Experience in The Icu

It is the requirement and hope of all the colleges and at-large life that a nursing student forges ahead; from being a nursing student to a nurse in practice. A process that can be referred as a transition. One must process various skills and experiences. One of the lessons required is the practical experience of working in the Intensive Care Unit. Students are expected to gain essential skills and knowledge in critical care. They are exposed to the roles of ICU nurses. I have had an opportunity to practice Nursing in the ICU. This paper is a description of my experience. It includes transition, ethics, caring, health promotion, communication, standards of practice, critical thinking, vocation and implications in various areas.

Transition

Transitioning from being a student nurse to practicing on the floor is stressful, especially in the intensive care unit. At times when my preceptor was quizzing me, I felt as if I had forgotten everything. Throughout my experience, at different points, it was overwhelming to put everything I had learned into practice and be able to understand why I was doing it. However, the more I worked, and the more my preceptor and those around me taught me, the easier my work became.

For the future and transitioning to my role as a nurse, I like to think of a quote I heard back when I was in high school “Success is not final, failure is not fatal: it is the courage that counts.” (Winston Churchill). I think of this quote because sometimes transitioning from the student nurse to a practicing nurse seems overwhelming and scary. However, I need to know that everyone who has gone from a student nurse to a practicing nurse has made mistakes, doesn’t know everything and will always continue to learn. In an article, I read they gave some excellent ideas on how to solve problems when transitioning. Assess the problem, identify what is holding you back, identify stressors, use effective communication, respect personal space, look at both sides of the issue and develop a positive action plan.

(Hunt, 2016). The other method I would use involves seven steps. Below are the steps:

• I. Identification of the issues
• II. Understanding the interests of the relevant (affected)
• III. Writing the possible options or solutions
• IV. Evaluations of the options
• V. Selection of the best options
• VI. Documenting the agreement
• VII. Making contingency agreements, monitoring, and evaluation.

The process was very constructive in making decisions. I always consulted my team although (Hicks, n.d.).

Ethics

When I think of ethics and nursing, I think of nonmaleficence, beneficence, fidelity, justice, and autonomy. These are some of the first principles we talked about when we entered the nursing program. I think they are key to ethics and nursing as they protect your patient and are core concepts in nursing. These concepts are ‘not harm’, to be good, being honest, following through with one’s commitment and having respect for the patient. In the ICU, a lot of ethical conflicts occur. There are ethical dilemmas often. Some of the ethical issue I experienced included end-of-life care issues, and verbal abuses. According to the code of ethics from ANA, the patient’s autonomy must always be respected. Patients have rights to direct how they want to be treated (Kim, 2015).
Some of the hardest times were where I saw ethics come in to play more than any other time. For example, when families of patients decide to place their loved one on comfort cares and let them go peacefully. When the family would be talked about this option you can see that some members didn’t necessarily want to as they said “give up” however, they do also see that at times it is what the patient wanted instead of remaining on machines for an extended period.
I think that for my future in nursing there will always be ethical issues that will arise. However, I need to remember my job is to advocate and respect the wishes of my patient whether I agree with them or not that is not why I am there. I also think if it’s possible I would like to learn more about working in palliative care just, so I can better educate and understand myself everything that it entails. Especially since the area, I plan to continue working in is critical care whether it’s with children or adults.

Caring is one of the fundamentals of all nursing; both for the patients and self. A good nurse should have a caring nature among other qualities. One thing that I learned from my practice is that the best nurses care genuinely and sincerely to their patients. In the ICU, comforting and supporting the patients is very important. Patients are vulnerable and scared of many things but mostly death. Deaths are frequent in the ICU. A patient must be given support and find a friend from the person taking care of him or her. I always made sure that I bonded with the patients I took care of. I was able to learn of patients fears and be able to support them. I thought it was an easy task but realized from the experience that having a person to trust you is not an easy task. I am well prepared for the future though.

Nurses, I believe play a very important role in promoting health. As a nurse by teaching our patients about evidence-based research, to communicate the best information available, we can help our patients and families lead a healthier life.
Who knows in the future where I will for sure be but the great thing about nursing is you can do so much with it. I could be promoting health promotions in education, practice or even research.

