ABSTRACT
Following a two-day history of pyrexia, stomach pain, diarrhoea and an emergency laparotomy my wife was admitted to an intensive care unit (ICU) with septic shock. Lucy was artificially ventilated for seven days, and was treated with fluids, vasopressors and antibiotics. Her condition continued to deteriorate and on about the third day she looked as though she might die. However over the next few days Lucy began to recover and she was eventually transferred to a ward and came home three weeks after admission to hospital. During her stay in the intensive care unit, Lucy developed pneumonia, bilateral pleural effusions, acute renal failure and a pericardial effusion. Over the weeks and months that followed, Lucy began to describe her experiences and the impact that these have had on her. She described what it felt like to be a patient in the ICU and the challenges that she faced during her recovery. I am a Registered Nurse and at the time my wife was admitted to the ICU I had spent twenty years working within the field of intensive care. Until my wife had been admitted to ICU, I thought that I had a good appreciation of what it was like to be a patient or a relative in an intensive care unit. Having experienced critical care at first hand and having had an opportunity to reflect on what happened I now realise what little insight I had. I have now come to realise that as nurses in intensive care there is much we can do to alleviate the suffering and discomfort experienced by some of our patients and relatives. Perhaps by describing what happened, I will enable the reader to understand more clearly and to reflect on those factors which have a deep and lasting impact on patients and their relatives and which can be influenced by nurses at the bedside. For the purpose of this account, I have chosen to call my wife, Lucy.
Subject(s)
Attitude to Health , Critical Care/psychology , Inpatients/psychology , Nursing Staff, Hospital/psychology , Spouses/psychology , Adaptation, Psychological , Critical Care/organization & administration , Fear , Grief , Humans , Nurse's Role/psychology , Nurse-Patient Relations , Professional-Family Relations , Shock, Septic/psychology , Shock, Septic/therapy , Visitors to Patients/psychologyABSTRACT
A number of interventions have been shown to improve the outcomes of patients who are invasively ventilated in intensive care units (ICUs). However, significant problems still exist in implementing research findings into clinical practice. The aim of this study was to assess whether the systematic and methodical implementation of evidence-based interventions encapsulated in a care bundle influenced length of ventilation and ICU length of stay (LOS). A ventilator care bundle was introduced within a general ICU and evaluated 1 year later. The care bundle was composed of four protocols that consisted of prophylaxis against peptic ulceration, prophylaxis against deep vein thrombosis, daily cessation of sedation and elevation of the patient's head and chest to at least 30 degrees to the horizontal. Compliance with the bundle was assessed, as was ICU LOS, ICU mortality and ICU/high-dependency unit patient throughput. Mean ICU LOS was reduced from 13-75 [standard deviation (SD) 19.11] days to 8.36 (SD 10.21) days (p<0.05). Mean ventilator days were reduced from 10.8 (SD 15.58) days to 6.1 (SD 8.88) days. Unit patient throughput increased by 30.1% and the number of invasively ventilated patients increased by 39.5%. Care bundles encourage the consistent and systematic application of evidence-based protocols used in particular treatment regimes. Since the introduction of the ventilator care bundle, length of ventilation and ICU LOS have reduced significantly.
