Psy·cho·ses
I tell you what ICU psychosis is. It’s much like the definition of insanity…doing the same thing over and over again and expecting different results. We’re actually going to focus on the aspect of this very serious and very dangerous occurrence in the ICU setting when this form of delirium, or acute brain failure occurs in your nurses.
There are plenty of valid reasons and research that back the validity of this illness. For the patient it can be a combination of medical and environmental factors. Clinical issues for the patient can include uncontrolled pain, the actual illness or trauma they may be experiencing, drug reactions, fever, electrolyte imbalances, lack of oxygen to the brain etc.
I want to focus on the environmental aspects. I have recently been wondering if there is any research indicating alterations in the mental capacities of medical employees being in the same environmental as their patients.
Environmental Causes
- Sensory deprivation: A nurse being put in a room that often has no windows, and is away from family, friends, and all that is familiar and comforting. Also occurs in nurses working nights.
- Sleep disturbance and deprivation: The constant disturbance and noise with the hospital staff going into the rooms at all hours to check vital signs, give medications, etc. Also seen in nurses working nights.
- Continuous light levels: Continuous disruption of the normal biorhythms with lights on continually (when working nights and no reference to day or night).
- Stress: Nurses in an ICU frequently feel the almost total loss of control over their life.
- Lack of orientation: (Some) nurses loss of time and date.
Lastly and certainly not the least:
- Medical monitoring: The continuous monitoring of the patient’s vital signs, and the noise monitoring devices produce can be disturbing and create sensory overload
Let’s take for instance the last 6 days of work. Mind you I have had 2 one-on-one patients for those 6 days. Thankfully I had a 2 day respite in the middle of all the nonsense. But I swear to you, in each case, both patients being on a ventilator, cardiac monitoring and some triple pump concoction of something or another. If it wasn’t the monitor beeping, it was the one the pumps. And if it wasn’t the pump, it was the alarms on the ventilator. As soon as you get one working, the other would one would frak up and start all over again. And then run to the other patient…rinse, repeat and do the same cycle over again about 300 times during the shift.
They never tell you in nursing school that you need minor degrees or apprenticeships in plumbing, electricity and computer networking. I have recently felt that you end up trouble shooting electronics more so that trouble shooting your patient. So as you watch your equipment blink on and off and watch the thing drop vital signs and randomly turn on and off, the real kick in the arse is when BIOMED shows up and the damn things work like a charm. GGRRRR…
Agreed. The whole post is precisely correct.
One other thing they didn’t teach in nursing school: I have come to see that the training and certifications really serve as the liability warning- “Yes, your honor, we trained him. He KNEW the proper procedure”. Critical care and it’s challenges are immensely rewarding. However, at some point we have to ask ourselves: How long can I operate in the most risk laden environment , taking the most critical sick patients the hospital has to offer before I get overloaded and hurt someone or myself? Nurses do not seem to understand- we have no personal obligation to anybody, any corporation, any professional code to get absolutely slammed, over and over, overly utilized and not ask ourselves- WHO ELSE IS PROFITING FROM THE FRUITS OF MY LABOR? IS THIS FAIR TO THE PT?
Risk vs. Reward. I greatly enjoy doing it. Hell, I like the challenge and risk. I look forward to work (sometimes) but I hate the drive home. I am expected to keep training, keep getting certs, keep taking more and more responsibility but THERE IS ABSOLUTELY NO EXPECTATION THAT I SHOULD GET PAID FOR IT. Some say- “Then quit!”
No, I’m not quitting. But I am going to bring up the point that as an employee I am doing more and harder work than your average staff R.N. and I want to be compensated for it. Just a couple quarters on my paycheck that says: Danger to license and self pay, we know we put you through the ringer.
My coworkers complain how broke they are but act like to ask for more money is somehow beneath them.
Of late, anesthesiologists are training staff R.N.’s to do more and more of their gig. MD’s hate it when R.N’s get paid for doing “their” work but don’t mind us doing it when we don’t get paid or acknowledged. Most R.N’s don’t realize they are actually helping the M.D.A.’s keep C.R.N.A’s out of the hospital. Good ol’ boy Dr. Drugs gets to bill out. Why don’t I get a cut?
You know those organ’s you helped get “donated”? Those were sold. Where’s your cut? Non-profit. Hilarious.
Fighter pilots call it “Situational Awareness”. 50 tiny flashing lights, bleeps, buzzes, warnings, guages, incoming calls with priority messages, information that absolutely must be communicated, all diving into your head and out-each one means life or death for you or someone else. This term was developed as competent, proven pilots made sentinel errors of the basic kind, i.e. flying the plane into the ground, colliding into other aircraft or structures, failure to prioritize most urgent crisis-getting shot down.
Same thing in nursing, ESPECIALLY in the I.C.U. Pure sensory overload. It’s gonna be a dumb move that does your patient and your career in.