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Informed Patient: Changing the Sedation Status Quo in the ICU
The article states that new treatment methods are being adopted to combat the length of time patients remain ventilated in the Intensive Care Unit (ICU). When patients are ventilated, they are almost always heavily sedated, and this has been shown to cause prolonged delirium “which can have a devastating and long lasting effect on cognitive function” (Landro, 2011). These new treatment methods are backed by the National Institutes of Health, the Veterans Health Administration, and John Hopkins University. New research has shown that “ at least some part of brain injury is preventable by lowering exposure to potent sedative medications and shortening the duration of delirium in the ICU with new monitoring and management techniques” (Landro, 2011). Another study shows that muscle weakness can be preventable if the patient gets up and moving while still on the ventilator. Critical care experts are holding conferences and reaching out to their colleagues in hopes of shedding light on new care techniques in the ICU. Hospitals have been aware for many years that prolonged ventilation was having negative effects on their patient’s well-being. Many institutions began adopting strategies to wean patients from heavy sedatives and to get them up walking.
In one account, a 51 year old musician was hospitalized in the ICU for pneumonia. The patient recalls having hallucinations while on sedation medication and had to be restrained multiple times. After being released from the hospital, the man claims to have difficulty singing and playing his music, and he reports having difficulty finding follow-up care from home.
I agree with the author. She arms her readers with irrefutable evidence that ventilation protocols need to be changed. First, health care professionals must become aware of this problem and the extent of consequences the patients suffer even after being released. Once there is a general awareness and understanding of the problem, solutions will start to be implemented.
Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU.
ICU Delirium
According to Vanderbilt University (2013), delirium is the inattention and confusion that presents like the brain is temporarily failing. Delirium is a common problem in the ICU and 7/10 critical patients usually experience it (Vanderbilt University, 2013). Patients who are on sedation, older, cognitively impaired, recovering from surgery, septic, or suffering from heart failure have been found to be more susceptible to developing delirium in the ICU. It appears to be caused by lack of oxygen to the brain, medications, infections, pain, and other chemical changes in the brain. If not identified and cared for, delirium can cause lasting cognitive impairment, post-traumatac stress disorder (PTSD), and depression (Vanderbilt University, 2013). To prevent or treat ICU delirium, the care providers should continuously reorient patients, provide stimulating activities, mobilize patients early, treat their pain, reduce noise and stimuli, and provide sedation vacations (Vanderbilt University, 2013). It is important for nurses to assess their sedated patients for delirium because early recognition can prevent a lifetime of psychological distress.
The article titled, “Sedation and Its Psychological Effects Following Intensive Care,” reviews and explores the relationship between sedation and psychological disorders after recover and discharge from the ICU. The review of literature found that lighter sedation reduced the length of stay in ICU and length of time on mechanical ventilation. However, lighter sedation generally did not reduce the outcomes of PTSD and more research is needed to identify more specific relationships between sedation and psychological distress (Croxall, Tyas, & Garside, 2014). More research should be done on the specific psychological effects of sedation and ICU delirium. Also, more research could be done on the specific types of sedation and which ones are the most psychologically impairing. I found that ICU stays can be shorted with lighter doses of sedation to be very interesting. This means that patients can wean from mechanical ventilation earlier and recover in a faster amount of time, which is beneficial to both the patients and care providers.
References
Croxall, C., Tyas, M., & Garside, J. (2014). Sedation and its psychological effects following intensive care. British Journal of Nursing, 23. Retrieved from http://web.b.ebscohost.com.summit.csuci.edu:2048/ehost/detail/detail?vid=3&sid=522b8a73-3c8f-4f87-9893-e2ba89b4bbe4%40sessionmgr114&hid=101&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2012702846
Vanderbilt University. (2013). ICU delirium and cognitive impairment. Retrieved from http://www.icudelirium.org/index.html
Week 4 – ICU sedation
Many mechanically ventilated patients in the ICU receive sedative drugs to decrease anxiety, provide comfort, and ease treatments. The exact level of sedation varies depending on the medical condition of the patient and their specific treatment needs. The level of sedation is measured by nurses or physicians according to the Ramsay scale or the Richmond agitation sedation scale (RASS). Jackson, Proudfoot, Cann, and Walsh investigated the impact of sedation practices on both patient safety and economic outcomes through a systematic review of literature. The review indicated a strong association between duration of ICU stay and ventilation times. There was also evidence of reduction in ICU-acquired pneumonia and short-term mortality in many cases. Daily sedation breaks deemed beneficial to patients as well. The quality and nature of standard care, and patient case are important determinants on the impact of changes within individual ICUs. Sedation practice is likely to influence health care costs and the improvement of sedation practice benefits not only the patient, but also reduces costs.
I agree with the article that there is a strong association between duration of ICU stay and ventilation times because the longer that patients are on a ventilator, the longer their stay in the hospital becomes. I’ve had a patient who was on a ventilator for numerous weeks and ended up being in the hospital for over 2 months. The next step is to find other alternatives for ventilated patients besides sedation in order to shorten their hospital stay.
References:
Jackson, D. L., Proudfood, C.W., Cann, K.F., & Walsh, T. (2010). A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Critical Care, 14(2). doi:10.1186/cc8956
Models Do Not Just Grace the Cover of Vogue…
I believe a role model is an individual that you look up to and try to emulate. It is someone who has a positive influence on you and pushes you to be better. It is someone you look at and think, “If they can do it, so can I!”
