HOW TO CONTROL YOUR POSITIVE SELF-IMAGE whilst your loved one is critically ill in ICU!&YOUR QUESTIONS ANSWERED

Published: Mon, 12/15/14

Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you're not a doctor or a nurse in Intensive Care!

In last week's BLOG you’ve discovered

“HOW TO STAY STRONG WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!”

You can check out last week’s BLOG by clicking on the link here.

In this week’s BLOG I want to share with you

“HOW TO CONTROL YOUR POSITIVE SELF-

IMAGE whilst your loved one is critically ill in

Intensive Care!”

The concept of self-image is a powerful concept!

The concept of our own and individual self-image is so powerful that we spend hours, days or even years trying to get the picture in our head right about what our self- image looks like and then we try and live our lives according and congruent to our self- image!

The concept of self-image is different for different people, however at the end of the day we all know and understand that we all have our own concept about our own self-image!

The self-image that we have attributed to our persona and personality is influenced by many facets such as the society we live in, our friends, our family and many other factors that we pick up along our way in life!

However in most cases our self-image is a positive one and our self- image is therefore relying on mainly positive attributes!

The attributes about our self-image that we like the most are attributes such as good health, youth, vitality, success, being in control of our own lives and being in control of our own destiny etc…

And that’s how it should be. If we don’t give ourselves permission to control and live according and congruent to our mainly positive self-image, life can be very hard and frustrating!

Ok, so you might say “Patrik, I understand all of that, but where is the connection to my loved one being critically ill in Intensive Care? And where is the connection to me and my family dealing with one of the biggest challenges and frustrations I have ever dealt with?”

Ok, that’s a very good point and a very good question.

Your POSITIVE self-image is critical for you having PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care!

The truth of the matter is that if your self-image is mainly positive and now all of a sudden you are facing this massive and “ONCE IN A LIFETIME” challenge of having a loved one critically ill in Intensive Care, your self-image is suffering one way or another!

And that’s OK, it is what it is, however controlling your positive self-image during this “ONCE IN A LIFETIME” challenge is crucial for you and for your family to have PEACE OF MIND, control, power and influence!

People who have a negative self-image and/or low self-esteem tend to be the 99% of families of critically ill Patients in Intensive Care who have no PEACE OF MIND, no control, no power and no influence!

Most people who read this blog and who are pro- actively looking for a solution, who are looking for ways out of their dilemma have a positive self-image!

And yet, even for people with a positive self-image and high self-esteem the challenges, the frustrations, the fear, the overwhelming emotions, the stress and the level of vulnerability they are experiencing when their loved one is critically ill in Intensive Care can get all too much!

And if you are having a mainly positive self-image about you and your family that’s a great starting point and you have great resources to tap into.

And you need those resources such as your positive self-image, especially if your critically ill loved one is either

very unstable and in a very critical condition

in a life threatening situation

in Intensive Care for long-term treatments and long-term stays

having a severe(traumatic) head or brain injury

THREATENED with an “NFR”(Not for resuscitation) or “DNR”(Do not resuscitate) order

In a situation where the Intensive Care team suggests a “withdrawal of treatment” or a “limitation of treatment” as being “in the best interest” of your critically ill loved one

approaching their end of life in Intensive Care

because those are the situations where at first sight, your and your family’s positive self-image might take a hard hit!

Nobody wants to be facing or let alone dealing with such massive and “ONCE IN A LIFETIME” challenges like the ones I just mentioned!

And I can assure you that in more than 15 years Intensive Care nursing in three different countries, where I have literally worked with THOUSANDS of critically ill Patients and their Families that even Families with a positive self-image and high self-esteem have been hit extremely hard because they were unprepared!

Don’t let “ONCE IN A LIFETIME” challenges impact on your positive self-image!

Even Families with a positive self-image and high self-esteem very often have no PEACE OF MIND, no control, no power and no influence whilst their loved one is critically ill in Intensive Care!

And that’s simply because they don’t know what to do, they don’t know what questions they should be asking and they don’t know how they can maintain their positive self-image and have PEACE OF MIND, control, power and influence!

Because let’s face it, maintaining your positive self-image during this “ONCE IN A LIFETIME” challenge whilst your loved one is critically ill in Intensive Care is very important to you!

