Positive Implications of the Critical Care Process

You need to analyse the video for quality of performance and identify practices not in line with the ARC guidelines and identify the strengths and weaknesses (technical and nontechnical) of the performance based on cited research. You can provide recommendations for practice change. 

Complex nursing care is the process which is applied for the patient suffering from severe health conditions and involves application of professional guidance and leading standards further it also requires day to day supervision of the processes and therefore it requires a multi-dimensional supervision team so that overall care of the patient can be achieved (Morton et al., 2017). The multi-dimensional team should involve occupational therapists, physiologists, sociologists, geriatric nurses, skilled auxiliary professionals, skilled speech therapists and further qualified and trained nurse so that all these clinical assessment related to the severe patient condition can be done without any adverse health outcome (Barr et al., 2013). In the nursing program, complex nursing care is an important aspect that helps to determine the untrained nurses are able to understand the processes and their positive or negative implications so that while practicing they can implement those processes in their regular practice. In this assignment, a video of a complex care session named “code blue” will be reviewed and all the positive and negative steps taken by the multi-dimensional healthcare team in the setting will be assessed. Further with reference to the Australian Resuscitation Council (ARC), the compliance of the taken steps of the video with the guideline will be assessed and will be supported with recent literature evidences.

The assignment is based on a video, named “Code Blue”, 4 to 5 healthcare professionals are seen to provide critical or complex care to a patient, Mr. Smith. He is a 37 year old patient and was admitted to hospital due to the concern of pancreatitis a couple of days ago. This approximately 14 min long video provides a detailed structure of the plan of care the multi-dimensional team arranged for Mr. Smith after he was found senseless in morning. This plan of care includes several positive and negative points. The video starts and within 30 seconds, the nurse Tammy found that Mr. Smith is not responding and hence she calls for another helper to help her assessing patient and ask her to call code blue. However, instead of pressing the emergency button for code blue, the nurse ask another helper to call the code blue. Tis step had a negative implication on the care process as wasted some precious time of the patient care. De Mu  et al., (2012) also mentioned in their article that, in emergency situation, nurses should press the emergency button so that multi-dimensional tem can reach to the emergency room without any delay. Secondly, while checking the breathing of the patient, the nurse did not went to close of his mouth, where the height of the bed was extremely low. Further as per mentioned in the ARC Guidelines (4), the patients head was not tilted or chinned up so that any obstruction in the airway can be minimized or removed. Parasarn et al., (2014) and Higginson and Parry (2013) included the evidences in which, in emergency patient condition, to manage and clear the airway in the patients, ‘tilting head’ and chin lift is an important step that helps to clear the airway of the patient.

Negative Implications of the Critical Care Process

The third negative point which was noticed was At 2:01 minutes when the nurse applied the pads to provide shock to the patient, however, at that time, no one provided compression to the patient. It should be noted that according to the ARC guidelines (6), interruption while providing compression should be minimized as longer gaps can lead to deleterious health outcomes and the patient’s unresponsiveness can be increased. Therefore, while implementing the pads as well, the healthcare workers should provide compression to the patient so that oxygen saturation within the patient can be increased. Evidences from recent literatures such as Stiell et al., (2012) determined that longer CPD related resuscitation is important for patient’s unresponsive heart to pump more blood throughout the body and maintain normal pulse rate. Kleinman et al., (2015) and Perkins et al., (2015) supported the evidence.

