11857 Health Across Lifespan: High Acuity Lecture Notes PDF

11857 Health Across Lifespan - High acuity care needs Mini Lecture – Technology and interprofessional teamwork in High Acuity Kate Steirn 11857 Health Across Lifespan - High acuity care needs Acknowledgement I wish to acknowledge the Ngunnawal/Darug people as the traditional custodians of the la...

11857 Health Across Lifespan - High acuity care needs Mini Lecture – Technology and interprofessional teamwork in High Acuity Kate Steirn 11857 Health Across Lifespan - High acuity care needs Acknowledgement I wish to acknowledge the Ngunnawal/Darug people as the traditional custodians of the lands where Bruce/Sydney Hills campus is situated. I wish to recognise any other people or families with connection to the lands of the ACT/Castle Hill and region. I acknowledge and respect First Nations peoples continuing culture and the contribution they make to the life of this city and this region. Kate Steirn 11857 Health across lifespan – high acuity care needs Lecture Objectives Technology in health care Clinical technology (monitoring and therapeutic/interventional) Clinical information technology Teamwork in high Acuity Role of the MDT members Teamwork strategies Digital clinical technology Monitoring Bedside monitors (including central station) End tidal CO2 monitoring Arterial blood gas analyser Invasive monitoring Arterial catheters Central venous pressure Intracranial pressure monitoring PiCCO/pulmonary artery (PA) catheter Access to imaging intensifier Ultrasound/mobile Xray Access to CT/MRI Digital clinical technology Therapeutic interventions ICU beds Ventilators (invasive and non-invasive) Infusion pumps Syringe drivers CVVHDF Resuscitators Temporary pacemakers Defibrillator Suctioning apparatus SCD machines And many others  Clinical Information Systems (CIS) Computerised order entry Dosing and (meds/ IVF, side effects diagnostic test standardised drug formulary Automatic Canberra health services.act.gov.au audits Drug interaction warning and patient alerts Lab / imaging results Criticisms of technology While technology has provided the nurse with many advantages and improved patient safety and outcomes it has digitalhealth.folio3.com/blog/clinical-decision- also given rise to some important issues or criticisms support-system-examples-tools/ Patient depersonalisation Should be used to enhance care and not replace nurse’s knowledge, assessment and observation skills and senses Can also lead to impediments to touching the patient Can be fear inducing for patients and families Overload and overreliance issues Data saturation alarm fatigue Careersmart.com/shop/alarm-fatigue-nurses- ccm-crc-cdms-nasw-2-ceus/  Teamwork Interprofessional care refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. Train in Silos however needs to know and understand each other’s knowledge, scope and focus. Engaging patients and families as partners in their healthcare is also critical. Donovan et al (2018). Interprofessional care and teamwork in the ICU Roles and focus of multidisciplinary team members Figure 10-5 Crisp et al 2021 p 189 Teamwork in high acuity Highly functional teams have: Safety viewed as a priority Flattened hierarchy that promotes speaking up about concerns Regular team training Use of effective methods of communicating Standardisation/clinical care guidelines Australian College of Nursing_monkey business images Clear delineation of team roles during emergencies Shared decision making RRS/MET teams REACH/CARE programs Teamwork strategies Protocols and clinical care guidelines Interprofessional ward rounding MDT case meetings Family conferences Team simulation training Team debriefing after critical incidents Unit based quality improvement initiatives Patient and family advisory groups – REACH End of life care coordinators References ACT Health (n.d). Canberra Health Services- Your Care Team. Retrieved from www.canberrahealthservices.act.gov.au Bucknall TK (2000) Critical care nurses’ decision making activities in the natural clinical setting. Journal of clinical nursing. 9 (1) 25-36 Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (2021). Potter & Perry’s Fundamentals of Nursing Australia and New Zealand (6th Eds) Elsevier Currey, J & Worrall-Carter, L (2001). Making decisions: nursing practices in critical care. Australian Critical Care. 14 (3) 127-131 Donovan, A.L., Aldrich, J.M., Gross, A.K., Barachas, D.M., Thornton, K.C., Schell-Chaple, H.M., Gropper, M.A., & Lipshutz, A.K. (2018). Interprofessional care and teamwork in the ICU. Critical Care Medicine. 45(6) 80 -990 Elliot, D., Aiken, L., & Chaboyer, W (2012) ACCCN’s Critical Care Nursing (2nd Ed) Elsevier Wagner, K., Hardin-Pierce, M., Welsh, D., Johnson, K. (2018). High-Acuity Nursing, (7th ed) Pearson  The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. 