Losses: In Search of an Honest Prognosis

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Several years ago I took care of a lady who’d suffered a small cerebral hemorrhage after falling and hitting her head. She was in the ICU for several days. Her husband stayed at her side constantly, and he became a part of a never-ending loop in which she would wake up startled to be in a hospital, and then notice her husband and ask him where she was and what had happened.  He’d hold her hand and gently relay the events of her injury, after which she’d react with mild surprise, every single time. Then she’d close her eyes and doze until she woke up to reinitiate the same conversation.

Her husband, after days of patiently playing his role in this repetitive scene, was clearly wearing down. He waited anxiously for the neurosurgeon, expecting explanations and hoping for reassurance.

When the neurosurgeon rounded later that day I heard him speak at great length about the details of her injury and the treatment plan. He ultimately advised that, although he thought she’d recover well, only time would tell.

Her husband wanted more […]

2016-11-21T13:10:27-05:00March 19th, 2012|patient engagement|1 Comment
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A Role to Live Up To

By Kinsey Morgan, RN. Kinsey is a nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her previous posts on working as a new nurse can be found here.

Now in my sixth month as a new nurse, I find every day that there is something new to learn, figure out, or adjust to. The constant stimulation and challenge is part of what makes me love being an ICU nurse.

Recently I was exposed to the simple yet powerful fact that being a “unit nurse” carries more weight than I’d thought. During a code blue on the medical–surgical floor a few weeks ago, I was performing CPR when it became necessary to initiate a dopamine drip to support a failing blood pressure.

One of the medical–surgical nurses spiked the bag and connected the tubing and proceeded to tap me on the shoulder and ask me if he had correctly entered the dosage of dopamine into the IV pump. Time stood still for a split-second while I contemplated the weight of this question. Though my mind and body quickly returned to the task at hand, the implications of that question haven’t left me yet.

The nurse who asked has been an RN for several years and has a lot more experience than I have. In reflection, I am honored and humbled by his trust. Not having encountered vasoactive drugs very often in his practice, this nurse […]

2016-11-21T13:10:35-05:00February 28th, 2012|career, nursing perspective|1 Comment
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Second Chances

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

by patchy patch, via flickr

I first met Ella (name and some details have been changed) when she was my patient in the intensive care unit. She’d been riding in a car she wasn’t supposed to be riding in, heading to a party she wasn’t supposed to be going to, high on drugs and not wearing a seatbelt when she was involved in a high-speed crash that left her with broken bones and internal injuries. She was in the ICU for more than a month.

Her situation wasn’t that remarkable. Ella could easily represent a common category of ICU admissions—the young adult who is often described by her parents as a “good girl,” yet who lives wildly, fearless and flip, taking risks as if consequences will never apply. I feel particularly protective of these patients, mostly because I relate to them, on some level. I remember the sense of invincibility that came with youth, and when I’m caring for these girls I often marvel at consequences I avoided in my own life. I shake my head at my younger self, alternating […]

2016-11-21T13:11:05-05:00January 3rd, 2012|nursing perspective, Patients|5 Comments
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Reading Between the Whiteboard Lines in the ICU

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

My hospital uses dry-erase whiteboards as a tool to communicate with patients and family members. Mounted to the walls in the patients’ rooms, the boards are prominent and concise.  Aside from a lot of basic information, notes get added to the board when diagnostic tests are completed, when complementary therapies have been implemented, and when housekeeping staff visit. The “meat” of the board, however, is the section that addresses plans and goals for the day. The plans and goals are updated and modified continuously by nursing staff. They’re specific to each patient, yet, despite their personalization, the goals for ICU patients tend to fall into distinct categories.

The first category includes goals which are often set by the patients themselves. They tend to require a certain amount of collaboration and active participation. These types of goals, which include things like “maximize incentive spirometer use,” “ambulate,” and “advance diet,” imply a relatively healthy state and tend to predict transfer orders.

The next type of goal is aimed at restoring health and stability. These goals don’t necessarily require patient participation and often focus on pathophysiologic processes. On the whiteboards of these rooms, the listed goals are likely to include things like “wean ventilator,” “control agitation,” “control fever,” or “increase level […]

2016-11-21T13:11:09-05:00December 15th, 2011|nursing perspective, Patients|3 Comments
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On Protocols, Shortcuts, and the Unforgettable Smell of Ether

By Linda Johanson, EdD, RN, associate professor of nursing at Appalachian State University, Boone, NC

In nursing school my professors warned us of the dangers of taking shortcuts when performing procedures. They cautioned that deviations from protocols could lead to serious error. I had to learn this lesson the hard way, and although it’s been about 30 years since I made this mistake, I still remember the occasion like it happened yesterday.

The patient was in ICU bed #10, a glassed-in isolation room across from the nursing station. He was in his mid-60s, but he was mentally handicapped, so he appeared and acted younger. He was in the unit recovering from a respiratory arrest, and on the day I was caring for him he was still intubated, but breathing spontaneously.

I was completing an assessment on him when the charge nurse called to me from the nursing station, and I stuck my head out the door to see what she wanted. She told me there was a new order to remove the patient’s indwelling urinary catheter. I checked my pockets for a 10 mL syringe to perform the procedure but didn’t find one.

When I complained about having to go all the way to the supply room to collect one, the charge nurse queried, […]

2016-11-29T13:29:41-05:00November 9th, 2011|nursing perspective|9 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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