Maintaining your positive self-image even if your critically ill loved one is either

very unstable and in a very critical condition

in a life threatening situation

in Intensive Care for long-term treatments and long-term stays

having a severe(traumatic) head or brain injury

THREATENED with an “NFR”(Not for resuscitation) or “DNR”(Do not resuscitate) order
In a situation where the Intensive Care team suggests a “withdrawal of treatment” or a “limitation of treatment” as being “in the best interest” of your critically ill loved one

approaching their end of life in Intensive Care

is very important and so it should!

Because if you let those situations impact on your positive self-image and if those challenging, difficult and frustrating situations cause you to not have PEACE OF MIND, control, power and influence you, your family and your critically ill loved one are doomed!

Imagine the Intensive Care team suggests to you and your family that a “WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” would be “IN THE BEST INTEREST” of your critically ill loved one!

You are in control and you can define your mental positioning!

If you and your family have a negative self-image, the Intensive Care team knows that, they might take advantage of it and they have an easy time to drive home their mainly hidden agenda!

If you and your family have a positive self-image and high self-esteem, you will question, you won’t take “NO” for an answer and you will challenge the Intensive Care team and their assumptions!

If you and your family have a positive self-image and high self-esteem you will start looking for answers, for solutions and you will start looking at what’s happening “BEHIND THE SCENES” in Intensive Care!

If you and your family have a positive self-image and high self-esteem, you won’t let this “ONCE IN A LIFETIME” challenge and you won’t let the negativity, the “doom and gloom” of the Intensive Care team define you or stop you from having PEACE OF MIND, control, power and influence!

If you and your family have a positive self-image and high self-esteem you also know that your mental positioning is just as, if not more important than the Intensive Care team’s positioning!

If you and your family have a positive self-image and high self-esteem you know that the financial interests($$$), the medical research interests, the bed management pressures, the resource limitations, the politics, the dynamics, the competing interests, the power play, the hierarchy, the intrigue and the psychology of the Intensive Care team are all but limitations for you to have PEACE OF MIND, control, power and influence!

If you and your family have a positive self-image and high self-esteem you know that the negative positioning of your critically ill loved one’s diagnosis and prognosis by the Intensive Care team is something that is to be challenged by your determination, by your strong mental positioning which is just as strong, if not stronger than the Intensive Care team’s positioning!

If you and your family have a positive self-image and high self-esteem you won’t budge, you won’t buy into the “perceived power” and the “perceived authority” of the Intensive Care team!

If you and your family have a positive self-image and high self-esteem you control your body language and you carry yourself well during this “ONCE IN A LIFETIME” challenge!

If you and your family have a positive self-image and high self-esteem you speak in a tone of voice and with carefully chosen words that lets the Intensive Care team know that you are out of your comfort zone, but you also let them know through your tone of voice and with carefully chosen words and through your body language that no matter what, you will have PEACE OF MIND, control, power and influence!

If you and your family have a positive self-image and high self-esteem you will, even in the face of massive and devastating adversity such as if your loved one is inevitably approaching their end of life in Intensive Care make sure that your loved one and your family have privacy, dignity and that all your emotional, spiritual, cultural and religious needs are met!

In any case, if you and your family have a positive self-image and high self-esteem you will make sure that the Intensive Care team is not walking all over you and you will make sure that you will have PEACE OF MIND, control, power and influence!

Also, check out our "YOUR QUESTIONS ANSWERED" section

where I answer all of YOUR questions

http://intensivecarehotline.com/category/questions/

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from one of our readers and the question last week was

"My friend is in ICU ventilated with Leukaemia! The doctors have made her “DNR”! I disagree, what are the best options?"

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of your questions answered I want to answer another question from our readers and in this week Judy, from Vancouver, Canada asks

My husband is quadriplegic and has been off the

ventilator for more than two weeks!

The Intensive Care team wants to send him home

with a Tracheostomy, but I don't believe he'll

need the Trcaheostomy! Help!

Judy writes

Hi Patrik,

My husband is a quadriplegic and had a serious Pneumonia!

He was vented for 2 weeks had a Tracheostomy done for pulmonary toileting for very thick secretions.

It is now 2 weeks since the Tracheostomy and my husband’s lungs are clearing nicely!

There are very little secretions left and his O2(Oxygen) saturations are ranging around 97%.