11857 Health Across Lifespan - High Acuity Mini Lecture – Person-centred approaches and family needs in high-acuity contexts Kate Steirn/Emily Wallis 11857 Health Across Lifespan - High Acuity Acknowledgement I wish to acknowledge the Ngunnawal people as the traditional custodians of the lands where Bruce campus is situated. I wish to recognise any other people or families with connection to the lands of the ACT and region. I acknowledge and respect First Nations peoples continuing culture and the contribution they make to the life of this city and this region. Kate Steirn/Emily Wallis 11857 Health across lifespan – high acuity care needs Supporting families Person Centred Care vs Family Centre Care Needs of family during critical illness 1. Need for information 2. Need for reassurance 3. Need for closeness 4. Need for support and comfort https://www.hamiltonfht.ca/en/who-we-are/what-is- patient-and-family-centred-care.aspx McCormack & McCance (2016) Person-Centred Practice Framework Meeting information needs Spend sufficient time with family members Information needs to make sense to them Assessing for understanding Repeating information and updating Determine when it is best to call family for updates Nurse led education sessions lower anxiety and improve satisfaction MDT rounds that include family and/or family meetings Leaflets and brochures Visiting practices Balancing privacy & confidentiality with need for family presence https://www.icudelirium.org/medical-professionals/family-engagement-and- empowerment The concept and interpretations of ‘family’ is highly variable Families can provide link to pre illness self and provide support and comfort Patients may want visitors restricted due to fatigue or visits causing stress Consider appropriateness of children visiting (E.g. closeness of relative, potential for trauma) Flexible visiting policies have been found to improve patient and family satisfaction but equally sometimes shown to contribute to staff and nurse burnout. Communication Inability to communicate causes or compounds anxiety, frustration and stress as people lose control over their life and decisions Communication barriers occur due to: mechanical devices (intubation) or Body language cognitive impairment from the disease and or Lip reading pharmacological medications or Writing language difficulties Alphabet boards Unconscious patients require verbal communication to Communication boards continue even during sedation Pictures gestures Cultural Care sensitivity Language needs: is an interpreter is required? Working with culturally and linguistically diverse people should be based on the following framework: 1. Partnerships Consider Preferences & Beliefs 2. Participation How the person prefers to be addressed 3. Protection Values and belief related to communication (eye contact, personal space or social taboos) Elliot, Aiken & Chaboyer (2018) Beliefs about health, illness, death and dying Locus of control health care providers (that is culture, gender or age) The nature of family support and family presence Food and nutrition How health and illness are managed (traditional healers, medicine, prayers) Religious practice patterns References Elliot, D., Aiken, L., & Chaboyer, W. (2018) ACCCN’s Critical Care Nursing. (3rd ed) Elsevier Hamilton Family Health Team (n.d.) What is Patient-and Family-Centred Care? Retrieved from https://www.hamiltonfht.ca/en/who-we-are/what-is-patient-and-family-centred-care.aspx McCormack, B., & McCance, T. (2021). The person-centred nursing framework. In Person-centred Nursing Research: Methodology, Methods and Outcomes (pp. 13-27). Springer, Cham. McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A., & Martin, S. (Eds.). (2021). Fundamentals of Person- centred Healthcare Practice. John Wiley & Sons. Slater, P., McCance, T. & McCormack, B. (2017). The development and testing of the Person-centred Practice Inventory – Staff (PCPI-S), International Journal for Quality in Health Care, 29 (4), https://doi.org/10.1093/intqhc/mzx066 References Vanderbilt University Medical Center (2024) ICU delirium prevention and safety - Family engagement and empowerment Retrieved from: https://www.icudelirium.org/medical-professionals/family-engagement-and- empowerment Wagner, K., Hardin-Pierce, M., Welsh, D., Johnson, K. (2018). High-Acuity Nursing, (7th ed). Pearson.  The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. 11857 Health Across Lifespan - High Acuity Mini Lecture – Fundamentals of Care Emily Wallis, 2025 Acknowledgement to Kate Steirn 11857 Health Across Lifespan - High Acuity Acknowledgement I wish to acknowledge the Ngunnawal/Darug people as the traditional custodians of the lands where Bruce/Sydney Hills campus is situated. I wish to recognise any other people or families with connection to the lands of the ACT/Castle Hill and region. I acknowledge and respect First Nations peoples continuing culture and the contribution they make to the life of this city and this region. 