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

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 […]

2016-11-21T13:06:16-05:00October 16th, 2013|nursing perspective, nursing research|2 Comments
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The Patient With No Name: When Nursing Illuminates Literature

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.

I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.

The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.

Other characters come […]

2016-11-21T13:08:53-05:00November 16th, 2012|nursing perspective, patient experience, Patients|4 Comments
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Can’t Even Think About It: An ICU Nurse’s Personal Taboo

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

The weekend was busy in the ICU; several critically ill trauma patients were admitted in quick succession and the unit was filled with grieving families. The air was heavy with tragedy and misery, and it was draining to work under such weight.

I had a single day off, which didn’t feel like enough, and when I returned to work there were new patients in the beds and the mood in the unit had drastically changed. Disarming, but not surprising; the ICU is always the same and yet different.

One of the young patients from the weekend had become an organ donor, which had been anticipated and was considered a positive outcome, relatively. In discussing the weekend events and the ways in which things had resolved, one of my colleagues mentioned that, if given the opportunity, she’d embrace the chance to go to the operating room with the organ procurement team. Her beloved niece had been an organ donor and she sees organ donation as a validation and continuance of life, an ultimate example of “paying it forward.” She takes great comfort in knowing that her niece did not die in vain; lives were saved. She’d like to see, firsthand, the workings of the surgical team as they extract the organs.

“I would never do that,” […]

2016-11-21T13:09:07-05:00October 10th, 2012|nursing perspective, Patients|4 Comments
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At the Terminus of Romantic Dreams, an ICU

It was early. The sun had yet to rise, but already the ICU was filled with stark fluorescence and beeping alarms. My patient sat alone and aphasic, helpless amidst the bustle of the unit. The day stretched long ahead of us.

The circumstances of Frank’s admission were unusual. The nursing report (conveyed with a snicker) was that, while vacationing in our coastal city with his mistress, he’d slipped away and visited yet another lady friend. While engaged in an “intimate” act, he’d hit his head on the coffee table and been knocked unconscious.

The paramedic’s report backed up that version of events, but Frank’s admission CT scans of the brain weren’t consistent with head trauma. Instead, a vascular abnormality was found. He’d suffered two seizures since admission to the hospital.

That’s the start of “The Love Song of Frank,” the Reflections essay in the May issue of AJN. Click on its title to read the entire essay (and, once there, perhaps click through to the PDF version for the best read). 

Those of you who know the T. S. Eliot poem “The Love Song of J. Alfred Prufrock” (beautifully spun, and a favorite of bookish adolescents for its highly quotable and world-weary take on conventional society) will recognize the irony in the title.

But the essay, by ICU nurse and regular AJN blogger Marcy Phipps, stands on its own in its sympathetic but unsentimental description of a nurse’s encounter with a man who’s reached the limits of […]

2016-11-21T13:10:15-05:00April 26th, 2012|nursing perspective|3 Comments
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The ‘Inexhaustible Well’: Notes from a Trauma Nurse on Mortality

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

Years ago, long before I was a nurse, I read The Sheltering Sky, by Paul Bowles. He speaks of the tendency of people to take life for granted, and says that in the unpredictability of death there lies a presumption that everything is limitless:

“Because we don’t know when we will die, we get to think of life as an inexhaustible well. Yet everything happens only a certain number of times, and a very small number really. How many more times will you remember a certain afternoon of your childhood, an afternoon that is so deeply a part of your being that you can’t even conceive of your life without it? Perhaps four, five times more, perhaps not even that. How many more times will you watch the full moon rise? Perhaps 20. And yet it all seems limitless.” 

Lately, especially at work, that quote has edged forward and lingered with me. The ICU I work in is primarily devoted to trauma, but there’s been a recent shift in patient demographics. Last week I took care of only one trauma patient—an athlete who’d […]

2016-11-21T13:10:16-05:00April 19th, 2012|Nursing, Patients|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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