Proud

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As I was reading through all of your first week posts and your initial thoughts about blogging, I have to say I have an overwhelming sense of pride. So let me explain …

I equally love and hate technology.

Technology is challenging, whether it is just getting logged in and started on what you want to achieve, or change a font or background, or figure out how does it seem ‘so easy’ to others, it is still frustrating beyond belief. I get it. I am amazed at your willingness to jump in and stand up to the challenge. I pretty much am anticipating many of you may surpass my skills and be teaching me. We are learning together. Small steps. There is no ‘perfect’ page.

Honesty is not given freely.

You have all been willing to honestly evaluate your thoughts and feelings. Reflect upon your learning. Evaluate yourself in both strengths and weaknesses. You say what you like and don’t like. However, you are willing to still try new things. Honesty and flexibility are wonderful skills for nurses, so this again makes me proud of you all. I know I am pushing you and stretching your limits in some areas (mostly technology!). I have the intent to try to further develop your learning beyond what you thought you could do. Recording is difficult. Blogging can be long and frustrating. I greatly appreciate your openness to try and sharing your thoughts. The end goal: learning.

 There is never enough time

This is my life-long complaint. There is never enough time to lead/guide you to all the information out there. There is never enough time to try out themes, or edit and modify pages or posts. There is never enough time for patient education, collaborative care planning, and hand-holding. There hasn’t been enough time to individually help you through CI Keys, but CI Keys is new this year. Hopefully you are finding the videos helpful and don’t forget to share tips with each other! I am proud and excited that you are some of the first few hundred students signed up! Many times, if you just show up and do the best you can, you will make a difference. Your ‘best’ is significant. Be in the present moment and enjoy every moment you can.

What Makes A Role Model

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A role model is someone who you personally feel exemplifies what you believe in.

Being organized, group oriented, personable, and capable of being a leader are all behaviors that a person in RHA should have.

Organizational and planning skills are things that I know I lack and need to focus on. I am not the type of person to have a planner and have it filled with events, meeting, and things I need to do.

Making the right choices and presenting myself in a favorable light are actions that I can take toward becoming a role model for others.

Changing the Sedation Status Quo in the ICU

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Informed Patient: Changing the Sedation Status Quo in the ICU

I found this article written by Health Blog to be very interesting and accurate. It discusses how many hospitals are now adopting new treatment methods in ICU’s to reduce the length of time patients spend sedated and immobilized on a ventilator. Nurses and doctors are now encouraged to wake patients from sedation and assess their pain and get them to breathe on their own as soon as possible due to the suffering that is noted from prolonged delirium in long ICU stays. This sort of delirium can have a huge and long-lasting effect on cognitive function and even cause PTSD for some patients. This article argues that patients do much better when they are liberated from ventilators, and have shorter hospital stays and shorter rehabilitation times.

The next steps needed in order to enact this policy in hospitals nationwide would be to get the evidence based practice and research out there and accessible. If patients will have better outcomes by simply decreasing the amount of sedation time and the amount of time on a ventilator, we should be advocating for our patients and creating policies that will bring this issue to light.

Changing the Sedation Status Quo in the ICU

What is a role model?

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  1. A role model is someone who influences someone in their goals and gives them insight on their experiences to get to their own goals. Role models also do in action what they tell their student peers to do, role models lead by example.
  2. The behaviors of a role model in the area of a peer educator is leading by example, academically responsible, and a responsible citizen.
  3. There aren’t any differences between my behavior and the ones listed above, the behaviors I have listed above are ones in which I see in myself.
  4. I love to talk and relate to what are interesting to others but I would like to communicate to others better on a intimate level and in group settings. I also hope to inspire my peer students in their academic journey and academic experiences, as my peer leaders have done for me.

nursing401

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Week 4 – ICU Delirium

This week for our research in regards to ICU delirium I found an article by Bathula and Gonzales (2013) titled “The Pharmacologic Treatment of Intensive Care Unit Delirium: A Systematic Review” from the Annals of Pharmacotherapy.  Bathula & Gonzalez (2013) used a systematic analysis to discover different research studies that have been conducted in regards to pharmacotherapy and ICU delirium.  Bathula & Gonzalez (2013) state that “treatment recommendations are conflicting” for ICU delirium (p. 1168).  Bathula & Gonzalez’s (2013) research indicates studies attempting to compare the efficacy of specific antipsychotic medications versus placebos.  Overall, Bathula & Gonzalez (2013) found no significant change in outcomes regardless of medication plan (p. 1172).  Bathula & Gonzalez (2013) recommend that first-generation antipsychotics should not be used, but suggest that there appears to be some efficacy with second-generation antipsychotics.  However, Bathula & Gonzalez (2013) highlight how the treatment of ICU delirium should focus “on the identification of the cause and risk factors and then modification of these causes,” (p. 1173).

