NURSING IN ICU PATIENTS

Nursing In ICU Patients



Nursing In ICU Patients

Introduction

Being a critical care nurse (CCN) means being responsible for the nursing care of critically ill people and their close relatives. As soon as someone who has been critically ill becomes healthier, it is time for them to leave the intensive care unit (ICU) (Goode & Rowe 2001). The CCNs might then not know how the ill person and their close relatives managed afterwards, or how they experienced their time in the ICU and CCNs have said they miss this (Engström & Söderberg 2007). The experience of critical illness affects the ill person not only while they are in the ICU, but also for a long while afterwards (Karlsson & Forsberg 2008, Storli et al. 2008).

People who have been critically ill have described how, after being critically ill, they felt more sensitive and experienced fatigue as well as difficulties in relaxing, concentrating and separating dreams from reality (Russel 1999). A link has been postulated between the abnormal environment in the ICU, the drugs and the illness, with the lack of a clear division between night and day, continuous noise from monitors and alarms on infusion pumps and the development of delirium resulting in hallucinations during and sometimes after the period in the ICU (Jones et al. 2000, Arend & Christensen 2009).

Not remembering one's stay in the ICU or having only patchy or delusional memories, nightmares, hallucinations and confusion are described as distressing (Johnson et al. 2006, Ringdal et al. 2006). People who have been critically ill have expressed a need to know what happened while they were ill in the ICU (Engström et al. 2009). Close relatives of critically ill people are also deeply affected in their everyday lives during and after the ill person's stay in the ICU (Engström & Söderberg 2004). Their relative, who has been critically ill, often asks about what happened in the ICU and the close relative of the ill person might have their own unanswered questions (Engström et al. 2008).

Several studies (e.g. Hall-Smith et al. 1997, Cutler et al. 2003, Pattison et al. 2007) have suggested the value of follow-up visits to the ICU for formerly critically ill people. Follow-up visits are seen as an opportunity for them and their close relatives to receive explanations about what happened and as a chance to discuss their experiences during and after the time in the ICU with staff who were involved in one's care (Engström et al. 2008, Storli & Lind 2009). Cutler et al. (2003) and Strahan et al. (2003) found that follow-up visits to the ICU offer the potential for expanding the staff's understanding of the critical illness experience by providing an opportunity for people who have been involved in the care to listen to the critical illness experiences.

One part of the follow-up visit may be talking about the content of diaries written for people during their critical illness (Bergbom et al. 1999, Bäckman & Walter 2000, Combe 2005, Roulin et ...