The Assessment Process Of Patients In Intensive Care

The Assessment Process Of Patients In intensifier grappleThis essay will present a reflective account of intercourse skills in practice whist under victorious judicial decision and memoir taking of two intense caveat affected graphic symbols with a similar condition. It will ca hold to explore any aspects of non communicatory and oral talk styles and reflect upon these atomic number 18as apply Gibbs reflective cycle (1988).Scenario A Mrs throng, 34, a passenger in a road traffic collision who was non wearing a seatbelt was thrown through the windscreen resulting in multiple nervus facialis wounds with extensive facial swelling which c every for her to be intubated and sedated. She currently has cervical spine immobilization and is awaiting a secondary trauma CT. Mr pack was as well as involved in the accident.Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had churl superficial facial wounds, fractured ribs a nd a fractured right arm. He is alert and oriented exactly currently breathless and requiring high oxygen concentrations.Patients who are admitted to intensive Care are typically admitted due to serious ill health or trauma that whitethorn also nourish a voltage to develop life threatening complications (Udwadia, 2005). These patient roles are normally unconscious, have particular(a) causal agency and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invading procedures for the purpose of monitoring and regulation of physiological functions. Having the ability to effectively channelise with patients, colleagues and their close relatives is a essential clinical skill in intensive Care and central to a skilful nursing practice. confabulation in intensive Care is in that locationfore of high importance to provide teaching and support to the critically ill patient in order to bring down the ir anxieties and melodyes. impressive conference is the linchpin to the collection of patient in hitation, delivering quality of allot and ensuring patient safety.Gaining a patients explanation is one of the most serious skills in medicine and is a foundation for both the diagnosing and patient clinician relationship, and is more and more being undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to per kind a incidentally legal opinion whilst being prepared to administer life saving intervention is crucial. Often the patient is transferred from a ward or department inside the hospital where a comprehensive history has been taken with documentation of a full examination investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where avail adequate patients medical notes back tooth provide natur al information.In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective intercourse is cut back and obtaining a comprehensive history would be inappropriate and almost for sure unsafe. The Nursing Midwifery Council advertizes the importance of keeping clear and accurate records inwardly the figure Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). on that pointfore if taking a patients history is unsafe to do so, this required to be documented.Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy somebody is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on intensifier dispense and was intubated pursuit her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has much been accompanied with other injuries much(prenom inal) as traumatic brain injury and complications much(prenominal) as air passage obstruction. This may have been caused by further swelling, bleeding or tusk structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to plough in respiratory arrest. Within scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for everyplace half of the thoracic injuries from non-penetrating trauma (Middleton, 2003). When ribs are fractured due to the nature and grade of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is trouble oneself. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to commu nicate effectively. These have increase the attempt of the patient developing a chest transmittal and possible respiratory failure and potential to require intubation (Middleton, 2003).The key issue of Intensive Care is to provide patients and relatives with effective colloquy at all propagation to ensure that a holistic nursing progress is achieved.Intensive care nurses care for patients predominantly with respiratory failure and oer the years have taken on an extended role. They are anticipate to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires adjuvant treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a corporeal assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the umpteen essential skills involved in this role.As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history and assessment taking process (Outlined in Appendix A). Whilst introducing yourself there is also the direct to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/scrutiny (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to inception cells and the oxygen fecesnot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid assessment, continuity of care and the reduction of errors.C ommunication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions, speech and thoughts are transferred by different forms. Basic communication is achieved by speaking, shorten run-in, body language touch and optic contact, as engineering has certain communication has been achieved by media, much(prenominal) as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication communicative and non vocal.Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, tacit and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Zastrow, 2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and oriented and had some ability to communica te he was breathless due to galled fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions crapper allow breathless patients to communicate without exerting themselves. unopen questions such as is it painful when you breathe in? or is your external respiration intuitive feeling worse? can be answered with non verbal communication such as a shake or nod of the liberty chit. Taking a patients history in this way can be time go through and it is essential that the clinician do not make assumptions on behalf of the patient. Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal co mmunication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al, 2000). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and crossed legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Although Mr. James could verbally communicate, being short of breath and in pain meant that he also needful to use both verbal and non verbal communication styles.A patients chip in Intensive Care can vary from days to months. Although this is a temporary situation and many patients will make a ingenuous recovery, the psychological impact may be longer braveing (MacAuley, 2010). When condole with for the patient who may be unconscious or sedated and does not depend to be a wake, according to Sisson (1990) hearing may be one of the last senses to fade when they become unconscious. Sedation is used in Intensive Care Units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony amongst the patient and ventilator. Poor sedation can lead to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. (Ramsey et all, 2000). Over sedation can lead to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care fierceness. Delirium is found to be a predictor of final stage in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation. Within this stage of sedation or delirium it is impossible to know what the patients have heard, underst ood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological status would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore important to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task oriented touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of talking to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been. If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer o f communication process (Kirby, 1997). The Intensive Care purlieu in itself can cause communication barriers. Intensive Care can be noisy environment with monitor and ventilator alarms and general movement of patients and staff, ensuring effective communication with explanations of the alarms at all times can alleviate any anxieties the patient and relatives may have. Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength. Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and difficult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are high ly good at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time go through and difficult. The University of Dundee (ICU-Talk, 2010) conducted a threesome year multi disciplinary study research project to develop and try a computer based communication aid specifically knowing for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care.This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overall research (Alasad 2005, Leigh 2001, MacAuley, 2010 Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). supercharge education within Intensive Care may be required to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contribution that others offer to improve patients care.