Chapter 2 Flashcards
Unexpected, life-threatening
events.
Critical Illness
Disrupts patient and family
equilibrium.
Critical Illness
ICU from Different Perspectives
- Safeguarding fragile lives
Nurses
Perception of Critical Illness
- Mixed feelings;
sometimes a hint of impending
death.
Patients/Families
Perception of Critical Illness
- Communication Challenges (3)
Physiological barriers, verbal
restrictions (e.g., tubes), cognitiveaffecting drugs.
Memories of ICU Stay
- Fear, pain, anxiety
Negative
Memories of ICU Stay
- Feelings of safety, trust in
nurses.
Positive
Memories of ICU Stay (2)
Negative
positive
ICU from Different Perspectives (2)
Nurses
Patients/Families
Disequilibrium caused by
stressors (Selye, 1956).
Stress
Physiologic &
Psychological triggers.
Stressors
Environment & Implications
- Rich with stressors affecting
patients & families
ICU
Environment & Implications
- Compromised wholeness,
security, and control. Increases
vulnerability and potential mortality
Effects
Stimulates hypothalamus-pituitaryadrenal axis.
Stress Physiology & Acute Response
Stress Physiology & Acute Response
- norepinephrine and epinephrine
release.
Fight-or-flight mechanism
Fight-or-flight mechanism stages
Alarm
Resistance
(potential) exhaustion
Stress for the Patient (2)
Environment & Implications
Stress Physiology & Acute Response
Stress for the Family
- Critical conditions affect a family’s
emotional well-being.
Immediate Impacts
Immediate Impacts Anxiety Signs (2)
Physiologic
Behavioral
Stress for the Family
- Unfamiliar settings and equipment
escalate fear.
ICU’s Stressful Ambiance
Stress for the Family
- Health care team’s focus might
neglect the family’s emotional state.
ICU’s Stressful Ambiance
Stress for the Family
- Potential strained dynamics with
health care staff.
ICU’s Stressful Ambiance
Stress for the Family
- Sudden events disrupt routines,
thrusting families into crisis.
Family’s Adaptation & Decision Making
Stress for the Family
- Family cohesion and problemsolving shape coping mechanisms.
Family’s Adaptation & Decision Making
Stress for the Family
- Acknowledges and empathizes
with family’s fear and anxiety
Role of the Nurse
Stress for the Family
- Understands the adaptive nature of
the stress response.
Role of the Nurse
Stress for the Family (4)
Immediate Impacts
ICUs stressful ambiance
Family’s Adaptation & Decision Making
Role of the Nurse
Environmental Stressors in the ICU (2)
Noise
Lighting
Environmental Stressors in the ICU
- Noise sources (3)
Equipment, staff, alarms
Environmental Stressors in the ICU
- Noise consequences (3)
Sleep disruptions,
heightened stress, impaired
healing
Environmental Stressors in the ICU
- Importance in maintaining circadian
rhythms
Lighting
Environmental Stressors in the ICU
- Lighting issues (3)
Bright artificial lights, lack of
natural views, disrupted sleep
patterns.
Creating a Healing Environment
- Florence
Nightingale emphasizes holistic
care nurturing the whole person
Foundational Insight
Creating a Healing Environment
- Marrying
advanced technology with
psychological needs. Solutions
include restful interventions, music,
and mindfulness
Contemporary Challenge
Creating a Healing Environment
- A
2014 initiative to reimagine a more
patient-centric ICU.
The Humanization Movement
Creating a Healing Environment
- Eight Pillars of Humanizing ICU
Care
o Open visitation.
o Effective communication.
o Prioritizing patient wellbeing.
o Engaging relatives.
o Support for healthcare staff.
o Addressing post-ICU
challenges.
o Patient-friendly design.
o Comprehensive EOL care.
Nursing Interventions for the Patient
-Creating a Healing Environment (3)
Foundational Insight
Contemporary Challenge
The Humanization Movement
Promoting Rest and Sleep in the ICU
- Types of Sleep (2)
REM and NonREM
Promoting Rest and Sleep in the ICU
- stages of sleep
stages N1, N2, N3 - deep
recovery phase
Promoting Rest and Sleep in the ICU
importance (4)
Vital for overall health,
cognition, emotion regulation, and
recovery.
