How ICU Staffing Ratios Relate to the Awake and Walking ICU Approach
The Awake and Walking ICU approach is deeply rooted in science, pathophysiology, and logic. Yet some of the best fruits of this method are humanity, compassion, dignity, and love. We use this approach to humanize the ICU, and I believe that is a desire of most ICU clinicians. But the reality is, no matter how
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The Financial Benefits of the ABCDEF Bundle
The ABCDEF Bundle is easily the best tool we have to improve patient care and outcomes in the ICU. If you know anything about these evidence-based practices, you’re probably well aware that they can decrease length of stay and readmissions, and reduce patients’ chances of dying, while making it more likely that they’ll return to
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Patients and Their Families Have the Right to Know the Risks of Sedation
Patient autonomy is a pillar of clinical ethics, and it’s vital to the integrity of any clinical practice. Observance of this principle works to uphold patients’ rights, fosters trust and collaboration, respects diversity, and empowers individuals to actively participate in decision-making regarding their healthcare. In our efforts to protect patient autonomy, one of the best
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ICU Rounding Culture: What Needs to Change and How We Can Help
One of the biggest barriers to improving ICU patient care is a lack of interdisciplinary collaboration, especially when it comes to ICU rounding. In theory, rounding should give clinicians the opportunity to review and discuss each patient’s care, and then come together to ensure that care is a reflection of best practices and the patient’s
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Unplanned Extubations: Dispelling the Fear and Understanding the Reality
When I think back to how I started my career as a nurse, it really does seem like a date with destiny. I could have gotten a job at any ICU, but for whatever reason, I landed my first nursing gig at a high acuity medical-surgical intensive care unit in Salt Lake City, Utah, which
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How Simulation Training Can Help to Improve ICU Patient Care
Despite many exciting advancements in technology and research, ICU sedation and mobility practices continue to be stuck in the past. A big part of this problem stems from ICU culture, which encourages clinicians to fear change and be resistant to new ideas and approaches. But regardless of these issues with ICU culture, the truth is,
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How Clinicians, Patients, and Families Can Benefit from Better Communication in the ICU
Back when I was studying to become a nurse, I had an experience in the ICU that changed me forever. As a starry-eyed 18-year-old nursing student, I was incredibly excited to finally be in the ICU, experiencing what I’d dreamed about for so many years. But when I got there and started to learn what
As far as the early mobility community is concerned, the benefits of early mobility in the intensive care unit are not up for debate. There are mountains of evidence to show these benefits and support the safety and efficacy of early mobility in the ICU, and this is something I’ve documented repeatedly. But unfortunately, ICUs
How the ABCDEF Bundle Can Improve the Quality of Death for ICU Patients
Over the years, I’ve witnessed first-hand how the ABCDEF Bundle’s evidence-based practices can reduce healthcare costs, while improving patient outcomes and working conditions in the ICU. But even though evidence shows that the ABCDEF Bundle can decrease the risk of death by 68 percent, its success is not always found in a patient’s ability to
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How I Was First Introduced to the ABCDEF Bundle
“Would you be willing to walk intubated patients on ventilators?” my future nurse manager asked me during my initial interview. As a new nurse, I failed to fully understand the importance of this question and eagerly answered, “Yes! Of course! Teach me everything.” During my first few years working as a nurse in an Awake
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As an RN in the Medical-Surgical ICU at the hospital I work at, I began my interest in ICU Liberation through an Evidence-Based Practice project.
While I was initially grabbed by what the literature has to say about over-sedation and patient outcomes, it wasn’t until I discovered Kali’s Walking Home From The ICU podcast that a culture of sedationless ICU care sounded tangible. The group I worked with on the project was both inspired, devastated, and intrigued by the stories Kali illuminates on the podcast, and we were able to bring her to our hospital for a virtual Zoom Webinar, where she presented on the practices in the Awake and Walking ICU.
This webinar was an incredible way to draw attention toward this necessary culture shift as Kali shared stories of patients awake and mobile in the ICU despite the complexity of their illness. The webinar inspired our final draft for the new practice guideline on analgesia and sedation management in the ICU, and since then we have seen intubated COVID patients playing tic tac toe on the door with staff members on the other side, taking laps around the unit, performing their own oral care using a hand mirror, and most importantly, keeping their autonomy and integrity while fighting to leave the ICU to resume the life they had before coming in.
Nora Raher, BSN, RN, MSICU
Virginia, USA
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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