Objectives

Identifying the evidence based practice relating to the nursing care of the critically ill patient?

The word evidence-based practice was first documented in 1991 by a clinical epidemiologist. It may be defined as a scientific procedure which apply various abnormal physiological condition based evidence and associating patient values in the management of patient care. It has three fundamental pillars that is physiological evidence , clinical expenditure and patient value associated with preference. And to this particular concern  nursing care have significant relationship. Nursing staff , health care facility and more of all patients, all are distinctly participated in health care system. The educational and practical efficacy of nurse, complexity of  patient physical condition and available operational facility, these all are significant factor in nursing care, especially in the case related to critically ill patient (Blevins, 2008).

Managing staff & associated personnel need to identify multiple variables prior to prominent performance. Most of the time skilled critical care nurses determining the significicance and levels of nursing stuffing as they have vast knowledge & experience for optimum patient need. (Brown, Swigris and Fischer, 2012)

• Comprehensive understanding of responsibilities and assessment of nursing care system for critical patient.
• Clarify the risk associated with physically complex condition patient to unsatisfied facility.
• Understanding the principle assay
• Ability to grip the appropriate timing sence to escalate management system of critical patient
• Proper comprehension regarding infection control and its effect on deteriorating patient.
• Acknowledgement of provision related to hygenicity and nursing care.
• Understanding of managing strategy associated with patient airways.

For acute ill, traumatic patient or other complicated physiological condition Hospitalization is usually occurs. A literature review shows that with the average time of length 4.5 days in 2005 there were the cases of 39.1 million. associated risks along with infection of risk is brings with hospitalization. (Davies and Leslie, 2012) Though critically sick patient have always been there but the concept of nursing care is recently evaluated on the patient need basis along with healthcare environment. As the new doses form of drug are launch in the patient care became complicated. In 1950 the intensive care unit firstly developed for physically very complicated patient. Generally these patients required 1 to 1 care of nurse. (Elliott Aitken, and Chaboyer 2012)

The report of 1996, March shows in U.S dept of health there are 273,851 nurses who are associated with health management of critically complex patient. It also indicate that 25% nurse are the responsible to care for critically sick patient of whole nursing population.

As stated by Davies and Leslie (2012) the professional care of critically acute patient by nusing care is depend upon various relevant factors like evidence-based practice , related healthcare facility to explore patient responses and associated phenomena. There are some  standard approaches for nursing care in critically ill patient. (Jevon, and Ewens, 2012)

Approach-1

Collection of proper  relevant data regarding patient regular health monitoring for the treatment of critically ill patient.

Approach-2

Analysis of  survey data related to  patient various physiological test report by nurse caring to comprehend the diagnosis and treatment of critical care patient.

Approach-3

Responses and clarified resultant form the patient and patient’s condition by the skilled critical care nurse.

Appropach-4

Preparing a concise plan associated with various relevant clinical findings which gives structural overview from admitting to attain resultant.

Approach-5

For promoting optimum health care  and  facilitated environment, implementation of plan, coordination of care process and application of strategies in order to nursing care of critically ill patient.

Background

Approach-6

Collection of Positive or negative resoponses from patient point of view towards the applied programmable strategies and management.

Approach-7

Scientific evaluation and analysis of responses and final blueprint of treatment after discussion with physician in order to improve the affectivity as well as quality of critically care nursing practice.

When a patient stays  prolonged time span in hospital, particularly in intensive care unit   for some serious physiological disorder or multiple organ dysfunction then some other problems also may appear. Such as problems associated with muscle stiffness, physiological disorder, deconditioning symptom, poor mental alteration, airway infection or other fundamental related organ due to lack of hygenicity, besides this problems associated with  breathing, circulatory system. (Kuehn, 2012 ). It may be also related to disability of one fundamental organ  like heart,lungs or kidney or partially or complete failure of multiple organ. Nutritional abnormality inherited by internal metabolic system also a significant element. These all factor and some other more factors  are greatly influenced the evidence based nursing related to care of critically ill patient.( McDonagh, and Micheli, 2012)

Here a detailed discussion will be there over the problems associated with airway.

Among  various complex problems or disorder of  human body system related to airway, pneumonia is most in focus in modern health care system. It is one of the most cultured administered nosocomial infection associated to hospital. (Missioncare.org.uk,2015) Pneumonia associated with ventilator (VAP)  is a very common among the various type of serious airway problems.

In the cost of each particular  patients’ care unit, of more than $10,250 are adds because it almost 2time more fatal and also increases the time span of ICU service. (Scott, 2012)

This recommendation associated with evidence-based practice for the treatrment of nosocomial pneumonia in  the disease control and prevention which is  centre for treatment and research, is published in medical article in  2004. (Betamethasone/temozolomide. 2012. Reactions Weekly, p.13)Various serious responsibility related to interventions of pneumonia associated with ventilator may be greatly affected by nursing care. In the case of  pneumonia associated with hospital critical care nurses have great responsibility particu;larly for the serious stage patient and also for ,auto mechanical ventilation, status after operation.( Taunton, 2015)         

Compromised airway is generally occur by  medicators release from basophills of human body which are responsible for some complicated , multiple reaction. (Urden, Stacy,and Lough, 2012)

Clinically cold and some more serious disorder like bacterial sinusitis also allergy are included to it. There are also some additional characterisatiomn are may be identified.