After that, 2:11 minutes, the code captain Dr. Salinger enters the room and without asking for the patient assessment data, first ask the nurse to stop the compression and provide a shock of 150 joules. Further, after delivering 150 joules shock, he asked the nurses to administer epinephrine 1 mg IV push intravenously. According to the ARC guidelines section 2, the healthcare professional first quickly go through the patient assessment related data so that prior to suggesting any medicine for the patient, his allergies, last critical symptoms, last eaten meal and so can be understood. This is an important step as without this, if the doctor suggests the nurses to administer any medication and if the medication had any adverse effect on the patient’s health, then the critical situation of the patient care would become more critical. This situation is also supported by several recent literatures such as Kim and Bates (2013), Baguley et al., (2013) and Marengoni and Onder (2015) has defined that patient assessment is the primary step of healthcare interventions and depending on the data collected from patient assessment the further interventions for patient improvement are included in the process. The doctor asked about the patient condition and assessment report at 3:41 minutes of the video which is too late for asking patient condition. The nurses present in the ward should have been provided him with the patient assessment data earlier. Further, one biggest loophole in the care process was noticed related to the compression process. IT was noticed that there were 4 5 nurses present in the ward, however they were scattered and did not lined up in a queue so that one after another the care process can continue. Therefore, maximum nurses were doing compression wrongly and therefore at 6:44 minutes, the video showed a nurse being completely tired and drained in the compression process. Further, after the change the compression process took a speed which was not appropriate as the rules and guidelines of providing compression, as per the Arc guidelines section 6. Johnson et al., (2017), Barnes et al., (2013) and Leung & Chow, (2012) also determined that nurses should form a queue and provide compression in a rhythmic manner so that appropriate cardiac output can be generated. Therefore, these above mentioned points were the negative points observed in the Code Blue video and was aligned with the ARC guidelines and backed with recent evidence based literature articles (Australian Resuscitation Council, 2018).

Positive Outcome Despite Negative Actions

Besides the negative aspects present in the critical care process, while treating Mr. Smith and his unresponsiveness, there were several steps that had positive implication on the care process. The first positive point was spreading the news of patients unresponsiveness so that everyone nearby becomes alert. Lind et al., (2012), mentioned that this attitude of nurses are able to save several lives and improve patient condition. It was also mentioned in the ARC guidelines 1.1 that after watching any serious signs, the nurses should ask for senior nurses or healthcare professionals help. Further, the nurse delivering the shock at 150 joules was very clear and announced that clearly to everyone. This is also an important aspect as while providing care healthcare professionals should be alert and loud so that complete focus can be implemented. Thirdly, the nurses removed the head rail at the primary stage of the critical care process that helped the nurses to clear the airway. Other helping staff such as the social care worker was aware of their roles and they inform the patient’s family related to the process. Besides these, other steps such as doctor’s assessment related to the ECG rhythm and after identification, delivering shock if the same rhythm and putting on sliding pad at start of medical intervention were also a positive implication of ARC guideline related rules, of which references can be found in recent literatures. These positive sections of the critical care unit was determined from the video determined that despite several negative actions, the critical care operation was carried out successfully in the Code Blue video.

Besides positive and negative point, there were several sections in the critical care unit that can be determined as a negative point of critical care process, however exerted a positive outcome in the patient assessment. These will be assessed in this next section. Firstly, while implementing the oxygen cylinder the nurses were not being able to make a sealed airway this was a negative point, as depending on the ARC related guidelines it is important for the airway mouth piece to be properly fit onto the face of the patient (Australian Resuscitation Council, 2018). Peters, Holets & Gay, (2013); Schwabbauer et al., (2014) also mentioned that it is important for the oxygen mouthpiece to be properly fit onto the mouth of the patient so that while compression continuous and proper amount of oxygen can be provided to the patient. However, in that situation the nurse used her active thinking ability and asked another nurse to hold the mouthpiece of the oxygen mask so that the oxygen can properly compelled in the mouth of the patient. Balas et al., (2012) has also mentioned such activity in the study where nurses holded the mouth piece of the patient so that air way can be maintained. The second negative but negative point in the critical care process observed from the code blue video was the assessment recorder nurses inability to recognize the name of the drug and the processes name. It has been observed from that video that in two stations, the nurse recording the details and data of code blue activities, the nurse was unable to recognize the name of the defibrillation process and recognized it as cardioversion process (5:32 min) as well as the drug amiodarone 300 mg IV push and asked the nurse injecting the drug into the patient body. These are negative points as the nurse was not trained or capable enough to recognize the name of the drugs or processes used in the critical care process (Hodgson et al., 2014). According to the ARC guidelines section 4 it is important for the nursing professionals to understand the process and collect accurate data so that further interventions can be carried out (Australian Resuscitation Council, 2018). However the positive aspect of this point was the nurse’s ability to make any doubt clear instead of noting down wrong or fake data. This is also an important aspect of care which determine that instead of implementing any doubtful step the nurses should always clear their doubt so that proper and accurate steps related to the critical care interventions can be implemented in the patient care. Therefore, from the provided video of the code blue, all these positive, negative and negative but positive interventional points were identified (Lee et al., 2017)

