Theoretical/Ethical Basis of Practice
Phenomenon of Interest
Cardiac arrest is one of the leading causes of increased morbidity and mortality rates throughout the nation. There are over 177,000 reported deaths in the United States and Canada per year. The immediate initiation of bystander CPR upon occurrence can increase the survival rate by 4 times compared to patients who do not receive the lifesaving technique. Unfortunately, less than 5% of bystanders engage in these actions when needed. Explanations for the low rates have been reported as low socioeconomic status, physical hindrances, emotional and religious beliefs, and knowledge deficits. However, advanced practice nurses have the knowledge and skills necessary to improve the rate of bystander CPR within all environments. In this paper, I will discuss bystander CPR
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and how it relates to the nursing meta- paradigm, nursing theories, complexity science, and ethical principles. Nursing Meta-paradigm The meta-paradigm of nursing entails four essential perceptions that addresses the patient as a whole, the patient’s physical environment, the patient’s health, and the nursing obligations and responsibilities. A holistic view of nursing is applied to the daily care of patients when the metaparadigm is implemented. The decision to participate or refrain from the initiation of bystander CPR can be interconnected with these four concepts. The person element of the meta-paradigm concentrates on the individual that is receiving the health care. However, this concept can also include family member and friends that are significant to the patient. The patient’s emotional and physical wellness is addressed to achieve an overall positive health outcome. Successful patient compliance is achieved when he/she is included in the collaboration and conduction of the care plan. Allowing individual patients to be proactive with their health maintenance will empower them to achieve long term goals and outcomes. When an individual in diagnosed with cardiac disease, he/she should be educated on the importance of the immediate initiation of CPR during the onset of a cardiac emergency. The patient can be educated mentally by evidence based practice material and physically through skills training. If the patient desires to obtain CPR if needed to prolong their life, then they can take the initiative to include family and friend in their training. The initiation of bystander CPR can be increased by including the patient’s family and friends in the education concerning the importance of the subject. The environment component of the meta-paradigm represents the surroundings that influences the patient. The environment entails external and internal encouragements. Internal influences consists of personal feelings and beliefs with the present subject. It also includes the personal thoughts and emotions of interactions with friends and family. External influences comprise components of the environment such as: economic circumstances, geographic settings, social acquaintances, culture, and technology. Individual belonging to communities of low socioeconomic status tend to have below average educational levels. Unfortunately, these patients are unaware of the increased survival rate that accompanies the immediate initiation of bystander CPR during the onset of a cardiac event. Advanced technology allows for the implementation of evidence based practice to be accessed and included in the education of individual and communities. Educational knowledge and effective skills can potentiate the confidence needed for bystanders to participate in the life saving technique of CPR. The health component of the meta-paradigm includes the degree of health care that is available to the patient. The meta-paradigm represents a multi-dimensional framework that involves the patient’s emotional, physical, intellectual, religious, and social welfare. The combination of the above mentioned attributes determines the positive and negative outcomes of each individual’s emotional and physical health status throughout his/her lifetime. An individual’s emotional and religious beliefs may guide their interaction during a cardiac event. Fear of harming the patient due to lack of understanding and proper technique can cause a person to refrain from participating in CPR. Emotions and religious beliefs can also promote positive actions, such as initiating life saving techniques because they feel obligated to help others and do what is necessary for prolonging the health and life of others. The nursing component of the meta-paradigm involves providing the highest quality of health care to sustain the most positive outcomes for the patient and community as a whole. Advance practice nursing allows the knowledge required for delivery of higher level of care. Evidence based practice can be accessed and implemented into the education and daily care of patients for the best possible results. Providing educational brochures and CPR classes to patients, family members, and individuals throughout the community can the morbidity and mortality rate of patients who experience cardiac arrest. Offering preventative education and free health screening can increase awareness of cardiac disease and decrease the secondary diagnosis that can accompany the patient that has or is at risk of developing the disease. Grand Nursing Theory The nursing theory that related to the chosen phenomenon of interest of bystander CPR is Martha Roger’s Science of Unitary Human Beings.
This theory supports the practice of viewing and caring for each patient as a total human being, instead of individual parts. It acknowledges that the human being and his/her surrounding environment are as one. The environment affects the thoughts and actions of the individual. If the environment is altered, so will the status of the individual. Possessing a healthy emotional and physical state of health and personal environment is necessary for positive outcomes and goals to be achieved and sustained throughout life. The initiation of bystander CPR depends on the knowledge and skills of the individual and surrounding environment. Acquiring the mental knowledge of the importance of the skill and taking the initiative to learn and initiate the physical technique of CPR is of utmost importance when striving for and increased survival rate of patients who undergo cardiac arrest. Existing in and educating the environment of proper technique and mortality rates can also increase the likelihood of patient
survival.
