Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
One of such early interventions may be offered by Roper, Logan, Tierney (1980) called the activities of daily living model. As explained in the presentation, the model consists of an individual’s ability to carry out self-care tasks such as functional mobility, self-feeding, personal hygiene and grooming (Roper, Logan & Tierney, 1980). Thus, any change in these may be considered as a deteriorating patient.
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.
On account of theses limits other tools that are more efficient, objective and accurate are necessary to enhance acute hospital care. The National Institute for Health and Clinical Excellence (NICE 2007) have highlighted the importance of a systemic approach and advocated the use of EWS to efficiently identify and response to pa...
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...ways the case as many studies have failed to validate these systems, some revealing poor sensitivity, poor positive predictive value and low reproducibility (Gao et al 2007; Smith et al 2008; Subbe et al 2007; Jansen et al 2010).
Considering the conflicting findings amongst the different EWS, it remains unknown whether these scoring systems are effective in identifying and responding to deteriorating patient in acute hospital settings. This essay intends to establish how successful, if at all, the EWS in particular SHEWS is in identifying deteriorating patients in acute surgical hospital settings. In order to do this we will be returning to patient X, a 22-year-old Asian female with a diagnosis of acute pancreatitis. By comparing the evidence base to reality I hope to get a better understanding of how effective this tool is in identifying deteriorating patients.
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
Long-term care (LTC) covers a wide range of clinical and social services for those who need assistance due to functional limitations. These limitations usually result from complications associated with age related chronic conditions, from disabilities related to birth defects, brain damage, or mental retardation in children; or from major illnesses or injuries suffered by adults (Shi L. & Singh D.A., 2011). LTC encompasses a variety of services including traditional clinical services, social services and housing. Unlike acute care, long-term care is much more complicated and has objectives that are much harder to measure. Acute care mainly focuses on returning patients to their previous functional level and is primarily provided by specialty providers. However, LTC mainly focuses on preventing the physical and mental deterioration of an individual and promoting social adjustments to suit the different stages of decline. In addition the providers of LTC are more diverse than those in acute care and is offered in both formal and informal settings, which include: hospitals, physicians, home care, adult day care, nursing home care, assisted living and even informal caregivers such as friends and family members. Long-term care services have been dominated by community based services, which include informal care (86%, about 10 to 11 million) and formal institutional care delivered in nursing facilities (14%, 1.6 million) (McCall, 2001). Of more than the 10 million Americans estimated to require LTC services, 58% are elderly and 42% are under the age of 65 (Shi L. & Singh D.A., 2011). The users of LTC are either frail elderly or disabled and because of the specific care needs of this population, the care varies based on an indiv...
“Medical futility is a complex concept as there is no universally accepted definition.” (Chow, RN, ANP-BC, 2014) Futility was found among the group of colleagues on the ICU floor to mean a considerable use of resources without hope for recovery. The most common answers as to why medically futile care was provided were due to demands from family members and disagreements among team members regarding their plan of action. A major concern in these situations is that family members are left to make decisions without any health care knowledge. Communication is key here; critical care team members and family members have to try to overcome the difficult situation they have been placed in to figure out what is the best plan. The palliative care team should have been brought in sooner in L.J.’s case because on top of the lack of communication, “the case happened at the beginning of an academic year when new medical residents and fellows were just becoming oriented in the hospital system.” (Chow, RN, ANP-BC,
In the case of Mr. B’s, an investigation into the events surrounding to and leading up to his untimely death would be required. Once the problem has been identified and described, data of events are collected and formatted into a timeline. From the events, any problems in the care of the patient which may have contributed to the end result are identified and determined whether they are causative. In appendix A, the timeline of the event is outlined.
Urden, L. D., K. M. Stacy, and M. E. Lough. Critical care nursing, diagnosis and management. Mosby Inc, 2010. eBook.
The RLT model is holistic, as it identifies five components, including the activities of Daily living (ADL), life span, dependence/independence, factors influencing AL and individuality in living, which are interrelated (Healy & Timmins, 2003; Holland et al, 2004; Roper et al, 1996). Roper et al (2000) view the patient as an individual that lives through the life span, with changing levels of dependence and independence, depending on age, circumstances and the environment (Healy & Timmins, 2003). The twelve ADL are influenced by five factors, namely; biological, psychological, sociocultural, and environmental and politico economic (Healy & Timmins, 2003; Holland et al, 2004; Roper et al, 1996).
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
There are many complications that can arise as one ages. As stated in the Aging Concepts and Controversies (2012) book, there are basically two worlds of aging; the ill-derly and the well-derly. While those that are well are able to take care of themselves or need very little help to perform their daily activities; those that are ill most likely we need to have some form of long-term care. As stated earlier, when looking at care options for older adults, there are two forms of care that many people try to decide between. The first option is home care. In this form of long-term care, the elder person is looked after by a spouse, family member such as a child or grandchild, or a close family friend. The other type of long-term care is nursing home or institutionalized care, where the elderly person is taking care of by professionals and lives in the facility where they are being taken care of. Many times it is not easy to decide which type of care will be best, it depends on many factors, such as the cost, level of care needed, and many other factors. Using this paper, I like to briefly look a...
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.
There are many ways to categorize illness and disease; one of the most common is chronic illness. Many chronic illnesses have been related to altered health maintenance hypertension and cardiovascular diseases are associated with diet and stress, deficient in exercise, tobacco use, and obesity (Craven 2009). Some researchers define the chronic illness as diseases which have long duration and generally slow development (WHO 2013); it usually takes 6 month or longer than 6 month, and often for the person's life. It has a sluggish onset and eras of reduction for vanishing the symptoms and exacerbation for reappear the symptoms. Some of chronic illness can be directly life-threatening. Others remain over time and need intensive management, such as diabetes, so chronic illness affects physical, emotional, logical, occupational, social, or spiritual functioning. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, all of these diseases are the cause of mortality in the world, representing 63% of all deaths. So a chronic illness can be stressful and may change the way a person l...
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
The purpose of this essay is to use the Activities of Daily Living (ADL) assessment to identify the needs of a patient called Ernest (pseudonim). Ernest is a 74-year-old man who was admitted to hospital with “off legs” due to infection. He has Chronic Kidney Disease (CKD) and haemodialyses three times a week. He has been diagnosed with dementia, which makes him sometimes confused, although he has been able to live on his own at home with the assistance of his two daughters. After three weeks in hospital, he was discharged to his home with a package of care.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
The following essay is a reflective paper on an event that I encountered as a student nurse during my first clinical placement in my first year of study. The event took place in a long term facility. This reflection is about the patient whom I will call Mrs. D. to protect her confidentiality. Throughout this essay I will be using LEARN model of reflection. I have decided to reflect on the event described in this essay since I believe that it highlights the need for nurses to have effective vital signs ‘assessment skills especially when treating older patients with complex medical diagnoses.
The University of Pittsburgh Medical Center uses a protocol for cardiopulmonary death in which they declare the patient dead after two minutes of cardiac arrest.1 This has become controversial because some critics argue patients could be resuscitated at the two minute mark, therefore the patients have not experienced irreversible loss of function and are not truly dead.1 In the event of organ donors, this violates the dead donor rule, which states that the patient must be dead in order to harvest organs.1 However, their council’s rebuttal states that ethically a patient has irreversibly lost function if the patient wishes to be free from life...