Negative Points Exerted Positive Outcome

While concluding the assignment, it should be mentioned that critical care nursing process or complex care process is a crucial situation in which the healthcare interventions demand complete determination and activity of the healthcare facilities. In the bachelor nursing programs this aspect of the student related to their activity and determination is assessed by providing them with a patient so that their ability to deal with critical situation can be assessed. In this assignment, a video of Code Blue having a patient Mr. Smith was assessed and the unresponsiveness related condition was managed by the crucial care intervention. The primary focus of this assignment was observing the critical care process handles by the code blue team and point out their negative, positive and negative but positive points complied with the ARC guidelines. This was done as the ARC guidelines section 1.1, 2, 3, 4, 6, and 10.6 was found to be met or unmet in the assignment. Further using evidence from recent literatures the authenticity of the recommendations were provided.

References

Australian Resuscitation Council. (2018). The ARC Guidelines | Australian Resuscitation Council. Retrieved from https://resus.org.au/guidelines/#

Baguley, D., Lim, E., Bevan, A., Pallet, A., & Faust, S. N. (2012). Prescribing for children–taste and palatability affect adherence to antibiotics: a review. Archives of disease in childhood, 97(3), 293-297.

Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., … & Ely, E. W. (2012). Critical care nurses’ role in implementing the “ABCDE bundle” into practice. Critical care nurse, 32(2), 35-47.

Barnes Jr, M. L. (2013). U.S. Patent No. 8,611,919. Washington, DC: U.S. Patent and Trademark Office.

Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., … & Coursin, D. B. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care medicine, 41(1), 263-306.

De Mul, M., Alons, P., Van der Velde, P., Konings, I., Bakker, J., & Hazelzet, J. (2012). Development of a clinical data warehouse from an intensive care clinical information system. Computer methods and programs in biomedicine, 105(1), 22-30.

Higginson, R., & Parry, A. (2013). Emergency airway management: common ventilation techniques. British Journal of Nursing, 22(7), 366-371.

Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., … & Green, M. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), 658.

Conclusion

Johnson, D. C., Sievert, J., Hoyme, K., LaLonde, J., Mass, W., & Duccini, D. V. (2017). U.S. Patent No. 9,848,058. Washington, DC: U.S. Patent and Trademark Office.

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J., … & Rea, T. (2015). Part 5: Adult basic life support and cardiopulmonary resuscitation quality. Circulation, 132(18 suppl 2), S414-S435.

Lee, Y. J., Noh, J. H., Choi, H. S., & Kim, S. E. (2017). Nursing Students’ Awareness and Behaviour of Academic Misconduct in South Korea. Indian Journal of Science and Technology, 10(20).

Leung, N. Y., & Chow, S. K. (2012). Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units. Journal of clinical nursing, 21(13-14), 2083-2093.

Lind, R., Lorem, G. F., Nortvedt, P., & Hevrøy, O. (2012). Intensive care nurses’ involvement in the end-of-life process–perspectives of relatives. Nursing ethics, 19(5), 666-676.

Marengoni, A., & Onder, G. (2015). Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ: British Medical Journal (Online), 350.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins.

Perkins, G. D., Lall, R., Quinn, T., Deakin, C. D., Cooke, M. W., Horton, J., … & Smyth, M. (2015). Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet, 385(9972), 947-955.

Peters, S. G., Holets, S. R., & Gay, P. C. (2013). High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respiratory Care, 58(4), 597-600.

Prasarn, M. L., Horodyski, M., Scott, N. E., Konopka, G., Conrad, B., & Rechtine, G. R. (2014). Motion generated in the unstable upper cervical spine during head tilt–chin lift and jaw thrust maneuvers. The Spine Journal, 14(4), 609-614.

Schwabbauer, N., Berg, B., Blumenstock, G., Haap, M., Hetzel, J., & Riessen, R. (2014). Nasal high–flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC anesthesiology, 14(1), 66.

Stiell, I. G., Brown, S. P., Christenson, J., Cheskes, S., Nichol, G., Powell, J., … & Vaillancourt, C. (2012). What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?. Critical care medicine, 40(4), 1192.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.