To me, a role model is an individual that is approachable, understanding, positive, helpful, knowledgeable, and open-minded. It is a person that will give you their undivided attention and will help you in anyway they can (or direct you to individuals who can assist you when they are at a loss).
Some of the differences between the behaviors I listed above and my own are that at times, I feel that I am not completely as understanding as I should be. I know individuals have the right to their own opinions and actions, but when I see that someone is doing something that will end up affecting them or others in a negative way, it is hard for me to understand their particular view. It is something I need to work at.
Actions that I can take to become a better role model are to practice my listening skills. I feel that this will slowly teach me to not immediately judge a person’s view or action that I particularly do not agree with. Instead, I will learn to step into their shoes and see why they feel the way they do. People have the right to their opinion and I have to learn to respect and understand them.
To like or not to like…
This is the question! I am amazed that I can say I remember a time when there was no internet. I also remember the time when the internet gradually creeped its way into our world. I even remember landlines phones that had dials. Gosh, I’m aging myself. But, so what, haha. I had a computer-geek boyfriend in high school who had one of the first cellphones ever…it was a little bigger than the size of a box of girl scout cookies! It is a far cry from the cellphones we have today. Cellphones these days are basically mini-computers in addition to being phones.
To say I am hooked on the technology of the internet and social medial would be an understatement. I absolutely love it. I am an admitted info junkie and the internet appeases my soft addiction. But, I also admit that it can be a time hog (gotta rope in that hog). I was little freaked out at first when I found we were doing this class mostly online via WordPress and such. This is a new arena. But, I’m going to embrace it. I think it is going to be an adventure, frustrating at times, but it will be a great learning experience. I appreciate that Jaime Hannans is having us do this. The reality is, blogging and social media is very much how the world communicates more than ever throughout the world. It is fascinating. I and I quite like it.
I look forward to gleaning as much critical care nursing knowledge as possible this Spring 2015 semester. I feel a bit overwhelmed already truth be told. I also feel a teeny bit sad because this is my last semester with some incredible fellow nursing students (and I love them all) and faculty. Here we go!
Role Model
What is a role model?
To me, a role model is someone who chosen to be looked up to and someone whose actions or behaviors you want to emulate. I don’t believe that someone can just wake up one day and say “I am now a role model to so-and-so,” I think that it is a title that must be given to someone.
What behavior describes a successful role model in the area served by your peer educator role?
In my role, I am supposed to emphasize the importance of academic and social success as a CI student and provide my students the necessary tools to achieve academic and social success. As a role model, the appropriate behavior would be to demonstrate academic and social success.
So what are the differences between those behaviors and your own behavior?
I would consider myself academically successful, but I am not very involved with student life on campus and that is a major component to my definition of social success as a CI student, or a university student in general.
Now what are some actions you can take to become a better role model for others?
I’ve been saying it since I started attending CI, but I really do want to and need to join some clubs or organizations on campus.
Techy Identity
- What does it mean to have a digital identity?
- A digital identity means that you have a presence on the internet. You don’t even need to have your own social media accounts to be tagged in photos or mentioned, even though it does make it harder for you to be found.
- What fact, statistic, statement, etc. from the readings surprised you the most and why?
- The most interesting facts I thought was the amount of applicants who were denied positions based upon their social media profiles. Because I do believe that people may have a very different work ethic then they do in a personal scenario.
- How does the fact that you are in (or are seeking) a leadership position impact ones digital presence?
- With being a Resident Assistant, we are more of in a fish bowl type scenario Once someone sees us doing things that we get people in trouble for, residents strip away our credibility and feel like they can hang that over us and can’t do our jobs properly if we are hypocrites.
- How do you plan to create your positive digital identity?
- By filtering what is posted by me or about me. There are multiple settings that can be changed in order to protect yourself. When it comes to your own posting, always think of how things may be interpreted and if things are capable of being seen as negative, don’t post it. Its better to be safe then sorry.
Personable over Professional
What is a role Model?
A role model is someone who people, in this case residents, to look up to and find the behaviors that will carry you to your goals and stay with you throughout life.
What behaviors describe a successful role model in the area served by your peer educator role?
The behavior that is seen as successful is that your are able to engage with your residents on their level and willing to help any and all people out with problems or issues they may have, while being “professional”.
So what are the differences between those behaviors and your own behavior?
The main behavioral difference between me and they way I am supposed to act is the element of being professional. I’m not saying to throw all composer out the window and degrade your reputation but being able to communicate without having the barrier in front of you.
Now what are some actions you can take to become a better role model for others?
I don’t feel like there is much for me to do to become a better role model, granted how are you supposed to be able to judge what you are pretty sure is the best you can do, but to maintain an image that people can look up to.
Role Model 101
A role model is someone who is representative as a icon or reflection of leadership, someone who is ambitious and persistent about what they want to accomplish. Successful behaviors among my peer educator revolve around character, including respect, resilience, perseverance, honesty, integrity, and devotion. I feel like I fulfill all of those behaviors maybe I can be a little more devoted . Some actions I can take is being successful in this UNIV 399 course by participating in all assignments and collaborating with my peers , I feel this class is a stepping stone towards that direction. Lastly I can seek out more leadership roles amongst campus and reflect my skills among my fellow peers.
