Posts Tagged ‘ICU’

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What’s That on My Stethoscope?

August 1, 2011

by rosmary/via Flickr

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer for this blog.

The long shifts in the ICU are often chaotic. The days are packed with procedures, “road trips,” transfers, and admissions. The high acuity of our patients adds to the emotional intensity, and even the relatively smooth days are busy. Assessments, medication administration, and charting are all pressing and time sensitive, and there are a lot of strong personalities among us, resulting in occasional combustible strife.

Nursing is a high stakes occupation, no matter the unit, and the stress can be overwhelming. I’m grateful to work with a group of nurses who have excellent senses of humor. The levity provided by a quick laugh can be priceless, and sometimes a pointed stare or quick comment provides an essential release to a tense and pressurized situation.

Lately, along with our usual quips and sideways jokes, we’ve been inventing new nursing games with compelling names. They’re spur-of-the-moment games, usually inspired by whatever’s currently happening. My favorite, so far, is “What’s that on my stethoscope??”

The answer? On this day, it was a drop of mannitol, which had dried into an unusual crystalline pattern. We came up with a lot of other possibilities, though. At the time, we found the game to be hysterically funny.

But mostly, we welcomed the chance to shift our focus, for just a second, to a situation that had no stakes at all.

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Laundry

March 10, 2011

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

An eager third-year BSN student was assigned to me yesterday. After introducing herself, she told me quite enthusiastically that she’d already decided she wanted to work in a trauma ICU after she graduated.

I love that. I remember feeling just as wide-eyed and excited as she looked. And I like having students with me, especially ones who are so teachable that they soak up everything around them like a giant sponge.

My student’s willingness to do “everything” served her well, as far as learning experiences go, and she approached tasks without trepidation. She was elated with success (insertion of a nasogastric tube) and mortified with failure (insertion of a rectal tube; she actually vomited). There were moments of fascination (touring the ICU and helping settle in a trauma admission) and boredom (attending a pain management process improvement meeting).

There was also frustration; at the end of the day, she ruined her new scrub top with a spill of dark orange rifaximin.

by adria richards/via Flickr

I’m not sure what her favorite part of the day was (although I’ll bet it was her nasogastric tube success), but my favorite part of her day was overhearing a member of the SWAT team, who was armed and stationed at the bedside of a nearby patient, tell her, in all seriousness, that Dreft laundry detergent would be her “best bet” at getting the medication stains out of her scrubs.

Now, I suppose that SWAT team members, like nurses, have a lot of first-hand experience in getting unusual stains out of work attire, but I must admit I’ve never given the matter much thought. I don’t think of tough guys doing laundry. I never imagine tough guys in the detergent aisle, shopping for Dreft.

I didn’t get to ask my student if she still wanted to work in the ICU, as she was running late for her post-conference, but I’ll bet she still does.

It’s not always pretty, but I can’t imagine someone not wanting to work in a place where rectal tubes and SWAT team laundry advice are punctuations in an otherwise ordinary day.

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Hour of Lead

January 10, 2011
originally uploaded on en.wikipedia by Wragg a...

Image via Wikipedia

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

Last week two of my patients died. This alone is not unusual in the ICU. What makes it feel different  is that I’d cared for each of them enough times to develop a solid sense of them and had come to know their families well. They died on consecutive shifts and their contrasting situations, coupled with their proximity in time, have left me unsettled. Poems of Emily Dickinson skitter through my head . . .

I reason, Earth is short-
And Anguish-absolute-
And many hurt,
But, what of that?

The first was a girl who’d fallen and hit her head. She’d been healthy, young, and strong, but it was a devastating blow. Her parents were dazed with shock. As a nurse I was up to the medical tasks, but the “mother” side of me was overwhelmed by their tragedy. When she died I slipped out and left them with the chaplain, lest I crumple into a puddle on the floor.

I reason, we could die-
The best Vitality
Cannot excel Decay,
But, what of that?

My other patient had fallen, as well, but he’d lived a full life and reached an advanced age. As pale and fragile as a baby bird, he lay in quiet dignity and peace. His family gathered around him and held his hands, each of his breaths drawing longer apart and shallower until he slipped away as gently as a morning star fades with the breaking day.

When the elderly man passed there was a prevailing sense that all was as it should be. That “rightness” did nothing to assuage the feeling that the young girl’s death had been unjust. If anything, the contrast made her death seem crueler. Ironic (and unfair), that the one who should have been the strongest was the most delicate, in the end.

I’ve been home from work for days—and plagued with this. At home I have more time to dwell on life and death, and on what seems fair. But instead of searching for resolutions that clearly aren’t mine to find, I’ll write to clear my head, then leave the ruminations to the poets.

I reason, that in Heaven-
Somehow, it will be even-
Some new Equation, given-
But, what of that?

(Indented excerpts are from Emily Dickinson, poem #301)

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No Explanation Required: A Preceptor’s Tale

October 20, 2010

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN. She has also contributed a number of thought-provoking posts to this blog (here’s the most recent).

puddle reflection/by joiseyshowaa, via Flickr

I’ve been precepting a new ICU nurse intern, which I generally enjoy doing. The only downside (from the preceptor’s perspective) is that I’m obliged to call ahead and request “unstable” assignments. This is meant to enhance the clinical aspect of the internship, and it definitely does.  Considering that I work in a trauma center, though, reserving the sickest patient in the unit feels a bit like ordering up a large serving of chaos. And although I can request the assignment, I can’t predict what will be learned.

Our most recent patient was a new admission with a traumatic brain injury. At the start of our shift he had a grim neuro prognosis and was hemodynamically unstable. His condition deteriorated throughout the day and he was eventually diagnosed as brain-dead. His family chose to donate his organs.

Taking care of an organ donor is difficult. Brain-dead patients are inherently unstable, yet certain parameters must be maintained to ensure adequate organ perfusion. It’s tedious and meticulous.  It also requires a shift of perspective—ironically, even though the patient is legally dead, the medical interventions are aggressive and the stakes feel higher than ever. Despite the fact that for the patient, at least, there is nothing left to lose, the potential organ recipients weigh heavily on our minds. Read the rest of this entry ?

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‘I Can Still See the Fear in Her Eyes’: An ICU Nurse Faces a Surprising Reversal of Roles

October 9, 2009

It was a typical day in the ICU. I was wrestling with the numerous tasks I had yet to do, wondering how I would get them all done. I had three patients, I needed to draw blood gases and give my afternoon medications, and the charge nurse had just informed me that I needed to transfer one of the patients to the step-down unit-we were in a crunch for beds, and patients were waiting in the ED.

I still had a total bath and bed change to do, but the family members were in the room of the patient I needed to bathe. I had politely asked them to step out for a few minutes so I could finish my work. Now I gathered my supplies and went to the room, hoping they would take the hint.

I can’t remember her name, but I can still see her face and the fear in her eyes—and in the eyes of her family every time her cough triggered the alarm or she grimaced in obvious respiratory distress. She was on the ventilator—and much too young to be dying of breast cancer.

OctoberReflectionsSo begins the Reflections essay in the October issue of AJN. The essay is about how quickly roles can reverse themselves. It’s also about trying to strike a balance between efficiency and compassion; many nurses, we imagine, face some version of this challenge, if not so extreme, on a daily basis. Do you?

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