EP 94: Why We Work in the ICU

EP 94: Why We Work in the ICU

EP 94: Why We Work in the ICU

In this episode, we will discuss why we work in the ICU. Precisely why we prefer ICU and why nurses like working in this department. The main reasons are; patient ratios, making us more marketable, more critical thinking, and being there for the patient in their most vulnerable point. We’ll also touch base on some good qualities of ICU nurses. 

Why Do We Work in the ICU?

Every year, intensive care units (ICUs) in the United States admit over 5.7 million patients. The ICU is a unit reserved for some of the most vulnerable patients, those who are critically ill and need close supervision in case their condition rapidly takes a turn for the worse.

Some ICUs specialize in certain areas, such as pediatric, cardiac, or trauma, but many serve a general purpose. Occupational, respiratory, and physical therapists, dieticians, doctors, and nurses collaborate in these units to achieve successful patient recovery.

ICU patients are often intubated, ventilated, and have multiple IV drips at a time. They must know the ins and outs of a lot more equipment than nurses who practice in a lower-stakes environment. They must also chart much more to keep up with intensive monitoring, assessments, and equipment. 

Two Patients Per Nurse is the Main Reason Why We Work in the ICU

Critical care nurses monitor their patients 24/7. Their patients need constant care, so there should always be a nurse to watch over patients. As such, ICU nurses often only work with one to two patients at any given time.

Having two patients sounds like a walk in the park, but these patients are very critical, with a change in condition within seconds. Even 1-1 patient is really sick, usually requiring CRRT, ECMO, IABP, and special catheters.  

Usually pays more/is more marketable.

Some facilities offer more pay to their ICU nurses or specialized units. These units care for a particular population and often require more critical thinking and hands-on work. 

ICU nurses tend to be more marketable because ICU is the highest tier in a hospital setting. ICU nurses can float to other parts of the hospital like med-Surg, tele, stepdown, etc. It’s expected that you should know more during a critical patient situation than other nurses. 

More thinking and fixing, less touchy-feely

A lot happens in the ICU. The majority of our patients are intubated and sedated. What that means is they can’t talk. It does have its positives and negatives. When you have an intubated and sedated patient, they run on your clock, patient care-wise.

You do your hourly rounding and plan out when to do what task. There isn’t the time or opportunity for the patient to refuse, no playing cat and mouse with their bath or dinner. You have more control.

There is a lot of emotion in the ICU, just not the touchy-feely stuff you commonly find in other units. A lot of the emotion comes from being the middle man; patient to family, patient to MD. Another part is during death or a crashing patient. Unfortunately, the ICU sees a lot of death and disgruntled family dynamics. 

Being there for people in their worst situation

There’s something about the ICU patients being at their most vulnerable and at the brink of death that draws nurses to it. It is also one of the reasons why we work in the ICU department. There are 2 options for a patient in the ICU, death or transfer. Our role in the ICU is to stabilize, treat, and repeat.

There are days in the ICU when every patient looks like they are fighting a losing battle with death, and as hard as those are, we are with that patient through it all. Even though we can’t always talk to our patients, the energy is in the rooms, drawing people. 

The worst situations bring out the best in us, which doesn’t only apply to living outside the scrubs but also to ICU nursing. As crazy as it sounds, critically ill patients stimulate our minds and are a learning opportunity. 