11857 Health across lifespan – high acuity care needs Lecture Objectives 1. Apply knowledge of fundamental care elements to high acuity settings 2. Consider safety for patient transport 3. Linking fundamental care and ‘missed care’ - Impacts and barriers 4. The impact of nursing leadership and fundamentals of care Fundamental care – definition “Fundamental care involves actions on the part of the nurse that respect and focus on a person’s essential needs to ensure their physical and psychosocial wellbeing. These needs are met by developing a positive and trusting relationship with the person being cared for as well as their family/carers” (Feo et al,. 2018). International Learning Collaborative Physical Psychological Relational  Seminal work by Kitson in 2010 and refined by Feo et al., in 2018, cited in Otonello et al. (2023, p. 2073). We know this, how do we apply this to high acuity areas? Communication, therapeutic touch, hair washing, shaving, perineal care, bowel care, mobility, oral care, pressure area prevention….. Fundamental care considerations A person/families individual requirements on clinical condition may influence the timing and way fundamental care, including personal hygiene is performed. Such as Pain Cultural preference Privacy and dignity Resources for safety Planning around interdisciplinary care Environmental temperature - heat loss Cooling febrile patients shivering may be contraindicated Fundamentals of care: oral care Oral care for a non-intubated patient Oral health assessment Twice daily toothbrushing, regular sips of fluid is recommended Immunocompromised or patients receiving high dose ABs may require antifungal mouthwash (thrush) Lip balms to prevent lips from cracking Strong association between pneumonia Oral care for unconscious intubated patients and inadequate oral care in ICU patients Variability in practices (Browne et al., cited A lack of consensus in literature regarding best practice (timing, products) in Haghighi et al, 2017) Using oral swabs only for oral hygiene is ineffective Toothbrush & toothpaste, with the addition of chlorhexidine mouthwash or gel may reduce incidence of VAP (Zhao et al, 2020). Good rinsing and suctioning of mouth is essential ETT can cause pressure areas on lips and in mouth,(frequent repositioning) Fundamentals of care: eye care Goals: Through eye assessment/care once per Comfort shift Protection Unconscious or paralysed patients may Incomplete eye closure can cause drying, infection, corneal erosion and scarring and require more frequent eye care vision loss (Agency for Clinical Innovation, Cleaning with sterile saline and 2024) sterile gauze every 2-4hrs Artificial tears 2- 4-hourly if patient receiving high flow oxygen therapy via a mask Eye closure with tape if eyelid closure is not achieved passively Fundamentals of Care – Physical comfort and mobility Goals: To facilitate patient activity to minimise Position for comfort muscles atrophy To enhance therapeutic benefits To implement early mobilisation as the patient condition allows To prevent pressure ulcers To ensure limbs are supported appropriately and to maintain flexible joints Fundamentals of Care – Pressure area care ICU patients risk for hospital acquired pressure injuries compared to non- ICU patients is 4 times higher (Coyer et al., 2022, p. 1787). (Coyer et al., 2022, p. 1788). Fundamentals of Care – Infection control Hospital Acquired infection (HAI): Prevention & Control Ventilator acquired pneumonia (VAP) Standard precautions; Transmission based Catheter associated UTIs (CAUTIs) precautions (contact, droplet, airborne) Central line associated bacteraemia (CLAB) Standard ANTT & Surgical ANTT Sepsis pathways/protocols Surveillance Administration of antibiotics; Antibiotic MRSA Screening (admission + regular intervals) impregnated catheters Inspection of lines & devices at insertion points Chlorhexidine solutions for signs of infection (redness, welling, heat and CVC dressings, lines, and IV administrations sets discomfort/pain) changed as per policy Fundamentals of care – VTE Prophylaxis Deep vein thrombosis (DVT) and pulmonary embolism (PE) are different conditions collectively referred to as venous thromboembolism (VTE). VTE prophylaxis: 1. Low molecular weight heparin is most effective pharmacological therapy (Fernando et al., 2022) 2. According to Fernando et al., (2022) compression devices may reduce VTE risk, such as graduated compression stockings and sequential compression devices (SCD) Considerations for safe transport of high acuity patient Intrahospital transfers Specific guidelines