Deteriorating health condition in the patient is defined as a predictable process evaluated through symptoms signalling towards worsening physiology of the patient in a clinical illness. Nurses play an essential role in providing suitable care and management for the deteriorating health condition of the patient (Liaw et al., 2014). Nurses can also identify the essential cues associated with the clinical deterioration that can prevent or limit subsequent worsening through appropriate interventions. Prompt identification of the deterioration must be effectively communicated in time with the concerned healthcare professionals to produce a maximised response (Jones & Johnstone, 2019).
Communication in nursing is an essential component and forms a fundamental core of providing effective nursing care in clinical scenario (Pauling & King, 2012). This paper is aimed to highlight the significance of nursing care in clinical scenario with the deterioration in the patient health. The premise of this paper is based on the case study of a 73 year old patient, Sally Brown who has been admitted for a total hip replacement surgery. This paper will discuss and critique the nursing approach undertaken by the registered nurse, Jeremy, in the scenario by recognition of the deterioration response, escalation and management. Further, this case will also be evaluated through the ISBAR table provided in the appendix A and the clinical reasoning table presented in appendix B for a complete analysis of the case of Mrs. Sally Brown.
The clinical emergency response system (CERS) is healthcare service that is provided to the patients with deteriorating health. The major components of the CERS system include a clinical review process to respond within 30 minutes for patient care, a rapid response process for the availability of all the required resources and equipments, escalation for the transfer of the patients to higher order facility to meet the care needs and for effective management of the health condition of the patient (Elliot et al., 2019). In the given clinical scenario of Mrs. Sally Brown, several response cues have been highlighted that mark deterioration of her condition.
On 2/02/2020 10: pm, the registered nurse was made aware about an observed concern of patient by her daughter where her behavioural changes were observed. This could have been an essential insight regarding the dosage of the medication prescribed and could have been intervened to prevent further damage. The patient repose to verbal stimulus and cognition is observed to have deetiolated at 12:45 am on 3/02/2020. At this point in time, A Glasgow comma scale (GCS) assessment should have been conducted for the patient. This would have allowed for the assessment of verbal, cognitive and the motor response, if the patients score would have been lower than 13, an intervention for a rapid response could be triggered.
However, the nurse finds this delayed response “normal” and fails to undertake suitable interventions. The deviations constantly observed in the blood pressure, heart rate and vitals of the patient also serve as essential cues that could have been considered for inclusion of the rapid force team. This could have led to an early diagnosis withing the yellow zone and prevented the acute ischemic stroke.
The registered nurse appointed to take care of Jeremy failed to escalate the patient to the higher order care facilities in time that could prevent the stroke. Jeremy calls for the rapid response team by 5:55 am on 3/02/2020. This is a delayed response as the patient had demonstrated the essential signs that could have been taken into consideration at 12:45 am. Further, as the patient’s vitals were worsening regularly, the nurse requested the prescription of paracetamol instead of providing the detailed information to clinician. It was possible that the clinician could have identified the cues that were missed by Jeremy and could have applied the required interventions for the care of Mrs. Sally Brown. As the blood pressure of the patient was monitored regularly, the worsening and the deterioration of the patient condition are evident. It was at 2 am, 03/2/2020 the patient has failed to respond to the verbal communication and was waking up to a physical stimulus generated by the trapezius pinch. If not at 12:45 am 03/2020 where the patient response was mildly impaired, the 2:am assessment of the patient required an immediate intervention. Calling of the rapid response team and the concerned clinicians could have prevented the stroke in the patient.
It is important for the nurse to develop strong communication skills. If the patient condition could have been more effectively conveyed to the clinician, the essential health deterioration cues could have been identified that might have prevented the occurrence of the stroke. The ISBAR tool for effective communication in the nursing could be applied (Kitney et al.,2018). This would include the identification of the patient and the situation, providing the relevant background to the clinician, assessment of the situation and gathering the recommendations.
The nursing care provided by Jeremy could have bene significantly improved. The registered nurse must have contacted the concerned clinician and communicated the entire situation so that proper intervention could be applied. The vitals of the patient in the given case situation are of extreme importance. The patient presents with the blood pressure of 220/40 mmHg against the normal blood pressure of 120/80 mmHg- 140/90 mmHg (Kharel et al., 2017). Further, the heart rate of patient is 110 against the normal heart rate: 60-100 (Liaw et al., 2014). The availability of oxygen in the patient is reduced with the oxygen saturation levels of patient at 89%compared to the normal oxygen saturation level of 96-98% (Takayama et al., 2019). This has also affected the respiratory rate of patient which has increased to 28 breaths per minute against the normal rate of 12-14 breaths per minute (Takayama et al., 2019). The patient presents herself with expiratory sounds, drooping face, lack of cognition, verbal impairment. To manage these conditions, the registered nurse must focus on:
Restoration of vitals.
Management of heart rate and blood pressure
Restoration of oxygen saturation levels
Restoration of verbal response and cognitive ability
This can be achieved by (Daniels et al., 2016):
Call for rapid response team
Provide supplemental oxygen to maintain oxygen levels
Provide ventilator support to prevent respiratory depression
Constant monitoring and evaluation
As proper care will be provided to the patient, the vitals of the patient will restore, the oxygen saturation levels will increase with observed reduction in the heart rate and blood pressure.
This paper aims to provide a detailed summary of the case of Mrs. Sally Brown who has been kept under observation in the clinical setting post her total hip replacement surgery. As per the case study, the vitals of the patient appear to be normal after the surgery. However, after a few hours, there is an observed cognitive disability and increment in the blood pressure and the heart rate of the patient. This report critically evaluated the approach taken by the registered nurse in the clinical setting for communicating the patient needs and management of her deteriorating health condition against the personal approach which I think should have been appropriate. The communication skills in nursing in this report have been based on the ISBAR clinical handover table. The suitable interventions in association with the patient health and condition have been included as per the clinical reasoning cycle.
In this process of report compilation and assessment, I have learned the significance of effective communication in nursing as well as the importance of adherence of the systematic approach. I am now more vigilant and considerate of my actions that I think will help me serve as a nurse in future to provide efficient care and assistance to the patients.
Daniels, S. K., Pathak, S., Rosenbek, J. C., Morgan, R. O., & Anderson, J. A. (2016). Rapid aspiration screening for suspected stroke: part 1: development and validation. Archives of Physical Medicine and Rehabilitation, 97(9), 1440-1448.
Elliott, R., Martyn, L., Woodbridge, S., Fry, M., Foot, C., & Hickson, L. (2019). Development and pragmatic evaluation of a rapid response team. Critical Care Nursing Quarterly, 42(3), 227-234.
Jones, A., & Johnstone, M. J. (2019). Managing gaps in the continuity of nursing care to enhance patient safety. Collegian, 26(1), 151-157.
Kharel, J., Reda, H. T., & Shin, S. Y. (2017). An architecture for smart health monitoring system based. Journal of Communications, 12(4), 225.
Kitney, P., Bramley, D., Tam, R., & Simons, K. (2018). Perioperative handover using ISBAR at two sites: A quality improvement project. Journal of Perioperative Nursing, 31(4), 17.
Liaw, S. Y., Zhou, W. T., Lau, T. C., Siau, C., & Chan, S. W. C. (2014). An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurse Education Today, 34(2), 259-264.
Purling, A., & King, L. (2012). A literature review: graduate nurses' preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23-24), 3451-3465.
Takayama, A., Nagamine, T., & Kotani, K. (2019). Aging is independently associated with an increasing normal respiratory rate among an older adult population in a clinical setting: A crossectional study. Geriatrics & Gerontology International, 19(11), 1179-1183.
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