NRS30005 : Complex Challenges In Nursing Care

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NRS30005 : Complex Challenges In Nursing Care

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NRS30005 : Complex Challenges In Nursing Care

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Course Code: NRS30005
University: Southern Cross University

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Country: Australia

The course is: Complex Nursing Care 3rd year Bachelor of Nursing subject. It is very different and difficult assignment. The media annotation requires you to review a video of an arrest scenario associated with the course and assess the performance of the skill. Analyse the video for quality of performance and identify the strengths and weaknesses of the performance based on cited research.
The person doing this assignment will have to do lot of research and should be an expert and highly professional in writing assignments. The only reason why I am stressing this is because the assignment is worth 100%.Please follow the marking guide.
Early recognition 

The healthcare professionals are to carry out DRS ABCD (dangers, responsiveness, send, airway, breathing, CPR, defibrillation) assessment in the process of resuscitation. At the very beginning of the video it is noted that the nurse calls out to her fellow nurse upon understanding that the patient she was attending was in need of urgent support [.0.06 secs]. A rich pool of literature indicates that nurses are supposed to use the emergency button for contacting other professionals in the time of urgency. The aim is to reduce the time required for attending the patient and providing with first line of care (Song et al., 2016; Aneman et al., 2015). All health care facilities providing critical care are to have provision for emergency button so that the process of resuscitation can be commenced appropriately.
According to (Wurster et al., 2017) the most important step is patient assessment prior to resuscitation is assessment of the airway. The rationale is that proper airway management increases the chances of speedy recovery. There were certain aspects in the resuscitation process that were not apparently weaknesses, but could not be adjudged as strengths also. Firstly, though the absence of seal in airway management process was a weakness, good non-technical skills was evident in that the nurse asked for assistance without delay. Acknowledging failure to comply standards and seeking assistance is appreciable (Ali et al., 2017). Further, the breathing pattern of the patients was assessed by the nurse from distant height. As opined by (Tasker, 2016) an unresponsive patient is to be assessed properly for breathing pattern which entails the professional to be at a suitable position near the patient. The nurse also did not adjust the height of the bed for assessing the breathing pattern of the patient. In the video it is noted that the nurse was not considerate of removing the pillow so that the patient is placed in an appropriate position to facilitate breathing. As per the ARC guideline (2016) professionals are to place the patient at a position that facilitates proper assessment of the movement of upper abdomen and lower chest to assess breathing pattern.
Poor technical skills were also evident in that there was negligible professionalism shown by the nurses while delivering compressions [0.39 secs]. The compressions were not rhythmic; meaning the time difference between two successive recoils was not similar for all compressions. Survival from cardiac arrest is dependent on two factors; early resuscitation and early defibrillation. Resuscitation has to be rhythmic since irregular chest compressions lead to artifacts in the ECG (de Guana et al., 2014). The code captain thought it to be appropriate to interrupt the compression in order to check the patient’s heart rhythm. The ARC guideline (2016) pinpoint that minimal interruptions are allowed while compressions are given. This is supported by the research of (Partridge et al., 2015). The researchers state that compressions are to be given in an uninterrupted manner as interruption affect survival. The nurse took a pause while giving compression and resumes after few seconds. Nurses are expected to show professionalism in applying in-depth knowledge of resuscitation process (Black, 2016; Edmonson et al., 2016). A further analysis reveals that the depth of compression is a crucial aspect for accurate resuscitation process. From the video it is seen that the nurses did not consider avoiding movement of the patient and the depth of the compression was not appropriate. The compressions were shallow and thus not effective. The ARC guideline (2016) had stated that the lower portion of the sternum must undergo depression to at least one third of the depth of the chest in case of each compression. This equals to more than 5 cm in adults. The guideline is supported by the research of de Guana et al., (2016) and Stiell et al., (2014). Present resuscitation guidelines focus on high quality compressions with a depth of no more than 6 cm and a rate of between 100 and 120 compressions per minute so that chest recoil between compressions is ideal.