Good Qualities of an ICU Nurse

  • Planning
  • Communication
  • Critical thinking
  • Research
  • Physical abilities
  • Problem-solving
  • Organization
  • Time management

Want to work as an ICU nurse? Watch the full episode here 👇👇👇

TIMESTAMPS:

00:00 – Intro
00:45 – Topic intro
01:45 – Why the ICU is special
04:00 – What is in the ICU
09:00 – We know our patient from head to toe
10:15 – Matt’s time in MedSurg
12:43 – Being an ICU nurse is a specialty
14:23 – ICU uses your critical thinking skills
16:17 – Being able to talk to your patients is a blessing
18:05 – We like to be there for people
20:43 – Control of a patient’s life
21:20 – The power nurses hold
22:42 – The worst feeling for an ICU nurse
27:15 – Good Qualities of an ICU nurse
27:35 – Planning
28:49 – Communication skills
32:25 – Critical Thinking skills
35:15 – Research
37:18 – Physical stamina
38:13 – Problem-solving skills
40:24 – Organization skills
43:40 – Wrapping up
44:05 – End of show

News EP 24: C-19, Caffeine, Positivity and Memory Decline, and Organ-on-chip

News EP 24: C-19, Caffeine, Positivity and Memory Decline, and Organ-on-chip

Covid-19 cases are steadily rising in the US and there is an aim for another lockdown. Evidence is showing that a more positive outlook on life and feeling happy in general is being associated with less memory decline.

The benefits of caffeine have been debated for years, most recently caffeine intake is being linked with long-term memory benefits. Organ-on-chip has the potential to transform the way we do research on human cells with the potential of benefiting reperfusion therapy.

Global Cases

As of 11/15 – Cases: 54,817,231 Deaths: 1,324,461

US: 11,366,503 Deaths: 251,836 Recovered: 6,935,630

  1. Texas – 1,093,645
  2. California – 1,033,687
  3. Florida – 885,201
  4. New York – 597,394
  5. Illinois – 573,616

Positivity Is Associated With Less Memory Decline: Evidence From a 9-Year Longitudinal Study

A new study finds that people who feel enthusiastic and cheerful — what psychologists call ‘positive affect’ — are less likely to experience memory decline as they age [1]. This result adds to a growing body of research on the positive effect’s role in healthy aging.

Unfortunately, we wish some memorization could last a lifetime, but emotional factors can negatively impact our ability to remember information throughout life.  

A team of researchers analyzed data from 991 middle-aged and older U.S. adults who participated in a national study conducted at three time periods: between 1995 and 1996, 2004 and 2006, and 2013 and 2014.

In each assessment, participants reported on a range of positive emotions they had experienced during the past 30 days. In the final two assessments, participants also completed tests of memory performance. These tests consisted of recalling words immediately after their presentation and again 15 minutes later.

Results

Results revealed that positive affect was associated with less memory decline across 9 years when analyses controlled for age, gender, education, depression, negative affect, and extraversion (state of primarily obtaining gratification from outside oneself.)

What’s interesting is as people get older, they experience fewer negative emotions. Older adults are more emotionally gratifying memory distortion for past choices.

This is a broad statement but the positivity effect in older adults’ memories seems to be due to their greater focus on emotion regulation secondary to cognitive control mechanisms that enhance positive and diminish negative information. 

Caffeine

80% of the population consumes some type of caffeine, in the US it’s at about 90%. Caffeine is a natural stimulant most commonly found in tea, coffee, and cacao plants. It works by stimulating the brain and central nervous system, helping you stay alert and prevent the onset of tiredness.

Caffeine vs Adenosine

To understand the function of caffeine one has to grasp the concept of another neurotransmitter called adenosine. 

Most people initially drink caffeine in the form of a beverage. It’s absorbed in the small intestines within an hour and becomes available throughout the blood and most parts of the body, including your brain. The mean half-life of caffeine is about 5 hrs. As it starts entering your brain, it starts competing with adenosine.

How Adenosine Makes You Feel Sleepy

There are many different receptors in your brain, different ones have different effects. The one we’re interested in is the A1 receptor. Adenosine locks with the A1 receptor, it promotes muscle relaxation and sleepiness, which is why people get tired as the day progresses.

Furthermore, adenosine can bind to the A2A receptor. This binding interferes with the release of mood-improving neurotransmitters, such as dopamine.

Adenosine itself is produced primarily from physical work and intensive brain use. That is why over the course of the day your body accumulates adenosine.

