patient
what is the primary role of the nurse?
ADVOCATE
List 4 effects of loud noise on patients
1. Sleep disruption
2. Decreased o2 sats
3. Elevated BP
4. Delayed wound healing
what are some effects that noise has on healthcare team?
What are some ways to reduce noise?
placing patients in private rooms,
installing sound absorbing ceiling tiles,
modifying overhead paging systems,
initiating programs to raise awareness among staff about their role in reducing noise
How can confidentiality be imporved
designating private place for communication
What is ideal setup of critical care units (specifically pt rooms)
private rooms that promote safety, privacy, and comfort
easy access to patients and monitoring devices from all sides of bed
accesible sinks and waste disposal,
noise abatement,
adequate ventilation,
natural lighting
Define sensory overload and sensory deprivation and describe difference.
Can these occur at the same time
Sensory overload: so much stimulation that pt cannot rest; can lead to discomfort and disturbed sleep. Noise level alone is enough to cause in hospital settings. Decreased O2 sat, increased BP, delayed wound healing. Effects on healthcare team: increased stress, fatigue, burnout, difficulty communication, distractions.
Sensory deprivation: lack of nonclinical interaction. being in new environment can be difficult. can lead to deprivation and hallucinations. ways to reduce: interact with patient, families can come and talk to pt and hold hands with pt
Yes the 2 can and often do occur at the same time
what are the 3 main components of critical care experience
environemnt
patient
family
Which pt population is at higher risk for developing PTSD post discharge from a critical care unit?
Describe 3 things patients recall about ICU experience
The nurse is participating on a committee to remodel the critical care unit and recommends which features to enhance care delivery and the patient-family experience?
a: Allowing children to visit is stressful for the patient and the child.
b: Family presence during procedures promotes adaptation.
c: Restricted visitation prevents family exhaustion.
d: Visitation shapes the critical care experience for the family but not the nurse.
B
Family presence during procedures has been shown to promote adaptation and reduce fear and anxiety. Allowing children to visit should be determined on an individual basis. Research has not shown child visitation to be associated with negative effects. Restricted visitation will not prevent family exhaustion and adds to stress. Visitation shapes the critical care experience for both the family and the nurse.
As part of the nursing assessment, the nurse asks the family spokesperson, “Since you have such a large family, can you tell me how well everyone gets along?” This question is part of which assessment?
a: Cultural assessment
b: developmental assessment
c: functional assessment
d: structural assessment
C
Functional assessment identifies how family members function and behave with one another. Cutural assessment identifies cultural aspects of the family. Developmental assessment relates to the developmental stage of the family.
T or F
Noise levels in hospitals routinely exceed WHO recommended noise level guidelines (35 dB during day, and 30 at night)
TRUE
Nursing interventions to reduce stress:
ensure safety
reduce sleep deprivation
minimize noxious sensory overload
Pleasant sensory stimuli in the critical care unit can be promoted by which interventions?
a: Conversing with another nurse about another patient’s condition
b: Discussing other patients’ conditions within hearing range
c: Moving the patient’s bed to facilitate looking out the window
d: Providing a clock, calendar, and family pictures in the room
e: Asking, “Do you know what day it is?”
C, D
Allowing the patient to look out a window and providing reorientation cues, such as a clock, calendar, and pictures, provide pleasant stimuli. Discussion about other patients adds to stress for the patient. “Do you know what day it is?” is not the best way to reorient the patient.
Describe the family bundle
structure for planning and carrying out family care
5 concepts:
•Evaluate - who is the patient's family? what is their desire to be included and to what extent, who is contact person
•Plan- organize family meetings; Encourage touching
•Involve - discuss patient care; have them bring items from home
•Communicate- answer their questions honestly, assist in communication with the other providers
•Support- be a family advocate, show concern, provide resources
Which stressors should the nurse anticipate the patient to have during the critical care experience? SATA
a: Difficult communication
b: pain
c: feelings of dread
d: difficulty sleeping
e: Thoughts of death and dying
A, B, C, E
Box 2-1 describes many stressors, including difficult communication, pain, feelings of dread, and thoughts of death and dying. Most patient’s do not report difficulty sleeping as a stressor.
The nurse is meeting with family members of a critically ill patient. Which statement best addresses the psychological needs of the family members?
a: “I’m adjusting the alarms on the monitor to reduce the noise level in the room.”
b: “It would help the patient if you can spend the night in the waiting room.”
c: "The team has just made rounds on the patient. We are going to begin weaning the patient from the ventilator today since the patient’s oxygen is improving.”
d: “There are coffee and cookies in the waiting room. Why don’t you take a short break?”
C
The need for information is the primary need of family members; providing daily updates is an excellent example of meeting family members’ needs. Family members should be encouraged to get adequate rest; staying all night may increase stress and fatigue. If they do stay, many hospitals provide in-room sleeping arrangements. Providing food and space meets physical needs for family members.
How to enhance communication with family members?
V - value what family tells you
A - acknowledge family emotions
L - listen to the family
U - understand the patient as a person
E - elicit questions of family members
3 most common problems post-discharge from a critical care unit
disability and weakness
psychiatric pathologies
cognitive dysfunction