Communication

Communication in the ICU involves both the verbal and non-verbal expression. A nurse must be able to tailor messages in such a way that they are clear. Delivery of the message should involve both the verbal and non-verbal cues. Enhanced expression of concepts and ideas using body language, facial expressions and gestures is a very important skill (Integrated Comprehensive Clinical & Communication Skills Approach For Patient Interviews & OSCE Exams, n.d.). Communication in the intensive care unit can be difficult at times as many of the patients are intubated. However, it is still very important to speak to the patients and let them know what you are doing or going to do next. Because you don’t know if they can hear you and if they can they are prepared for what is about to happen. Communication with the patient’s family is also very important so that you can ease their anxiety and help them understand what is happening. For the patients who have a problem communicating, using pictures, symbols and icons helped a lot. One skill I learned while in practice (a skill that I will always) is soothing to difficult patients. Encounters with difficult patients and family members are very common. Soothing them and calming them is very difficult yet crucial for effective communication.

When I think of standards of practice the first thing I think of is ‘ADOPTED’ Assessment, Diagnosis, Outcomes, Planning, Implementation, and Evaluation. This standard gives a process for how to go through your nursing practice. First assess the patient to collect data, then analyze the assessment data to determine the issue or diagnosis. After you have analyzed the information and identified the issue you must individualize expected outcomes to that patient and their situation. Next, develop a plan to reach those outcomes and then implement them. To understand the standards of practice, I was first taken through what I was supposed to do and behave while at work. I was then given opportunities to practice ‘ADOPIE’. At first, it was hard but later I was able to implement and evaluate my plans. I realized that ‘ADOPIE’ is very effective methods of ensuring I always observe the Standards of Practice.

Critical Thinking

Critical thinking is very crucial in the health care especially in the ICU. Things sometimes happen very quickly. A nurse should be able to think rationally and clearly about what to do. Some of the things that are worth thinking include how to talk to the family, patients, and about treatments. Caring for most of the patients in the ICU requires critical thinking (Jonathan M Sharples, 2017). Throughout my clinical experience, I was forced to use my critical thinking skills. Before I gave my patients medication I had to think about why I was giving the medication, what vital signs or other aspects I needed to check before giving them the medication and of course the five rights. The right dose, right patient, right drug, right time and right route.

Vocation

Initially, I used to hear people say that nursing is difficult and stressful people tend to discontinue at some point in life. For me, it is very different. The more I practice this vocation the more I feel as if I am achieving what I was called to do. I have a calling to continue working as a nurse. I enjoy my shifts even if they are 12 hours and at night I have found much joy in what I do and the complexity that this job holds. The challenges that I have met in the practice keep pushing to keep learning and improve my skill more and more.

In the school, we were taught about the qualities of a good nurse. A good nurse should be compassionate, caring, empathetic, emotionally stable, adaptable, have mental and physical endurance, have clear and quick judgments and be a good communicator. I came to learn these qualities are acquired through experience and passion. I am now better in all the qualities I have listed here. I must admit that being emotionally stable was something I was struggling with before I started practicing in the ICU. I am now better. I can make ethical decisions, think critically and above all, make quick judgments. I understand more about the standards of practice since I have seen with my own eyes. I can happily conclude that my practice in the ICU was completely fruitful. I am now well equipped to practice nursing in my future.

Works Cited

1. Hicks, C. (n.d.). Problem Solving and Decision Making: Seven Steps for a Winning Team. Retrieved from https://www.mindtools.com/pages/article/newTED_85.htm
2. Hunt, K. (2016). Transitioning From Student Nurse to Registered Nurse: Six Top Tips. British Journal of Nursing, 25(2), 104-107.
3. Integrated Comprehensive Clinical & Communication Skills Approach For Patient Interviews & OSCE Exams. (n.d.). Retrieved from https://www.sgh.com.sg/medical-professionals/education/graduate-programmes/i3-csa-competency-training
4. Jonathan M Sharples. (2017). Critical Care Nurses' Use of Cues for Clinical Reasoning and Decision Making: A Descriptive Study. Australian Critical Care, 30(6), 290-296.
5. Kim, Y. (2015). Ethical Challenges Experienced by Nurses in Intensive Care Units. Journal of Nursing Research, 23(4), 266-272.
6. Standards of Professional Nursing Practice. (2015). American Nurses Association. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/standards/