I recently had an in-depth conversation with a gentleman who had been a patient in the ICU during the last year. He was on a ventilator for over a month. The experiences he told me about were alarming. He told me his story in a social setting so I won’t tell his whole story because it is his to tell; however I will share my take-aways.

I’m sure by now we have all heard about ICU psychosis. As nurses we are to be aware that the ICU setting can create an environment in which patients struggle to heal due to the constant light and alarms; the restraints and procedures done to them. We have been trying to lessen this by turning lights down at night and having limited visiting hours, lights on during the day, less sleep allowed during the day, alarms are silenced, etc. When someone is talking “crazy” when they come out of the ICU we just assume they are having delirium and we treat them as though what they are saying or talking about is just in their imagination.

This gentleman I was talking to told me about “dreams” he had in the ICU. They are perfect descriptions of things that were done to him and his mind turned them into dreams. He was aware of what the nurses were doing to him even though he was sedated on the ventilator. He had a feeding tube put in and he was restrained. He has nerve damage from the restraints. He remembers conversations that were had over him about him. He described fear, anger, and isolation. It was such a harrowing story that as a nurse all I could do was apologize to him.

It’s understandable that at times it is “wham, bam, thank you ma’am” type of healthcare. In a trauma in an emergency room, of course the “feelings” of the patient are last on the list while you are just trying to save a life. When patients are moved from the ED to the ICU and you are just trying to get them stable, same goes. When a patient comes out of surgery and their BP crashes and you are just trying to get them back, wham and bam, thank you ma’am. There are times that saving a life is all that you are doing, thinking and caring about. If a patient is aware of you saying an f-bomb or that you are a little rough in your approach, it is more than OK in that moment because they would be dead otherwise.

HOWEVER… when a patient is lying in a bed either after surgery in the PACU, or in the ICU sedated and on life-support the situation is very different. There is really no excuse for talking over patients; for talking about personal things, private things, or things about the patient while in their presence. Respect is an all the time sort of thing. Or at least it should be. In some situations we become so hardened and assume that patients can’t hear us or won’t remember conversations or actions and so we act disrespectfully.

At the heart of nursing is care. When we forget that and act as though we are only taking care of machines we are all in jeopardy of losing the soul of nursing. We are caring for humans; for other souls; for someone’s loved one. No matter the circumstance, we should act like it.

When doing hospice care, nurses talk to their patients when they are unconscious and even when they are dead. They move them carefully and always try to cause as little discomfort as possible. Believing that a person loses their sense of hearing last is one reason nurses do this, but another reason is respect. Respecting the boundaries between your personal life, feelings, etc. and your patient’s AND respecting that they are of equal value in their humanness as you are.

Most nursing jobs are not in the ICU, ED, or PACU. Most nurses work outpatient, clinic, surgery centers, schools, and medical units in the hospital; however, the issue of disrespect of patients exists everywhere. Talking loudly at nursing stations, talking about patients when we assume they can’t hear us, causing pain for our patients, making them wait intentionally, disregarding patient’s feelings because of our prejudices about them, etc.

Nurses are hard working, loving, gentle, smart, giving, caring, and respectful as a rule. It just breaks the heart to hear of the instances when they aren’t. We can’t blame Covid or nursing shortages for bad behavior. We have to own it and figure out how to do better.