All posts by Deborah

ICU Sedation

I was very surprised to learn how devastating and long-lasting ICU sedation can be on both the cognitive and physical effects are on ICU patients. It never occurred to me that some ventilator patients could and should be ambulated if possible. Even during my ICU rotation, which was only 2 days, I did not realize that sedation with benzodiazepines does not allow the patient to experience a normal sleep cycle. Even though sleep deprivation in critically ill patients has been well documented for more than 30 years (Tembo, Parker, & Higgins, 2013), clinicians still struggle with methods of care that seek to support restful sleep and prevent or alleviate sleep deprivation and nightmares. The study done by Tembo et al. (2013), explored the lived experiences of critically ill patients in ICU with daily sedation interruption. Patients reported “longing for sleep” and ‘being tormented by nightmares”. When the outcomes of patients with daily sedation interruption (DSI) where compared to those with continuous infusion the findings suggested that DIS did not result in psychological harm. Patients in the DSI group fared better for PTSD than those with continuous sedation. It was also found that the DSI group had a shorter length of stay in ICU.

Sleep deprivation is known for causing disorders of the mind, including delirium. The effects of sleep deprivation are both psychological and physiological. In addition to the types of medications used for sedation, the sounds, lighting, and continuous contact with care providers are all factors in poor sleep quality. Participants in the study report having nightmares for months after their ICU experiences. The study’s finding suggested a need for models of care that support restful sleep and prevent or alleviate sleep deprivation and nightmares.

The “Care of the Ventilated Patient – The New Paradigm” was one of the most informative videos about delirium in the ICU that I have seen. It was interesting to see how much of what we do help our patients, is actually harmful. This video that appears to have been created in March 2012, indicates that a study done 10 years previous showed that ICU stays can be reduced and patients benefit from DSI and less sedation. Ten years later and we still haven’t figured it out. I have no experience in the ICU but would be interested to know if there are significant changes in how patients are sedated today.

Tembo, A. C., Parker, V., & Higgins, I. (2013). The experience of sleep deprivation in intensive care patients: Findings from a larger hermeneutic phenomenological study. Intensive and Critical Care Nursing, 29, 310-316.

Digital Technology and Healthcare

I found it both interesting and a little overwhelming at the numbers of apps out there for nurses and other medical professionals. The increased use of technology in nursing impacts us in many ways. The time invested in learning new software takes away from hands on care in hopes that it will eventually allow us to make better use of our time and ultimately patient care will benefit. Unfortunately, many of the newer charting systems seem geared more toward those things that increase hospital reimbursement and not with the nurse’s workload in mind. While these technological advances should make charting easier and less time consuming, I do not hear nurses saying how much more they have for hands on patient care. Some of the electronic charting has alerts set up that are routinely ignored by the nurse due to redundancies in the software. It is difficult to imagine working without the technology that we now have. With drug resources, lab values, assessment data, and clinical procedures all available on hand held electronic devices we definitely have an advantage and opportunity to increase the quality of care. On the other hand, do these resources make us less available to our patients? It seems like the more technology we have available, the more we are expected to do. So, do we really have more time for patient care and what is the quality of that care?
A study done by Free et al. (2013) on the effects of mobile technology using text messaging to patients using ARTs and smoking cessation programs supports that these types of interventions can increase adherence. Health-care providers need effective ways to encourage “health-care consumers” to make healthy lifestyle choices and to self-manage chronic diseases. The amount of information, encouragement and support that can be conveyed to individuals during face-to-face consultations or through traditional media such as leaflets is limited, but mobile technologies such as mobile phones and portable computers have the potential to transform the delivery of health messages (Free et al., 2013).
My only experience with technology and patient education is on a personal level. My husband is a diabetic and has an app suggested by his primary care provider. The app allows him to track blood glucose levels, insulin administration, carb counting, and exercise. He used is religiously when it was first introduced but the frequency decreased over time. His feelings were that it was too time consuming and he could not see the benefit from it.

Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P.,…Haines, A. (2013). The effectiveness of mobile-health technology-based health behavior change or disease management interventions for health care consumers: A systematic review [Supplemental material]. PLOS Medicine, , . doi:10.1371/journal.pmed.1001362

Hello fellow RNs!

Sam DebbieMy name is Deborah Keck.  I am a married mother of one with 3 grandchildren.  Life has had some interesting twists and turns bringing me to where I am today.  I was a pre-med student 36 years ago but I found it difficult to stay on task with all the things going on in my life.  I was fortunate to meet a man who tries to make me laugh everyday and lives everyday like it was his last.  I often wonder why he put up with me for so long.  We moved many times and did many different things along the way.  I have lived in Michigan, Ohio, North Carolina, Tennesse, Texas, Florida, Puerto Rico, and California.  I never minded the changes and would not change a thing in my life.  Even those things that are less desirable bring us to the place where we are now.  I love my life and the people in it.  When my husband decided to retire, I decided to move forward with the one thing that had been on my mind for years, a career in nursing.  So here I am today, trying to complete this BSN program and get to work.

Me dimitri lovevellRebecca and I

Not to be forgotten from my family are our 3 “furkids”.  They are always happy to see you and love unconditionally.