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Role of nurses
Role of nurses
Communication with doctors and nurses
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There are events, subtle or otherwise, leading up to a critical change in health status. As nurses at the bedside, we must have strategies and protocols implemented in order to monitor changes in vital signs and trends leading towards a cardiac, respiratory, or neurologic event. In a hospital setting, patients are monitored for changes in condition, whether it be improvement or deterioration, allowing clinicians to decide the course of action to follow in their care. In the Intensive Care Unit (ICU), patients are being monitored very closely while their vital signs, their neurological status, and their physical status are being managed with strong medications, lifesaving machines, and the clinical knowledge and skills of trained ICU nurses. Outside of the ICU, it is essential for staff nurses to identify the patient that is clinically deteriorating and in need of urgent intervention.
A Code Rescue or
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Calls to outpatient areas such as radiology, rehab, and the hospital lobby are also on the rise, with family members, visitors, and employees being added, besides the inpatients, to the list of eligible Code Rescue calls for the ICU nurse to respond to. With Code Rescues involving a Stroke Alert, the ICU nurse must accompany the patient to the CT Scan area for a STAT CT of the brain, which takes the nurse away from their assigned patients for an even longer period of time based on the status of that patient. When a nurses take their break, another nurse is required to monitor those patients as well as take care of their own patient assignment. The attention given to the other patients is not considered to be extensive, basically “keeping an eye” on them until their nurse returns. This patient assignment could be at a safety risk if their nurse is also the one assigned to respond to Code Rescues at any time during the
Noticeable indications of deterioration have been shown in numerous patients few hours prior to a critical condition (Jeroen Ludikhuize, et al.2012). Critical condition can be prevented by recognizing and responding to early indications of clinical and physiological deterioration ( kyriacosu, jelsma,&jordan (2011). According to NPSA (2007) delay in responding to deteriorating vital signs have been defined as an complication resulting in prolonged length of stay, disability or death, not attributed to the patient's underlying illness procedure along but by their health-care management ( Baba-Akbari Sari et al. 2006; Helling, Martin, Martin, & Mitchell, 2014). A number of studies demonstrate that changes or alterations in a patient’s
...s, physicians, and family members on the importance of prevention, detection, and treatment of ICU delirium. When successful, the ICU staff can promote a healthy environment to support physical and physiological well-being.
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
During clinical this week, the student nurse got the opportunity of an observational experience in a Specialty Care Unit. The student was directed to the Surgical Intensive Care Unit (SICU) to observe a patient that was critically ill and receiving extensive treatment. The student observed a nurse caring for a patient while administering therapeutic hypothermia after cardiac arrest.
Determining nurse-to-patient ratios is a difficult task with no single or definite solution and many variables exist to develop guidelines to cover every possible situation in an acute care facility. There are two boards of the state of Ohio that help with patient safety and keeping a safe workplace for the healthcare professional such a nurse. The first board is the Ohio board of Nursing, and the following is their description of what they are responsible for:
As a result, patient safety is improved and poor outcomes are decreased. Communication of vital information was reported as being more complete among these research. Sand-Jecklin and Sherman (2014) identified an increase in report accuracy and the increase in nurse perceived accountability. This study reported that patient falls during bedside handoff reporting decreased from twenty pre-implementation to thirteen post implementation at 3 months to four at 13 months (Sand-Jecklin and Sherman, 2014). The practice of bedside handoff reporting offers the opportunity to address toileting and other needs thus decreasing the incidents of falls. Kerr et al. (2014) reported that participants in their studies believed that early encounters with their patients during bedside handoff reporting afforded them early assessment of their patients’ condition. This particular finding is relevant to our area, since the deterioration of most of patients condition could be identified during handoff bed reporting. Ultimately, this would improve patient safety and clinical outcome. Jeff et al. (2013) study reported that since bedside handoff reporting provided patients the opportunity to ask questions or clarify concerns. It also serves as trigger for the patient to update caregivers on new developments or concerns. During bedside handoff report nurses are able to assess the clinical environment such as intravenous lines, drainage tubes and infusion flow rates. “Patient reported that they felt safe when experiencing shift report at the bedside” Gregory et al., 2014,
In the patient situation described, the nurse characteristics enabled improved patient care, by ensuring the family understood the true nature of B.H.’s medical status and her prognosis. Experience enables CNS’s to create strategies to provide specialty based anticipatory coaching (Spross & Babine, 2014). The use of caring practice created a trust with the patient and the healthcare team permitting the CNS to coach and guide the family to change B.H.’s code status to include withholding resuscitation. Collaboration allowed the family to be involved in B.H.’s care and clinical judgement allowed the CNS to coach the family into accepting a facility transfer for an opportunity for improved care
Healthcare Professionals in Intensive Care Units: A Systematic Review.” PLOS Medicine, Public Library of Science, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0136955.
