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Lecture Objectives

• The point is to consider the role of technology and teamwork in high-acuity settings.
• Clinical technology (monitoring and therapeutic/interventional) and information technology is the primary focus
• The objectives look at teamwork in high acuity, the role of the multidisciplinary team (MDT) members, and different teamwork strategies

Digital Clinical Technology: Monitoring

• Bedside monitors, including central stations are used
• End-tidal CO2 monitoring provides crucial respiratory information
• Arterial blood gas analysis assesses oxygenation, ventilation, and acid-base balance
• Invasive monitoring includes the insertion of arterial catheters for continuous blood pressure monitoring
• Central venous pressure monitoring assesses fluid volume status and right heart function
• Intracranial pressure monitoring manages patients with head trauma or neurological conditions
• PiCCO (pulse induced contour cardiac output)/pulmonary artery (PA) catheters help optimize hemodynamic management
• Imaging intensifiers enhance visualization during surgical procedures, providing real-time feedback
• Ultrasound and mobile X-ray enable rapid diagnostic imaging at the bedside
• Access to CT/MRI scans provides detailed anatomical and pathological information

Digital Clinical Technology: Therapeutic Interventions

• ICU beds are specialized to provide support and facilitate patient care in critical conditions
• Ventilators—invasive and non-invasive—support or replace the patient's breathing
• Infusion pumps deliver medications and fluids at precise rates
• Syringe drivers administer medications in small, controlled doses
• Continuous veno-venous hemodiafiltration (CVVHDF) is used for continuous renal replacement therapy
• Resuscitators provide manual ventilation during emergencies
• Temporary pacemakers regulate heart rhythm
• Defibrillators deliver electrical shocks to restore normal heart rhythm
• Suctioning apparatus removes secretions from the airway
• Sequential compression devices (SCD) improve blood circulation and prevent blood clots

Clinical Information Systems (CIS)

• CIS assists with dosing and side effects through standardized drug formularies
• Computerized order entry systems reduce medication errors and streamline the ordering of medications and diagnostic tests
• CIS provides drug interaction warnings and patient alerts to prevent adverse reactions
• Automatic audits ensure compliance with protocols and guidelines
• CIS delivers lab and imaging results quickly to health professionals

Criticisms of Technology

• Technology usage can lead to patient depersonalization
• Technology should enhance a nurse's assessment skills, not replace them
• It might impede the physical act of touching the patient and can be fear-inducing for patients and families
• Technology can cause overload and overreliance, resulting in data saturation and alarm fatigue

Teamwork

• Interprofessional care occurs when a team of healthcare professionals with overlapping expertise provide coordinated care
• Partners are team members achieving a common goal
• Training individuals in silos should understand each other’s knowledge
• Engaging patients and families as partners in their healthcare is critical for optimal outcomes

Multidisciplinary Team Members

• Nurses monitor vital signs, wound care, respiratory function, nutrition, emotional responses, and manage stoma and tracheotomy care
• Social workers offer adaptation, emotional support, and access to community services
• Physiotherapists focus on mobility, chest and airway management, exercises, and discharge planning
• Occupational therapists offer support for aids and equipment, discharge planning, home and work modifications
• Surgeons focus on wound healing, tracheostomy function, treatments, , and medications
• Speech therapists are responsible for speech retraining, swallowing, and discharge planning
• Dieticians provide dietary support to assist growth and regeneration

Teamwork in High Acuity

• Highly functional teams prioritize safety and psychological safety
• The team structure has a flattened hierarchy encouraging all team members to speak up
• Utilizes regular training, effective communication, standardization, and clear roles
• Shared decision-making, along with Rapid Response Systems (RRS)/Medical Emergency Teams (MET), and REACH/CARE programs are essential

Teamwork Strategies

• Protocols and clinical care guidelines
• Interprofessional ward rounding to facilitate shared understanding
• MDT case meetings to coordinate comprehensive care plans
• Family conferences to involve and inform the patient’s family
• Simulation training that improves teamwork and preparedness
• Team debriefing after critical incidents to promote reflection and learning
• Unit-based quality improvement for continuous improvements
• Patient and family advisory groups to incorporate feedback

Supporting Families

• There is a need for a family-centered approach
• Needs during critical illness include:
  • Information
  • Reassurance
  • Closeness
  • Support and comfort

Meeting Information Needs

• Spend sufficient time with family members
• Information needs to make sense to them, which requires assessment for understanding
• Repeat and update information
• Determine when it is best to call families
• Nurse-led education and MDT rounds can include family meetings
• Leaflets and brochures also help with disseminating information

Visiting Practices in Healthcare Settings

• A balance is necessary between patient privacy, confidentiality, and family presence
• The concept of family can be interpreted differently
• Families can link the patient to their pre-illness self
• Fatigue among patients can lead to visitor restrictions
• Evaluating whether or not children should visit depending on trauma
• Flexible visiting policies have improved patient and family satisfaction, and have burdened staff and nurses

