Nurse's Role in Recognizing and Acting on Clinical Deterioration - Case Study Example

Recognizing and acting on clinical deterioration Name Institution Date Nurse’s role in recognizing and acting on clinical deterioration Introduction It is true that nurses have a fundamental responsibility of promoting patient outcomes at an optimal level. There are situations that occur during patient care hence nurses who are observant in the early detection of complications are in a position to minimize negative outcomes for the patient. This is demonstrated through various factors such as having a good background about the physiological changes in the patient’s condition so that proper and effective measures can be taken. However, there are incidences when nurses can be reluctant to take action when deterioration has occurred simply because he or she does not know the physiological changes that have occurred. A good example of a nursing intervention which can certainly affect the outcome of a patient is the quick reaction to changes in a client’s respiratory status (Duff et al, 2007). With this in mind, this paper discusses the role of a nurse in detecting the deteriorating status of a patient with reference to the case study. Nurse’s role in detecting the deteriorating patient status One of the major roles that nurses have is to promote the optimal outcome of a patient. This is seen through proper assessment and observation of patients who are in the acute care setting. Odell et al (2009); Henneman et al (2012) argue that there are some concerns that are demonstrated in the context of literature concerning client’s security as well as potential of harm in case the patient’s physical state worsen suddenly. A number of studies have shown that sometimes nurses do not take action promptly on unwanted outcomes or they may not appreciate the degree of urgency once they cannot understand the physiology concerning what is at hand on changes taking place in the patient’s condition. It is important that nurses act beyond day to day assessment. They need to be involved in ongoing observation of the patient so as to be familiar with the patient’s condition hence recognize any deteriorating signs. Case study Ms. Rosie Smith a 27 years old woman is presented to the ED with severe attack of asthma. The woman experiences difficulty in breathing, occasional coughing, complains of chest pain, and has an evident wheezing sound. She states that she has had coughing and lethargy ×3days. She shows signs of cyanosis and is much disoriented. Her respiratory rate is 28 bpm, has a normal BP and temperature. Her HR is markedly elevated. She manages her attacks with albuterol. She admits smoking at 15 years of age. She lives with her boyfriend. Her medical history card indicates three hospitalization following asthma. The nurses on duty include 1 EN and 2 RN. Ms. Rosie is planned for oxygen through Hudson mask at 50 % in order to reach and maintain O2 sat greater than 90%. Other medications include IV lidocaine 100 mg to suppress her cough, 0.5 mg/4-5 mL ipratropium neb, IV magnesium 2 gm, and oral predinsolone 2gm. Nursing actions Clinical deterioration happens at whichever point in the course of the patient’s condition, or management process, although patients are specifically susceptible after an emergency admission, following surgery and in critical illness recovery (Elliott & Coventry, 2012). To effectively comprehend why incidents of deterioration take place, some methods of data collection were used is a certain study so that fundamental causes may possibly be established from several perspectives. The results indicated that consistently and successfully detecting and taking action on client deterioration is an issue that is complex. The findings illustrated imply a sequence of areas where the detection and action process can fail. Some of them include and not limited to: not taking routine observation like pulse, respirations, oxygen saturation, and temperature; not making essential visual observations like of consciousness and color; taking observations that are not complete particularly omitting the rate of respiration; not recording the taken observations; not appreciating observations are basis for concern; not disclosing previous observations as well as clinical history during staff handover or during departments or wards transfer; poor communication of concern to other members of healthcare providers; and staff getting the communication but not reacting with proper urgency (Elliott & Coventry, 2012). Research indicates that respiratory rate is the most overlooked vital sign during observation yet it is the fundamental indicator of a clinical deterioration (Parkes, 2011). The rate of respiration is a primary sign of physiological decline and should be documented alongside other major vital signs in clients presented in the ED. In adults, the standard respiration rate is between 12-20 bpm and this must be done in a whole minute (Odell et al, 2009). With regards to the case study, the patient has a respiratory rate of 28 bpm meaning that her respiratory rate is elevated. An elevated rate of respiration is a powerful and definite predictor of severe unwanted incidences like cardiac arrest. It is important to note that measurement of pulse oximetry is not considered a respiratory measurement replacement (Odell et al, 2009). It is very imperative that nurses at the ED be educated on how to determine the rate of respiration as an effortless and specific evaluation for serious illness, and ought to be directed on proper measures to be considered once abnormally high rates of respiration are recorded (Odell et al, 2009). Hospital systems which support proper reactions to an elevated rate of respiration as well as other unusual vital signs may be gladly and quickly implemented. Systems like these facilitate in raising and sustaining understanding of the vital signs’ significance. The nurse’s role should always be to enhance outcomes of the patient via regular vital signs’ measurement, early recognition of deterioration as well as proper escalation of the management of the patient. Pain assessment as well as reassessment should be done to establish the continuous analgesia’s effect. Reassessment frequency is established through pain severity, the needs and reactions