Collateral Damage: A Patient, a New Procedure and the Learning Curve

“Patient combative …”

It was around 1 AM when the nurses called. I pulled on some jeans and a shirt and walked over to the hospital, more than a little nervous in the middle of the Baltimore night.

It seems that Pam had been making a ruckus. She was arguing with the nurse, demanding nickels and dimes so she could use the pay phone which she saw hanging from the IV pole next to the bed.

“My husband told me I could call him anytime and he’d be right here. He said even if I was only scared I should call him! I want to talk to my husband!”

The nurse said she would call me.

The nurse informed Pam that there was in fact no telephone where she saw one. Pam accused the nurse of conspiring to keep her from talking with her husband. She demanded to be given some change so she could use the pay telephone across the street. Then she told the nurse to bring her a bologna sandwich and an ice cold beer and then the check. She was going to go home.

***

This was published three days later:

Keeping the ICU-Induced Demons at Bay

“A large percentage of patients in critical care units experience some level of agitation, disorientation, delirium, or psychosis,” says Brenda Hixon-Vermillion, RN, BSN, program manager of Medical ICU, division of critical care at Ohio State University Medical Center in Columbus, OH.

Patients who have extended stays in ICUs, which Hixon-Vermillion defines as anything longer than two or three weeks, are more prone to the development of serious psychological and cognitive problems. Most critical care nurses are familiar with the term ICU psychosis. Brown cites studies which show that approximately one in every three patients who spend more than five days in a critical care unit will experience some sort of psychotic reaction.” She defines ICU psychosis as “a disorder in which patients in an ICU or similar setting experience anxiety, have visual and/or auditory hallucinations, become paranoid, agitated, and potentially violent, and may become disoriented to time and place.”

Many healthcare professionals believe that ICU psychosis and other changes in mental status are caused by factors inherent in the critical care environment, such as the constant noise, frequent interruptions, windowless rooms, overwhelming and unfamiliar technology, and the lack of orientation clues.