Assessment task 3: Reflection on individual and team performance in the simulation encounter
Intent: This assessment supports students to observe and reflect on their individual and team responses to a case scenario which requires timely assessment and management of an acutely unwell patient.
Objective(s): This assessment task addresses subject learning objective(s): A, B, C, D and E
This assessment task contributes to the development of graduate attribute(s): 1.0, 4.0 and 5.0
Weight: 40%
Task: Students will write a paper where they critically reflect on both their individual responses, and the responses of their various team members in a simulation activity involving a clinically deteriorating
patient. This simulation will be observed "live" and, all team members permitting, there may be an opportunity to access an audio-visual recording of the activities.
Using Gibbs reflective cycle (1988), students are required to reflect upon the following aspects of the simulation activity:
1. What process or system was used to identify the clinical deterioration?
2. What type(s) of leadership was demonstrated by you and/or your team members?
3. What communication techniques were used? How did your specific role in the simulation demonstrate accountability for the patient and/or your team members?
4. In this paper, students are expected to reflect upon their experiences and consider these in light of academic literature and best practice guidelines. Please note: In-class instruction and support on how to use Gibbs reflective cycle (1988), and write reflective papers will be provided prior to the simulation encounter.
Length: 2500 word
The nursing profession is one of the most challenging professions due to the requirement for nurses to act promptly in a critical situation. With no scope for correction, a nurse must always be analytically correct to deal with any situation and ensure the patient’s wellbeing.Hence, mastering the essential skills of nursing like communication, teamwork, and decisiveness is imperative(Lordet al., 2015). Having pursued nursing, I often find myself dealing with the various demands of the job. Especially, in the case of acutely ill patients, the situation is most accountable and needs responsiveness.
Acute care is provided based on the need of the acutely ill patient, even though the patient's location as clinical deterioration is observed at any stage of illness as the patient can be vulnerable at many definite episodes of illness. The vulnerable conditions may account for adverse effects. To minimize the chances of an adverse effect such as cardiac arrest, patient collapse, its responsibility of health team members to interpret physiological changes and perform timely clinical management of the physiological changes which is crucially essential. Delay recognition of these changes and incorrect therapy are the prime cause of patient poor outcomes and death (Quirke et al.,2011).
With a rapid onset, acute illness can arise. With the effect of medical treatment,this condition can be resolved quickly as these illnesses are severe enough, which can result in patient death like cardiac arrest. Acute word is used to emphasize the severity or suddenness of health condition. There are various conditions which are at risk of acute changes such as animal bite, cellulitis, closed trauma, secondary to an infection, drug reaction and many more. Assessment of clinically deteriorating patient can be done by:
Reflective Analysis
Performing reflective analysis assists in delineating the event in a better way and help in understanding the protocols in different situations. The self-analysis process of Gibbs' reflective cycle is classified into six steps, namely description, feelings, evaluation, analysis, conclusion and action plan. While performing the analysis, I would also relate to incidents experienced and learned from the NCAS standards of Nursing and Midwifery Board of Australia (NMBA) and with other guidelines like registered nurse standard of practice by Nursing and Midwifery Council (NMC 2016).
In the given case scenario, I have used the Gibbs' reflective cycle to analyze my performance and enhance my learning. With the Gibbs reflective cycle, I can identify areas of improvement,thus improving patient outcomes and attain my career goals.
Description:
In a simulation activity involving a clinically deteriorating patient, I was working as an airway person along with the team member of a team leader, scriber, CPR, airway person and a medication person. We observed that a patient was admitted four days ago due to an insect bite in her right leg. During assessment at 10:57 blood pressure was 80/40mm of Hg, oxygen saturation (spo2) shows the poor signal, the oxygen level was under level of control, and at every 5 seconds, the temperature was checked. Suddenly at 10:58, the patient condition changed.She turned unresponsive, then immediately,CPR person gave CPR and canalization for the drug administration done.At 10:59, the patient area was cleared from the top, middle, bottom and placing hands off from the patient to perform the rhythm analyses.The CPR was continued as the non-shockable rhythm was noticed. As per the instructions, intravenous infusion of normal saline 500 ml was also started.Arterial blood gas analysis was performed as the patient was on oxygen therapy. It shows the findings of hyperkalemia, hypovolemia, and hypothermia. Later on, the site of insect bite was exposed to check local signs of bite then documentation checked to retrieve the history of toxins, cardiac tamponade, and the presence of thrombus. Rhythm analysis was again conductedafter 2 minutes, at 11:01, and ventricular tachycardia was observed. Immediately, the shock was delivered followed by injection 1 mg of adrenaline intravenously as per ordered at 11:02. During the reassessment of the patient condition, the team members realized that toxin could be because of insect bite in the leg. Hence, determining the toxin level and taking pictures of the insect bite area is essential to find out anti-dote for the same. Again rhythm was checked at 11:02 and found ventricular tachycardia; therefore, the shock delivered at 11:03 followed by injection amlodorane 300mg intravenously.
