With warmer weather now upon us and the promise of some hot shifts ahead, it seems a good time to discuss the virtues of the well hydrated nurse.
Proper hydration has been found to play a significant part in efficient digestion, elimination of toxins, joint lubrication, energy production and thermoregulation.
During the typical busy shift we lose water via our respiratory system, perspiration and via our kidneys. Hot weather results in increased water loss from the skin and lungs. An increased vapour pressure gradient from air conditioned environments has a similar effect.
The resultant increase in our plasma osmolality and decrease in plasma volume activates the thirst sensation.
However, under the multitude of work stressors and mental distractions we typically encounter in our work day, this thirst stimulus will often be lost amidst our other 100 priorities resulting in our fluid intake lagging significantly behind our body fluid loss.
This is known as ‘involuntary dehydration’.
There may also be a voluntary dehydration component amongst some nurses, who simply restrict their fluid intake because they don’t have the time to be going to the toilet multiple times during the shift.
Physical performance has been found to be impaired when you become dehydrated by as little as 2% of your body weight.
At this early point dehydration already has a significant impact on you ability to perform sustained physical activities.
A loss of 4% results in some degree of oliguria, tachycardia and postural hypotension.
Fluid depletion in excess of 5% can decrease your capacity for physical work by 30%.
Dehydration leads to a drop in circulating plasma volume and increased viscosity as all as a decrease in brain volume.
It also impacts on the bodies ability to loose heat, with both sweat rate and blood flow to the skin decreased compared to the euhydrated or normal state.
There are now several studies highlighting the impact of dehydration on both short & long term memory as well as cognitive performance (concentration, alertness, short term memory, perceptual discrimination, arithmetic ability, visuomotor tracking, and psychomotor skills).
In one US study (that was looking at the effects of dehydration on older adults), mental performance was found to be far less in a dehydrated group where there was as little as one or two glasses of water difference.
In another study, dehydrated school children were found to show a significant drop in performance by the end of the day.
How much water?
So. How much water do you need to drink?
Well that depends on your individual situation, diet (increased salt and protein intake will increase water requirement) and environment.
But just as is the case with our patients, urine output will give you a pretty good guide to your own hydration status.
A full bladder every few hours and clear, un-concentrated urine is a good indicator.
Of course now you will have a whole new set of problems around of lack of time to get to the toilet, and the resulting engorged bladder management. Good luck.
Also, try to listen to your bodies thirst signals. Are your lips or mouth dry?
Do you actually feel a little thirsty?
Do you feel irritable, or hungry, or having problems concentrating?
Might be time for a slug of H2O.
Often we are so busy with our tasks that we feel we might not have time to go and make these frequent water stops.
To solve this, many nurses now carry their own water bottles on the unit. There now are many aluminium and plastic varieties commercially available.
This is a very good idea. With a few simple caveats:
- Watch for clutter. With many staff members bringing their individual water bottles out onto the floor, desks and shelves can quickly become cluttered decreasing work spaces and looking shabby. Try to find an accessible and discrete place to store your water supply.
Perhaps you can work to produce a hydration station for water bottle storage on your own unit.
- Take care of your bottle. Make sure your bottle is clearly labelled with your name. Don’t leave your bottle laying around at the nurses station when you are on days off. Keep it clean. Keep it fresh.
- If you can, try to avoid using commercially bottled water. These things are outrageously priced, of little health advantage over most tap public water, and and leave a big environmental footprint.
- If you must use bottled water at work, try to refill it with tap water once it is empty.
- If you find water boring, add a little cordial to taste.
If you do take cordial out into the ward, remember that any spills or leaks on desk spaces leave a sticky residue that can be very annoying for others.
Don’t forget your patients.
During these warmer months, make sure your patients also have access to sufficient water supplies.
This is of most importance to our paediatric and aged populations.
Offer fluids frequently, keep accurate fluid balance charts when required, and assist the patient with intake if needed.
“The relation of hydration status to cognitive performance in healthy older adults.”. International Journal of Psychophysiology 53 (2004) 121–125