Critical Incident

Rich & Parker 2001 defines vituperative incidents as snapshots of something that happens to a persevering, their family or healthcargon paid. It whitethorn be something positive, or it could be a side where someone has suffered in some fashion. Reflecting on tiny incidents w adverse onlyow 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 changing my way of thinking or practice, as I learn valu fit littleons when I reflect on an incident.This helps me to interrupt self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). On the early(a) hand, Johns 2003 defines reflection as creation mindful of self, either within or after an experience, as if a window through which the practioners stinkpot view and focus self within the context of a particular experience, in order to confront, g o through and move towards resolving contradiction between ones vision and actual practice.I will be apply the Beckwith model of reflection which states clear that reflection is a tool to give deal with challenges that will influence the speed and amplitude of ones development, to explore these effects in other to understand and learn from this incident, with the hope of improving my practice (Beckwith & Beckwith 2007). The incident I will be reflecting upon occurred period attending a clinical emplacement in the critical portion out unit at my placement hospital which for the purpose of this essay will be referred to as X hospital.Critical Care is the multi-professional health plow specialty that cares for forbearings with acute, intent history-threatening illness or deformity, (Sheppard & Wright 2005). Critical care can be provided wherever life is threatened. Critical care provided at the scene of an accident or in an ambulance is basic life support. canonic life su pport is the emergency manipulation of all condition where the headspring stops receiving adequate group O it could be a cardiac or respiratory arrest, (Kumar).A cardiac arrest is one where at that place is no pulse and is un bidly the diligent will rec e very(prenominal)place with basic life support simply nonwithstanding advanced life support with a defibrillator is required. It is important to carry out basis life support until defibrillator arrives even after careful assessment one discovers its a cardiac arrest, as one usually leads to the other, (Kumar). The importance of recognizing, assessing and reacting to cardiorespiratory arrest is very important.Immediate response increases the chances of a lucky out get under ones skin, (Davey and Ince). Shostek says critical care in a hospital range is provided by multi-professional teams of super experienced and professional personnel who use their unique expertise and ability to interpret important therapeutic informatio n, manage highly sophisticated equipment and provide care that leads to the best outcome for the long-suffering.Patients are usually admitted from the emergency room or surgical area where they are starting signal apt(p) care and stabilized to CCU, (NHS Careers). The management of the critically ill patient ranges from eye care(Appendix 1), spontaneous 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 hauteur according to trust form _or_ system of government.Suction pumps are also vital in the critical care setting as skyway hygiene is impaired in critically ill patients as a closure of depressed cough reflex and ineffective mucociliary clearance from sedation, high inspired oxygen concentrations, elevated endotracheal underground cuff twinge, and tracheal mucosal inflammation and damage, (X Hospital Policy). Du e to this, care of intubated patients includes tracheal suckinging to facilitate the removal of airway secretions ( suck 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 surface of the catheter must be chosen carefully using a simple formula of doubling the surface of ET tube minus 2. One should be careful to suction on withdrawal using a suction crush 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 trauma, laryngospasm and bronchoconstriction are associated with it.Hence tracheal suctioning of intubated patients should be performed on a when extremityed basis defined by the amount of money of secretions obtained, non at prescribed, set intervals, (X Hospital Policy). The incident I will be reflecting on is approximately a Twenty-Nine-year-old male admitted to the critical care unit with a closed head injury sustained in a motor vehicle accident. His young wife, parents and other family members faced real idolises. 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 burster of staff members overwhelming.Just by looking at them and watching their reaction each time they come visiting was enough to tell me how scared and worried they were of their sons illness and the environment they were in. I started to wonder what was going on in their minds and was drawn to them not only for this reason but because the patient and his family members were the youngest I ever saw in the unit. I was thinking to myself if they halt asked questions or done any research about CCU they will most likely be thinking their sons situation is hopeless(prenominal).It is important to label and date all the lines as this helps to know what each is used 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 set back and difficult to reinsert a cannula on a patient as most of them are oeadematous. As I was involved in the care of the patient I had to beg off to the wife why her husband was connected to a ventilator and it use. A ventilator is an artificial external respiration machine that moves oxygen-enriched air in and out of your lungs.If your lungs have failed and you cannot breathing spacee on your own, you will need to be attached to a ventilator (See appendix 3). Being helped to breathe by a ventilator performer that you will usually need to be sedated. Ventilators can suggest different levels of breathing assistance. If you only need help breathing for a couple of days, it is likely you will have an endotracheal tube from the ventilator to your embouchure or nose. The tube will usually be held in place behind your neck as was the case with my patient. However, if you need help with breathing for to a greater extent than a few days, you may have a short operation called a tracheostomy.This replaces the tube in your mouth with a shorter tube that is placed immediately 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 two 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. elbow room of cellular respiration system should be tailored to the needs of the patient. Understanding these settings is important as they may need to be changed quickly.Once my patients next of kin fully understood the treatment he was receiving I could see this young ladys face soften a bit. I later learnt from my conversations with her that their 5years-old daughter, had been in the back seat with him when the accident occurred. She had not slept properly since the incident, expressing that she was afraid he would never come home. She has continually asked her mother and grand parents, When is daddy coming back home? The 5-year-old miss would not enter the parents bedchamber at home and insisted that the light remain on and has refused to take her bath as her dad evermore gave her a bath each evening.From this conversation I concluded that this little daughter needed to see, touch, heart and be with her dad to understand what had happened. I believe that she needs to be allowed to grieve and participate in the healing 