What it means to have a digital identity?

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  • What it means to have a digital identity means to have a presents on social media and social media sites, but in a way that is more personal than just having a basic presents on the internet like an e-mail . Digital identity is personal because we share our thoughts, personal information, pictures, videos, and more. A digital identity is also used differently because we interact on the web different than we do in person.  This is what makes-up a digit identity.
  • A statement in the readings and the videos that surprised me was that you should never give your full birth date, and that most people don’t check privacy settings. It surprised me that I should be more careful on who sees my birth date because I usually never think about giving a false birth date to protect myself. Also that most users look over the privacy settings, the settings that are suppose to make our status more private or safe.
  • There is an increasing presents of social media for not just individuals but businesses as well. I think since businesses are increasing their media usage  they are also looking at future employee’s social media activities and status. For employers it could tell a lot or very little about a person. It could be difficult for one who enjoys posting what they like and saying what ever comes to mind, because some argue that the person on social media is not the same person in reality. Those who keep a positive status give the employer insight on the person their interviewing is similar to the person online.  Also the readings recommend to get involved with social media and post at least once a month. However, check your status frequently, see what people are posting on your wall, and what pictures people are posting of you. It causes one in leadership to  be constantly aware of how their digital identity can determine how an employer can feel about them.
  • I plan to create a positive digital identity by watching what people post on my walls, and if the content is inappropriate then I will remove them. I will have a user name that is professorial and every now and then check my privacy setting.

Week 4 Discussion: ICU Delirium

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Hello all!

I think that topics related to ICU such as ventilators, sedation, safety, and ICU delirium are all very interesting. I wanted to explore the effects of sedation medications on patients in the ICU. The question I had is if there was a reduction of sedation medication administered to ICU patient would there be a decrease in ICU delirium overall?

There were a couple articles I found that related to the about my subject of interest about effects of sedation medications on patients in the ICU. In the article, Fluctuations in sedation levels may contribute to delirium in ICU patients, the authors, Svenningsen, Egerod, Videbech, Christensen, Frydenberg, and Tønnesen (2013), conducted a prospective study of adult patients at three multidisciplinary ICU with an aim to investigate the impact of fluctuating sedation levels on the occurrence of delirium in the ICU, (p.228). The authors addressed that delirium is a serious complication for patient in the ICU and could possibly increase mortality and morbidity, (Svenningsen, Egerod, Videbech, Christensen, Frydenberg, and Tønnesen, 2013, p.228). Svenningsen et al. (2013), went onto emphasis orthodox treatment of ventilated ICU patient involves deep sedation with the goal to reduce anxiety, pain, and stress but in the past decade treatments have shifted and more focus is now on moving away from deep sedation because it has been proven “…daily interruption of continuous intravenous infusions of sedatives decreased the duration of mechanical ventilation, length of ICU stay, and length of hospital stay”, (p.228). In the study, Svenningsen et al. (2013) used the Confusion Assessment Method for the ICU (CAM-ICU) which is a tool used to assess presence of delirium among patients in the ICU and the authors used the CAM-ICU which they detected results of hypoactive, hyperactive, and mixed-type delirium, (p.228 & 292). Additionally, the authors concluded that, “…dosage, administration, timing, and choice of sedative agent may potentially influence delirium status in ICU patients”, (Svenningsen et al., 2013, p.292). Overall there are a lot of factors that can cause ICU delirium in patients, which can increase the length of stay and possibly the mortality rate for ICU patients but by utilizing the new treatmentss of reducing sedation levels in ICU patient or even stopping sedative agents the risk of developing delirium can be greatly reduced and better outcomes for patients can be achieved.

Furthermore, another example of new treatment for ICU patient was seen in the video, Patients and Aging Brain Problems, where Dr. Wes Ely discussed about how a team of physicians, which including himself got funding for a study so they could do a multicenter investigation where they called it the “ABC” approach or the awakening, breathing, control trial. What they were essentially doing is waking patients up, seeing if they can breath, and then liberating them from the life support. Dr. Wes Ely explained, in the study half the patients got a standard approach where their drugs were targeted to the exact level the doctors and nurses thought they should be and the other half of the patients got that targeted drugs regimen but on top of that they overlaid a mandatory rule that as long as some safety criteria were met they stop the drugs cold everyday. At first staff was a little hesitate to stop the drugs cold everyday but it turned out that they cut the drugs by 50% and there was no increase in pain or bad dreams or awareness of bad memories and despite non of those problems the physicians found a huge difference in length of stay and death rates. Dr. Wes Ely was excited to reveal that the results of the study was the length of stay was four days less in the ICU and the patients were 15% less likely to die.