The nurse considered mentioning ‘all clear’ to ensure that minimal interference was there when the patient was subjected to shock [2.28 mins]. This is a sign of professional behavior and the same also paves the way for safe environment (Chism, 2017). The code captain considered carrying out ECG rhythm assessment before shock was delivered. From the ARC guidelines (2016) it is understood that analysis of heart rhythm prior to resuscitation is of prime importance for patient safety. This is based on varied research papers such as that of Rajan et al., (2017) and Tanguay-Rioux et al., (2018) who point out those chances of survival is more when rhythm analysis is done on time as there is a vital link between early rhythm detection and early resuscitation. Moving on with the video it was pointed out that the nurse was considerate in acknowledging the fact that the sinus rhythm strip had been printed with a time difference of ten minutes [13.14 mins]. Code blue documentation is the basis for future care practices and all the events of code should be documented accurately for reasons of continuity. Complete disclosure of patient related information is to be included in the document (Jackson & Grugan, 2015).
Some of the factors that drive better patient outcomes in clinical care and particularly resuscitation process include suitable handover process and appropriate administration of medications. This is understood by reflecting on the work of (Wagner et al., 2018). The ARC guideline (2016) also recommends that when the medical emergency teams takes in charge of a patient situation, an accurate handover at the time is required as soon as possible. In this alignment Spangenberg et al., (2018) mentioned that exchange of patient information between professionals at the early stage enables safe care practices. In the present scenario the code captain was late in requesting for briefing of the situation. A briefing about the scenario and patient condition at the earliest stage would have guided the code captain better to take suitable actions.
Since the code captain prescribed epinephrine before checking for the patient’s tendency to have allergic reaction to the same, the risk of patient harm was evident. Though administration of medications after checking for allergic reactions in emergency situation is not always feasible, it is advisable that the professional assesses patient’s previous records to understand whether there are any risks of allergic reaction (Nolan, 2015). Hypersensitive reaction to certain drugs decreases chances of survival for certain patients (Sacco et al., 2017). At this juncture it is advisable that a code captain demonstrates assertiveness and leadership traits (Bennett et al., 2017). Administration of adrenaline has been supported by literature. According to Anderson et al., (2016) epinephrine (adrenaline) is used in resuscitation after cardiac arrest for a long time. The effect of the drug is related to the alpha-adrenergic effects as a result of which there is improved coronary perfusion pressure.
Vital signs
Another concern that arose in relation to technical skills is that there was no attempt to record the blood glucose level, pulse, blood pressure and oxygen saturation of the patient. Poor practice is indicated in that blood pressure was recorded after the blood glucose level was checked, and there was delay in checking the oxygen saturation (Black, 2016). Initial recording gives a clear idea of the vital signs of the patient that influence resuscitation process since the process is guided by suitable clinical decisions. Patients requiring resuscitation are at increased risk of deterioration after the vital signs have returned to normal. Therefore early monitoring is required for establishing an environment in which close monitoring and anticipatory care can be provided. Vital signs can be assessed after the compression has been started (Schreiber et al., 2015).
Assignation of roles
The weakness in demonstration of non-technical skills was pointed out when the professionals failed to delegate their roles and carry out clinical tasks in an independent manner. The ARC guideline (2016) mentions that professionals are to have clear understanding of the tasks they are to perform in an independent manner in a code blue situation. In same regard Porter et al., (2013) and Ford et al., (2016) mentioned that professionals are to have a proactive approach in taking part in the resuscitation process. In the present case, the nurses did not have sufficient knowledge of the tasks they needed to perform and moreover were not spontaneous in acting as per the need of the hour. This delayed clinical decisions to be taken.
Further review of the video brings into limelight the concern that the debriefing process could have been carried out in a better manner. The scribe did not consider discussing with the professionals regarding the process carried out before requesting them to signs the document. It has been mentioned in the ARC guideline (2016) mentions that quality of resuscitation can be highly improved if debriefing is done in a way that points out the areas needing further improvement. It is recommended that nurses taking part in critical care are aware of their role and tasks they need to perform. This can be done by engaging in communication with fellow professionals that facilitates exchange of information. Group sessions as well as one-on-one sessions promote exchange of ideas and opinions (Chism, 2017). Further, open communication resolves interpersonal conflicts, if any, that might hamper patient care. An added weakness was that no one did compressions when pads where put in place. According to CPR should not be interrupted while the adhesive pads are being applied (Nolan, 2015).
