several types that can cause VAP/CDC

Scanning electron micrograph of Pseudomonas aeruginosa, one of several bacteria types that can cause VAP/ CDC image

So begins one of our CE feature articles in the current issue of AJN. In “Mouth Care to Reduce Ventilator-Associated Pneumonia” (which you can read for free), the authors discuss why mouth care is so important among the interventions to reduce VAP—and why it is often not given a high priority among patient care procedures.

I have to confess that in my clinical days, mouth care was done almost as an afterthought. In our critical care unit, we were always diligent in monitoring vitals signs and IV fluids, suctioning, turning and positioning the patient, but oral care usually was a perfunctory task, completed with a few quick swipes with lemon-glycerine swabs.

Booker and colleagues explain why oral care deserves the careful attention we give to other measures. They also review the research on barriers to our providing this care. Many nurses are simply unaware of the connection between oral flora and subsequent development of VAP or the importance of addressing oral hygiene in the first few days after admission. This article is an eye-opener.

In addition, the authors include an evidence-based, step-by-step guide to providing oral care for intubated patients. Read the rest of this entry ?


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