Meanwhile patient allergic reaction to flucloxacillin antibiotic intravenous infusion was observed so with immediate effect the infusion turned off, and at 11:05 after completing 2 minutes, the rhythm was analyzed.We found that circulation improved, sometimes patient was breathing at the rate of 3 breaths per minute, on auscultation chest was found clear, blood pressure also rises by 110/60 mm of Hg, heart rate was 87, but oxygen saturation was still poor, so CPR was discontinued, but airway was continuously maintained. At 11:06 patient was shifted to ICU after performing ECG analysis and X-ray.
Feelings:
During the simulation, I experienceddifferent feelings. Firstly, I was anxious when I found that patient was unresponsive by using the AVPU scale (alert, verbal, pain unresponsive) for grading level of consciousness of the patient. Low level of AVPU demonstrates a lack of oxygenated blood supply to the brain(Zadravecz et al., 2015; Planas et al., 2020).
Secondly, I realized theimportance of time management as every second patient's condition was deteriorating, and the patient needs immediate resuscitation. Hence, for CPR, I called health team members immediately rather than wasting time as in urgency medical condition CPR has a scope of returning of spontaneous of circulation ( ROSC) by providing appropriate chest compression and maintain airway (Tschan et al., 2006).
Lastly, I felt that the role of the nurses is crucial in such critical patients. The nurses should take responsibility at such situations, but, teamwork is also an important aspect. I felt the gravity of such critical cases and realized that nurse should act responsibly and sensibly in such situations (NMC, 2016).
Evaluation:
In this situation, I had evaluatedthat management of the critical condition of the patient requires good teamwork, proper time management and effective communication along with the mutual respect to managingthe situation effectively. Therefore, all the team members who are involved in taking care of the patient must be competent in assessment, observation and interpretation of vitals parameter so that appropriate level of care can be provided as per their code of conduct (NMC 2015). In this simulation, I observed that history related to the patient condition and assessment related to pathological changes was performed appropriately. In this data related to the health issues such as tamponade, tension, toxicity and thrombus, which may impact upon the patient’s prognosis was collected and analyzed. Furthermore, Conditions of the vital organ had been checked by analyzing health indicators which can be obtained by a quick review of physical examination. It was reflected that patient was hypothermic, observed poor blood circulation shows symptoms of hypovelemia such as cold extremities, diaphoresis, tachycardia etc. The blood chemistry was checked by arterial blood gas analysis to detect the potassium level, and it revealed hyperkalemia, low oxygen concentration, increase the carbon-di-oxide level.
As per my evaluation, I felt that we should have also checked airway patency to promote oxygen supply.Allocation of CPR person should be changed after completing one cycle of CPR as the person providing continuous chest compression may get tired thus impacting the effectiveness of the resuscitation. However in this simulation negligence towards medication was also found as the dose of 1 mg adrenaline administration in the first loop was neglected, for the prevention of drug reaction sensitivity test is important, which has to be perform prior to antibiotic infusion so that drug reaction can be prevented, this is also one of the negligence which I observed and the exposure of site where insect bite was present was also not done properly.Such improper steps are not expected at the time of managing critical conditions. Hence, it can give rise to further complication like death.
Analysis:
The analysis of the condition states that the patient was admitted in the hospital four days ago with the complaint of insect bite. During the assessment of health parameters, it has been found that patient vitals were stable.Still, suddenly condition changed and acute illness turned into the critical condition which required immediate management and a team approaches so that resuscitation can be done effectively and timely. To avoid adverse incidence, it's crucial to closely monitor physiological changes and early detection of physical and psychological decline (RCP, 2012).I have also analyzed that leadership, along with teamwork, is significant in such critical cases.Moreover, my analyses conclude that effective, clear and complete verbal communication is important so that patient can recover from deteriorate the situation.
Conclusion:
I concluded that health professional should be competent enough to deal with the life-threatening condition while providing CPR, physiological data should also be collected by hemodynamic analysis via arterial blood gas analysis along with the other vital parameters to evaluate the feedback of the rescuer. Hence, I learned from this situation that it is essential to collect information about tamponade, tension, toxin and thrombus, if any, and also drug allergy history before planning for any intervention.
As every second, the condition of the patient can deteriorate; hence proper time management is an essential requirement to improve health condition and to deliver the highest quality of care (Nichol et al., 2010).
