ICU «

One of the worst parts of working in healthcare is knowing you can’t save everyone

26 Jun 2011 Leave a Comment

by littlenursey in Experiences, Placements Tags: acute, death, dying, hospital, hospital ward, ICU, intensive care, nurse, nurses, nursing, patient, student nurse

I was discussing nursing with my boyfriend Kov a few days ago (something we often do – he questions me a lot about healthcare and seems to find it very interesting) and he said something that really made me think: “You can’t save everyone.”

It reminded me of the time I trained on an Intensive Care Unit (ICU) and witnessed death in a very different way. I had seen and heard about patients dying on other wards after being very ill for some time. But on ICU it wasn’t like that – people were being brought in from A&E with severe illness and were at high risk of dying.

During my first week there I witnessed a consultant tell a woman in her seventies that her son was going to die that day.
I had been caring for her son who was in his fifties and very unwell, under sedation, ventilated and not improving at all. His only other family was his younger brother. I was collecting a blood sample from him earlier that day as his family arrived, and I stayed with them for a little while just to chat to them and see what they were thinking and feeling. They told me that they were expecting the worst, and that a consultant had already explained that he may not pull through. They seemed to accept this, and eventually left to go and get some lunch.
While they were gone, the patients consultant found me writing at the patients bed side and told me that the decision was made – they were going to have to let the patient die. He needed to tell the patients family.

I couldn’t believe my eyes when I saw the consultants behavior for the next thirty minutes – he was extremely nervous. I found him leaning against a wall away from the bed areas, thinking about how to break the news and looking very sad. I approached him and asked if he was okay – he told me that even after years of working in healthcare he had never hardened up to breaking bad news like this to patients families. He was upset and the fact that it was the patients mother he was breaking the news to made the situation even worse.
I told the consultant that I had already met the family and that they were expecting the news, which brought him some relief.

When the patients family came back, they were escorted into a private room with the consultant, myself and the nurse I was working with that day. There I witnessed the consultant break the news. It was heartbreaking – the mother cried and found it difficult to speak, and her other son was comforting her. It was clear he was trying to be the stronger one through this. They accepted the news and returned to the bedside. The patient was taken off the ventilator and all invasive treatment was stopped immediately. He died later that day.

I found this particularly upsetting as the man was around the same age as my Dad, and the mother around the same age as my Grandma. They even looked similar to my Dad and Grandma. I heard the nurses saying that no parent should outlive their son, and I couldn’t help thinking about how the mother was there when her son was born and there when he died.

Intensive Care Unit; a learning experience not to be forgotten

12 Mar 2011 Leave a Comment

by littlenursey in Placements Tags: acute, arterial lines, central venous line, death, ICU, intensive care, intravenous, manchester, nursing, oxygen, student nurse

So I’ve just finished a 5 week placement on the Intensive Care Unit (ICU) at a hospital in Manchester, and am currently enjoying a week off. I have done a lot of sleeping. It feels like I’d been on ICU a lot longer than 5 weeks, because the amount I learned was unbelievable.

I am currently studying the Acute Care in Adult Nursing unit at university, so ICU was a perfect fit for that unit. Acute care can be considered as an urgent event in healthcare, whether that means a person being in sudden pain from an injury, or a person choking on a bit of potato.
On ICU it can be things such as a patient’s O2 saturation levels suddenly dropping from 99% to 80%, or a patient going into urinary retention and not being able to eliminate toxins and waste.
The action taken in these situations is the ‘acute care’ given, such as sticking an oxygen mask on someone and giving them 15lites of O2 a minute, or inserting a urinary catheter.

ICU consisted of an awful lot of Intravenous medicine, bed bound patients, urinary catheters, blood samples, chest physio, machinery, ventilators, tracheostomies, suction catheters and death.

It looks a little like this, only the machinery is far bigger:

Above: I could not find the artist of the above image so I don’t wish to take any credit for it – I just really like it.

A typical day on ICU – a whole day of new learning experiences:
At this particular ICU, an early shift would start at 7.30am and finish at 2.45pm. A 7hr shift with a 15min break (I much preferred early shifts as more care was given than on a late shift). You look after 1 patient per shift.
If you want to learn how to prepare IV medicine then ICU is the place for you. Just as I’d finished preparing IV drugs for 9am (aseptic technique, syringes, needles, calculations, potions and all) it would be time for hygiene care to be given. Teeth brushed, Chlorhexidine mouthwash begrudgingly given (it tastes AWFUL), full bed bath and moisturiser massaged into wherever needed moisturising. Sometimes a patient would be hoisted into a chair (if they were conscious) to help them regain muscle strength. Fluid levels, blood gases and paperwork would then be completed.
By the time this was all done, it would be time for afternoon medication. Back to the clinical room! Once the afternoon drugs were completed, any other tasks to be done that day would be completed – this could be surgery, replacement of lines, inserting a tracheostomy etc.
Most patients on ICU have a Central Venous Line inserted for the majority of their drug administration. This is a catheter that is inserted into a large vein in the neck, such as the internal jugular vein:

Above: A patient with a triple-lumen CVL inserted for antibiotic drug use. Image taken from http://bit.ly/gvmQOj

Makes it much easier with CVPL’s as large veins can take the pressure of a lot of drugs being administered several times a day.

There is no doubt that ICU was one of my most difficult placements because of how much I had to learn about the ventilation system – I will not even start going into it. The majority of patients are also admitted under sedation and can be sedated for days – this makes the work heavier and more time-consuming as you are moving a patient’s full weight when they are unable to move. Plus there are a huge amount of wires and tubes going in and out of the patient – a patient can have 3 syringe drivers on at the same time, plus 3 or 4 suspended drips, an NG and NJ tube (you can google the difference), a urinary catheter and sometimes a drain from a wound or an infected bodily organ.

The clinical technology used can be intimidating. Blood pressure cuffs are not used on ICU – arterial lines are used instead to get a constant record of the patient’s blood pressure (check this out http://bit.ly/fy5XWJ). It can also be used to get blood samples so the patient’s blood gases (blood ph levels, CO2 levels, sodium, potassium, glucose etc) can be checked at regularly intervals.

Death was definitely something to get used to on ICU – my first patient died on my 2nd shift. 1 or 2 patients died a week during my time there, some of them not that old and some of them leaving behind people who then had no one to care for them.

Luckily for me, the staff at this ICU were more than amazing. Everyone was very keen to teach me and I was made to feel very involved in patient care. I was given many opportunities to do anything that I was able to as a student nurse, which gave me the confidence to use more of my intuition. Shame that ICU also meant that I was completely knackered most of the time.

If you get a chance to train on ICU, make sure you get stuck in and do everything you are able to do (obviously, administering IV medication is a no-no, as is deciding to mess around with sedation and morphine levels without being told to). You will leave realising that you knew less than you thought beforehand. Unless you’re a registered nurse of course.

ICU could end up being my elective placement in 3rd year