In the case scenario 2, the patient’s oxygen saturation dropped to 88% on room air, respiratory rate increased to 30 per minute. The nurse then tried to apply the oxygen mask to the patient. The patient’s daughter was worried about the patient, and kept asking the nurse about the rationale for each intervention. Reflect on the scenario, the nurse did not acknowledge patient’s daughter’s distress, did not provide clear explanations and reassurance to her. This is the reason why the daughter seemed to be anxious and kept asking questions. The nurse should initiate communication with both the patient and her daughter from the beginning, inform the daughter about patient’s condition timely, and articulate rationale for each intervention. Study conducted byMitchell and Chaboyer (2010) highlighted that the challenges issues for nurses during crisis time not only include the multifaceted patient care issue but also the complexity that the patient’s family can add to the
...arch are to gain more knowledge and apply the solutions that I will find from evidenced based practice to my own. Identifying the barriers to effective communication and finding ways to overcome them can help improve the gap. As a critical care nurse, I have to provide exceptional patient care to sustain life, but must also accept the circumstances when a patient’s death is inevitable. I will bring the information that I will discover to my place of work, hoping that we can learn from it for the benefits of the population that we serve. The notion that the ICU is a known place for prolonging life and delaying death will find its essence if doctors and nurses will collaborate and communicate, effectively. When communication needs are met, there will be increase in trust and satisfaction not only for patients and their families, but also for those who provide care.
The nursing process is one of the most fundamental yet crucial aspects of the nursing profession. It guides patient care in a manner that creates an effective, safe, and health promoting process. The purpose and focus of this assessment paper is to detail the core aspects of the nursing process and creating nursing diagnoses for patients in a formal paper. The nursing process allows nurses to identify a patient’s health status, their current health problems, and also identify any potential health risks the patient may have. The nursing process is a broad assessment tool that can be applied to every patient but results in an individualized care plan tailored to the most important needs of the patient. The nurse can then implement this outcome oriented care plan and then evaluate and modify it to fit the patient’s progress (Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P., 2011). The nursing process prioritizes care, creates safety checks so that essential assessments are not missing, and creates an organized routine, allowing nurses to be both efficient and responsible.
According to Joint commission “a recent Globe investigation found that, from January 2005 to June 2010, 216 hospital patient deaths nationwide were linked to issues with patient monitor alarms. In many cases, medical staff failed to notice the alarm or take immediate action to help a patient in distress.” When the post ox is not in use to turn off the parameter on the monitor. Next step would be to place the monitor on standby when patient is off the unit to prevent the constant alarming. Retraining of the nurse to the monitor to help trouble shot can benefit the patient as well as the nurse to help them to be more proficient in their task. Small changes can lead to a better outcome for patient safety. The pilot will take place in ICU with all nurse educated on the process along with the doctors. Two monitor will be as to voluntary to monitor the alarms and the response time. Data will be collected for two weeks and reevaluated to ensure that Patient safety is first and foremost maintain. All information would be shared with nurses, management, Doctors and
This reflection of vital signs will go into discussion about the strengths and weaknesses of each vital sign and the importance of each of them. Vital signs should be assessed many different times such as on admission to a health care facility, before and after something substantial has happened to the patient such as surgery and so forth (ref inter). I learned to assess blood pressure (BP), pulse (P), temperature (T) and respiration (R) and I will reflect and discuss which aspects were more difficult and ways to improve on them. While pulse, respiration and temperature were fairly easy to become skilled at, it was blood pressure which was a bit more difficult to understand.
Nursing assessments are to be completed at least once every 12 hours and include each physiological system. Assessments are documented in electronic medical records (EMRs) by charting by exception, or complete documentation of all physiological systems (Rothman, Solinger, Rothman, & Finlay, 2012). According to Weis and Levy (2014), EMRs have led to a series of techniques that are called content importing technology (CIT), which make it possible to import information about patients into the chart and move the information to other sections of the EMR. CIT techniques offer opportunities for efficiency, but they can be misused (Weis & Levy, 2014). Subbe and Welch (2013) defined failure to rescue (FTR) as the lack of the proper response to patients who are deteriorating in the hospital.
(2011), patient mortality increased by 2% when nurse staffing was below target and increased by 4% when the patient was on a unit with “high turnover”, which refers to the admissions and discharges. The authors also point out that nursing workload increases when admitting, discharging, and transferring patients (p. 1039). Once a patient arrives to the unit, the nurse has to perform physical assessments, obtain a detailed health history, document home medications, orient the patient to the room and unit, provide education regarding their conditions, initiate doctor orders for procedures and medications, initiate vascular access, and so forth. During this lengthy period of time, the other patients are not directly receiving care. If the acuity level of those other patients is high or there are many other patients, adverse events may occur. Hinno et al (2011) states that this increase in workload increases risk for hospital acquired infections, falls, pressure ulcers, and medication errors (p. 1585). By staffing appropriately, the authors state a decrease in mortality, nosocomial infections, and failure to rescue rates. This translates into financial loss as insurance does not pay for “never events” (Needleman et al.