Enhancing Patient Safety through Critical Thinking and Communication in Nursing Care

Question

Task: How did the neglect of "don't normalize the abnormal," inadequate documentation, lack of critical thinking, and failure to "speak up" contribute to the unfortunate outcome in Matt's case? How could these aspects have been effectively employed to ensure better patient care and prevent deterioration?

Answer

Complex Nursing Care Review of Evidence Written Assignment

1. ‘Don’t normalize the abnormal’ plays a significant role in reminding healthcare professionals to focus on unusual conditions and circumstances and provide significant intervention and precautious measures necessary. It explains the need to maintain professional conduct and to consider every necessary early indicator of deterioration and ensure prevention of further worsening (Coster, Watkins & Norman, 2018). It thus serves as a critical and significant practice for nurses and health care professionals.

Here the discussion of ABCDE systematic approach will be discussed based on the video. It will help to identify the sign of deterioration that was neglected by the nursing professional or normalized, which led to the patient's death. ABCDE Systemic approach is one of the strategical approaches which helps professionals maintain “don’t normalize the abnormal” within their practice and provide better services to the patient and avoid deterioration. It serves by spotting and analyzing early signs of deterioration in patients (Bliss & Aitken, 2018). It consists of five chief aspects, which include Airways, Breathing, Circulation, Disability and Exposure, and each element serves as a crucial component of health assessment to identify complex conditions (Costa et al., 2018).

On the assessment of the case study of Matt, it was found that there were significant sets of signs which indicated deterioration. Airways assessment of Matt highlighted he had sustained laryngospasm, which was considered to be an issue developed post-surgery, based on which he was bagged, and further stability was maintained. He had a pink cough which was easily normalized by the nurses. According to Chapman (2020), having blood in the cough highlights the chances of severe chest infection, which was ignored. The breathing pattern of Matt was also abnormal, as he was having a rapid respiratory rate as well as difficulty in breathing. It was post-surgery and laryngospasm, which was also neglected, and he was taken to the recovery room, which contributed to his further deterioration. The circulation assessment of Matt highlights the condition of low oxygen saturation (92%) level in the blood for which he was provided with a high oxygen supply. Even after stabilizing Matt, he was given with continuous oxygen supply leading to hyperoxia. As a symptom of Hyperoxia, Matt developed pulmonary oedema, which contributed to one of the major causes of his death (Smit et al., 2018).Disability assessment showed that he was angry and irritated at the time of medication. According to Singer et al. (2021), irritation and dizziness are all the symptoms of hyperoxia which was completely neglected. Due to the hyperoxia, Matt suffered a seizure and went into a coma. On exposure assessment, it was assessed that Matt, post appendectomy, was found to have a high fever along with continuous vomiting. It was also found that Matt sustained negative exposure to pulmonary oedema, which was also not considered a sign of deterioration by the nurses and other health professionals. These signs were neglected and considered to be post-operative reactions of the body. These were some of the early signs of deterioration that were neglected. They justified these red flags by stating it as some of the condition that patients normally suffers, and they also avoided the change in oxygen level in blood.

2. Documentation innursing and healthcare has a necessary and significant role in maintaining the standard of service provided for patient health safety. It provides professionals with the ability to store and manage patient information promptly and accurately to avoid any misconduct or error in the treatment and care provided (Adubi, Olaogun & Adejumo, 2018). It also ensures continuity of care and treatment, maintains information-based communication as well as conducts legal record-keeping. According to Akhu-Zaheya, Al-Maaitah & Bany Hani (2018), inaccurate or incomplete documentation leads to improper care of the patient, which was also observed in the case of Matt. It would have been necessary in the case of Matt to maintain proper documentation of the care and treatment provided as well as health assessment to avoid any error in treatment. The documentation in the case of Matt should have included a proper record of the liquid intake, medication, vitals as well as output. It would have provided the healthcare setting and associated professional to have a firm record and conducted a thorough analysis of his case to provide emergency treatment and avoid deterioration (Watt et al., 2018). In the case of Matt, many signs and symptoms, such as pink cough, irritability, oversupply of oxygen, and pulmonary oedema, have not been documented properly. Due to this, the specialists were not able to derive the actual issue Matt was suffering from. As per the case study, during the visit, the health specialists not even tried to consult Matt or his parents to know more about the discomfort and issues in detail. A prompt care plan is done solely based on the document. The importance of documentation is clearly highlighted in the case of Matt, as it would have saved his life.