The caffeine in your brain is competing with adenosine and preventing it from binding to A1 receptors. This is why it promotes wakefulness.

Caffeine doesn’t actually lock in with the A1 receptor. It’s more like something that gets in the way and occupies the lock, rather than actually unlocking it.

It similarly gets in the way of the A2A receptor, which can help promote the release of dopamine and glutamate, making you feel good after a cup of coffee.

Before Caffeine

When you first wake up, your body has metabolized away the adenosine molecules. You’re a bit groggy, but you’re waking up.

Effects of Caffeine

  • Stimulates your central nervous system, which can make you feel more awake and give you a boost of energy
  • Is a diuretic, meaning that it helps your body get rid of extra salt and water by urinating more
  • Increases the release of acid in your stomach, sometimes leading to an upset stomach or heartburn
    • May interfere with the absorption of calcium in the body

How much Caffeine 

  • 1 cup of coffee = 100 mg
  • 1 cup of tea = 50 mg
  • 1 can/ 12 fl oz red bull = 112 mg
  • 1 can/ 16fl oz monster = 160 mg
  • 1can/ 16 fl oz bang = 300 mg

Interesting Studies

  • This study investigated the within‐person relationship between caffeine intake and sleep duration at home.
  • 377 participants (aged 35–85 years) completed a 7‐day diary study.
  • Results revealed a significant effect of sleep duration on the change tendency of caffeine use: a shorter sleep duration predicted a stronger tendency to consume caffeine, and this phenomenon was only found in middle-aged adults (aged 35–55 years) not in older adults (aged 55+) [2].
  • This study measured the effects of 0, 12.5, 25, 50, and 100 mg caffeine on cognitive performance, mood, and thirst in adults with low and moderate to high habitual caffeine intakes [3].
  • All doses of caffeine significantly affected cognitive performance, and the dose-response relationships for these effects were rather flat. 
  • The effects on performance were more marked in individuals with a higher level of habitual caffeine intake, whereas caffeine increased thirst only in low caffeine consumers. 
  • Conclusions: After overnight caffeine abstinence, caffeine can significantly affect cognitive performance, mood, and thirst at doses within and even lower than the range of amounts of caffeine contained in a single serving of popular caffeine-containing drinks. Regular caffeine consumers appear to show substantial tolerance to the thirst-increasing but not to the performance and mood effects of caffeine.
  • A group of 1875 healthy adults, stratified for age (range 24 – 81 years), sex, and general ability, were screened for the habitual intake of coffee and tea and took part in extensive cognitive testing [4].
  • Multiple regression analysis with control for age, sex, socio‐demographic variables, and substance use showed that habitual caffeine consumption was significantly related to better long‐term memory performance and faster locomotor speed. 
  • No relationships were found between habitual caffeine consumption and short-term memory, information processing, planning, and attention as measured with the Stroop Test. Moreover, no difference in sensitivity to caffeine intake between different age groups was found, suggesting that caffeine intake did not counteract age-related cognitive decline.

Reviving Cells After a Heart Attack

Researchers have unraveled potential mechanisms behind the healing power of extracellular vesicles and demonstrated their capacity to not only revive cells after a heart attack but keep cells functioning while deprived of oxygen during a heart attack [5].

The researchers demonstrated this functionality in human tissue using a heart-on-a-chip with embedded sensors that continuously tracked the contractions of the tissue.

Extracellular Vesicles

  • Extracellular Vesicles (EVs) are nanometer-sized messengers that travel between cells known as intercellular communication.
  • EVs are a promising tool for the next generation of therapies for everything from autoimmune and neurodegenerative disease to cancer and tissue injury. 
  • EVs derived from stem cells have already been shown to help heart cells recover after a heart attack, but exactly how they help and whether the beneficial effect is specific to EVs derived from stem cells has remained a mystery.