He has passy Muir speaking valve and he is taking foods well. They want to send him home leaving the Tracheostomy. He was perfectly fine before the Pneumonia. Is it necessary for a permanent Tracheostomy?

My husbands injury was C6/C7 incomplete and was 11 years ago. He has been off the ventilator for over 2 weeks is speaking fine with the passy Muir speaking valve and has only been suctioned twice in 24 hours. His last chest X-ray was clear. Yesterday the Respiratory Therapist said there was good air entry throughout the lungs and his chest sounded clear.

The reasoning I have been given for a permanent Tracheostomy is that if he gets Pneumonia again I will have clear access to suction. I am a retired RN director of nursing so I have insight into this. I have asked to have my husband seen by a respiratory physician for further explanation.

Thx so much for your response

Judy

Dear Judy,

thank you for making contact.

I am very sorry to hear that your husband was perfectly fine without the Tracheostomy prior to his hospital admission for Pneumonia.

From what you are describing, especially if he is taking foods well, my first guess would be that the Tracheostomy doesn't have to stay.

However, two weeks with a Tracheostomy and without trying to take it out is by far too early to suggest that the Tracheostomy has to stay in.

But this is just my first guess without actually knowing for sure, however if your husband was fine without a Tracheostomy before the Pneumonia there shouldn't be any reason why he should need it now.

Is your husband still requiring ventilation support? How often does he need suctioning? Can he talk with the passy muir valve?

From what you are describing, there should be no reason why the Intensive Care team shouldn't be able to take out the Tracheostomy tube.

The reasoning that if your husband "will get Pneumonia again" is just not a strong and convincing reason to live with a Tracheostomy permanently.

Of course you should be taking their opinion into consideration, however a "what if" scenario should not be the reason for somebody to permanently live with a Tracheostomy.

It also means that if your husband is requiring suction twice daily and if he is able to cough then they should at least try and take it out.

Why don't they try anyway while he is still in hospital?

You should also look into the guidelines for Tracheostomy removal here

As a rule of thumb, the current guidelines for Tracheostomy removal should be considered before removing the Tracheostomy (decannulation)

Your husband should be off the ventilator for at least 3-4 days, which it sounds like he has been

He should be able to cough and swallow and therefore not at any risk of aspiration(aspiration is the entry of stomach content or sputum into the lungs after swallowing or vomiting)

The frequency of suctioning, therefore suctioning should be at a minimum and less than once or twice a day

Your husband should be able to clear and maintain his own airway and he should therefore be able to cough up his secretions

Generally speaking the Tracheostomy protects from aspiration because of the blocking of the trachea(wind pipe) with a cuff

A normal and satisfactory ABG(Arterial blood gas) test, which checks the level of oxygen(O2) and carbon dioxide(CO2) in the blood
Oxygen saturation in the blood above 93-94%

A normal and clear chest x-ray that doesn’t suggest anything malicious like an infection, collapse or Pneumonia

A swallowing test that is normal, because again after Tracheostomy removal you want to make sure that there is no aspiration and that your father can actually enjoy some food and drinks. A swallowing test should be carried out by the speech pathology team

You can also check out the answer to a similar question from a reader here

My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?

After your husband fulfils all of those requests, his Tracheostomy may be plugged(closed) for twenty four hours and they are monitored for breathing/respiratory difficulty or suction requirements before the tube can be removed.

In any case you should be fighting for what you believe is the right thing to do!

I believe it's very poor from the Intensive Care team to not try harder and improve your and your husband's quality of life.

A Tracheostomy is a big impairment and he should have it removed if possible!

It sounds to me like you have insight anyway, however you should not be giving in to the Intensive Care team's demands and plans!

Please let me know if there is anything else I can help you with!

Thank you& Kind Regards

Patrik Hutzel

If you want your questions answered just hit reply to this email or email me at support@intensivecarehotline.com and I'll answer your questions!

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long-term stays in Intensive Care
end- of- life situations
Family meetings with the Intensive Care team
withdrawal of treatment situations and/or perceived medical futility
what to do if your critically ill loved one is THREATENED with an "NFR"(Not for resuscitation) or "DNR"(Do not resuscitate) order
severe head and brain injuries

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Patrik Hutzel

Critical Care Nurse

Founder& Editor