ICU Sedation Practices

The article : Changing the Sedation Status Quo in the ICU was very interesting to me because it talks about how hospitals are adopting new policies that limit the amount of time a patient is sedated in the ICU. The new treatment methods would allow patients to be awakened from sedation to assess for pain and removing them from a ventilator as soon as possible.  A growing body of research suggests that patients who are heavily sedated in the ICU are suffering from prolonged delirium. This can have long term effects on cognitive function long after the patient leaves the hospital (Landro, 2011).

Hospitals began rethinking the standard of care in the early 1990s, when patients reported suffering from depression, stress and extreme physical limitations linked to therapy they had received in the ICU (Landro, 2011). Studies conducted by Vanderbilt University show that new monitoring techniques will shorten the duration of delirium by decreasing the amount of potent sedatives a patient receives. Research from John Hopkin’s University shows that getting patients up and moving even when still on a ventilator can also prevent the muscle weakness that results when patients lose conditioning from misuse and the body becomes frail. Hospitals now plan to use milder sedation medication and to wean patients off as soon as possible and not put them back under. This will help patients to go home sooner and avoid having to go to a rehabilitation center.

I agree with this article, I think that it is not healthy to have patients sedated for a prolonged amount of time. If there is a way to get them moving sooner I think this would be beneficial for circulation, skin care, and oxygenation. However the research presented here also shows that in addition to the physical reasons there are also psychological reasons to wean patients from section sooner rather than later. Before reading this article and watching the videos, I had no idea that patients were experiencing delirium while sedated in the ICU. Furthermore it is also very concerning to see how the delirium they experienced in the ICU can affect their lives even months to years afterward. Some patients experience PTSD or depression that interferes with their daily lives. I think that if the amount of time a patient can be sedated can be shortened, and they can be ambulated sooner this will be therapeutic for the patient and will help them to recover sooner.

I think that the next step is to implement this practice in more hospitals by training ICU doctors and nurses. Educating healthcare professionals about delirium will help patients to get the support they need sooner.




Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved September 24, 2015, from

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.



Delirium has been recognized as a serious acute medical condition that’s been called a medical emergency. Every day, 30,000 to 40,000 ICU patient in the United States are suffering from acute brain dysfunction called delirium (Maniou, 2012). Delirium is a manifestation of CNS dysfunction, it is important to recognize and treat life-threatening conditions that may result in delirium such as; sepsis, pneumonia, myocardial infarction, pulmonary embolism and medications. It’s recommended that after nurses’ exclude life-threatening complications that they turn their attention to the patients environment and make attempts to minimize any factors that may exacerbate delirium such as; avoiding prolonged sleep deprivation, minimizing artificial lighting, and being mindful of clustering patient care to avoid additional disruptions.

Patients on mechanical ventilation increase the risk of delirium three-fold. It has been found that the mortality rate with patients experiencing delirium may exceed twice the six-month mortality rate of nondelirious patients, and it is associated with longer hospital stays and with a higher rate of cognitive impairment at discharge (Maniou, 2012). CAM-ICU is a useful tool in diagnosing and monitoring delirium and is recommended to be used frequently in the ICU, it is constructed with yes/no questions for use with nonspeaking, mechanically ventilated ICU patients. To reduce the length of time patients spend heavily sedated and immobilized on a ventilator healthcare providers are awakening patients from sedation earlier, assessing pain, and getting them to breathe on their own as soon as possible to avoid prolonged delirium which can have long lasting effects on cognitive function. Focus is also aimed at getting patients up and moving while still on a ventilator can also help reduce muscle weakness and assist in a speedier recovery.


Landro, L. (2011). Informed patient: changing sedation status quo in the ICU.  Health Blog, Wall Street Journal. Retrieved from

Maniou, M. (2012). Delirium: a distressing and disturbing clinical event in a intensive care unit. Health Science Journal, Vol 6, Issue 4.


