I started teaching online in 2003 and as I grew into the role of an online instructor a lot of things began to change for me. My teaching (both online and face-to-face) became more active, placing my students at the center, and my views about how people learn also began to change. Last spring, I […]
The risk of spreading disease through the proliferation of pathogens is a real concern in the hospital setting. The current narrative in infection control focuses in hand washing as a primary and first line of defense in preventing the transmission and spread of pathogens. But should health personnel focus only on hand washing as a tool to combat the spread of pathogens? In the ICU ventilators are common. While these devices are crucial in sustaining life, they are also possible sources of life threatening diseases. An interesting study by researchers in Taiwan suggest that frequently disinfecting the surfaces of ventilators with 75% alcohol could significantly reduce the spread of pathogens.
As nurses, we are acutely aware of the possibility of our patients contracting bloodstream infections and ventilator associated pneumonia. Microorganism such as E-coli, C-diff, and Stpahylococcus aureus grow and proliferate on environment surfaces. In the study the authors assessed the effectiveness of using 75% alcohol and found out that this particular solution is quite effective in combating the offending microorganism. However, the study also postulated that without proper hand hygiene the effectiveness of the disinfectant was compromised. One suggestion that the authors made was to use sterile gauze to wipe 75% alcohol on ventilator surfaces.
Reference:
http://web.a.ebscohost.com.summit.csuci.edu:2048/ehost/pdfviewer/pdfviewer?sid=cbe5062b-d583-423c-bcaf-747e1afdd9ab%40sessionmgr4001&vid=0&hid=4101
Summary: Prolonged sedation and paralytic therapy has negative effects on patients. One of the negative effects is delirium which is associated with hallucinations and nightmares. This delirium leads to devastating and long lasting effects on cognitive function. Several studies have identified positive effects by attempting wean patients off of stronger medications to milder ones that provide the same benefit and getting them ambulating earlier even if its a few steps.Pros for changing sedation methods: Reduce delirium, reduces depression, reduces anxiety, and reduces muscle wasting. Cons: Risk of self injury by pulling out ET tube, tracheotomy tube, and/or, IV lines.
Agree Or Disagree? : I agree with this article. Especially, after watching the video of the patient in the ICU’s personal account of his ordeal. I am sure in his case this wasn’t an option since his case was so severe. I feel the positive effects out weigh the possible negative outcomes.
The article I had was titled, “Informed Patient: Changing the Sedation Status Quo in the ICU,” by Laura Landro. The article talks about changing the treatment methods in the ICU to improve patient outcomes. The new approach includes waking patients from sedation to assess pain and getting them to breathe on their own as soon as possible. This gives the patient a break from being in delirium for too long which can cause effects on cognitive function. Also, by lowering exposure to potent sedative medications and shortening the duration of delirium in the ICU, this can prevent some part of brain injury. Lastly, getting patients up and moving even when on ventilator can prevent muscle weakness.
I agree with these new methods because I feel that this will shorten the length of time in the ICU and ultimately get the patient to a healthier state sooner, and that is always our goal.
The next steps are to gel the senior nurses to adapt to these new methods as the article states that they are having trouble with this. To help with this new graduate nurses are being trained with this new method in the ICU.
– Brittany Sandoval
According to the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV delirium is defined as “a disturbance of consciousness and cognition that develops over a short period of time (hours to days) and fluctuates over time.” Delirium is an all too common problem in the ICU and according to Girard, Pandharpande, & Ely (2008), “Delirium occur[s] in up to 80% of the sickest intensive care unit (ICU) populations.” Patients in the ICU share some common risk factors for developing ICU Delirium which, according to Girard, Pandharpande, & Ely (2008), include “exposure to sedative and analgesic medications.” To help reduce the risk of a patient developing delirium, factors such as sedatives and analgesia can be closely monitored and titrated. Girard, Pandharpande, & Ely (2008), also suggest “that all ICU patients be monitored using a validated delirium assessment instrumentmay be modified to reduce risk.” It is important to decrease the risk and the occurance of delirium in ICU patients because “delirium is now recognized to be a significant contributor to morbidity and mortality in the ICU…Patients with delirium have longer hospital stays and lower 6-month survival than do patients without delirium, and preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after after discharge” (Girard, Pandharpande, & Ely, 2008). As nurses we should be aware of the signs and symptoms of ICU delirium and attempt to implement assessment tools to monitor for this complication.
Girard, T., Pandharipande, P., Ely, E.W. (2008). Delirium in the intensive care unit. Critical Care 12(3).
The article I chose is called “Delirium assessment in intensive care units: practices and perceptions of Turkish nurses” by Aysel Özsaban PhD. The aim of the article was to identify current practices of intensive care nurses regarding the delirium assessment and to find factors that affect these perceptions. Being an ICU nurse is a very important job, it is different from any floor in the hospital. The patients are more critical and the nurse to patient ratio is more intimate. It is very important for a nurse to know how to do an appropriate delirium assessment. Data were collected from five Turkish public hospitals using a structured survey questionnaire. The study sample comprised 301 nurses who agreed to participate. Data were analysed using descriptive statistics. Results showed more than half of the nurses performed delirium assessments. However, the proportion of nurses who use delirium assessment tools was quite low. Almost all of the nurses perceived delirium as a problem and serious problem for ICU patients. The patient group least monitored for delirium was that of unconscious patients. While most nurses know the importance of doing a delirium assessment and understand this is a serious problem, the proportion of those who perform routine delirium assessments was less. It was found that delirium assessment practices of nurses were affected from their perceptions of delirium and the implementation of patient-centred care delivery.
I would say that I agree with this article because in nursing school we are taught that doing a good assessment could make a difference in the care that we provide for a patient. Just because most of the patients we do a delirium assessment on are sedated, does not mean we have to skip important steps. Steps needed to reduce this problem is to teach nurses the correct way to do this assessment and the importance of it. There should be classes that help nurses understand and comprehend what exactly they are assessing for.
Thank You, Ashleigh
http://onlinelibrary.wiley.com.summit.csuci.edu:2048/doi/10.1111/nicc.12127/full
Scroll to top