Lastly, I wanted to share with everyone a video published on October 2, 2012 I found that I believe was informative and also touched on the different types for sedative agents to consider when sedating patient in the ICU. It also talks about how the new idea of sedating patients less has been proven to decrease ICU delirium in patients. The video is from the Expert Commentary Series on Medscape and Dr. Shoor discusses how researchers look at the safety and efficacy of dexmedetomidine vs midazolam or propofol for long-term sedation of mechanically ventilated patients in the ICU. Click on this link to watch the video: http://youtu.be/D27WW0ya-78

 

In conclusion, I am very interested in this subject of ICU delirium and effects of sedation on ICU patients. I believed I learned a great deal from the articles and video I found about the subject and I hope you too enjoy reading and watching them as much I did. I think that the new treatments of reducing time spent on sedative agents and the ventilator while really increase a patient’s quality of life after their hospitalization in the ICU. In the article, Informed Patient: Changing the Sedation Status Quo in ICU, from the Wall Street Journal’s Health Blog, the author, Laura Landro, also discussed about the new treatments hospital are utilizing in the ICU that consist of decreasing the duration patients spend heavily sedated and on a ventilator. Landro (2011) expressed that this new treatment that includes waking patients from sedation, assessing their pain level, and aspiring to have patients breathe on their own sooner all show that heavily sedated ICU patients often suffer from prolonged delirium that can have devastating and long-lasting effects on cognitive function, (2nd paragraph). As all the articles and videos have answered my questioned and I have learned that the new treatment of reducing time the ICU patient is sedated and on a ventilator the less likely the will have ICU delirium and lasting cognitive dysfunction. I completely agree with this new treatment and am happy to see medicine go in a direction that has the patient’s quality of life post-ICU in mind.

Thank you for reading my post :)

Take care, Emily

References

Ely, W. (2013, January 1). ABCDEFs of Prevention and Safety: Patient and Aging Brain Problems. Retrieved January 29, 2015, from http://www.icudelirium.org/

Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved January 29, 2015, from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/

Sedation in the ICU: Comparing 3 Drugs for Safety, Efficacy. [Video]. (2013). USA: Georgetown University. http://youtu.be/D27WW0ya-78

Svenningsen, H., Egerod, I., Videbech, P., Christensen, D., Frydenberg, M., & Tønnesen, E. (2013). Fluctuations in sedation levels may contribute to delirium in ICU patients. International Journal of Anaesthesiology and Intensive Care, Pain, and Emergency Medicine., 57(3), 288-93. Retrieved January 29, 2015, from CINAHL Plus with Full Text. DOI: http://dx.doi.org.summit.csuci.edu:2048/10.1111/aas.12048

Who Are You Online?

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To have a digital identity is to have an online presence through social media.

I found it rather high that 8% of companies had fired an employee over abusing social media. I find this odd because I find it hard to believe that many people were in a position to abuse their power through means of social media

Because I am seeking a leadership role on campus and potentially in the political realm I need to hold myself to a higher standard and be very selective when it comes to the content I allow to become public.

I plan to create a positive online identity by being careful and vigilant of what I post and what I allow others to post that may affect me.

Looking forward to seeing your thoughts!

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Hey Students!

Don’t forget to complete your work due tonight for our class. I’m looking forward to seeing your thoughts on creating a digital identity; I encourage you to think outside of the box here… don’t just think about how to post “appropriate” pictures and protect yourself.  What can you do to make the MOST use of the web for establishing your digital identity?

 

Don't forget

CI Computer Girls volunteering at The Great Race of Agoura Hills on March 28!

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CI Computer Girls were invited to volunteer in The Great Race of Agoura Hills, which in its 30th edition, is one of the largest running events in our area with the goal of raising money for elementary schools. If you would like to participate as a runner here is the registration information: http://greatraceofagoura.com/register/ – the registration closes on February 6th.

CI Computer Girls will have a table at the water station on Mile 8 (intersection of Paramount Ranch and Cornell) from 6:45 to 10:30 am.

Hello world!

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Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Discussion #4

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Discussion #4

Pain management in sedated and mechanically ventilated patients is always something that has interested me. Though we have scales and modalities through which we assess and manage pain in patients that aren’t coherent, it seems impossible that they are all completely foolproof in terms of accuracy and effectiveness.

Additionally, according to a 2013 article, these treatments may also have a negative effect on patient outcomes. I read an article titled Pharmacological Management of Sedation and Delirium in Mechanically Ventilated ICU Patients: Remaining Evidence Gaps and Controversies. This article explored the treatment of pain, anxiety, and delirium (PAD) in ICU patients. The authors assert that, drugs once thought to have a been effective in reducing PAD have been shown to have either little benefit, the potential for significant risk associated with any benefit, or in some cases, the potential to worsen patient outcome (Devlin et al., 2013).

The article provides health care practitioners with background on the most important areas of delirium pharmacotherapy in the ICU,  information on the recent evidence based practice surrounding the treatment of PAD, and discusses areas in relation to this topic that require further investigation or study. The recommendations are all based on the Critical Care Medicine (ACCM) Pain, Agitation, and Delirium Clinical Practice Guidelines.

