I had the opportunity to be a student nurse at the Meijer Heart Center in Grand Rapids where I met a critically ill

patient by the name of Debbie. She had just recently undergone surgery requiring intubation and sedation. Debbie visited the emergency department with complaints of abdominal pain and right lower leg pain when she was taken in for immediate surgery. The doctors discovered that she had blood clots in her right lower leg ascending to her aorta and was not expected to recover from surgery. In result of the clotting and surgery, she was intubated for three weeks and had a below the knee amputation on her right leg. Although she is still in the intensive care unit (ICU), she was extubated 4 days ago and is hoping to progress to the step-down ICU within a week or two. As a student nurse, I was expected to provide comfort and listen to expressed concerns from Debbie while recording her thoughts and experiences through her intubated fight for survival. I asked Debbie to recall the intubating process before and after her abdominal surgery and amputation. Debbie said that she had gone in for surgery and remembers talking to the nurse and doctor but it was all a blur after that until she woke up feeling paralyzed. She recalls hearing a lot of beeps and people talking. Debbie recalls having a lot of questions and concerns she could not express so those questions did not get answered. She stated that it felt like being in a movie or unrealistic. She recalls trying to move her arm to grab the nurses hand but no one responded because she couldnt move. Debbie said she feared that she was dying or close to death. I asked Debbie if within all the chaos she was experiencing if anyone stopped to talk to her and explain what was going on. She recalled the nurse saying her name and telling her that she was on a ventilator. Debbie also recalled the nurse grabbing her hand and telling her not to worry that she is under sedation so that is why she was not able to move. Debbie recalled being in a lot of pain and every time she was moved it was worse. She said that she wanted to yell at everyone when they moved her but she couldnt. She said that details are vague she just recalls being scared, angry, and in a lot of pain.

Debbie was not able to recall who provided the majority of her care to her while she was intubated but did remember that her nurse always informed her when anyone came into the room. She said she could sense when someone was close but never could identify who the individual was unless it was family. I asked Debbie if it was frightening to not be able to identify or recall who was providing her care and she recalled that in the beginning it was strange but then she just got used to it because trust was built. Debbie recalled that through each procedure, the nurse would stay by her side and walk everyone in the room through the entire process. She felt that this was comforting and helpful. I asked Debbie what she believed was the most significant event through the intubation process and she recalled that it was when she was able to breathe but could not talk. She called this event reassuring yet scary all at the same time. Debbie is appreciative of the care she received and is still receiving. I asked if there was anything else that she would like to tell me or give me advice for when I care for a sedated patient on a ventilator. She said that one thing to remember is to explain to someone who went in for surgery why they are now on a ventilator when they did not expect to be. She said that the nurse explained everything well she just did not recall being told why she woke up on a ventilator when it was not an expected outcome. Insight learned through this interview is to always comfort your patient and be aware of the environment surrounding the patient. Since this experience is so frightening for patients and their families, it is essential to explain every process and procedure to the patient as if they were awake and coherent. In this particular case, Debbie felt that her nurse did an excellent job introducing those who entered the room but since there were so many people all at one time, it was hard for her to keep track of who was who and whom was doing what. This can be difficult to prevent because it is beneficial to keep a calm and soothing environment with minimal amount of noise and clutter so to have all persons involved speak every time they approach the patient could contribute to even more anxiety.

I also believe think that it is essential and ethical to treat the sedated and intubated patient as if they could see everything and ask questions if they do not understand. Providing quantity care should never be more important than providing quality care. The quality of care could in return contribute to the patients survival.