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 maj ority of create studies evaluating family member charge in surgery have shown the positive effect it has on family members irrespective 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 everything 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 death occurred, families have reported that their presence gave them a sense of closure and facilitated the grief process, (Kingsnorth et al 2010). With this information I spoke with my mentor and she agree how awful 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 asked if I wanted to be involved with it, I said yes. We approached our patients f amily about scheduling an educational 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 handle the information but 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 as God may take him and Dad 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 wer e asked to draw picture 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 coiffure I could see that the little 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 look 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 might be beneficial. Now we were confronted with the hospital policy prohibiting children in the critical care unit. The sisters 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 siste r came back and asked the patients wife to take her daughter to the ICU door, patch 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 evidently 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.Except for the hum of ventilators, the unit was quiet as the little girl held hands with her father, stroked his hair, sang him a song and said goodnight with prayers. I savored this moment as I accomplished it was an important journey in the little girls life. As a student I concluded that surely there can be nothing superior to this type of care giving. by means of 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 understan ding 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 meliorate way to do this. Following the visit, we were told how the little girl had become more agreeable 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 humanity in a technologically driven healthcare system is advocated, (NHS Careers). I truly agree with this statement.For me the critical environment was a different setting and candidly I believe there can be no other like it. It is a very emotional setting that requires strong willed people yet competent in their jobs as well as having a heart full of love to care for their patient and 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 around as well.In my trust eye care is recognized as a basic nursing care mental process 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 individualized testify based eye care which ranges from no action required to hydration treatment with and sterile water to a more complex treatment prescribed by a doctor. If hydration or cleaned care is taken to wipe from the nasal 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 necessary, (X Hospital arrogance Policy). Appendix 2- Oral 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 vulnerable to complications if inadequate oral care is practiced.Also there are more factors that pose as barriers to carrying out effective oral care such as difficulty to admission price oral cavity, changes in mucosa and normal bacteria flora of the mouth, immunocompromise and medication, presence of endotracheal tubes, oral suctioning and therapeutic dehydration. found 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 away from the gums, change the tongue 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 w ater can be used in cases of extreme dryness as its is effective for moistening oral cavity. easygoing paraffin can also be used to prevent lips from cracking. Dentures are usually removed and cared for process when patient needs it, (X Hospital Trust Policy). Appendix 3 Understanding ventilators settings Tidal muckle This is the lung volume representing the normal volume of air displaced between normal inspiration and expiration with no extra effort. veritable(prenominal) 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 body weight is generally indicated. The goal is to dress the TV so that plateau pressures are less than 35 cm H2 O. Continuous mandatory ventilation (CMV) Breaths 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. In frontierittent 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 protection of the airway tubing and ventilator valves, which may be formidable. This mode has given way to synchronous intermittent mandatory ventilation (SIMV). Synchronous intermittent mandatory ventilation The ventilator delivers preset breaths in coordination with the respirato ry effort of the patient. Spontaneous breathing is allowed between breaths. These modes are beneficial for patients who require high minute ventilation. unspoilt support reduces oxygen consumption and CO2 production of the respiratory muscles.A potential drawback of A/C ventilation in the patient with obstructive airway disease is worsening of air trapping and breath stacking. Pressure support ventilation For the spontaneously breathing patient, pressure support ventilation (PSV) has been advocated to limit barotrauma and to lessen 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 extend falls below a certain cutoff.PSV is frequently the mode of choice in patients whose respiratory disaster is not severe and who have an adequate respiratory drive. It can result in improved patient comfort, reduced cardiovascul ar effects, reduced risk of barotrauma, and improved distribution of gas. CPAP is an acronym for continuous positive airway pressure, a variation 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 mean 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 unhealthy patients when using a permissive hypercapnia technique. Positive end-expiratory pressure Positive end-expiratory pressure (PEEP) is a term used in mechanical ventilation to denote an airway pressure that is kept above atmospheric pressure at the end of the expiratory cycle.The equivalent in a spontaneously breathing patient is CPAP. One obvious beneficial effect of PEEP is to shift lung water from the alveoli to th e perivascular interstitial space. It does not simplification the total amount of extravascular lung water. This is of clear benefit in cases of cardiogenic as well as noncardiogenic pulmonary edema. An excess 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? A pedagogical revolution in North American health care education. Refereed Program of the E-Leader Conference at Krakow, Poland, Chinese American Scholars Association, New York, New York, USA June 2008, Courey, A. J. and Hyzy, R. C. Up to date 19. 1(2010) Over view of mechanical ventilation. Availableat http//www. uptodate. com/contents/search? earch=ventilators&source=USER_INPUT&searchOffset=assessed on 13/03 /2011 Hatfield A, Tronson M, (2009), The arrant(a) Recovery Book, 4th edn. New York Oxford University Press. Chapter 2, Page 29. Johns, C. (2004) Becoming a Reflective Practitioner, 2nd edn. UK Blackwell Publishing Ltd. Kingsnorth, J. , OConnell,K. , Guzzetta, C. E. , Edens, J. C Atabaki, S. Mecherikunnel, A. and Brown, K. (2010)Journal of Emergency Nursing Family Presence During Trauma Activations and Medical Resuscitations in a pediatric Emergency Department An Evidence-Based Practice Project,36/2,pp115 NHS Careers (2009) Operating Department Practice. 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