Week 4: Insight on Delirium

Click to watch a brief video on research about ICU Delirium: Video is the first one on the page, listed as “Patients and Aging Brain Problems”

For this week’s discussion, you will have to have sent me your URL for your site to have your blogs all connect – if you have not done that, please email me to syndicate you. Step 1: Decide what you want to blog about related to ventilators, sedation, and/or safety. Step 2: +New Post and write what you want – include videos, images, or anything to make it appealing. You can write it like an opinion post or informative. Be creative. Step 3: Categorize to “nursing401” and publish! Step 4: reply to another student’s blog post. Happy blogging!

Week 3 Recording, blogging, and learning!

Great work wrapping up Week 2 ! I am hoping you are sifting through all the reading, simulations, resources and technology to feel successful. You should be recording on VoiceThread, figuring out how to blog, and getting hands-on practice in class. I hope you are finding our simulation and lab time helpful in further developing your knowledge, reflective thinking, and clinical decision making. Hang in there as we hurdle Week 3! You are almost half-way there!  However, if you are feeling like this:


Please email me and tell me your struggles. I try to be available by email on phone when I am away from the computer. If you don’t get an answer in 48 hours, then email me again – in case I missed it. Week 1 discussion grades are posted. Please check it out and if I did not see your post, you may have a zero; if you did it, please recategorize or redirect me to it. Thanks!

I realize I may be stretching you all with this new technology, but for good reason. Check out this blog another faculty member about the reasons for testing you in addition to all the great comments and thoughts you had in Week 1 blog and Week 2 VoiceThread discussions. I am impressed by your thoughts, experiences and discussions going on about Healthcare and Insurance. Many of you used video also – great job! If you still have individual questions about VoiceThread, please email me.

I hope you are enjoying simulation and find it meaningful to your learning. Keep up the good work, and have a great week!


Technology and Patient Care

EKG monitoring through a person’s iphone to prevent stroke sound like a great invention that I may personally use one day since Afib runs in my family. Raney Linck is right in his blog about nurses needing to step up to the challenge…the changing technology in healthcare challenge (2014). I agree that we are going to have to increase our knowledge of the upcoming tools and resources that will impact our patient’s lives. I believe society will continue to increase their spending on quick and easy access to apps, devices, and biometric measuring tools, like the now common Fitbit, to improve their health. As nurses are educators and advocates, we must be prepared by expanding our own knowledge of technological health tools.

Mental health issues continue to affect society and finally people are starting to open up about specific mental health concerns that they are experiencing. People are looking for ways to overcome their personal problems by watching television shows like Dr. Oz, surfing the internet, and asking healthcare providers. New interventions like mobile health sensors along with therapy may be the answer to help those that are struggling with diagnoses of depression, anxiety, or PTSD.

Along with verbal, demonstration, and multiple printed educational handouts that we use in the NICU at St. John’s Regional Medical Center to educate our babies caregivers, we also use educational videos on a tablet. Caregivers can choose to watch multiple videos about NICU baby care on our unit’s tablet at their baby’s bedside or they can access the website from anywhere by logging on to and using our hospital’s password 02557. This free website contains a video library in English and Spanish and also contains many helpful articles in the parent resource section. The education provided by leading Neonatologists and neonatal nurses on this website, in my opinion, is a great informative and helpful tool for caregivers of NICU babies (The Wellness Network, 2015).

Linck, R. (2014, August 1). MHealth: What do we do with all the data? [Web blog post]. Retrieved from

The Wellness Network (2015). Your nicu baby. Retrieved from


Digital Trends in Nursing

Digital technology is exponentially growing in the healthcare setting, including its increase access into the community. New research studies are pinning down ways to utilize the advance technology available, such as in: mobile device apps detecting health effects on academic performance, EKG ambulatory monitor assessments reducing risk of strokes, to simple ear buds that detect heart rate and calories lost as well as other developing trends.

