first, i just have to say i had a shitty day at work yesterday. i took care of two very not ITU patients on friday and saturday, both with respiratory difficulties requiring tracheostomies. i never took care of these kind of not very sick patients in the states and i have to say they are generally my least favorite because they usually have been in the ITU for a long time, they also used to be very sick but now recovering and so the families can be quite anxious and demanding.
the gentleman i took care of friday was pleasant and as undemanding as they come. even though he couldn’t eat or do much of anything as he was limited by being attached to a ventilator he also politely declined my offers of TV, radio and a newspaper….even when i had to tell him he couldn’t text on his mobile he just shrugged and said no problem.
on saturday i took care of a patient i am very familiar with from night shifts. he has been a real challenge due to anxiety, sedation, confusion and aggression. i have spent lots of time, hours and hours, in the middle of the night trying to calm him down and get some sleep, for which he thanked me by telling me to fuck off.
the difference between these two men??? i think it’s their families…the first man is older and has a lovely, bright, cheerful wife. when she comes in she is all sweetness and light and focuses on the good stuff, she even said hi to me on saturday when i stuck my head in to give her husband the thumbs up because he’d finally gotten something to eat.
the second man is a few years younger than me, has a heavy alcohol history and a “partner” who has over his 40 odd days on the unit, pissed off and annoyed virtually every staff member. it has long been apparent and discussed that he is relatively calm until she shows up, she complains and picks at everything. she appears fairly educated and socially well off which she seems to think gives her open access to the consultants. we, nurses, and particularly the royal blue nurses are just there to run messages over the middle doctors straight to the top dog. to say she is anxious is an understatement….she reminds me of that line from ferris bueller
Pardon my French, but Cameron is so tight that if you stuck a lump of coal up his ass, in two weeks you’d have a diamond.
so, i was dreading 11am when visiting starts and sure enough even though the patient was calm and relaxed…she comes in and starts telling me what she wants done. we had a heated discussion but when she lied to me and i showed her on the chart where she was “mistaken” she became very rude…and everyone heard her! my colleagues came to my defense by offering to take her outside and tell her she couldn’t talk to staff like that and another offered to poke her eyes out. i shrugged it off, i don’t take other peoples anxiety personally but it did set up a very long and difficult day. she intentionally or not proceeded to wind up the patient so he was coughing and sputtering while she was there and passed out out from exhaustion when she stepped out. he was out cold asleep and as soon as he half opened his eyes , she had a straw at his lips telling him to have a drink…..
the loser in it all? the patient. we discussed at lunch how difficult it is to be anurse when you have to cater to the family knowing that you are not doing the best for the patient…i sat him out in the chair and she started this monologue…are you in pain are you uncomfortable you look uncomfortable do you want a drink do you want a pillow behind your back do you have any pain do you want the tv on do you want some strawberries does you leg hurt do you need the toilet?? aha!! the magic word the one that always gets results, the one that can’t be ignored!!! she won…i put him back to bed after only 45 minutes and no he did not need the bedpan…but she won…
i am not the only one she has done this to, she has a preference for navy blue nurses and had one the previous day. when everything was perfect!! can you imagine how many times she told me that…”yesterday everything was perfect, he was sooo much better yesterday, yesterday everything was fine!!!!”” …and today he is crap!!
oh well, like i said everyone was really supportive of me and agrees that she is the problem so here is my advise to family members:
if your family member is a patient on ICU
1~do your best to curb your anxiety, the nurses know that it is a stressful time for you, but if you can’t handle it…step outside the unit. get a breath of fresh air, come back when you are calm and relaxed.
2~learn how to sit quietly at the bedside, don’t feel like you have to make polite conversation. the nurse is there to take care of your family member and may have a million things on her mind other than hearing about what you had for lunch or recounting everything she has just done or is planning to do. if your family member is awake, try not to go on about how painful everything must be, don’t keep reminding them of how restricted they are…be positive, reassure!!! focus on their progress, the good stuff. distract!! talk to them about the weather, family news, current events in the world…
3~when the nurse says your family member is fine, stable, unchanged… that is a good thing…there are lots of ups and downs in ICU, that’s why we monitor them contiuously…just because the oxygen changes from 40% to 50% or we are giving a unit of blood doesn’t mean you need to panic. those are routine interventions in ICU…..go back to number one!
4~never make judgemnets about nurses skills. sometimes the nurses who have the most experience or wear a certain uniform are NOT the “best” nurses, sometimes they don’t care for patients very often and their skills are a little rusty. sometimes, believe it or not nurses come into work with personal issues on their minds or not feeling particularly well. nurse are human and everyone has their own personality…just because a nurse is friendly and chatty does not make her the “best” nurse.
5~when your family member starts to make their recovery, they need to start doing things for themselves. when equipment and machines are taken away and the nurse is not hovering constantly at the bedside…that is a good thing!!! the nurse is NOT neglecting them, she is starting the rehab process! go back to number 4…
like i said i am counting the days….till i start my new research job!!! it will be refreshing to have a new perspective and working only the occasional shift!