There is high risk of death and poor neurological function with unconscious survivors in out of hospital cardiac arrest. Trails were undertaken with the patients after awakening from cardiac arrest, which was compared with Ther...
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
Despite the fact that from May 2009 - February 2010, in Contra Costa County alone, there were 9 sudden cardiac arrests experienced by children and youth, there is no standard curriculum in place at school for youth and their parents to learn lifesaving CPR skills. The youngest was 10 years of age and the oldest was 17, which resulted in 4 deaths and 5 saved lives (Darius Jones Foundation, 2011). In each case, there was a direct correlation between bystander use of cardio-pulmonary resuscitation (CPR) and those children who survived.
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.
Hammer, L., Vitrat, F., Savary, D., Debaty, G., Santre, C., Durand, M., et al. (2009). Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. American Journal of Emergency Medicine, 27(5), 570-573.
However, this approach not only lacks objectivity, but it also fails to acknowledge the abnormal physiology that precedes this breakdown in self-care. For instance, it has been reported that 70% of patients preceding cardio-pulmonary arrest had a physiological decline in respiratory or mental function (Schein et al 1990). Observing deterioration in activities of daily living alone does not accurately mirror underlying physiological deterioration occurring in patients.
According to the American Heart Association (AHA), over 350,000 people experience cardiac arrest outside of hospitals every year. Every second that a heart doesn’t beat dramatically decreases a person’s survival rate. CPR is a simple way to keep blood pumping through the body until medical personnel arrive. Only 46 percent of cardiac arrest victims receive CPR, primarily because most bystanders don’t have the proper training. Fortunately, schools are in a unique position to greatly improve that statistic.
To perform CPR, first you must establish unresponsiveness. Try tapping the child and speaking loudly, to provoke a response. Once unresponsiveness has been determined, if you are alone, you should shout for help. Then provide basic life support for approximately one minute before going to call 911. If a second person arrives, send him or her to call the ambulance.
Fischer, P., Krueger, J., Greitemeyer, T., Kastenmüller, A., Vogrincic, C., Frey, D., Heene, M., Wicher, M., & Kainbacher, M. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and non-dangerous emergencies. Psychological Bulletin, 137, 517-537.
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
Bibb Latané and John Darley, two psychologists, studied the bystander effect during their experimentation after the murder of Kitty Genovese. The Bystander Effect refers to the effect that bystanders have during the intervention of an emergency. Latané and Darley used a series of experiments to look at different aspects of the bystander effect; The series of experiments included smoke, a lady in distress, hand in the till, stolen beer, “children don’t fight like that,” and fit to be tried (Latané & Darley, 1970). Latané and Darley asked, “What is the underlying force in mankind toward altruism?” and “what determines in a particular situation whether one person will help another?” Their hypothesis was that “the number of other people present
With the utilization of the internet search engine Bing, I was able to pursue a Pennsylvania State University source from the electronically published brochure Policies Safety & U: 2017 Annual Security Report and Annual Fire Safety Report in PDF form, updated on September 28th. As a well-established institution, Penn State has an accredited reputation that accumulated over the course of the last century and a half, dedicated to education, research, and serving the public through various ways. The current information gives insight into the procedure of the esteemed institution, in addition to other links and sources that can supplement the discussion topic. Being a periodically issued document to all students of the University, it states non-biased procedures, actions to take in case of an emergency, and moreover, crucial information leading to external resources to assist the enrolled scholars in various areas concerning Penn State.
As you sit in a classroom at the Community College, you may not think that saving a life is something you could do today, but, in fact, it's quite easy to do.
With heart attack, a patient can get worse by the minute with their 90 minutes or less strategy, they can save a patient’s life rapidly. This can help decrease the amount of damage to their heart muscles. It is also important that the employee’s work habits should match the team culture. For example, if just one doctor or nurse has a disagreement with another co-worker over treatment or does not let the other employee’s weigh in on the outcome of a patient can damage the trust of the team. Then the teamwork of the staff in the hospital could decrease and make that environment more vulnerable to mistakes causing a patient to die. With having a well culture work place employees share the same values of treating the patient in a timely matter to make sure they do less damage than they have to (Ivancevich, Konopaske, & Matteson, 2011).
In the past families were not allowed in the room during resuscitation because there were concerns that procedures could be too traumatic for the families and could cause liability issues for the institution. This paper will focus on staff and families thoughts and views on having family in the room during CPR. This review will have background information about FPDR including a systematic review (Howlett & Tsuchiya, 2010), a meta-analysis (Madden, 2014), two qualitative studies on nurses and families thoughts on being present during CPR (Meyers & Eichhorn et al., 2008) (Knott & Kee, 2009), and two quantitative studies (Condon, 2010), (Porter & Sellick et al., 2013) and will conclude on the existing best practice at this point in time. FPDR has benefits and disadvantages with countless studies and surveys concerning this.