After having read the article by Bathula & Gonzalez (2013), I agree that ICU delirium needs to be treated first by finding the sources and applying non-pharmacological methods as much as possible.  In addition, I found it interesting that with the placebo groups that were allowed to use “rescue meds” (ex: sedatives for agitation), that there was no change in outcomes between study groups.  Suggesting that there is no benefit to the use of antipsychotic medications for ICU delirium.  But in saying this, every case needs to be treated on a case by case basis.  Bathula & Gonzalez (2013) highlight how there are different types of ICU delirium and may require different plans of treatment.  Overall, Bathula & Gonzalez’s (2013) article was very informative on current pharmacological approaches being considered for the treatment of ICU delirium.

Bathula, M. & Gonzalez, J. (2013).  The Pharmacologic Treatment of Intensive Care Unit Delirium: A Systematic Review.  Annals of Pharmacotherapy, 47(9), 1168-1174.  doi: 10.1177/1060028013500466

 

 

NRS401: Week 4 – Sedation Level Linked to Delirium in ICU

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The use of sedatives in patients within ICU’s has been used to decrease anxiety, reduce pain, and relieve any stress to help in the healing process of patients. It has been found that a long amount of time spent under sedation can have acute delirium effects and in some cases more long term effects. Currently, the use of daily interruptions of sedation, also known as sedation vacation, is being practiced to help in lowering the length of mechanical ventilation, length of ICU stay, and length in hospital stay (Svenningsen et al., 2013). In a study done by Svenningsen et al. (2013), the researchers explored the idea that high fluctuation levels in sedation could lead to delirium in ICU patients. Their study included 640 patients over two years in two hospitals. To assess the patient’s levels of sedation and delirium, the Richmond Agitation and Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU) tools were used. The researchers found that there was a “significant association between major changes in sedation level and incidence of delirium” (Svenningsen et al., 2013).

I feel that this article does make a good point about how the patient’s levels of sedation are correlated to the effects of delirium. To me, it makes sense. If a patient is heavily sedated, when they wake up, wouldn’t they have some level of delirium? There are some limitations within this study that could potentially make a difference such as assessing the patient’s pain level. But I liked how they utilized two tools to measure the levels of sedation and delirium which helped in determining the different degrees of sedation (ie. hypoactive, hyperactive, and mixed delirium). More studies are needed to determine if a set amount of dosing time, type of medication being used, or the amount of the medication increase the effects of the delirium. After reading this article, I now feel that if we continuously monitor the sedation level that the patient is experiencing throughout the day and are able to adjust the amount of sedatives given based on those levels, the onset of delirium will drop.

Reference

Svenningsen H Egerod I Videbech P Christensen D Frydenberg M Tonnesen E 2013 Fluctuations in sedation levels may contribute to delirium in ICU patients.Svenningsen, H., Egerod, I., Videbech, P., Christensen, D., Frydenberg, M., & Tonnesen, E. (2013). Fluctuations in sedation levels may contribute to delirium in ICU patients. Acta Anaesthesiologica Scandinavica, 57(3), 288-293.  201501281916161677993059

ICU Delirium

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I found an article on Medscape Medical News titled, “Establishing Familiar Routines in ICU Reduces Delirium.” It was written by Nancy Melville on January 20, 2015. The article speaks of using daylight control and various cognitive stimulation to reduce delirium in patients. Pamela Smithburger, PharmD, from the University of Pittsburgh School of Pharmacy stated, “We have been practicing some individual components of this approach in the ICU in a somewhat inconsistent manner, but once we protocoled the interventions, we saw a significant decrease in the amount of time patients were delirious.”

A review of the literature on nonpharmacologic interventions for the condition led the researchers to develop a protocol, which they call MORE. It involves blinds to define a number of factors, from circadian balance, sense of day and night, eye and ear care, cognitive stimulation with music, etc. In the study, the researchers evaluated patients in the ICU of a large academic hospital and used a checklist to score findings every 4 hours.

They found that after the implementation of the protocol, there was a decline in the amount of time the patients suffered delirium. Dr Smithburger stated, “We were hoping to see an improvement, and it was indeed significant.” She added, “Psychotropic medications, due to their myriad effects on neurotransmitters, can worsen delirium. In addition, the ICU is a foreign and unfamiliar environment for the patient who is critically ill and often receiving sedative or pain-relieving medications.

I think the article makes a good point. Considering the causes that can lead to delirium and the overall stress that an ICU patient is under, it certainly seems more human, natural and following common sense to address delirium with natural remedies that involved activities and lifestyle patterns that can help resolve the stresses on the patient. Routine can make the “foreign” environment more familiar and friendly.

I think it would be helpful to see further study on this from the scientific standpoint to back up the intuitive agreement with the content. Seeing it in practice would reinforce my opinion. However, for now I think there is a lot of promise in the MORE protocol.

http://www.medscape.com/viewarticle/838409

Role Model? I want to do that type modeling!