Raney Linck, MSN instructor from Minnesota school of Nursing, has created a blog based on digital trends occurring in nursing and healthcare. It was unique to view his outlook of creating such a blog, however the most recent post is fairly outdated, October of last year. One of his discussions was on mobile health apps (mHealth), being used in research to gather information on student’s overall health by just having the users cellphone in close proximity. Sensor data was collected and organized by the cellphone app installed known as, “StudentLife.” For example, the camera of a phone was able to tell when the lights were turned off in a room, detect the sleeping duration and amount of time a student was in a particular area. I never heard of such a study but it did intrigue my thoughts wondering how I, as a student, would rate among their study from my mental health effects in my academics and how I can improve it based on the data available. It also made me realize with this research how much work it must take to analyze all the data and who was responsible for that role.

It’s incredible how a software may collect accessible data by using a cellular app, however it takes a humans manual manipulation and labor to analyze. Linck brought up a good point, if we have all the data imaginable with increased use of mHealth apps or EKG ambulatory monitoring and other healthcare related vehicles who will analyze the data? Imagine the changes that can evolve if there was a new job description for this role, possibly RN’s to step up in this changing technologic era and utilize the data for improving outcomes in the community based on the set of identified problem areas.

Nursing will always have a necessity to become socially mindful with using newly updated software’s, applications and programs being used in their facility. Such as with documenting healthcare information in patient care for reimbursements from Medicare and Medicaid. Then there is nursing assessments logged on the computer that allow easy access to trends in patient data such as their labs or imaging, MD/RN progress notes providing a larger picture of the entire patient. It may play a con with documentation say if there is downtime/power outage, I believe not all paper charting should be excluded as we will  eventually need the reliable paper and pen practices in a critical event. The public has become more proactive in their care including the assistance of increased availability to their own medical records from home.

Another interesting study from an Australia, Concord Hospital are participating in this new technology advancement creating wristbands that record the patients vital signs including oxygen saturation which electronically sends to patients medical electronic record instantaneously. They plan to expand their line product to over 27 hospitals over the next three years, allowing benefits for safe and efficient patient care saving time and reducing human error (ANMJ, 2015). The information sought out during this search of the digital trends shows how technology can have meaningful use ensuring quality and safety while improving care communication and management.


ANMJ. (2015). New wristband technology streamlining patient care. Australian Nursing & Midwifery Journal23(1), 5.

Piscotty, R. , Kalisch, B. , & Gracey‐Thomas, A. (2015). Impact of healthcare information technology on nursing practice.Journal of Nursing Scholarship47(4), 287-293.

Linck, R. (2014, October 8). Digital trends in nursing. Retrieved September 7, 2015,   from

First Day and Tips for Blogging …

Thank you for your contributions today and participation in simulation. I look forward to our coming weeks together. Please email me for any questions. I have posted the VoiceThread I intended to review today below, and in the “VoiceThreads” tab for your course.



I thought I might also share tips for those of you who are interested in doing more with your blogs. There are many other ways you may consider using your blogs beyond this class – updates to family or friends; post ideas and thoughts on topics of interest; or perhaps even make a page (or subdomain) as a resume! Lots of options…

If you are interested in learning more or even just small tips on using wordpress, you have access to multiple videos at through MyCI. Just login, and look for

Screenshot 2015-01-02 21.41.48 has many useful videos on “how to” from the very simple to more complex. Just search WordPress and you will find tutorials. Remember, this is not required, but just information for anyone who is looking to learn more about this topic.


About Me

My name is Lisa Esplana, I received my ADN from College of the Canyons in Spring of 2014, I currently live in the Santa Clarita area. I am not working currently, I would like to work in Pediatrics or the NICU. I have been married for 14 years, I have 3 children, 2 boys ( ages 4 and 10 ) and 1 girl ( age 13). Outside of school I enjoy spending time with my family and doing outdoor activities with them such as hiking, biking, camping or just hanging out at the beach. I also like to read whenever I can. My current goal is to finish the BSN at Channel Islands and start working as a nurse so I can explore the different fields of nursing and gain experience. My future goal would be to obtain a Masters in nursing as a Nurse Practitioner.


Connecting students on the web