Researchers from the Harvard School of Engineering and Applied sciences have unraveled a potential mechanism that demonstrated the potential mechanism behind the healing power of EVs.

It demonstrated their capacity to not only revive cells after a heart attack but keep cells functioning while deprived of oxygen during a heart attack. 

How was this discovered? Researchers used a heart-on-a-chip with embedded sensors that continuously tracked the contractions of the tissue.

The team tested the effect of Endothelial-derived EV’s (EEVs) on human heart tissue using the heart-on-a-chip model. Organ-on-chip platforms mimic the structure and function of native tissue and allow researchers to observe, in real-time, the effects of injuries and treatments in human tissue.

Reperfusion Injury Mechanism 

The absence of oxygen and nutrients from blood during the ischemic period creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress rather than (or along with) restoration of normal function.

The ischemic tissue produces more reactive oxygen species but less nitric oxide following reperfusion and the imbalance results in an inflammatory response. 

Findings in the research study 

  • The researchers simulated a myocardial infarction and reoxygenation on chips that were infused with EEVs and those that were not. 
  • They found that in tissues treated with EEVs, the cardiomyocytes could better adapt to stress conditions and sustain a higher workload. 
  • The researchers induced injury by three hours of oxygen restrictions followed by 90 minutes of reoxygenation and then measured the fraction of dead cells and the contractile force of the tissue. 
  • The heart tissue treated with EEVs had half as many dead cells and had a contractile force four times higher than the untreated tissue after injury.

What will be the future of Exosomal cell therapies?

EP 93: Mental Health and Psychology with Aleks Zubek

EP 93: Mental Health and Psychology with Aleks Zubek

Mental Health and Psychology with Aleks Zubek

This episode will cover self-care, burnout, and mental health. We would also like to introduce our guest, Aleksandra Zubek. She is currently in a clinical psychology counseling internship. We discuss Mental health, self-care, depression, and burnout during COVID. 

Mental Health Facts:

  • 1 in 5 U.S. adults experiences mental illness each year
  • 1 in 20 U.S. adults experiences severe mental illness each year
  • 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
  • 50% of all lifetime mental illness begins by age 14, and 75% by age 24
  • Suicide is the 2nd leading cause of death among people aged 10-34

These are some of the questions we answer with Aleks:

  • What is burnout?
  • What is self-care?
  • Why do you think people see it as selfish? Is it selfish? 
  • Because if your cup isn’t complete, you can’t give more.
  • How can we promote our self-care during covid? What can people do? 
  • Ever thought about what you do for yourself that makes you feel good?
  • Whether it’s going to do a face mask, reading a fun novel, or going on a 10-minute walk.
  • How can someone figure out what makes them feel good? Let’s take, for example, someone with depression that can’t find something to be happy about. How can they find that spark, or can we help them find it? 
  • Drug overdoses have been on the rise in 2020. Where can it stem from? 
  • How can we promote self-healing? In this sense, how can we get past trauma? 
  • How to approach Different types of trauma?
  • Violence
  • Traumatic grief
  • Bullying 
  • Annual prevalence among U.S. adults, by condition, top 3. Can we touch upon each? What are they, their symptoms, whos at risk, how it develops, best approaches?
  • Anxiety Disorders: 19.1% (estimated 48 million people)
  • Major Depressive Episode: 7.8% (19.4 million people)
  • Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)
  • Depression

Learn how you can take care of your mental health by clicking on this full episode 👇👇👇

TIMESTAMPS:

00:00 – Intro
00:18 – Welcome to the show
00:43 – Guest Intro
01:17 – What is Burnout?
02:45 – Asking patients what is one good thing they can do for themselves today
03:33 – Signs That You’re Burnout
04:43 – Can burnout lead to depression?
09:00 – Talking to patients over zoom or video calls
11:20 – Long-term consequences of the pandemic on our mental health
18:39 – In what ways can nurses promote self-care to prevent burnout?
22:23 – Compassion Fatigue
27:22 – Are people seeking drugs more now than before?
29:50 – How to help people who are in isolation?
32:30 – What would it be if we could change something in the mental health department?
36:30 – Favorite psychologist – Irvin Yalom
40:34 – Mimicking behaviors
43:00 – Tips to decrease anxiety/depression
44:20 – Wrapping up the show
44:44 – End of show