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What is a role model? There are so many different definitions, and it can all be so confusing. But, to me, a role model is someone who others can look up to, and that “role model” will not even know they are being looked up to.  The behaviors that describe a successful role model are that unconsciously you are educating the people around you, and helping them learn life decisions. I do not really see many difference in these behaviors and my behaviors, I try to have an attitude in which someone always feels comfortable asking me questions about anything. On that note, I know I always have to better myself. Some of the things I can do to better myself are, to have more confidence in my leadership style as well as in myself when I am doing something

ICU Delirium

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Health Science Journal published an article in 2012 titled “Delirium: a distressing and disturbing clinical event in a Intensive Care Unit.” ContentServer.asp In this article the severity and prevalence of ICU delirium is addressed and its consequential damages and costs.  According to this article, delirium occurs in a very high 60 to 80% of ventilated patients and that there is a 10% increase of death and cognitive disfunction with every day a patient spends in delirium.  Though it is a very real problem, it has yet to be medically recognized and addressed.  The delirium assessment tools available at this time were found to be a challenge to ICU nurses for three reasons: one being it is difficult to assess an intubated patient, second being the inability to assess sedated patients, and third the complexity of the delirium assessment tool.

The article argues that sleep deprivation due to the stressful and often chaotic environment of an ICU as a major factor in which nurses can apply some interventions.  ICU nurses should initiate delirium preventing interventions in most patients but especially those with higher risk factors, such as older age or those with pre-existing cognitive disfunction.  Nurses can also orient the patient to time, place, situation, and also discuss the plan of care as he/she is performing them.  Initiate mobility as soon as possible and provide appropriate aides for patients with sensory deficits (glasses, hearing-aids) during wakeful hours.  Provide adequate nutrition and hydration, and try to perform ADL (Activities of Daily Life) such as hygiene during the appropriate hours.  Lights can also be adjusted during the evening to help orient the patient to night or day time.

The findings from the research are strong enough that future research of delirium prevention and treatment should be stimulated.  And it appears to be the case, for there are people like Dr Ely who is seeing this as a real issue: http://fast.wistia.net/embed/iframe/d257te30h2?popover=true.  However more research and efforts to address this area is needed.  I say this because while searching ICU delirium articles, a majority of the articles that came up in the search were still supportive of heavier sedation, which is shown to likely worsen the risk and severity of delirium.  Nurses implementing interventions within their scope and more research on the very real issue of ICU delirium are the necessary next steps.  As said by Dr Wes Ely, “essentially… medical research is… trying to improve the lives of the people you will never meet.”

References:
“ABCDEFs of Prevention and Safety.” ICU Delirium and Cognitive Impairment Study Group. Web. 29 Jan. 2015. .
Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a Intensive Care Unit. Health Science Journal, 6(4), 587-597.

Week 4 ICU Delirium

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ICU Delirium

I found an article titled “their altered mental states: the confusion of delirium.” This was a magazine article from 2007 published in U.S. News & World report. Whose summary concludes with a quote from Wesley Ely, a critical-care specialist who founded the ICU Delirium and Cognitive Impairment Study Group at Vanderbilt University School of Medicine. Mr. Ely introduces the Idea that “Delirium is a predictor of death, a longer hospital stay, and increased costs.” This article episodes of delirium are not uncommon in the ICU, particularly amongst the elderly. Delirium is not always apparent and can present as simply as disorientation or inattentiveness.

We learned from the video that we watched as instructed for the class, that often times patients, while having episodes of delirium can feel as if they are being bound, and/or incarcerated. These patients describe a confused longing to be set free from whatever they perceive as binding them. Having never experienced this myself, I can only imagine the feeling as exaggeratedly unpleasant to the patient and, as is mentioned in this article “enormously distressing to the families.” Furthermore, researchers have unearthed evidence that “sun-downing,” as delirium states are nicknamed because of their timing, may be far from benign and could have lasting effects. We learn that sedated and ventilated patients are far more vulnerable to these delirium-like states. These patients are also likely to experience increased instances of pneumonia, infection, low blood oxygen, a specific drug or combination of medications, too much fluid in the body, and out-of-balance electrolytes.

I agree with the author in that these patients are confused and can be re-oriented to their situation. The medical staff as well as visiting friends and family can intervene crucially by continually reminding patients where they are and what is going on. Anything that can be brought into the ICU such as stuffed animals or bedside clocks can help to keep the patient oriented to time and place as well. Psychiatric consultation is often employed in efforts to find the root causes of delirium states as intervening physicians can be often too focused on the reasons for the hospitalization rather than the resulting delirium states. Findings during cognitive functioning examination may indicate the need for further mental health screening (Zator Estes, 2010, p. 713).

References

Baldauf, S. (2007). Their altered mental states: The confusion of delirium. U.S. News & World Report, 143(3), 64.

Zator Estes, M. (2010). Health assessment and physical examination (4th ed.). Vienna, Virginia: Delmar.