Flexibility the new "F" word

You can tell fall is a upon us. Not just because of the wonderful changes in the foliage, the crispness in the air, the fall root crops almost ready for the picking. But from a medical stand point. With the change of seasons comes the change in the kind of patients we see.

This past set of shifts I have seen a significant rise in respiratory patients. This is very common this time of year. People who suffer from asthma, or bronchitis or people with chronic obstructive pulmonary disease(COPD), the smokers or ex-smokers seem to have difficulties with their breathing. There is a theory that the respiratory patients conditions are exacerbated by the change in temperature and/or the increase in moulds and other environmental factors.

What that means for me, is that in the ICU I see more patients requiring the need to be put on ventilators(breathing machines). In my 3 shifts this week we have had 3 patients on ventilators. When I worked I in the big city that was not unusual, actually that was the norm. But for the small ICU that I work in, that is a lot. These were young patients as well, early to mid 50's. It has made for busy shifts. But I like that. I have always liked working with ventilated patients they always present with a challenge. Even though their main reason for being in the ICU is for airway management, one can't ignore the person as a whole. One system does not work alone, they are intertwined and you have to remember that anything could go wrong at any given moment.

The one thing that I find that gets overlooked is the pychosocial needs of these patients and their families. As evident by my shift last night. I didn't have the ventilated patients last night but I worked with the patient next to the ventilated patient and I observed the interaction of the nurse/patient/family. I was disturbed by it. Don't get me wrong, the care the nursing was giving the patient was exceptional. It was the nurses need to control the environment that I took offense to.

You see in ICU or any critical care environment we try and set visiting hours and control the amount of traffic in and out of the ICU for numerous reasons. But the primary reason is for patient care and safety. I would hate for a family member to coming walking in while I have their loved one beared to the world while I am either performing a procedure/treatment, or giving a simple bed bath for that matter. Hence the visiting hours are set to allow for patient rest time and time for the RN to perform her duties.

Now with that being said. Does flexibility ever enter anyone's head. I call it the new "F" word "Flexibility" . I can't believe how strict and controlling some of the RN's can be. I know change of shift can be crazy or when the new patient comes to the ward from ER or OR we need to assess the patient and settle them in. But after that I think it is fare game to let the families in. The role the families can play in the recovery of the patient is paramount. Rather than medically sedating the patient, just having their loved one nearby helps decrease the level of stress and anxiety the patient is going through.

This RN last night was just not going to have any of that. Granted it was change of shift when the wife showed up for the patient, and wanted to see her husband. So yes she needed to wait at least until report was over with. Then the nurse should have gone out and told her that she was just going to do an assessment and then she could come in. That nurse left that woman out there for over 45 mins. I thought that was terrible. It would have made the world of difference for the patient and the patients wife had the RN let her in even if for a few mins. Then explain to her what is going on and ask if she could step out for a bit and then come back. "Flexibility" people........Jeesh!!!!

I get so frustrated with this kind of control. I think maybe it had something to do with my many years as a palliative nurse. I enjoyed having the families present. They often would participate in the patient care and it made them feel good as well as the patient.

I believe the same stands true in ICU. I firmly believe that the families play an integral part in the patients road to recovery.

Ok I will step down from my soap box now.

Stay healthy everyone. Wishing you all a fantastic weekend.