Appropriate documentation is vital in the successful completion of care process in critical care unit. From the video it can be understood that documentation was not up to the standard. The aim of accurate and complete record documentation in resuscitation process is to foster quality and continuity of care. The scribe showed poor skills as she needed clarification on more than one situation prior to documenting the detail. Nevertheless, recording of accurate patient details enhanced patient safety. The medication name was confirmed on the first instance and later the scribe confirmed the correct process undertaken between cardio version and defibrillation. As highlighted by Copper et al., (2016) accurate patient data record ensures that patient-centered care is provided. Any inaccurate documentation reduced the provision of appropriate care, putting the patient at risk of harm. It is recommended that professionals taking part in the resuscitation process such as the scribe enhance their skills through increasing their knowledge (Nolan, 2015).
Social worker
From the video it is noted that the social worker had a positive approach to inform the family members of the patient. As per the Australian Resuscitation Council guidelines (2016), family members of patients undergoing resuscitation are to be given the option of being present at the time of resuscitation. Study by O’Connell et al., (2017) argue that presence of family members at the time of recitation, if possible, leads to improved measures of positive emotional and health outcomes, and coping. The ARC guideline (2016) strongly recommends that prescience of family members at the time of resuscitation is valuable since the provision of support of increased. The rationale for the same can be understood from the research paper of Powers and Candela (2017) that has the opinion that coping is easier after successful resuscitation when the patient has the support of the near ones. Positive health outcomes can be achieved when the input of the family members is received, making it easier for the care givers to understand the preferences of the patient (de Stefano et al., 2016).
In conclusion, the process of resuscitation holds much importance in trauma care, intensive care and emergency medicine. The objective of practicing evidence based resuscitation is to minimize the risks of patient harm and to ensure best patient outcomes within a stipulated time. The present assignment was a valuable opportunity to understand guidelines for resuscitation and the existing literature to support the same. Based on the learning from the present annotation after a systematic analysis own professional practice can be enhanced in future.
Healthcare professionals in the contemporary era need to be highly skilled and efficient for addressing evolving needs of patients through advanced technologies. In critical care domain, one of the most significant and critical care processes is resuscitation. Resuscitation refers to the process of improving physiological disorders in patients who are accurately unwell Hospital emergency codes are coded messages that are to be announced over a public address system of a hospital for alerting on-site emergencies. Code blue indicates that there is an emergency as a result of a patient suffering cardiac arrest. Research indicates that professionals must consider maximum available evidences and existing literature for practicing resuscitation. The Australian Resuscitation Council (ARC) is a voluntary co-ordinating body in Australia involved in the practice and teaching of resuscitation. It is significant to follow the same since the guidelines is highly evidence-based, bringing in key insights from research into practice. The guideline thus meets the objective of fostering simplicity and uniformity in resuscitation techniques. In the present paper an attempt is made to come up with a media annotation that reviews the video titled “Code Blue’, focusing on resuscitation on an arrest scenario. A critical analysis is done to identify the strengths and weaknesses of the procedure undertaken in light of the Australian Resuscitation Council guidelines and existing evidences in literature. Recommendations are put forward for better practice change.
A meticulous analysis of the video was undertaken to understand the aspects of practice that were poor and non-complying with the guidelines. Comparison with existing literature was also done to understand the relevant research that supported the guidelines. The breaches to the ARC guidelines are to be discussed first. This would include technical as well as no technical skills as deemed fit for resuscitation process.
Ali, N., Sawyer, T., Barry, J., Grover, T., & Ades, A. (2017). Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey. Journal of Perinatology, 37(2), 172. DOI: 10.1038/jp.2016.193
Aneman, A., Frost, S. A., Parr, M. J., & Hillman, K. M. (2015). Characteristics and outcomes of patients admitted to ICU following activation of the medical emergency team: impact of introducing a two-tier response system. Critical care medicine, 43(4), 765-773. DOI: 10.1097/CCM.0000000000000767
Andersen, L. W., Kurth, T., Chase, M., Berg, K. M., Cocchi, M. N., Callaway, C., & Donnino, M. W. (2016). Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. bmj, 353, i1577. DOI: https://doi.org/10.1136/bmj.i1577
ANZCOR Guideline 11.1– Introduction to and Principles of In-hospital Resuscitation. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
ANZCOR Guideline 2 – Managing an Emergency. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
ANZCOR Guideline 3 – Recognition and First Aid Management of the Unconscious Person. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
