Critical Incident

Rich & Parker 2001 defines scathing haps as snapshots of something that happens to a forbearing, their family or health concern professional. It whitethorn be something positive, or it could be a view where some ane has suffered in some foc apply. Reflecting on full of life incidents pass on conquer me to explore and analyse incidents and how it has affects me and what I hope to do with these effects in the course of my training towards becoming a registered practitioner. It also gives me the opportunity of ever-changing my elbow room of intellection or practice, as I learn valuable lessons when I reflect on an incident.This helps me to develop self-aw arness and sk light-headeds in critical thought and problem solving (Rich & Parker 2001). On the other hand, Johns 2003 defines facial expression as existence mindful of self, either indoors or after an make believe intercourse, as if a window through which the practioners give the bounce view and focus self within the context of a particular experience, in order to confront, reckon and prod towards resolving contradiction between ones vision and substantial practice.I will be using the Beckwith way of lifel of reflection which states clearly that reflection is a tool to deal with challenges that will operate the speed and amplitude of ones development, to explore these effects in other to insure and learn from this incident, with the hope of improving my practice (Beckwith & Beckwith 2007). The incident I will be reflecting upon occurred while attending a clinical arrangement in the critical conduct unit at my placement hospital which for the purpose of this essay will be referred to as X Hospital. full of vitality Care is the multi-professional health conduct specialty that heraldic bearings for longanimouss with acute, sustenance-threatening illness or injury, (Sheppard & Wright 2005). decisive feel for can be fork upd wherever life is threatened. Critical share provided at the scene of an accident or in an ambulance is elementary life jut. Basic life fight down is the emergency intercession of whatsoever condition where the brain stops receiving adequate oxygen it could be a cardiac or respiratory arrest, (Kumar).A cardiac arrest is one where there is no pulse and is un kindredly the forbearing will regenerate with basic life support alone that advanced life support with a defibrillator is required. It is important to carry out basis life support until defibrillator arrives even after bursting chargeful assessment one discovers its a cardiac arrest, as one usually leads to the other, (Kumar). The grandness of recognizing, assessing and reacting to cardiopulmonary arrest is very important.Immediate response augments the chances of a successful out manage, (Davey and Ince). Shostek says critical care in a hospital consideration is provided by multi-professional teams of extremely experienced and professional personnel who use their unique ex pertise and power to interpret important therapeutic information, manage in high spiritsly sophisticated equipment and provide care that leads to the best import for the enduring.Patients are usually admitted from the emergency manner or surgical area where they are first devoted care and stabilized to CCU, (NHS Careers). The management of the critically ill unhurried ranges from inwardness care(Appendix 1), verbal care(Appendix 2), infection control, health and safety issues, tissue viability among other vital issues like care bundles for this high risk group of patients who are dependent these care to maintain integrity and dignity according to trust policy.Suction pumps are also vital in the critical care setting as airway hygiene is impaired in critically ill patients as a result of depressed cough reflex and in trenchant mucociliary dynamic headroom from sedation, high inspired oxygen concentrations, elevated endotracheal underpass cuff obligate, and tracheal mucosa l inflammation and damage, (X Hospital Policy). Due to this, care of intubated patients intromits tracheal suckinging to accelerate the removal of airway secretions (suction therapy) is carried out on all unconscious patient, as it maintains airway patency and prevents pulmonary infection, (X Hospital Policy).A tube or catheter is passed down inside the endotracheal tube and attached to a suction pump, the coat of the catheter must be chosen carefully using a straightforward formula of doubling the size of ET tube minus 2. One should be careful to suction on withdrawal using a suction wardrobe that is appropriate. Suction depth varies depending on the size of the trachea tube hence suction can be shallow, pre-measured and deep suctioning. Despite the importance of suctioning some complications like hypoxia, cardiac arrhythmias, hypotension, tracheal combat injury, laryngospasm and bronchoconstriction are associated with it.Hence tracheal suctioning of intubated patients should be performed on a when needed basis defined by the quantity of secretions obtained, non at presc ribed, set intervals, (X Hospital Policy). The incident I will be reflecting on is about a Twenty-Nine-year-old male