i took care a ventilated, 74 year old, patient today. he came in unconscious with opening eyes and motor response to pain only. due to high pco2, he was intubated and sedated. as his thyroid function was corrected. he was more alert. and predictable, his fist reaction was anxious and disoriented. i explained to him and gave reassurance to him from time to time. and it happened that he was a christian, i talked to him and read him a few interesting passage of my christian book. he was obviously calm down. spiritual encouragement did help him as it seemed.
the trouble was he kept knocking at the cot-side after that for more attention. and my colleague said because of my tlc, the patient would start to give us trouble..
and i would say she is no different than just a management-centered staff nurse as if she doesn't know that anxious and knowledge deficit are nursing diagnosis.
It's a nice idea, but I usually don't have time for patting and comforting. When I do, and they need it, I give it. However, I (and I'm sure most of you) have a frustrating amount of charting to finish. Oh, and those other patients...
May I never be too busy to listen to a patient while I'm prepping their meds.....may I never be too busy to put charting on hold for 10 minutes while I listen to why my patient is "really" being a PITA......I would rather be behind all night and get my patient from the VA who hasn't eaten anything in 2 days to eat some pudding, some meat, and a cup of coffee....
I know we have a lot to do....but really, aren't we there to care? and meds aren't the end all to be all....."dude."
May I never be too busy to listen to a patient while I'm prepping their meds.....may I never be too busy to put charting on hold for 10 minutes while I listen to why my patient is "really" being a PITA......I would rather be behind all night and get my patient from the VA who hasn't eaten anything in 2 days to eat some pudding, some meat, and a cup of coffee....
I know we have a lot to do....but really, aren't we there to care? and meds aren't the end all to be all....."dude."
Hey, we ALL want to be this way, we all try to do the best we can.
Is just isn't always feasible. Wish it wasn't always this way, but more than likely it is.
Yes, we are here to care. We are also here to do lots, and lots, and lots of other things. I can only put off pharmacy, lab, CT and charting, oh-and my other pt who is also scared or dying-for so long.
When we CAN, we give the best care that is possible. But, it's not always possible. And giving meds such as a fentanyl or versed bolus isn't such a bad thing to a panicking, awake, ventilated pt. Unless we are weaning, they shouldn't be awake anyway.
And as much as we all like to say "it's only 5 mins, and I'd rather be late...." just remember, it's not only 5 mins. This pt needs constant support because he's scared and awake. It's 5, 10, 20 mins now, and the next hour, and the next hour. He's not going to be less scared in one hour from now. And the things I'm not doing, like checking my labs, calling pharmacy for the 4th time because my meds aren't in the pxysis, feeding calls from the Dr because he's mad because I didn't notifiy him of the labs that I didn't find yet, and the other pts family-yes it may REALLY be IMPOSSIBLE for me to spend 10 mins every hour soothing an awake, vented pt.
Like I said, if we aren't weaning, then he shouldn't' be awake anyway. I find that cruel.
When I have my pts on sedation vacation and spontaneous breathing trial, I am right by their side. I turn the light low, keep them calm, tell them this will only last 30 mins, and that they are doing well. I hold their hand, rub their arm, and tell them to just go to their place, take slow, calm breaths. I tell them that this is the worst of it, that it all gets better after this. That in 30 mins, this will all be over. I keep it quiet and calm.
Works like a charm.
But sedation vacation is a dangerous time. I can't have my pts on day long sedation vacation. This kind of calming is what they need. As long as they are awake, then they NEED the TLC. And if you can't give it to them, then you need to advocate for sedation.
Hey, there are demanding people and then there's the terrified person on a vent with a paralytic.
Please comfort frightened people.
Paralyzed people should never be without sedation. A nurse should never allow it. I will fight until I'm blue in the face, or until I've spoken with the attending, medical director, etc, etc until my paralyzed pt gets the sedation he needs.
I find that we should never forget the key element of nursing - caring. I am now getting more support that I am doing the right thing for him.
He was planned to be extubated today but his p02 is not that good despite fi02 is 0.4.. He was more cooperative today but I could tell that he was depressed. ICU psychosis already. Hopefully, his gases would be better tomorrow.
I do find nurses from med or surgical ward who were so busy because that they have 30 to 40 patients to take care of. Thus, they would'nt have the time to sit and talk to the patients. I fully understand in such condition by the never-ending serving med and making changes... writing reports. I do realize many nurses felt frustrated with patients, patient's relative or even doctors. And often, many have turned to be cold hearted and rude owing to the dissatisfaction that they had encountered.
But I would like to say here is, don't despair to continue to smile, to care for your patient, you are appreciated and supported by lots of people around the world that you can find in allnurses.
I would just blow off your peers comment. Yeah - you probably DID make it harder on the next shift. And much much much easier on your patient. That's a no-brainer.
That being said - I've both been teased (almost every shift) for the amount of time I spend in my rooms... and I've teased a co-worker who makes her patients custom milkshakes and smoothies. (Grrr... who has time for that?? )
Perhaps your co-workers said it with a grain of salt included?
)
pattycakeRN
94 Posts
It's a nice idea, but I usually don't have time for patting and comforting. When I do, and they need it, I give it. However, I (and I'm sure most of you) have a frustrating amount of charting to finish. Oh, and those other patients...
oh, and precedex = dexmeditomidine
and amidate = etomidate
right?