Saturday, October 21, 2006

Communication Strategies

We've all been in that position where we just don't know how to word things when talking to a patient or a patient's family. Here are some useful communication strategies when discussing end of life care:

Less Helpful: Do you want us to do everything?
More Helpful: Let's review what treatment options are possible, and discuss the impact on your quality of life

Less Helpful: Will you agree to discontinue care?
More Helpful: Some of the care that you have been receiving is no longer beneficial. Let's discuss other care options that are available.

Less Helpful: I think we should stop treatment.
More Helpful: It's time to reconsider our goals of care. There are other options available that are geared toward relieving discomfort and maximizing your ability to function.

Less Helpful: You failed to respond to treatment.
More Helpful: The treatment that we have offered to you has not been the success we'd hoped for. Let's discuss other options.

Less Helpful: There's nothing more we can do.
More Helpful: There are many other things we can do to help you, and will.

Less Helpful: There is no hope.
More Helpful: We can always hope for the best. Let's also plan for the worst.

Less Helpful: We're going to withdraw care on this patient.
More Helpful: The goals of care have changed for this patient from curative care to comfort care.

Tuesday, October 10, 2006

The Night Shift Transition Tips

Working the night shift isn't easy. Here are some tips for making the transition:

1. Let your friends and family know your schedule. Nothing is worse than getting a phone call at 1pm after working 12 hours the night before. Explain it to them like this: 1pm for me is like 1am for you. That gives them some perspective.
2. Exercise before you go into work. It will energize you and you'll be less likely to get as tired later in the night.
3. Between 2-4am are the sleepiest times of the night. Don't leave charting for this time. Give baths or do something active. Also, have some caffeine around this time.
4. Don't drink caffeine after 4am. It will be more difficult for you to go to sleep when you get off.
5. If you're having trouble going to sleep during the day, Benadryl is something to try. Although it can be addicting so try to get sleep naturally.
6. Use a fan, ear plugs or a sleep machine to drown out the noise while you're sleeping. Depending on where you live, noise may be a problem. Apartment buildings can be very noisy during the day.
7. Wear a sleep mask or get blackout curtains/shades. Your body senses when there is light and will make it more difficult to stay asleep.
8. Cluster your days together. This may not be possible for some, but when you work every other day you are either working or sleeping at some point during the day. This can lead to depression.
9. After working a cluster of days only sleep a few hours your first day off, then get up, get dressed and leave the house. Go run errands and do things you've been unable to do while you've been working. You'll be really tired but you'll come home later in the day and go to bed at a normal hour. When you wake up in the morning you'll be back on the day time schedule and you'll be able to function with the rest of the world again!


I've been working in a CVICU for almost 4 months now. In the beginning everything was fantastic. I felt fortunate to have landed a job in critical care because I had heard it was hard for new grads to accomplish this without prior nursing experience. There is an extensive program for new grads where I work. They call it a residency. For the first 6 weeks, we take critical care classes and do the usual hospital orientation. After that we're assigned a preceptor. I started with 6 other new grads in my unit so at least there was a mini support system built in. The hospital also has what I call a "New Grad support group". We meet once a month for a year and discuss things like:
What was my biggest screw-up so far and what did I learn from it?
What has been the most unexpected reality?
What am I most proud of so far?
What is the jury still out on?.
So the hospital has a great system in my opinion, but it still doesn't reduce the shock value of spending over 4 years on a degree to get out and find that you know absolutely nothing!
I've talked to more experienced nurses and they've all told me it takes about 1-2 years to be comfortable with everything. The #1 thing I need to work on is time management and knowing what to do when the patient starts going downhill. Thankfully, every day I learn a little more. I'm picking up faster ways of doing things (and still sticking to hospital policy). I'm learning what to look for in my patient's condition. I'm learning the politics of the unit. So there IS light at the end of the long, dark tunnel!
I'm here to share with all of you what I've learned so far, tips that have been recommended, and resources that have proven to be useful for new grads starting in ICU.