Can the CAM-ICU Be Cruel?

The rhythm of life, for most people, goes something like this: every day they’re awake, every night they’re asleep.

The hours awake and asleep change as do some of the other particulars. Sleeping is something we do every day. We all sleep. We all need to sleep.

And we need to sleep for several hours at a stretch.

Yet the need to sleep still isn’t universally respected by people who definitely should know better, namely by people who spend years studying the body and how it works.

In a post titled “CAM is a sham…Q1H Neuro Checks” on the nursing subreddit on Reddit, user 37040 posts that they know many know you need three to four hours to reach REM sleep.

That stage, Stage Five, is the stage of sleep where people dream. While science isn’t sure exactly why people dream, they know it’s related to sanity and proper brain functioning.

I work in a Neuro ICU…

The poster says they work in an intensive care unit “and neurosurgery often has patients on (every hour) neuro checks for greater than 10 days. One patient had (every hour) neuro checks for 15 days. Intubated then trached. (I)  can’t imagine not sleeping for 15 days and still following commands.”

The poster then wrote that they understood why you’d have to do it for one or two days, maybe even three. After that, patients should have one to two opportunities to sleep three to four hours at a time every shift.

In a hospital ICU, the patients are the sickest of the sick. These are neurological patients, too, so they have to have some problem in their brain that’s being treated. That’s why their neurological status is being checked. This could involve any number of tests like having a light shined in their eyes and checking to see if the pupil constricts, seeing if the patient can squeeze their hand equally on both sides. If there’s a change in their status, there could be something going on.

When someone is so sick, you’re going to want to stay alert for any changes in their condition.

Nevertheless, you have to ask yourself this: how do you think you’d do after being woken up every hour for 15 days in a row? The poster has a point, no matter how sick the patient is.

CAM stands for “Confusion Assessment Method.” It’s often referred to as the CAM-ICU. Never mind if someone is confused after 15 days, even after a week of this they’ll become confused!

In the CAM-ICU test, patients are asked questions like:

  • Will a stone float on water?
  • Are there fish in the sea?
  • Does one pound weigh more than two pounds?

Or they’ll test the ability to follow commands:

Hold up this many fingers. (The examiner then holds up two fingers in front of the patient.)

Many other nurses and doctors on the board chimed in describing how they handled the issue in their hospital. Some suggested changing the way those orders are written on the computer. Others stressed the importance of communication or letting the patient refuse such frequent assessments.

Hopefully, someday critical care nurses and doctors will both be universally aware of the need to sleep for several hours at a time, and act on that awareness.

Until that day, yes, the CAM-ICU can be cruel.

Also on the blog:

James Cobb, RN, MSN is the founder of the Dream Recovery System, a top sleep blog dedicated to promoting awareness of sleep issues.

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