Critical Condition

As our parents and grandparents age, we will be confronted with one absolute truth: dying is inevitable. Do you know what your parents would want if they couldn’t speak for themselves?  Moreover, Personal Health Mastery includes knowing this for yourself, and then expressing your desires to loved ones in the event that you were unable to make medical decisions for yourself.  Kim Vial, RN, an intensive care nurse talks about some of the misconceptions about the ICU that influence people’s experience.

Common Misconceptions in the ICU

Kim Vial, RN, BSN, CCRN

The intensive care unit (ICU) provides close monitoring and minute-to-minute interventions for organ support in patients in critical condition. Specially trained doctors, nurses, and other staff team up to provide lifesaving care to patients in the ICU, sometimes in chaotic circumstances. For the families and friends, the ICU can be not only daunting, but also a personally traumatic time, as they deal with life decisions for loved ones. Because the onset of critical illness is usually rapid and untimely, the patient’s wishes are often not known and loved ones are confused and unprepared to make major decisions. The staff in the ICU is not only there for the patient but for the family as well.

Here are a few common misconceptions about the ICU.

Misconception: Do Not Resuscitate (DNR) means to stop all treatment and care:     This is not necessarily true and because of the confusion, the DNR tends to get a bad rap. DNR means that no “extraordinary” measures should be taken to save a loved one if, for example, their heart or their breathing should stop. However, this does not mean that we as nurses won’t continue to care for and keep the patient comfortable, clean, and safe. Palliative sedation is given to relieve suffering associated with dying.   However, any decision to withdraw or withhold any treatment should be discussed with all those involved in the patient’s management of care.  This can be a difficult discussion but can prevent more turmoil.

Misconception: Death in an ICU is undignified and impersonal:    

This is completely untrue. With modern advances, many medications and palliative treatments can be given to ease this time and the discomfort that can be experienced. The patient remains in a calm, safe environment where the family can stay if they choose. The patient and the family maintain complete autonomy in the decision-making. This is all with the benefit of being surrounded by highly trained personnel who carry out these wishes in a humane and compassionate way.

Misconception: Restraints are a form of punishment:    Restraints used in the ICU are usually wrist restraints. This type consists of a soft “bracelet” that the patient wears on the wrist, which is then attached to the bed to prevent the patient from pulling out vital lines, tubes, or worse, from harming themselves or others. Tubes frequently pulled by patients include IVs, bladder catheters, and breathing tubes, all of which could cause serious harm to the patient if removed accidentally or too early. This type of physical restraints is often used after other options are exhausted.

Misconception: I can make a living will when my “time comes.”    This is a very important misconception. A living will should be made by EVERYONE and BEFORE they enter the hospital. I am not yet 30 and my family knows my wishes if I am ever incapable of making my own decisions. As a critical care nurse, a lot of our patient’s onset of illness is very rapid and too often the patient’s wishes are not known. This causes a tremendous added stress on the family. With expanding technology, we sometimes have the ability to keep people alive for weeks. However, this does not always increase the chance of real survival, but instead can simply prolonging dying. Take time to have this discussion with your family.  It is very easy to fill out a living will. Any hospital or clinic can give you forms to fill out.

Kim Vial, RN, BSN, CCRN

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