Promoting Rest and Sleep in the ICU
challenges (2)
internal
external
Promoting Rest and Sleep in the ICU
Challenges
- Noise, light,
constant interventions.
external
Promoting Rest and Sleep in the ICU
Challenges
- Illness, pain,
certain medications.
internal
Direct link between
trust and improved patient
outcomes
Significance of Fostering Trust
Fostering Trust
- nursing goals (2)
o Combine a caring attitude
with technical skills.
o Communicate effectively to
build trust
Fostering Trust
- Connect genuinely, listen
actively, and value the
patient’s perspective
Building Trust
Techniques in Fostering Trust (4)
Eye contact,
kind words, touch, setting
clear expectations.
Providing Information (3)
Compassionate Care
Patient Communication
Family Interaction
Providing Information
- Establish a
bond to understand and address
multifaceted patient challenges.
Compassionate Care
Providing Information
- Offer
clarity on current events, future
outcomes and help differentiate
reality from delusions
Patient Communication
Providing Information
- Provide regular
updates with a balance of hope and
realism.
Family Interaction
Boost patient autonomy
by reinforcing a sense of control.
Objective of Allowing Control
Allowing Control Methods (5)
Establish Routine
Anticipatory Guidance
Offer Choices
Involve in Decisions
Inform and Explain
Allowing Control methods
- Promote
order and predictability for
preparedness.
Establish Routine
Allowing Control methods
- Helps patients brace for
upcoming situations and
strengthens coping.
Anticipatory Guidance
Allowing Control methods
- Small
decisions like side
preference, IV arm, bed
height, or timing of specific
actions.
Offer Choices
Allowing Control methods
- Ensure
the patient is part of bigger
healthcare choices.
Involve in Decisions
Allowing Control methods
- Provide
clarity on procedures.
Inform and Explain
Prevent delirium,
confusion, and other complications
by promoting patient mobility.
Encouraging Early Mobilization purpose
Encouraging Early Mobilization benefits (6)
o Prevents ICU-acquired
weakness.
o Reduces ICU and hospital
length of stay (LOS).
o Enhances functional
mobility.
o Decreases incidence of
complications (e.g..,
ventilator-associated
pneumonia, deep vein
thrombosis, pressure
injuries).
o Shortens the duration of
mechanical ventilation.
o Facilitates improved healing
and positive mood.
Using “Presencing” and Reassurance
- Therapeutic use of self
to alleviate distress.
Presencing
Using “Presencing” and Reassurance
- More than just physical
presence; encompasses
active listening and giving
full attention.
Presencing
Using “Presencing” and Reassurance
- Focus is entirely on the
patient and their
needs/feelings.
Presencing
Using “Presencing” and Reassurance
- Involves using all capacities
(eyes, voice, energy, touch)
in a healing manner.
Presencing
Using “Presencing” and Reassurance
- Can be through presencing,
caring touch, or verbally.
Reassurance
Using “Presencing” and Reassurance
- Effective when it provides
realistic encouragement or
clarifies misconceptions.
Reassurance
Using “Presencing” and Reassurance
- Not valuable if it suppresses
patient emotions or halts
further dialogue
Reassurance
Using “Presencing” and Reassurance
- Aimed to reduce fear and
anxiety, especially for
patients with unrealistic or
exaggerated fears.
Reassurance
Employing Cognitive Techniques (4)
Internal Dialogue
External Dialogue
Cognitive Reappraisal
Guided Imagery & Relaxation
Employing Cognitive Techniques
- Shift from
negative self-talk like “I can’t handle
this pain” to constructive thoughts
such as “I’ll handle this pain a
minute at a time.”
Internal Dialogue
Employing Cognitive Techniques
- Correct
misconceptions by highlighting
patients’ abilities, reducing feelings
of helplessness.