EP 92: 5 Nursing Careers You Should Consider

EP 92: 5 Nursing Careers You Should Consider

EP 92: 5 Nursing Careers You Should Consider

In this episode, we will talk about the highest-paying nursing careers in 2021. The top 5 are Certified Registered Nurse Anesthetists, General Nurse Practitioners, Clinical Nurse Specialists, Psychiatric Nurse Practitioners, and Certified Nurse Midwives.

Highest-paying Nursing Careers You Shouldn’t Miss

A nursing career is a career in which you work for people. You deal with individuals during one of their most challenging and vulnerable times. It is a selfless career, and all the emotions and stress we go through as nurses have no price point. Nurses still have to make a living, and a nurse does make a decent income, but more schooling and certification leads to a higher paycheck. These are the top 10 most-paid nursing careers of 2021.

1 – Certified Nurse Anesthetist

Nurse anesthetists provide anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and emergency services, such as airway management. According to the American Association of Nurse Anesthetists, this highly skilled profession involves preparing and administering anesthesia to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals.

CRNA Qualifications

Be prepared to hit the books to achieve a minimum of a master’s degree from an accredited nurse anesthesia educational program and pass the National Certification Examination upon completion. You’ll need to work in an acute ICU for at least a year before being able to apply to school. Then you’ll need an MSN or DNP, which can take 2-4 years.

What Makes a Good CRNA

A great CRNA has excellent critical thinking skills, attention to detail, calm logic and quick action in an emergency, and a daily desire to learn and improve continually.

2 – General Nurse Practitioner

The role of a General Nurse Practitioner can be defined as an Advanced Practice Registered Nurse (APRN) who may perform duties similar to those of a family doctor.

General NPS have the education and skillset to examine patients independently. They might prescribe medications, diagnose illnesses, or recommend alternative treatment options. In addition, they can interpret diagnostic lab tests.

According to the U.S. Bureau of Labor Statistics (BLS), Advanced Practice Registered Nurses typically perform the following tasks:

  • Recording patients’ medical histories and symptoms
  • Performing physical exams
  • Creating patient care plans or contributing to existing ones
  • Performing (or ordering) diagnostic exams
  • Operating medical equipment
  • Diagnosing various health problems
  • Analyzing test results
  • Administering patient medications and treatments
  • Monitoring patient’s condition during and after treatment
  • Collaborating with doctors and other healthcare professionals, as needed
  • Counseling patients and their families on staying healthy or managing their health conditions

Requirements

To become a General Nurse Practitioner, you must earn a Bachelor’s degree in Nursing (BSN) and a Master of Science in Nursing (MSN) degree.

Although it’s not required, some nurse practitioners hold a Doctorate of Nursing Practice (DNP) degree.

Nurse Practitioners must also obtain national certification in a patient population focus and state APRN licensure.

3 – Clinical Nurses Specialist

Those who wish to work in a specialized unit or clinic should consider the Clinical Nurse Specialist (CNS) path. In addition to diagnosing and treating various conditions, you’ll be considered an expert within your healthcare team. Clinical Nurse Specialists focus on improving the status of nursing at the hospital. They are involved in research and bettering the care provided in the healthcare setting.

  • Manage the care of complex and vulnerable populations,
  • Educate and support interprofessional staff to provide optimal care through the use of evidence-based research
  • Facilitate a culture of safety within health care systems.

Traditionally, the CNS role has been described as having four major components: expert clinician, educator, researcher, and consultant.

