Critical Care Nursing.

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Introduction:

The scenario included in Appendix n.1 shows multiple errors consequently leading to a patient’s deterioration. There was poor communication and record-keeping leading to an incomplete Early Warning Score Chart (EWS) and Fluid Balance Chart, and lack of practical knowledge and skills of the nursing staff in recognizing signs of deterioration of the patient. Furthermore, there is failure to understand the life-saving importance of intravenous antibiotics and the necessity of intravenous access in the case of emergency in acutely ill patients, and failure of the regular review of the patient by the nurses and doctors alike. Identified as the primary issue is the lack of communication and secondary problem an incomplete fluid balance chart, so it is evident that the lack of the communication (verbal and written) lead to a secondary problem and consequently to a deterioration of Mr. Albert.

Essential components in delivering high quality nursing care are good communication and interpersonal skills (Webb, 2011). Nursing and Midwifery Council (NMC, 2010) identified communication as one of the essential skills that students must acquire in order to make progress through their education and training to become qualified nurses. The Department of Health (DH, 2010) initiated The Essence of Care – the government’s strategy to improve the quality of the fundamental aspects of nursing care – which has communication as one of its ten key benchmark areas and stated that staff should communicate effectively with each other to ensure continuity, safety and quality of health care for all. The National Patient Safety Agency (NPSA, 2007) identified communication difficulties as a major factor affecting patient outcomes. Particular concerns included incomplete documentation and nurses not being clear and confident in their reporting. As an outcome of these findings, the essential professional guidelines highlighted health care professional’s legal accountability for the maintenance of accurate and up to date records (NMC, 2008) as poor communication and record keeping can be dangerous, and misunderstanding can lead to misdiagnosis and even medication errors (DH, 2010).

Fluid chart is one of the methods of nursing communication as its correct filling is an essential tool in determining hydration, although many researches indicated another major problem responsible for the poor recording of fluid balance charts. Education, especially life-long continuing professional development, is highly emphasized by DH framework (2004) as an essential feature of maintaining competent professional practice. This is equally supported by The Code (NMC, 2008), as presented in Appendix n.3, which recognizes the importance of appropriate learning and practice activities to maintain and develop the nurses’ competence and performance.

According to NMC guidelines (2008), names mentioned in the assignment are altered as set in the Code for nurses and midwifes to respect people’s right to confidentiality.

Core:

Fluid balance is a term used to describe the balance of the input and output of fluids in the body allowing metabolic processes to function correctly (Welch, 2010) and is influenced by dietary intake, illness and the environment (Scales et al, 2008). A fluctuation in fluid volume of just 5-10 % can have an adverse effect on health (Sheppard et al, 2006). Scales and Pilsworth (2008) identified three elements for assessing fluid balance and hydration status: clinical assessment, review of fluid balance charts and review of blood chemistry.

The physical symptoms of fluid imbalance as present in Appendix n.2 are part of the clinical assessment and should be never omitted when drawing a picture of overall patient hydration status. McMillen (2011) described the fluid balance chart as a record of a patient’s fluid input and output in 24 hours (Appendix n.1.4, 1.5 and 1.6). Critically ill patients cannot maintain normal water and...
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