Thoughts on Preventing Delirium During an ICU Stay

It’s well known that an ICU stay presents several risks to patients, whatever their reason for needing critical care.

  • Various infections are more likely to develop than in other care units.
  • Intense drug therapy can result in adverse drug interactions.
  • The excess stimulation and (often) windowless rooms increase the risk for delirium and its consequences.

Would you do anything to protect your own health if you knew that after surgery you would be spending time in an ICU?

In this month’s Viewpoint column, author Patricia Gavin describes how she coped with her own ICU stay, which she knew in advance would be part of her post-op care:

“…when I realized I would be there for a few days, I decided to create
my own ‘care plan’ to stave off delirium and its adverse outcomes.”

Does it help if the patient knows her own risk factors?

She goes on to explain what she knew about her own risk factors for delirium, and the things she could do to stave off the complication during this stressful time.

And she notes how one nurse made a particular difference in helping her to get through her stay without cognitive complications. Gavin reminds us of the practical strategies that nurses can employ, beginning with, […]

2019-09-26T10:31:05-04:00September 26th, 2019|Nursing, patient safety|0 Comments
Read More

Approaching Ostomy Care with Confidence

A first experience of as a nursing student.

I encountered my first stoma as a nursing student and the incident is seared into my memory. It was in the first semester of my medical–surgical nursing course. The patient was a middle-aged man three or four days post-op after a colon resection. I was very nervous, but figured my instructor would know what to do. My stomach dropped when she confessed that she was not all that familiar with stoma care but was confident we’d figure it out with some help from the staff.

Fortunately, the head nurse of the surgical ward (I’m dating myself: yes, it was a ward and yes, her title was head nurse, not nurse manager or patient care coordinator) was very experienced with new ostomy care. She helped both of us gather the correct supplies and briefed us on what to assess and do. We were able to competently change dressings, change the ostomy appliance, and make the patient comfortable. However, I don’t think I encountered another patient with an ostomy until a few years later. By then my knowledge had faded. I had to seek a refresher.

Stoma assessment and common complications.

Photo by Amelie-Benoist / BSIP / Alamy.

I am very pleased that Susan Shelton […]

2019-06-11T11:56:29-04:00June 11th, 2019|Nursing|0 Comments
Read More

Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact […]

2018-06-12T12:53:06-04:00June 12th, 2018|Nursing, nursing research, patient experience|1 Comment
Read More

Palliative Care: Often Overlooked in the ‘Acute’ Setting

Does this description of a patient sound familiar to you?

“… a 91-year-old man diagnosed with moderate Alzheimer’s disease, hypertension, and benign prostatic hypertrophy whose change in mental status has prompted hospitalization from a long-term care facility…. This is his third admission in five months with similar symptoms; each time he was given IV fluids and sent back to the long term care facility within a few days.”

Figure. Photo © Photofusion Picture Library / Alamy Stock Photo.

With minor adjustments in age, gender, and the exact illnesses involved, this paragraph describes patients that I cared for on a regular basis in a large medical center. I always found such patients frustrating, and sad. I was frustrated because it seemed all we could do was “patch them up,” send them back to the nursing home, and wait for their inevitable return; and sad because there seemed so little quality of life to reach for.

In AJN’s September issue (“Palliative Care […]

2017-10-02T08:33:17-04:00October 2nd, 2017|Nursing|1 Comment
Read More

The Words We Use to Talk About the Act of Suicide

    marie + alistair knock/flickr creative commons

Suicide. A dear friend of mine died this way almost 40 years ago, leaving behind a beautiful six-month-old boy and a beloved and loving husband. I have never given any thought to the way we friends and family refer to her death. Then last week, I came across a 2015 blog post by the sister of a man who died in the same way.

In the post on a website that shares experiences of disability and mental illness, former hospice social worker Kyle Freeman argues that this term suggests criminality. She points to laws in the U.S. that, until a little more than 50 years ago, defined suicide as a criminal act. Kyle feels this history has perpetuated a sense of shame and embarrassment in survivors.

“…the residue of shame associated with the committal of a genuine crime remains attached to suicide. My brother did not commit a crime. He resorted to suicide, which he perceived, in his unwell mind, to be the only possible solution to his tremendous suffering.”

Kyle believes that the common use of the phrase “committed suicide” is not only inaccurate but can add to the suffering of those who have lost friends or family in this way. She prefers the term dying by suicide. […]

2017-09-15T09:29:16-04:00September 15th, 2017|family experience, patient experience|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top