and hospital policies Risk/benefit assessment Experienced staff Appropriate equipment and monitoring Full assessment and careful stabilisations of patient prior to transfer Reassessment during transfer Continuing care during transfer Direct handover Documentation and audit  Missed Patient Care Impact of missed care Work environment Missed care associated with decreased nurse Inexperienced staff reported quality of care Patient safety culture Decreased job satisfaction Prioritisation of care considerations Increased staff turnover and intent to leave Nurse and patient personal values and behaviours Decreased patient satisfaction Lack of staff communication between shifts and Increased adverse events - Associated with skin teamwork and staff attitudes breakdown, medication error, new infection, IV Patient with poorer health status of mental health running dry or leaking problems reported more missed care. Causes: limited nursing resources Griffiths et al 2018; Gustafson et al 2020  Fundamentals of care and nursing leadership A qualitative systematic review established that nurse leadership was pivotal in elevating fundamental care standards (Pentecost et al., 2020). Prioritising, valuing and embedding fundamental care into nursing culture requires strong nursing leadership, voice and data (Pentecost et al., 2020; Pattison & Corser, 2022) Pattison & Corser (2022) argue that nurse leaders must communicate their vision for fundamental care prioritisation to colleagues, the organization and the wider patient population. Furthermore, Pattison & Corser (2022) argue that relational leadership approaches (transformational/compassionate styles) can model and embed the delivery of fundamentals of care by inspiring nursing teams to drive up quality and deliver optimum rather than sufficient care (Pattison & Corser, 2022).  References Agency for Clinical Innovation. (2024). Eye care of the critically ill. NSW Government. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/239731/ACI-Eye-Care-of-the-Critically-Ill-Clinical-Practice- Guide.pdf Coyer, F., Labeau, S., & Blot, S.. (2022). Preventing pressure injuries among patients in the intensive care unit: insights gained. Intensive Care Medicine, 48(12), 1787–1789. https://doi.org/10.1007/s00134-022- 06838-3 Wagner, K., Johnson, K., & Hardin-Pierce, M. G. (2018). High-Acuity Nursing, Global Edition (7th ed.). Pearson Fernando, S., Tran, A., Cheng, W., Sadeghirad, B., Arabi, Y., Cook, D., Moller, M., Mehta, S., Fowler, R., Burns, K., Wells, P., Carrier, M., Crowther, M., Scales., D., English, S., Kyeremanteng., K., Kangi, S., Kho, M. & Rochweg, B. (2022). VTE Prophylaxis in Critically Ill Adults. Chest., 161(2). https://doi.org/10.1016/j.chest.2021.08.050 Feo, R., Conroy, T., Jangland, E., Muntlin Athlin, Å., Brovall, M., Parr, J., Blomberg, K., & Kitson, A.. (2018). Towards a standardised definition for fundamental care: A modified Delphi study. Journal of Clinical Nursing, 27(11-12), 2285–2299. https://doi.org/10.1111/jocn.14247 Gustafsson, N., Leino-Kilpi, H., Prga, I., Suhonen, R., & Stolt, M. (2020). Missed Care from the Patient’s perspective – A Scoping Review. Dove Medical Press. Vol 14. 383-400 Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Brigss, J., Maruotti, A., Meredith, P., Smith, G.B., & Ball, J. (2018). The Associated between nurse staffing and omissions in nursing care: A Systematic review. Journal of Advanced Nursing. 74 (7) 1474 -1487 Haghighi et al. (2017). The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients. Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses., 30(2). https://doi.org/10.1016/j.aucc.2016.07.002 Ottonello, G., Napolitano, F., Musio Maria, E., Catania, G., Zanini, M., Aleo, G., Timmins, F., Sasso, L., & Bagnasco, A. (2023). Fundamental care: An evolutionary concept analysis. Journal of Advanced Nursing, 79(6), 2070–2080. https://doi.org/10.1111/jan.15451 Pattison, N. & Corser., R. (2023). Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge ornon‐sequitur? Journal of Advanced Nursing., 79(3). https://doi.org/10.1111/jan.15202 Pentecost, C., Frost, J., Sugg, H. V. R., Hilli, A., Goodwin, V. A., & Richards, D. A.. (2020). Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis. Journal of Clinical Nursing, 29(11-12), 1858–1882. https://doi.org/10.1111/jocn.15082 Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD008367. DOI: 10.1002/14651858.CD008367.pub4.  The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather. The University of Canberra acknowledges the Ngunnawal people, traditional custodians of the lands where Bruce Campus is situated. We wish to acknowledge and respect their continuing culture and the contribution they make to the life of Canberra and the region. We also acknowledge all other First Nations Peoples on whose lands we gather.