The guidelines include recommendations such as giving patients daily sedation interruptions while in the ICU; titrating medications to induce a light sleep as opposed to deep sedition, in addition from drug specific recommendations to guide health care practitioners.

The article stresses the importance of closing the gap between evidence-based recommendations and current PAD management practices. In order to achieve these guidelines as well as the many others suggested, the authors suggest a multi-faceted, interdisciplinary approach. They stress the importance of facility specific protocols for PAD management in addition to standardized order sets. The article concludes by saying that in order for the ACCM guidelines to be achieved and patient outcomes to be improved, comprehensive staff accountability and consistent patient education is vital.

 

Devlin, J. W., Fraser, G. L., Ely, E. W., Kress, J. P., Skrobik, Y., & Dasta, J. F. (2013). Pharmacological management of sedation and delirium in mechanically ventilated ICU patients: remaining evidence gaps and controversies. Semin Respir Crit Care Med, 34(2), 201–215.

 

Informed patient: Changing the Sedation Status Quo in the ICU

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This article spoke about the changes being done to decrease the length of time patients are sedated and immobilized on a ventilator. The article had mentioned that the longer a patient is immobilized and sedated the more likely they will experience delirium which can cause them to suffer from long-term effects of decreased cognitive function. Being immobilized, and heavily drugged with sedatives and paralytics could leave a person depressed, stressed, and suffer with extreme physical limitations. They had given an example of a patient that had received paralytics (however it was not mentioned how long he was on this drug) that had survived and was in a wheelchair because it had taken him 2 years to learn how to walk again. How devastating that could be for people. Knowing that you were capable of walking by yourself, then you wake up days, weeks, or even months later not knowing how to walk because of drugs given to you as well being immobilized the whole time you were hospitalized.  The article spoke about adopting strategies to wean patients off of their sedatives and paralytics and never putting them back on it once they are weaned off. I agree with this idea but wonder how they would deal with unstable patients with extreme conditions. How would they know when to start weaning them off (does their condition warrant otherwise?) Getting them up out of bed is a great idea even if it is just four steps to the chair. As long as they are not just lying in bed the other time they are there and being turned every 2 hours. I also think they should be provided ROM exercise a long with compression stockings on a consistent schedule . Just to get the blood following especially with them being immobilized they are at risk for DVTs so I’m sure lovenox will be administered as well.  What worries me is the veteran nurse who are hesitant to adapt the new changes because they are used to the old ways. How will hospitals deal with these nurses ? I think they need to continue teaching the new grad and other nurses who are on board to adapting the new changes and continue to persuade/convince/teach the older nurses that the change is for a better patient outcome in the long run. They are the ones that will have to live with the life-long effects of depression, constant stress and worry, and decreased cognitive functioning.

Insight on ICU Delirium

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To me, it is very scary to take care of a patient on a ventilator. To think that a machine is making the patient breath and keeping them alive is quite intimidating. I am sure it is a scary sight to witness a delirious patient while in an intense environment. Having to monitor critical patients when sedation vacation is happening could be very frightful especially when they start trying to pull out tubes, IVs, and foleys. I am absolutely for the mnemonic THINK solution. Where the components within the pneumonic is looked at when a patient is delirious. Toxic, Hypoxia, Immobility, Non-pharmacological interventions (clustering care, having hearing aids and glasses available) and the Potassium level are the most important factors that could tell you why a patient is delirious. Making sure these factors are not causing the patients delirium is very important. The video of the gentleman who was in the hospital for 22 days was very eye-opening. He stated he can remember these vivid nightmares like it actually happened. He remembers the 15 IVs in the constant worrying that he continues to go with on the daily basis. To be on paralytic and sedatives for so long can cause cognitive impairment. This gentleman is living with post-traumatic stress disorder (PTSD) due to the flashbacks he experiences of the nightmares he endured during his time in the ICU. He also stated that his family wanted to be involved more than they were. This is a scary situation and I am surprised that family members would want to be more involved but I can understand because it could be a scary being in an environment and seeing their loved ones in a situation like this. Study show that early ambulation in the first three days decreases delirium. So the study shows this I think it needs to be done. Evidence-based practice is done because of the best patient outcomes. One hospital decreased the amount of sedatives and paralytics and noticed that 15% of their patients were less likely to die and their length of stay was shortened by four days. Combining the decrease in the amount of drugs given an early ambulation can decrease delirium in the ICU patient. I also agree that follow-up care at home should be done because there’s no way of knowing if the patient had an out of body experience or the constant state of worry and fear while they were under the strides. Being able to identify the psychological stresses and intervene can help them get back to life they were living before the incident.

NEW POSTS!

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Hello!

Remember that we decided today, all new posts you want syndicated should be ‘categorized’ as ‘Nursing420′

I am trying to see if I set it up right, so we may have adjustments between now and next week. Any posts from week 1 please categorize as ‘Nursing420′ so they stay connected.

Thanks! Jaime