of the patient, and the used medication (Higginson & Jones, 2009). Reassessment should as well consider the possible unwanted outcomes of analgesia. In accordance to the case study, the patient presented with chest pain hence it is very important for pain management to be instituted so that the overall patient health outcome can be achieved. Within the ED setting, pain is nearly ever-present. It presents chronically or acutely and accompanies approximately every disease. Pain strikes anyone regardless of age. Whereas the ED might be the refuge for patient in pain, strategies of pain management that are effective are frequently not applied as the ED visit element. Actually, healthcare providers in the ED do not possess an excellent record with regards to pain management since it is often overlooked, an afterthought, or impeded by hesitation of building addiction or encouraging drug seeking characteristics (Odell et al, 2009). In reality, majority of patients in the ED are not seekers of drug but pain relief seekers. Failure to address and manage pain properly can undermine an effective resuscitation, stabilization, or intervention of diagnosis. Proper monitoring of patients needs actions beyond the normal protocols of vital signs. Surveillance is one of the nursing interventions acknowledged as a significant strategy in prevention and identification of medical errors as well as adverse incidences. Surveillance is defined as the focused and continuous acquisition, analysis, and combination of patient’s information that facilitate clinical decision establishment (Henneman et al, 2012). Surveillance as a term is frequently applied interchangeably with monitoring; however surveillance differs considerably from monitoring in both scope and purpose. Monitoring is regarded a fundamental activity during the process of surveillance, whereas monitoring on itself is not sufficient for carrying out effective surveillance (Henneman et al, 2012). A lot of the concern within the bedside movement in patient safety has been centered on endeavors to execute the process that eventually enhance the process of surveillance. These include interdisciplinary rounds, checklists, support systems of clinical decision, and systems of clinical information. To establish maximum patterns of surveillance and to device and test expertise that facilitate nurses in critical care in carrying out effective surveillance, further research is required, specifically with modern approaches to illustrate and analyze the best practices of surveillance for bedside nurses (Henneman et al, 2012). It is expected that nurses who have fundamental skills will properly assess and establish clients who are at great risk of deterioration (Odell et al, 2009). Through a comprehensive assessment of individual patient and early identification of problems, nurses are able to initiate definite interventions which might improve or stabilize the outcomes of a patient and assist in prevention of unnecessary admission to the intensive care unit. Every nurse ought to be skilled when performing an assessment of respiration using key principles of look, listen and feel. The framework of ABCDE which denotes airway, breathing, circulation, disability and exposure is frequently used by nurses to assess the state of a patient (Higginson & Jones, 2009). Besides this framework, competent nurses should also check out for elevated pulse since this is an indicator of a respiratory to cardiovascular disease; a decrease in blood pressure could indicate a sign of sepsis; raised temperature is an indication of pneumonia; and a decrease in O2 saturation could be a sign of respiratory distress (Higginson & Jones, 2009). With respect to the case study, some of the indicators that can help an observant nurse in the early detection of complications to reduce negative outcomes for the patient include difficulty in breathing, coughing, pain, wheezing sound, cyanosis, elevated respiratory rate, and raised heart rate. These indicators assist the nurse to take clinical action in order of priority hence enhancing patient outcome (Levett-Jones et al, 2009). Interdisciplinary care is very imperative because it has been known to enhance proper management of the patient. However, this is only achieved once there is proper communication between the involved parties. To avoid common nursing mistakes, nurses must be updated with the modern approaches of patient care so as to improve patient safety (Gregory & Susan, 2012). Some medical mistakes can be avoided whenever an observant nurse recognizes this mistake hence promoting patient safety. Conclusion In conclusion, this paper has indicated that indeed nurses have a pivotal task in enhancing patient outcome. With timely action, some of the preventable deaths that occur within ED can be avoided. It is noted that the rate of respiration is considered as an early indicator of unwanted incidences with the basis that time is indeed an essential factor in the clinical reasoning of a nurse: patient should be categorized in an appropriate way in order to institute nursing actions to take action on abnormal findings (Levett-Jones et al, 2012). The paper has indicated that nurses who have adequate knowledge about the physiological changes in a patient are a greater advantage of facilitating patient outcome. Reference list Gregory, D. & Susan, P. (2012). Patient safety manifesto: A professional imperative for prelicensure nursing education. Journal of Professional Nursing, 28(2), 110-118. Parkes, R. (2011). Rate of Respiration: the forgotten Vital sign. Emergency Nurse, 19(2). Elliott, M. & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 1(10). Henneman, E., Gawlinski, A. & Giuliano, K. (2012). Surveillance: A strategy for improving patient safety in acute and critical care units. Critical Care Nurse, 32(2), 9-18. Levett-Jones,T., Hoffman, K., Dempsey, J., Yeun-Sim J., Noble, D., Norton, C., Roche, J. & Hickey, N. (2009). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today, 30, 515-530. Odell, M., Victor, C. & Oliver, D. (2009). Nurse’s role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing, 65(10), 1992- 2006. Higginson, R. & Jones, B. (2009). Respiratory assessment in critically ill patients: airway and breathing. British Journal of Nursing, 18(8), 456- 461. Read More