admitted to the critical care unit with a closed head injury sustained in a motor vehicle accident. His three-year-old wife, parents and other family members go about real fears. Most of the family members had never been inside a critical care unit, and found the array of pumps, tubes, machines, monitors and lines, as well as the rush of stave members overwhelming.Just by looking at them and watching their reaction severally time they come visiting was enough to tell me how scared and upturned they were of their sons illness and the environment they were in. I started to wonder what was acquittance on in their minds and was drawn to them not exclusively for this reason only when because the patient and his family members were the youngest I ever saw in the unit. I was thinking to myself if they have asked questions or done any research about CCU they will most likely be thinking their sons smudge is hopeless.It is important to label and date all the lines as this helps to know what each is use for and how long it has been in situ for. Also care should be taken when moving patients to ensure the stay in place as it can be very uncomfor instrument panel and difficult to reinsert a cannula on a patient as most of them are oeadematous. As I was knobbed in the care of the patient I had to explain to the wife wherefore her husband was connected to a breathing device and it use. A ventilator is an contrived breathing machine that moves oxygen-enriched air in and out of your lungs.If your lungs have failed and you cannot pass on your own, you will need to be attached to a ventilator (See appendix 3). Being helped to breathe by a ventilator marrow that you will usually need to be sedated. Ventilators can offer diametrical levels of breathing assistance. If you only need help breathing for a pit of days, it is likely you will have an endotracheal tube from the ventilator to your mouth or nose. The tube will usually be held in place rump your neck as was the case with my patient. However, if you need help with breathing for more than than a few days, you may have a short motion called a tracheostomy.This replaces the tube in your mouth with a shorter tube that is set(p) directly into your trachea. As well as being more comfortable, a tracheostomy makes it easier to keep your lungs clean, and usually requires less sedation. There are cardinal kinds of ventilators, negative pressure and positive pressure. Negative pressure ventilators are not commonly in use today. In my trust we have only the positive pressure ventilators. Mode of cellular respiration should be tailored to the involve of the patient. Understanding these settings is important as they may need to be changed quickly. at one time my patients next of kin fully understood the handling he was receiving I could see this young ladys suit dottyen a bit. I later learnt from my conversations with her that their 5years-old missy, had been in the back hindquarters with him when the accident occurred. She had not slept properly since the incident, expressing that she was afraid he would never come seat. She has continually asked her mother and grand parents, When is daddy coming back home? The 5-year-old misfire would not enter the parents bedroom at home and insisted that the frolicsome remain on and has ref apply to take her bath as her dad always gave her a bath each evening.From this conversation I concluded that this piffling girl needed to see, touch, smell and be with her dad to understand what had happened. I believe that she needs to be allowed to grieve and participate in the meliorate process surrounding her dads trauma. However, there were barriers, because our institutions written policy was to not allow anyone under the age of 12 to visit patients even though the majority of published studies evaluating family member forepart in surgery have shown the positive effect it has on family members disregardless of their age, (Kingsnorth et al 2010).Some of these benefits included removing the familys doubt about the patients situation and allowing them to see that allthing possible is being done in caring for that patient, reducing their anxiety and fear about what is happening to their love one, maintaining the family need to be together even at this time. In addition, when and if shoemakers last occurred, families have reported that their presence gave them a sense of closure and facilitated the distress process, (Kingsnorth et al 2010). With this information I spoke with my wise man and she agreed how horribly it must be for her and promised to look into it.Three days after the accident, my mentor came to me and said they have come up with something that will help this young family and aske d if I wanted to be involved with it, I said yes. We approached our patients family about scheduling an developmental conference for the family. We agreed to include aunts, uncles, grandparents a young niece and two nephews. There were fears about how the children will wrap up the information entirely the adults were advised that, if the children exhibited fear or discomfort, they can be allowed to leave the conference room.At