Talking to patients

In ICU the majority of patients are sedated to a certain extent, though as they begin to recover their sedation is turned down and they begin to wake up, and they often do not respond to tactile stimulation or pain. When treating these patients we are supposed to talk to the patient and explain what we are doing, even though the patient does not appear conscious or respond in any way. I understand that this is very important, as we have no way of knowing how much they are actually aware of, and we need to try and make sure that, especially if we are doing an invasive intervention, they know what is about the happen to them.
However, for the first few days of prac you feel a bit stupid talking to a patient who is sedated and seemingly oblivious to their surroundings, and you begin to slip into the habit of just jumping in and treating the patient (esp. if you have treated them before and know that they are sedated and don’t respond) without explanation or warning. It is really hard because you do it without thinking, and if it was me in the bed I know that I would want to know what was happening, and even if they aren’t aware it is still an important thing to do.
Yesterday I was treating a patient with one of the other students, we had seen her a number of times over the last two weeks, as she has been in ICU for almost as long as we have. She had been sedated for all of that time, and hadn’t responded to any stimulus, but she was beginning to recover and had had her sedation decreased gradually overnight. When we went in to treat her we explained that we were going to put our hands on her chest (to assess chest expansion) and listen to her lungs, we also looked at her ventilation and saw that she was taking spontaneous breaths-which was important for our intervention-bagging (MHI). We had got everything set up and started to bag-without having explained what we were about to do, when she started to move her jaw, and tried to open her eyes and bite the ETT. At this point we explained that we were giving her some bigger breaths and that she should try to relax, and we completed her treatment-explaining that we were going to suction her and that it would make her cough.
I felt so bad about not telling her what we were doing, and her response to our treatment! We should have realized that she might have been more aware since her sedation had been turned down, and even if we hadn’t we should have explained what we were doing to her.
We can never really be sure how aware a person is of their surroundings, even if they are sedated, and is it vital that we always let a patient know what we are about to do, especially if it is an invasive technique. It doesn’t matter whether the patient looks unconscious or that they don’t respond to stimuli, it is a basic courtesy and it is very important to ensure that the patient doesn’t react badly to your treatment because they weren’t prepared for the sensation or didn’t know it was coming. In order to do no harm, we need to talk to our patients, whether they talk back or not.