There were so many essential aspects that were not documented that were completely ignored. For instance, it also would have been necessary in the case of Matt that the ward nurse assist him during the night shift to maintain a regular assessment and analysis of his vitals for tract recovery or deterioration. It would have also ensured that Matt is assisted with pain relief measures and well as calming assistance. The ward nurse should have also ensured that the change in observation and records of Matt was routinely reported to the treatment team and medical staff to ensure immediate action against his condition (Duncan et al., 2018). As a major change in respiratory rate was identified in the case of Matt, it would have been necessary to transfer Matt to a senior professional to ensure stability. Pain treatment should also have been maintained in the case of Matt to ensure better comfort and easy recovery, which was highly neglected and led to a life-ending condition for Matt (Vuille et al., 2018). Besides, the pink cough was also not documented by stating that it was just because of the aggressive coughing. However, according to Lihan et al. (2021), pink Phlegm is one of the significant symptoms of pulmonary oedema. Also, Matt was found irritated with the treatment, which was also not documented, considering it was just a part of his behaviour. But as per his mother, Matt is not like that. Also, irritation might be a sign of hyperoxia which was completely ignored by the health professional and not documented.

3. Critical thinking in nursing serves as a vital factor in nursing and healthcare practice which demands the use of appropriate information, documentation, experience, knowledge and skill to implement the professional decision. In the case of Matt, there were so many instances where the implementation of a critical thinking approach might have saved his life. For instance, might be transferred to the recovery room post-surgery without checking his vitals (Cui et al., 2018). Critical thinking would have also ensured that Matt was assisted with immediate action against the condition where he was found coughing pink froth. Immediate action with critical decision-making by the nurse could have helped him overcome the deterioration and sustain stability in health. Also, the issues identified post-surgery Matt would have been managed with appropriate protocol and intervention if critical decision-making and thinking had been implemented according to the indications (Rizany, Haryati & Handayani, 2018). It is necessary that a patient with deterioration is assisted with proper immediate actions to avoid further complexity and associated death. It ensures that patient safety or occurring error in service is professionally communicated within the therapeutic team so that active actions are taken into account.

In the case of Matt, the standard could have ensured better treatment options and early recovery from the state of deterioration. In such a condition where Matt was deteriorating and was undergoing, if the nurse had used critical thinking condition, she would have been able to manage the deterioration and ensure rapid stability in health. One of the most active actions should have been focused on providing consideration to the issues faced by Matt and providing immediate interventions. Initiating immediate actions would not have provided stability in respiration but also would have guided the development of health deterioration (Alamarani et al., 2018). If Matt had been provided immediate respiratory support, he could have sustained full recovery. Critical thinking skill thus explains the necessity of using them in health care services.

4. ‘Speaking up’ in the field of nursing is considered to be one of the necessary and chief patient safety behaviour. It highlights nurses' role in maintaining and voicing patient safety matters in order to provide the best service. It tends to guide and teach nursing professionals to use a common language within the setting to maintain organisational culture and communicate effectively regarding patient safety and concern (Alingh et al., 2019). The Recognizing and Responding to Acute Deterioration Standard has been found actively working within the health care system of Australia. It aims to ensure that any early signs of deterioration in patients are recognized and that needed actions are implemented (Australian Commission of Safety and Quality in Healthcare, 2023). It accounts for both the mental and physical state of determination associated with acute change. The standard is known to guide and support timely care and assistance provided to the patients. In the case of Matt, the standard could have ensured better treatment options and early recovery from the state of deterioration. The Recognizing and Responding to Acute Deterioration Standard has been found actively working within the health care system of Australia, which aims to ensure that any early signs of deterioration in patients are recognized and that needed actions are implemented (Australian Commission of Safety and Quality in Healthcare, 2023). It accounts for both the mental and physical state of determination associated with acute change. The standard is known to guide and support timely care and assistance provided to the patients.

References:

Adubi, I. O., Olaogun, A. A., & Adejumo, P. O. (2018).Effect of standardized nursing language continuing education programme on nurses' documentation of care at University College Hospital, Ibadan. Nursing Open, 5(1), 37-44.Retrieved from: https://onlinelibrary.wiley.com/doi/pdf/10.1002/nop2.108

Akhu?Zaheya, L., Al?Maaitah, R., & Bany Hani, S. (2018). Quality of nursing documentation: Paper?based health records versus electronic?based health records. Journal of clinical nursing, 27(3-4), e578-e589. Retrieved from:https://www.researchgate.net/profile/Rowaida-Al-Maaitah-2/publication/320249477_Quality_of_Nursing_Documentation_Paper-Based_Health_Records_versus_Electronic-Based_Health_Records/links/5a19eec7aca272df080d81f5/Quality-of-Nursing-Documentation-Paper-Based-Health-Records-versus-Electronic-Based-Health-Records.pdf

