Views on Critical Care from a Novice.

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Finding out I was going to be placed in an Intensive Care Unit (ICU) brought upon many mixed emotions upon the day placements were released in mid-August. Needless to say, I was stressed, scared, but also excited to embark on a new challenge in critical care. My feelings were found to consistent in the literature with new grad nurses reporting feeling of being “overwhelmed and unaware of the clinical expectation and skills needed to care for the complex critical care patient population” (Lewis-Pierre, Amankwaa, Kovacich, & Hollis., 2014, pg. 47).  For the most part, it was daunting to be placed in a setting where I would be expected to be more independent and have a preceptor, rather than a group to turn to throughout the day.

Having worked 3 shifts in the ICU officially, I can say I am amazed at the amount of detail and professionalism these nurses put into the care of their patients. The level of detail when doing patient assessments is astonishing and the calamity during stressful and rapidly changing situations has been eye opening. 

Following John’s Model of Structured Reflection, I will walk through one of the clinical experiences that stood out the most for me. As a new student familiarizing myself with the unit I had been wandering around looking for small tasks to do, one senior nurse who had been behind on charting asked if I would be so kind as to help make her patients bed while they were seated for dinner. Being new, I happily obliged to helping with a task I knew and felt confident I could accomplish thinking nothing of the interaction I would have with the patient. I entered the room and began to unfold the sheets that had been brought in and started off with the fitted sheet. As I was placing the sheet on the bed, the patient, a relatively young female began chatting and asking about myself and how busy the unit had been that day. Being relatively independent she apologized for the inconvenience she likely caused upon her admission a few days prior. Puzzled, I asked her what had brought her to the ICU, and she stated she had overdosed and was nearly dead upon arrival.  The room went quiet, and she began to cry as she walked me through her story of how she had been raised by an addict and lost her daughter because of the choices she had made in the past and the grief she felt having lost her husband to an overdose 3 years ago. She then opened about how she was nervous but excited to be offered the opportunity to attend rehab after her discharge. 

As a novice nurse, I felt overwhelmed at first to be surrounded by a patient who now felt very vulnerable because of the circumstances she had placed herself in. In the moment, I felt no sense of judgment, what I saw in front of me was a human who was struggling to cope with the immense amounts of grief she had yet to resolve and the circumstances she was raised in. At this moment, I felt the need to put down the tasks I was doing and sit on the edge of the bed closest to her table and sat with her at eye level. In the moment, I knew it would feel impersonal to stand above someone who was sharing such a vulnerable part of their life. I knew it was important to remind her that healing wasn’t a destination but a journey and that while it would be difficult at times setting small goals might help with achieving a bigger picture. I encouraged her to advocate for herself when she went down to a step-down unit in speaking with the discharge team the hospital offered and to show compassion to herself even in times where she felt it wasn’t warranted. I also felt it was important to remind her that blame would lead to nowhere and that being able to learn to forgive both herself and others was an important step in the process because she either had the option to move forward or be held back in the past. I believe from her body language and optimistic tone, she was receptive and thankful for my presence, having felt largely isolated in her hospital room with no company to drop by.

In this case, I based my actions on being empathetic towards my patient’s needs. Oftentimes I felt so wound up caring for patients who were under sedation, I felt out of my comfort zone to deal with a patient who had willing opened about themselves to me. I think some of the broader issues that were brought to my mind after reflecting, was looking more into community resources that she perhaps could have used throughout her journey. Not being from the region, I am unfamiliar about the services offered to those who are struggling with not only addiction but also poverty. I think in this scenario, I offered another form of care that this patient needed in that moment. I offered to listen to her and let her speak to her story, rather than use traditional means of treatment like administering medications or performing physical assessments. 

I believe if the situation arose again, I would continue to do the same thing I did in this moment. Upon leaving the room, the patient repeatedly thanked me for taking some time out of my day to sit with her and attend to her needs, which included having someone listen as she reflected upon her own feelings of the situation. Upon going home, I considered the literature of healthcare professional compassion and learned that when patients received messages of kindness and empathy that were at least over 40 seconds their anxiety levels were measurably reduced (Trzeciak & Massarelli, 2019). I am grateful for the vulnerability she showed me in the moment, as a new nurse I feel I often get caught up in the performing and learning new skills and assessments, rather than stopping for a moment to get to know my patient at a deeper level. While I am aware getting too close to very sick and dying patients can lead to burn out (Awdish & Berry, 2017), I believe it is also important to show patients they are more than just that. One study showed the opposite effect in that, connecting with patient made healthcare providers happier and more fulfilled than those who didn’t engage in empathetic care due to factors such as “lack of time” (Reiss, Kelley, Bailey, Dunn, & Phillips, 2012). Specifically, Treciak and Massarelli found in their work on compassion, that those with low compassion are the ones who are most predisposed to burn out (Ritchie, 2019). 

If this situation taught me anything, it’s the importance of humanizing the care we as nurses provide at the bedside.  I believe through researching care giving compassion, I plan to incorporate this into my practice and lean in more, rather than less and offer at least 40 seconds of compassion to my patients and see how these changes transform my future experiences. 

References:

Awdish, R.L.A & Berry, L.L. ( 2017, October 9). Making time to really listen to your patients.        Harvard Business Review. Retrieved from https://hbr.org/2017/10/making-time-to-really-listen-to-your-patients

Lewis- Pierra, L.T., Amankwaa, L., Kovacich, J., & Hollis, L. (2014). Workplace readiness of new  ICU nurses: a grounded theory study. Global Journal of Human- Social Science, 14(2).  Retrieved from https://globaljournals.org/GJHSS_Volume14/7-Workplace-Readiness-ofNew-ICU-Nurses.pdf

Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. Journal ofgeneral internal medicine27(10), 1280–1286.  doi:10.1007/s11606-012-2063-z

Ritchie, L.C. (2019, April 26). Does taking time for compassion make doctors better at their jobs?. Health News from NPR. Retrieved from            https://www.npr.org/sections/healthshots/2019/04/26/717272708/does-taking-time    for-compassion-make-doctors-better-at-their-jobs

Trzciak, S. & Mazzarelli, A. (2019). Compassionomics: the revolutionary scientific evidence that  caring makes a difference. Pensacola, FL. Studer Group.