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.

References:

Landro, L. (2011). Informed patient: changing sedation status quo in the ICU.  Health Blog, Wall Street Journal. Retrieved from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/

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

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 http://www.yournicubabynow.com 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 http://digitaltrendsinnursing.blogspot.com

The Wellness Network (2015). Your nicu baby. Retrieved from http://www.yournicubabynow.com

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.