Alamrani, M. H., Alammar, K. A., Alqahtani, S. S., & Salem, O. A. (2018).Comparing the effects of simulation-based and traditional teaching methods on the critical thinking abilities and self-confidence of nursing students. Journal of Nursing Research, 26(3), 152-157. Retrieved from: https://www.twna.org.tw/WebUploadFiles/PubMagFiles/Article/TWNA_BACKEND/upload/web/ePublication/8180/JNR26(3)_p.152-157.pdf

Alingh, C. W., van Wijngaarden, J. D., van de Voorde, K., Paauwe, J., & Huijsman, R. (2019). Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses’ willingness to speak up. BMJ quality & safety, 28(1), 39-48. Retrieved from: https://repub.eur.nl/pub/110268/110268_Chapter_5-Speaking_up_about_patient_safety_concern.pdf

Australian Commission of Safety and Quality in Healthcare, (2023). Recognizing and Responding to Acute Deterioration Standard.Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/recognising-and-responding-acute-deterioration-standard#:~:text=The%20Recognising%20and%20Responding%20to,in%20cognition%20and%20mental%20state.

Bliss, M., & Aitken, L. M. (2018). Does simulation enhance nurses' ability to assess deteriorating patients? Nurse education in practice, 28, 20-26. Retrieved from: https://openaccess.city.ac.uk/id/eprint/19239/1/

Chapman, C., Cadilhac, D. A., Morgan, P., Kilkenny, M. F., Grimley, R., Sundararajan, V., ...& Andrew, N. E. (2020). Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry. International Journal of Stroke, 15(4), 390–398. https://doi.org/10.1177/1747493019833

Costa, D. K., Valley, T. S., Miller, M. A., Manojlovich, M., Watson, S. R., McLellan, P., ...& Iwashyna, T. J. (2018). ICU team composition and its association with ABCDE implementation in a quality collaborative. Journal of critical care, 44, 1–6.Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831474/

Coster, S., Watkins, M., & Norman, I. J. (2018). What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. International journal of nursing studies, 78, 76-83. Retrieved from: https://link.springer.com/article/10.1186/s12912-018-0273-3

Cui, C., Li, Y., Geng, D., Zhang, H., & Jin, C. (2018). The effectiveness of evidence-based nursing on development of nursing students' critical thinking: A meta-analysis. Nurse education today, 65, 46-53.https://doi.org/10.1016/j.nedt.2018.05.024

Duncan, B. J., Zheng, L., Furniss, S. K., Solomon, A. J., Doebbeling, B. N., Grando, G., ... & Kaufman, D. R. (2018). In search of vital signs: a comparative study of EHR documentation. In AMIA Annual Symposium Proceedings (Vol. 2018, p. 1233).American Medical Informatics Association.Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371263/

?lhan, U. Z., Kiyan, G. S., ÖzÇete, E., YalÇinli, S., Korgan, M. B., Altunci, Y. A., ...& Yavuzg?l, O. (2021). Is the flow-safe disposable continuous positive airway pressure (CPAP) system as effective as non-invasive mechanical ventilation (NIMV) in the treatment of acute cardiogenic pulmonary oedema?.The American Journal of Emergency Medicine, 39, 109-113. Retrieved from:https://aula.rmjf.ec/wp-content/uploads/2020/07/ARTICULO-REVISTA-MEDICA-SOBRE-LA-EFECTIVIDAD-FLOW-SAFE.pdf

Rizany, I., Hariyati, R. T. S., & Handayani, H. (2018). Factors that affect the development of nurses’ competencies: a systematic review. Enfermeria clinica, 28, 154-157.Retrieved from: https://www.researchgate.net/profile/Rr-Hariyati/publication/324373733_Factors_that_affect_the_development_of_nurses'_competencies_a_systematic_review/links/5b13cd110f7e9b4981072bbd/Factors-that-affect-the-development-of-nurses-competencies-a-systematic-review.pdf

Singer, M., Young, P. J., Laffey, J. G., Asfar, P., Taccone, F. S., Skrifvars, M. B., ...& Radermacher, P. (2021). Dangers of hyperoxia. Critical Care, 25, 1-15. Retrieved from: https://link.springer.com/article/10.1186/s13054-021-03815-y

Smit, B., Smulders, Y. M., van der Wouden, J. C., Oudemans-van Straaten, H. M., & Spoelstra-de Man, A. M. (2018). Hemodynamic effects of acute hyperoxia: systematic review and meta-analysis. Critical Care, 22(1), 1-10. Retrieved from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-1968-2

Vuille, M., Foerster, M., Foucault, E., & Hugli, O. (2018). Pain assessment by emergency nurses at triage in the emergency department: A qualitative study. Journal of clinical nursing, 27(3-4), 669-676. Retrieved from:https://doi.org/10.1111/jocn.13992

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: an integrative literature review. International journal of nursing sciences, 5(1), 81-88.Retrieved from: https://www.sciencedirect.com/science/article/pii/S235201321730087X