The primary focus of a CNS is to take care of the nurses so they can take care of patients safely and efficiently using the best evidence available. The CNS’s primary focus is to ensure that the stretcher-side nurses have the knowledge, skills, processes, policies, supplies, and equipment they need to provide safe and effective patient care.

  • Optimizing patient care by working with the nursing staff. This includes evaluating current practices, reviewing alternatives, consulting patient care managers, and educating staff.
  • On the job, clinical nurse specialist roles can vary depending on their specialty, but general tasks include:
  • Developing specialized treatment plans after patient examinations
  • Educating patients and families on how to manage their conditions best
  • Incorporating practices to promote staff teamwork
  • Analyzing patient data and outcomes
  • Participating with colleagues on new research

Requirements

A Clinical Nurse Specialist must earn a Master of Science in Nursing specializing in clinical nursing.

4 – Psychiatric Nurse Practitioner

Responsible for helping patients heal from various psychiatric disorders, psychiatric NPs help patients manage different psychiatric illnesses and disorders, including anxiety, ADHD, mood disorders, and substance abuse. They also help patients with more severe disorders, including schizophrenia.

Working as a psychiatric nurse practitioner for nurses interested in mental health will allow you to work with psychiatric medical physicians and counsel patients regarding mental health disorders. Psychiatric nurse practitioners also work with patients suffering from mental health disorders and substance abuse issues. 

The role of the PMHNP is to assess, diagnose and treat the mental health needs of patients. Many PMHNPs provide therapy and prescribe medications for patients with mental health disorders or substance abuse problems. PMHNPs may also provide physical and psychosocial assessments, emergency psychiatric care, and treatment effectiveness evaluations. Nurses interested in this career path should be aware that most PMHNPs working in inpatient settings have traditional working hours with some night shifts when on call.

Requirements

  • Depending on their unique situation, nurses can gain some nursing experience before returning to school or going directly into an MSN program. Most NP programs will require a minimum of TWO years of relevant work experience.
  • Enter into an MSN/NP program that offers a program to become a Psychiatric Mental Health Nurse Practitioner.
  • Pass the Psychiatric-Mental Health Nurse Practitioner exam

5 – Certified Nurse Midwife

A certified nurse-midwife, or CNM, is an advanced care registered nurse who gives care and counseling during pre-conception, pregnancy, birth, and postpartum. CNMs also provide primary health care for women and their families throughout their reproductive lives.

Becoming a Certified Nurse Midwife is the perfect career path for RNs who love obstetrics, labor and delivery, and prenatal care. CNMs primarily work in OB/GYN offices, clinics, or hospital settings, but many open their practices depending on their state.

As part of their core duties, certified nurse midwives:

  • Educate women on birth options and partner with them in planning their birth
  • Monitor fetal growth and maternal health, and treat health conditions that arise during pregnancy
  • Attend births in hospitals and birthing centers
  • Perform low-intervention techniques to induce labor or relieve pain during labor
  • Engage medical doctors or specialists as needed during pregnancy or childbirth
  • Assist mothers with breastfeeding, self-care, and postpartum healthcare
  • Develop treatment plans for patients
  • Write prescriptions
  • Order and review lab tests
  • Perform physical exams

Requirements

Complete the MSN program and pass the national midwifery certification exam.

Learn more about the 5 nursing careers to consider in this entire episode, click here 👇👇

TIMESTAMPS:

00:00 – Intro
00:40 – Top 5 Nursing Careers
06:45 – Nurse Practitioner
09:10 – How to be a Nurse Practitioner
11:20 – Clinical Nurse Specialist
15:10 – Psychiatrist
17:25 – ICU Nurse
18:48 – ICU patients
20:15 – Nurse Midwife
21:53 – Labor & Delivery Nurse
23:37 – Male Nurse
25:20 – Duties of a Nurse Midwife
27:10 – Recap of the Top 5 Nursing Careers
27:27 – Wrapping up the show
27:52 – End of show