the conference, I sat with the children at the table and provided them with crayons and paper. Drinks and cookies were available. I was glad the atmosphere was gentle, quiet, comfortable and conducive to learning. We began the session by discussing definitions of grief, mourning, loss and coping. The adults agreed that this was the first trauma in the family and were giving the children explanations such(prenominal)(prenominal) as God may take him and protactinium may never wake up. It was now time to listen to the children.They were asked to talk about a time when they had been sick. We went over what each part of the anatomy did and how they worked together. The children were asked to draw check of what they understand of the discussion, drew pictures of lungs, a heart, a brain and a rib cage. When the patients daughter drew her Dad, she placed wires and tubes in his organs. At this stage I could see that the impose-ranking girl now understands what had happened to her Dad. The adults who previously did not fully understand the injury to their son appreciated the education.The patients young wife had her eyeball full of tears but I saw relief on her face regardless. As the clinical picture becomes clearer, the little girl asked if she could see her dad. All agreed this powerfulness be beneficial. Now we were confronted with the hospital policy prohibiting children in the critical care unit. The babes spoke among themselves. I was praying silently that they can make an exception here. It is believed that every patient should be treated as an individual and critical care involves the care of family members as well (Kingsnorth et al 2010).I was glad when the sister came back and asked the patients wife to take her daughter to the intensive care unit door, while all the staffs were informed of the plan. The decision was to allow the young daughter to see her dad and hospital policy was explained again, they all understood and were seemingly glad like I was. The daughter entered the unit with wide eyes and stood at her dads bedside, where she was told about every tube and its purpose. The little girl took her dads hand and cried, as did the entire staff. eject for the hum of ventilators, the unit was quiet as the little girl held work force with her father, stroked his hair, sang him a song and said goodnight with prayers. I savored this moment as I realized it was an important journey in the little girls life. As a student I concluded that certain(p)ly there can be nothing superior to this type of care g iving. Through out the lecture I couldnt help but think that God forbid if this was me or my family member I would hope for a care team as nice and understanding as these ones looking after my family.I imagined if these were my children I sure would want them to understand what is happening and to be able to confront it if they want to and what better way to do this. Following the visit, we were told how the little girl had become more amenable at home. She says I have to keep things in order until Dad comes home. Making a difference is what care exemplifies, particularly when the art of valet de chambre in a technologically driven healthcare system is advocated, (NHS Careers). I truly agree with this statement.For me the critical environment was a contrasting setting and honestly I believe there can be no other like it. It is a very emotional setting that requires hard willed people yet competent in their jobs as well as having a heart full of love to care for their patient an d family members. This is an experience that will stay with me throughout my career and influence me in a positive way as I can clearly understand that delivering quality care goes beyond what is done for the patient but for family members nigh as well.In my trust eye care is recognized as a basic nursing care procedure required by critically ill patients to prevent complications such as eye infections or injury. This care involves regular eye assessment on each patient in the ward to ensure that all patients receive separate exhibit based eye care which ranges from no action required to hydration treatment with and sterile water to a more complex treatment cocksure by a doctor. If hydration or cleaned care is taken to wipe from the emaciated corner outwards starting with the lower lids using a different wipe or gauze each time.If there is an infection the non-infected eye should be cleaned first. Sometimes a bacteria barrier cream may be applied if the doctors deem it necessar y, (X Hospital Trust Policy). Appendix 2- spontaneous Care Similarly, all critical ill patients who are intubated receive individualized evidence based mouth care. All orally intubated patients will have moisture, integrity and cleanliness of all oral surfaces. Intubated patient are especially susceptible to complications if inadequate oral care is practiced.Also there are many a(prenominal) factors that pose as barriers to carrying out effective oral care such as difficulty to access oral cavity, changes in mucosa and approach pattern bacteria flora of the mouth, immunocompromise and medication, presence of endotracheal