Action plan:
Being a part of this health team in this conditionimparted a sense of accountability on me. While performing in a health team, it's important to understand the importance of teamwork in which every individual accounts avital role in providing quality care to the patient. One should have a complete history of medical and surgical condition to prevent complications. Drug administration and instructions should be followed appropriately as per leader without any fail and negligence. Moreover, the best practice for the health team member is to perform under the instructions while improving the knowledge via experience (Pelvin, 2010; White, 2013). Secondly, proper time management is the initial requirement of critical condition as delay every second decreases the chances of survival and makes the condition most deteriorate. Thirdly, effective and clear communication among the team member also enhances the quality of care so that appropriate assessment of condition can be performed on time. One should give holistic care by considering other associated conditions like in this situation analysis of hypovolemia, hyperkalemia, hypoxia, and hypothermia is also need to consider for providing the optimum level of health. Last but not least frequent and continuous assessment of vital indicators is essential to interpret the physiological changes which make the condition worse.
Critique Analysis of Various Qualities Displayed During the Given Situation
As per my personal experience after being a part of a team in providing care during clinical deterioration, I found that correct treatment and time management is imperative for the safety of the patient. For identifying and responding to life-threatening conditions, a systemic ABCDE approach for the patient assessment should be used (Smith, 2017). This approach includes airway, breathing, circulation, disability and exposure. For determining clinical deteriorations, vital signs as a component of ABCDE analyses should be used as an indicator for the detection of the physiological deprivations. This assessment can be done at the bedsidefor managing the life-threatening condition so that the initial step of improvement can be gained instead of making a diagnosis. While taking decisions about ongoing care of the patient, it is essential to know about their health history, and diagnosis and team performance in deterioration condition of patient found as an assessment tool which is a vital measure of assessing patient condition (Cooper et al., 2013).
Leadership Skill:
Authorityis the first component of emergency management leadership (Waugh, 2016). So I demonstrated authority leadership during the simulation. In any situation, a leader must hold a clear vision, strategies implementation, planning, organizational values, collaboration skills and effective communication (Fields, 2009). As a leader it's my responsibility to arrange effective and multidisciplinary team member for proving emergency care, performing rapid analyses of the complex situation and establishing effective communication among the team members so that effectively informed decision can be made for providing an optimal level of care during rapidly changing situations (Pronovost et al., 2009). During uncertainty of patient condition and emphasized time pressure, the importance of skills demands more for an automatic response and leaders are expected to decide while keeping mission and organizational values in mind (Kreisset al., 2010). Leadership should be more directive and transactional to overcome mental and physical stress of team members. At the time of the mission, the leader plays a pivotal role of everlasting strengthening the endurance of team so that I can take care of my team member in finding their needs, fear, ambition etc. which helps in establishing practical and ethical system during medical practice (Merin et al., 2010).
Communication:
Identification, escalation and management of the deterioration condition can be facilitated by the effective communication technique which I have used while managing the acute illness of the client. For providing high quality, safe care to the deteriorating patient, verbal communicationis required.Proper communication includes diagnosis, strategies for observation monitoring, continued management and documentation. By the use of the structured protocol, communication can be improved and helps health members in clear, precise and logical communication. Poor communication and practices like inappropriate documentation reading may lead to an adverse incident, and also recognition and action for acute deterioration can be neglected. Therefore it is imperative to transfer appropriate information to the right person at the right time. The nurses can strengthen the health system, and they are critical at the time of rendering essential health care services (Mokoka et al., 2011; WHO,2016).
During the simulation, I, as anairway person, maintained the airway of the patient.The team leader alsocommunicated clearly to the team member about their duties like scriber, CPR person, and medication administration. It is very crucial to specify their role while dealing with the deterioration condition. As a team leader,it is crucial to decide who will take on the role so that every team member can assist in accomplishing the desired goal.
Accountability:
At the time of intervening, I was observing the action of team member also so that if any member fails to handle particular action appropriately, I can reallocate the work to another member or should take over the duty so that I can handle the situation tactfully and professionally as well. Holding my accountability of monitoring and communicating the current status of the patient is important so that situation can be reevaluated and treatment can be decided so that best possible care to the patient can be provided. I verbalized loudly about patient summary and condition with mutual respect for an efficient team-leading and also for facilitating effective communication.
As per our roles, all the team members assessed the warning scores of the vital parameters to reduce the chances of failure to rescue events. The vital parameters like an assessment of respiration rate, oxygen saturation, heart rate, arterial blood gas analysis, blood glucose level should be monitored so that team members can be directive based on patient’s parameters (RomeroBrufau et al., 2014). And my team members helped each other in recognition and escalation of deterioration conditions. As a team member, each one holds accountability to determine patient and non-patient factor which can alter the intervene plan of care and knowledge about barriers and facilitators are an essential component to plan safer system of health care (Johnston et al., 2015).
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Words: 890