ANZCOR Guideline 4 – Airway. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
ANZCOR Guideline 6 – Compressions. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
ANZCOR Guideline 8 – Cardiopulmonary Resuscitation. (2016). [ebook] Available at: https://resus.org.au/guidelines/ [Accessed 19 May. 2018].
Bennett, G., Besuyen, J., Krenkel, S., O’Gorman, T., Dong, T., & Bellows, M. (2017). Code blue: an innovative approach to improve the response. Canadian Journal of Cardiology, 33(10), S211. DOI : https://doi.org/10.1016/j.cjca.2017.07.418
Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=ndcEDAAAQBAJ&oi=fnd&pg=PP1&dq=professional+nursing,+book&ots=Ly3_kFNyXw&sig=Z8q6i6khjAzgtACsKLaG3ciZ9S8&redir_esc=y#v=onepage&q=professional%20nursing%2C%20book&f=false
Chism, L. A. (2017). The doctor of nursing practice. Jones & Bartlett Learning. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=Q8E6DwAAQBAJ&oi=fnd&pg=PR1&dq=+nursing+practice&ots=q_gXhnsKJx&sig=ordQ_EYmBA7OYLpRhn-ROjm8HHY&redir_esc=y#v=onepage&q=nursing%20practice&f=false
de Gauna, S. R., González-Otero, D. M., Ruiz, J., & Russell, J. K. (2016). Feedback on the rate and depth of chest compressions during cardiopulmonary resuscitation using only accelerometers. PloS one, 11(3), e0150139. DOI: 10.1371/journal.pone.0150139 
De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., … & Vicaut, E. (2016). Family presence during resuscitation: a qualitative analysis from a national multicenter randomized clinical trial. PloS one, 11(6), e0156100. DOI: https://doi.org/10.1371/journal.pone.0156100
Edmonson, C., Klacman, A., & Tippy, J. (2016). Nurse Leaders as Disruptive Innovators in Cardiopulmonary Resuscitation Competency. Nurse Leader, 14(3), 191-194. DOI: https://doi.org/10.1016/j.mnl.2016.03.001
Ford, K., Menchine, M., Burner, E., Arora, S., Inaba, K., Demetriades, D., & Yersin, B. (2016). Leadership and Teamwork in Trauma and Resuscitation. Western Journal of Emergency Medicine, 17(5), 549–556. https://doi.org/10.5811/westjem.2016.7.29812
Jackson, J. E., & Grugan, A. S. (2015). Code blue: Do you know what to do?. Nursing2017, 45(5), 34-39. DOI: 10.1097/01.NURSE.0000463651.10166.db
Nolan, J. (2015). 2015 Resuscitation Guidelines. Retrieved from https://link.springer.com/article/10.1007/s10049-015-0102-0
Partridge, R., Tan, Q., Silver, A., Riley, M., Geheb, F., & Raymond, R. (2015). Rhythm analysis and charging during chest compressions reduces compression pause time. Resuscitation, 90, 133-137. DOI: 10.1016/j.resuscitation.2015.02.025.
Porter, J. E., Cooper, S. J., & Taylor, B. (2013). Emergency Resuscitation team roles: What constitutes a team and who’s looking after the family?. Journal of Nursing Education and Practice, 4(3), 124. DOI: https://dx.doi.org/10.5430/jnep.v4n3p124
Powers, K. A., & Candela, L. (2017). Nursing Practices and Policies Related to Family Presence During Resuscitation. Dimensions of Critical Care Nursing, 36(1), 53-59. DOI: Powers, K. A., & Candela, L. (2017). Nursing Practices and Policies Related to Family Presence During Resuscitation. Dimensions of Critical Care Nursing, 36(1), 53-59.
Rajan, S., Folke, F., Hansen, S. M., Hansen, C. M., Kragholm, K., Gerds, T. A., … & Gislason, G. H. (2017). Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation, 114, 157-163. DOI:  https://doi.org/10.1016/j.resuscitation.2016.12.021
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Schreiber, M. A., Meier, E. N., Tisherman, S. A., Kerby, J. D., Newgard, C. D., Brasel, K., … the ROC Investigators, D. B. (2015). A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. The Journal of Trauma and Acute Care Surgery, 78(4), 687–697. https://doi.org/10.1097/TA.0000000000000600
Song, K. J., Kim, J. B., Kim, J., Kim, C., Park, S. Y., Lee, C. H., … & Hwang, S. O. (2016). Part 2. Adult basic life support: 2015 Korean guidelines for cardiopulmonary resuscitation. Clinical and experimental emergency medicine, 3(Suppl), S10. DOI: 10.15441/ceem.16.129.
Spangenberg, T., Schewel, J., Dreher, A., Meincke, F., Bahlmann, E., van der Schalk, H., … & Kuck, K. H. (2018). Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest. Resuscitation, 127, 73-78. DOI: https://doi.org/10.1016/j.resuscitation.2018.03.036
Stiell, I. G., Brown, S. P., Nichol, G., Cheskes, S., Vaillancourt, C., Callaway, C. W., … & Free, C. (2014). What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients?. Circulation, DOI https://doi.org/10.1161/CIRCULATIONAHA.114.008671
Tanguay-Rioux, X., Grunau, B., Neumar, R., Tallon, J., Boone, R., & Christenson, J. (2018). Is Initial rhythm in OHCA a predictor of preceding no flow time? Implications for bystander response and ECPR candidacy evaluation. Resuscitation. DOI: https://doi.org/10.1016/j.resuscitation.2018.05.002
Tasker, R. C. (2016). Positioning the breathing but unresponsive patient: what is the evidence?. BJM, 101 (6), DOI: https://dx.doi.org/10.1136/archdischild-2015-309362
Wagner, M., Olischar, M., O’reilly, M., Goeral, K., Berger, A., Cheung, P. Y., & Schmölzer, G. M. (2018). Review of Routes to Administer Medication During Prolonged Neonatal Resuscitation. Pediatric critical care medicine, 19(4), 332-338.DOI: 10.1097/PCC.0000000000001493
Wurster, L. A., Thakkar, R. K., Haley, K. J., Wheeler, K. K., Larson, J., Stoner, M., … & Groner, J. I. (2017). Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool using video review. Journal of Trauma and Acute Care Surgery, 82(6), 1002-1006. DOI: 10.1097/TA.00000000001717

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