Communication

• The inability to communicate in high acuity settings often triggers anxiety
• Communication difficulties can be triggered by these factors
  • Mechanical devices can be installed
  • cognitive impairment may arise from disease
  • pharmacological medications may be administered
  • Language differences may exist
• Verbal communication and sedation is required for unconscious patients

Facilitating Communication

• Various strategies facilitate communication, including:
  • Body language
  • Lip reading
  • Writing tools
  • Alphabet boards
  • Communication boards
  • Pictures
  • Gestures

Cultural Care Sensitivity

• Is an interpreter is required to promote good communication
• Understand people's beliefs and preferences, including:
  • How they like to be addressed
  • Whether there are values and beliefs related to communicating
  • Ideas about illness, dying, and death
  • What their locus of control is
  • Who they rely on as health providers, gender, or age of provider
  • Who gives family support
  • What food and nutrition they require
  • Which religious practices they maintain
  • How illnesses are traditionally managed

Fundamental Care: Definition

• Encompasses nurse actions that appreciate a person’s essential needs
• Ensures physical and psychosocial well-being
• Positive relationships develop with the person along with family/carers
• Includes areas for physical, psychological, and relational wellness

Overview of Fundamental Care Needs

• Includes ensuring safety and harm prevention
• Communication and education are vital in care
• Providing sufficient nutrition is essential for health
• Support elimination and meet personal cleaning needs
• Prioritize maintaining rest/sleep
• Provide physical comfort and pain management
• Emotional support fosters well-being
• Respect maintaining a sense of dignity
• Promoting a sense of privacy
• Respecting a person's choices
• Assisting promote mobility during hospital stay

Considerations for Fundamental Care

• Consider individual requirements and the clinical condition of the individual
• Consider culture around fundamental care
• Consider patient sensitivity around privacy
• Allocate the required safety resources
• Coordinate care between healthcare professionals
• Consider physical environment around temperature

Oral Care Guidance

• Routine dental and oral health assessment
• Twice-daily toothbrushing, and regular sips of fluid is recommended
• Immunocompromised patients are at risk of thrush if receiving high does ABs
• Lip balms prevent lips from cracking
• Oral care for unconscious intubated patients:
  • Practices can vary
  • The effectiveness of just using oral swabs for cleaning is ineffective
  • toothbrushes, toothpaste, and chlorhexidine mouthwash reduces VAP

Eye Care Goals

• Comfort and hygiene are key goals
• Protection of vision is important
• Use an assessment performed once per shift
• Lack of eye closure results in corneal erosion and scarring
• Patients with paralysis can have frequent eye care
• Use sterile saline to clean sterile gauze
• Artificial tear application every 2–4 hours
• Applying tape, if necessary can maintain eye closure

Strategies to Promote Physical Comfort and Mobility

• Position patients for comfort
• Promote therapeutic benefits
• Prevent pressure ulcers
• Support limbs to prevent injury
• Provide assistance to limit atrophy
• Early mobilization depends on specific conditions

Care Strategies for Pressure Injuries

• Pressure redistribution is critical
• Conduct regular skin inspections and assessments
• Routine hygiene should be done on a regular basis
• Size devices like tubes appropriately, and check skin
• Turn and change positions regularly

Hospital Acquired Infections

• Major HAIs include VAP (ventilator-acquired pneumonia)
• CAUTIs (catheter-associated UTIs)
• CLAB (central line associated bloodstream infection)
• Surveillance for HAIs includes MRSA screening
• Conduct insertion points for signs of infection

Infection Control: Preventative Measures

• Standard and transmission precautions
• Surgical aseptic techniques
• Antibiotics should be administered along with antibiotic-impregnated catheters
• Chlorhexidine solutions
• Dressing, lines and sets should be changed

Prevent Blood Clots (VTE Prophylaxis)

• VTE (venous thromboembolism), includes DVT (deep vein thrombosis) and PE (pulmonary embolism)
• Prophylaxis methods include low molecular weight heparin
• Compression to wear graduated stockings

Intrahospital Transfers: Safety

• Make sure you follow safety protocols
• Conduct risk/benefit analyses to determine if the patient is safe to transfer
• All equipment has to be available and working correctly
• The patient needs full assessment -Ensure an experienced, qualified team accompanies the patient
• Ongoing transfers require reassessment of patient during transfer
• Clear communication and handovers
• All transfers require documentation and audits

Missed Patient Care

• Nurse quality decreases with missed care
• Leading to decrease in job satisfaction
• Resulting in turnover
• As well as patient satisfaction and events that affect skin
• Causes:
  • High resources are needed
  • Inexperienced staff
  • Environment leads to safety
  • Values result in poor staff behavior

Foundations of Nursing

• Nurse leadership results in fundamental care
• Team is key
• There must be high levels of communication