Walking Home From The ICU Episode 59: One Nurse Bringing Change to a Hospital System
How can one nurse make bring the change? What can happen when a team catches the vision? How can a team transition their culture from deep sedation and immobility to awake and walking? Nora tells us about igniting her team’s fire and the changes they are celebrating. Episode Transcription Kali Dayton 0:29 Hello, we’ve
Walking Home From The ICU Episode 58: Deadly Treatment for a Deadly Virus?
Louise, ACNP, has dedicated her career to preserving lives in the Awake and Walking ICU. So what was it like for her to have her own loved one die from sedation and immobility? She tells it like it is and gives us a sobering insight into both sides of the bedside during COVID19. Episode
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Walking Home From The ICU Episode 57: The Shock of Working in a “Normal ICU”
When all you’ve ever known is walking patients on ventilators, what is it like to enter a time machine and go back to sedation and immobility? What did Tara learn taking care of COVID19 patients outside of her “Awake and Walking ICU”? She shares with us her reaffirmed empowerment to change patients’ outcomes through evidence-based
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Walking Home From The ICU Episode 55: Walking in ICUs Around the World
Where in the world do patients walk on ventilators and ECMO? Providers from 22 countries share with us their experiences with helping patients walk home from the ICU. Episode Transcription Kali Dayton 0:28 Okay, let’s talk about walking patients on ventilators. Though one of my favorite topics, I recognize that it is a big
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Walking Home From The ICU Episode 49: The Cost of Rot
How do Hospital Acquired Pressure Injuries (HAPI) impact patient outcomes and quality of life? How can they be better prevented? Cami, our wound care specialist, shares with us penetrating insight into the reality of rotting in the ICU. Episode Transcription Kali Dayton 0:28 Today, we’re going to talk about hospital acquired pressure injuries (HAPIs). I
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Walking Home From The ICU Episode 48: Q&A
What do you want to know about the Awake and Walking ICU? Episode Transcription Kali Dayton 0:28 Hello again, I hope you were all staying safe out there as COVID is hitting our ICU world hard right now. I was recently contacted by Chelsey Rogers, who is the founder of the Facebook group, “Tribe RN”
Walking Home From The ICU Episode 46: Waking Up After Decades of Sedation
What is like for a seasoned ICU nurse with decades of valuable experience to completely change their sedation practices? What is like to then re-enter a “normal” environment and strive to continue the best practice? Paula shares with us her personal shock and conversion. Episode Transcription Kali Dayton 0:28 Hello, and welcome back. New listeners,
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Walking Home From The ICU Episode 45: Physical Therapy In the ICU During COVID19
What roles do physical and occupational play in helping COVID19 patients survive and thrive? How have they changed their approaches during the challenges of COVID19? Why should we never remove their therapies from ICU care? Episode Transcription Kali Dayton 0:28 When COVID-19 came our way with concerns about isolation, patient load, and PPE immediately physical
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Walking Home From The ICU Episode 42: The Power of Nursing Care Against COVID19
When good nursing care is not possible during a pandemic, what happens to patient outcomes? Makenzie tells her tales as an ICU nurse in NY as we explore the role nursing care plays in saving and restoring lives. Episode Transcription Kali Dayton 0:28 Makenzie, thank you so much for being with us on the show.
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Walking Home From The ICU Episode 40: Cultural Revolution
Kali talks with Patty, a nurse, about what was it like in the early phases of the “Awake and Walking ICU” and how the new practice was introduced. We ask how the culture revolutionized in spite of opposition and who rejected the change? How did nurse Patty go from incredulous to emphatic? Episode Transcription Kali
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Over the last few years I have become aware of the PICS (post-intensive care syndrome) condition and the very serious negative impact that it has on our ICU survivors. I have become much more aware of the potential negative impact of anxiety, depression, PTSD and cognitive dysfunction. Many patients whom we consider saves in the sense they leave the ICU alive have many issues that most people would consider far from a successful experience. Their lives are often dramatically changed in a very negative fashion.
I am a professor of medicine and have been an ICU director for over forty years. What I find very disturbing in my own experience and that of many other intensivists is that this outcome is generally considered acceptable; the patient survived and will get better with time. We have little access to these patients and almost zero information about their condition unless they are unfortunate enough to return to our ICUs. Very few of us have a PICS clinic where we would have a chance to better understand the challenges that some of our patients encounter, and there are very few systems in place to provide feedback to us as ICU clinicians. Therefore, we are blissfully ignorant of the many challenges that a substantial number of our survivors encounter. This is a major problem. The vast majority of ICU survivors and their families will experience cognitive, emotional and physical symptoms which often have devastating impacts on their lives. At this time, with PICS clinics being a rarity, there is no reasonable mechanism for intensivists to have a solid perspective on the frequency and severity of this condition.
How patients and their families are treated in the ICU often has a major impact on how the patient and families survive post discharge. It is generally agreed that most sedation infusions, particularly benzodiazepines, frequently have higher incidences of delirium and post-discharge dysfunction. There are a few hospitals in this country where sedative infusions are rarely used and the incidence of the complications described above are dramatically decreased. I have visited one of these hospitals and was amazed to see how effectively patients on maximum ventilator support can be managed, even walking without sedative infusions. In an effort to explore this treatment option in greater detail I have identified Kali Dayton. She is a nurse practitioner who has practiced in this Awake and Walking ICU for many years and is an amazing source of information on this topic. After extensive discussion with many colleagues, administration and many others, and reviewing the major potential benefits of the program for our patients, we have decided to introduce this program into our hospital.
Peter J. Murphy, MD, FCCP, MRCPI, BSc
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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