tubes, oral suctioning and therapeutic dehydration. Based on the above, assessment is carried out daily using the Eilers assessment guide. Whatever the outcome of this assessment oral care on all critically ill patients on a daily basis involves using a soft tooth brush and toothpaste every 12hours in a circular stroke external from the gums, cleaning the tongu e and inside of the cheeks.A through rinse using a syringe and gentle suction to remove secretions thereby minimizing trauma to soft tissues in the mouth. Foam sticks and sterile water can be used in cases of extreme dryness as its is effective for moistening oral cavity. Soft paraffin can also be used to prevent lips from cracking. Dentures are usually removed and cared for till when patient needs it, (X Hospital Trust Policy). Appendix 3 Understanding ventilators settings tidal volume This is the lung volume representing the median(prenominal) volume of air displaced between normal inspiration and expiration with no extra run.Typical values are around 500ml or 7ml/kg. To avoid adverse effects of barotrauma and volutrauma it is recommended to use lower tidal volumes. An initial TV of 5-8 mL/kg of ideal clay weight is generally indicated. The goal is to adjust the TV so that plateau pressures are less than 35 cm H2 O. Continuous authorization ventilation (cytomegalovirus) Breat hs are delivered at preset intervals, regardless of patient effort. This mode is used most often in the paralyzed patient because it can increase the work of breathing if respiratory effort is present. CMV has given way to assist-control (A/C) mode.Many ventilators do not have a true CMV mode and offer A/C instead. Assist-control ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. With each inspiratory effort, the ventilator delivers a full assisted tidal volume. Spontaneous breathing is not allowed. This mode is better tolerated than CMV in patients with intact respiratory effort. Intermittent mandatory ventilation With intermittent mandatory ventilation (IMV), breaths are delivered at a preset interval, and spontaneous breathing is allowed between ventilator-administered breaths.Spontaneous breathing occurs against the metro of the airway tubing and ventilator valves, which may be formidable. This mode has given way to sy nchronous intermittent mandatory ventilation (SIMV). Synchronous intermittent mandatory ventilation The ventilator delivers preset breaths in coordination with the respiratory effort of the patient. Spontaneous breathing is allowed between breaths. These modes are beneficial for patients who require high dainty ventilation. Full support reduces oxygen consumption and CO2 fruit of the respiratory muscles.A potential drawback of A/C ventilation in the patient with obstructive airway disease is worsening of air housing and breath stacking. Pressure support ventilation For the spontaneously breathing patient, pressure support ventilation (PSV) has been advocated to limit barotrauma and to decrease the work of breathing. Pressure support differs from A/C and IMV in that a level of support pressure is set (not TV) to assist every spontaneous effort. Airway pressure support is maintained until the patients inspiratory flow falls below a certain cutoff.PSV is frequently the mode of choic e in patients whose respiratory failure is not severe and who have an adequate respiratory drive. It can result in modify patient comfort, reduced cardiovascular effects, reduced risk of barotrauma, and improved distribution of gas. CPAP is an acronym for continuous positive airway pressure, a variate of the PAP system. Respiratory rate A respiratory rate (RR) of 8-12 breaths per minute is recommended for patients not requiring hyperventilation for the treatment of toxic or metabolic acidosis, or intracranial injury.High rates allow less time for exhalation, increase reckon airway pressure, and cause air trapping in patients with obstructive airway disease. The initial rate may be as low as 5-6 breaths per minute in asthmatic patients when using a permissive hypercarbia technique. Positive end-expiratory pressure Positive end-expiratory pressure (PEEP) is a term used in mechanical ventilation to denote an airway pressure that is unbroken above atmospheric pressure at the end of the expiratory cycle.The kindred in a spontaneously breathing patient is CPAP. One clear beneficial effect of PEEP is to shift lung water from the alveoli to the perivascular interstitial space. It does not decrease the total amount of extravascular lung water. This is of clear benefit in cases of cardiogenic as well as noncardiogenic pulmonary edema. An additional benefit of PEEP in cases of CHF is to decrease venous return to the right side of the heart by increasing intrathoracic pressure.ReferencesAmitai, A. and Kulkarni, R. Medscape (2010), Ventilator Management. Available at http//emedicine. medscape. com/article/810126-overview,assessed on 13/03/11 Beckwith, M. A. R. Beckwith, P. T. (2008) Reflection or Critical Thinking? 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Unknown Author (2006) embouchure care for intubated patients, X Hospital Policy.