External Dialogue
Employing Cognitive Techniques
- Modify
reactions to stressors, viewing them
as less threatening.
Cognitive Reappraisal
Employing Cognitive Techniques
- Use
visualization and muscle relaxation
techniques for pain management,
mental prep, and tension relief.
Guided Imagery & Relaxation
Encouraging Deep Breathing solution
Diaphragmatic Breathing
Encouraging Deep Breathing
- Acute anxiety can _
regular breathing patterns.
disrupt
steps in Diaphragmatic Breathing
o Hand on the abdomen.
o Deep inhale via the nose.
o Brief hold.
o Exhale with pursed lips.
o Aim: Push abdomen out
during inhale
Demonstrate and
rehearse with the patient.
Encouraging Deep Breathing practice
Implementing Music Therapy objective (3)
Alleviate anxiety,
promote relaxation, and improve
sleep.
Implementing Music Therapy
- Tailored music sessions
(_).
o Preference for familiar
songs with a _
tempo.
20-90 mins, 1-2x daily
60-70 bpm
Implementing Music Therapy benefits (4)
o Reduced anxiety, pain, and
agitation,
o Stabilized physiological
rates.
o Diminished sedative use &
delirium risk.
o Enhanced sleep quality
Employing Humor benefits (3)
o Boosts endorphins - natural
pain relievers.
o Reduces tension, anxiety
and relaxes muscles.
o Helps in coping with
stressful experiences.
Employing Humor implementation (4)
o Can be spontaneous or
planned.
o Use after establishing
rapport.
o Align with the individual’s
cultural perspective.
o Take cues from patients and
families.
Offering Massage, Aromatherapy, and
Therapeutic Touch
- Circular strokes with palm,
from distal to proximal.
Effleurage Massage
Offering Massage, Aromatherapy, and
Therapeutic Touch
- Lotion may be added to
enhance comfort.
Effleurage Massage
Offering Massage, Aromatherapy, and
Therapeutic Touch
- Proven to reduce pain and
anxiety in patients.
Effleurage Massage
Using Animal-Assisted Therapy benefits (3)
o Strengthens human-animal
bond.
o Reduces anxiety and
improves vital signs.
o Enhances comfort and wellbeing.
Using Animal-Assisted Therapy implementation (2)
o Patient’s own pet or
volunteer owner, - dog
teams.
o Requires coordination
between staff & family.
Using Animal-Assisted Therapy pet should (2)
o Be healthy with current
vaccinations.
o Be well-behaved in new
settings
Fostering Spirituality and Healing
- More than just religious
beliefs.
Understanding Spirituality
Fostering Spirituality and Healing
- Seeks meaning, a
connection beyond self
Understanding Spirituality
Fostering Spirituality and Healing
- Includes intuition, universal
connection, and reverence
for life.
Understanding Spirituality
Fostering Spirituality and Healing Role in Critical Care (3)
o Patients find strength in
prayer and faith.
o Critical illness can deepen
or challenge spirituality
o Patients may seek support
from spiritual or religious
leaders.
Nursing Interventions for the Family (8)
• Involvement in care and decision-making
• Providing required information and support
according to family-specific needs
• Explaining specific aspects of the ICU
environment
• Advocating for visitation
• Advancing the nurse-family relationship
• Helping the family problem solve
• Involving the interprofessional team
• Incorporating cultural competence and
humility.
Offering Massage, Aromatherapy, and
Therapeutic Touch
- Not suitable for all patients
(e.g., hemodynamically
unstable). Nurses need
special training in advanced
techniques.
consideration
Nursing Interventions for the Patient (13)
Creating a Healing Environment
Promoting Rest and Sleep in the ICU
Fostering Trust
Providing Information
Allowing Control
Encouraging Early Mobilization
Using “Presencing” and Reassurance
Employing Cognitive Techniques
Encouraging Deep Breathing
Implementing Music Therapy
Employing Humor
Offering Massage, Aromatherapy, and
Therapeutic Touch
Using Animal-Assisted Therapy
Fostering Spirituality and Healing