• complication related to mucosal erythema as well as edema.
• discharge from nasal base like transparent followed by denced greenish or yellow secretion for consecutively several days.
• There is also sign associated with fever mainly shows in adults temperature may like to be 101 degree F or may higher.
• There will be also foul breath.
• Breaythlessness or shortness of breath in patient
• A markedly sharp pain of chest associated with inflammation will also may occur.

The abnormalities associated with airway track is mainly due to air sacs infection of lungs by various bacteria or viuses. among these most of the cases it is the responsibility of bacteria, known as stepcoccus pneumonia and in children basically viral pneumonia is mostly shown. (White, and Dudley-Brown, 2012)

As lungs is divided in the each lobes –left lung consisted with 2 lobes and right lung with 3 lobes. A one lobe  or multiple lobes could be affected by pneumonia at a time.generally it is associated with following steps

• Steps of vascular congestion of lobe.
• Lobe became redish which associated with liver accusation.
• After then lobe of lungs became dry and grayish. As inflammatory cell destroyed, neutrophillic cell became excudates in decreasing manner.
• Gradually lung alteration is conducted as fibrinous became liquefied.

Optimal parameters for critical care evidence based nursing practice

 Critical care nurse have to take over mainly four factor such as hygiene factor related to hand, management of respiratory track , positioning of patient and knowledge of staff.

1. In the management of abnormality related to airway passage for critically sick patient,

 hand hygene is significant factor. Prominent evidence suggested that Infection of  fatal pathogens from stuff and nurses associated with critical care management to hands of affected patient may markedly reduced by washing the hand with alcohol. And even it is far more anti-bacterial and effective than simple medicated  soap. The much preferable  process is wash hand with warm water along with antimicrobial soap. Glove which needed to be wom in case of respiratory secretion. With each patient handling contamination free, well washed hand and changes of gloves should be fundamental requirement. It is also applicable for the handling of single  patient associated with contaminated body parts and the lower or upper respiratory track equipment. (Winkelman, 2013)

Particularly in case of postoperative critically care patient, respiratory track complication may significantly minimizes by the exercise of deep-breathing which is a important factor for nursing management. A long-term research on meta-analysis conducted from 1966 to 1991 suggested the impact of exercise associated with deep breathing performed by McIntosh. The study  also taking the other factor like spirometry and condition after operation. The result also shows that even than medicinal treatment the particular exercise along with spirometry is much more fruitful.

A present-day study taking subjects into two group. first who are maintaining deep-breathing after surgery of upper abdominal, second who are in the group without after that sugery. Results shows that complication related to upper airway track were markedly improve in exercising conducting group upto 8.5% versus 20.5% in the group which is controlled.Even after a surgery of coronary artery this breathing exercise proven to be more significant and risk of further attacking of disease also reduced. (York and Kane, 2013)

Besides that another significant evidence based factor in nursing care for critically ill patient obviously will be respiratory management equipments and the validation method regarding their decontamination as well as sterilization also. There is still some underwork strategies regarding application of catheters and the use methodology of it for management of abnormal airway condition.

A significant role is drown upon concerning the treatment of abnormal airway condition of physiologically complicated patient. Elevated head followed by the body position is prominent which could minimizes the reflux rate of esophageal which is associated with pneumonia along with hospital admission. In difference with that position in supine stage is independent for risk factor in fatal patient  or patient who are in mechanical ventilation.

A recent scientific study in crossover base have been done in two groups like, one group with recumbent position and other hold in supine position. The study was performed in 19 complicated  patient which are in mechanical ventilation. The results shows after radio labeling that the more count of radioactive gastric elements in subjects where it is held in supine position than the position of recumbent.

The inexpensive as well as simple intervention when the patient’s elevated head position on bed at risk of critically sick patient. But till the opposite effect of this elevated head position is  not been analyzed in subjects without any contraindication. Another recent study in the coordination to  backrest elevation of  pneumonia associated with ventilation. It is done on  65 subjects.elevation of backrest was consistently monitored. Average backrest elevation is 21.8 degrees, for complete study span. Here by a statistical procedure calculative design, the risk of pneumonia on day 4 is 80%  in the variability. (Yao, Malhotra, and Fontes, 2012)

Education of staff especially along with nurses who are closely related with the management of critically sick patient or those who are in the deep ventilation is the fundamental element. Physician should be proponented by a skilled nurse in order to minimize the chances of pneumonia associated with ventilation in addition to launching the appropriate practice for the management of critically ill patient. Targetting of minimizing the evidence of pneumonia associated with ventilation applying a self-study design on element related to risk and developed practiceexolained outcomes on other trial. The knowledge design, preferred to abnormal airway care physician and critical nurses which was performed by prominent team with sound scientific knowledge.

Conclusion-  

For understanding the management of serious disorder associated patient, their behavior and relatively collected proper response of the patient a critical care nursing should must cply with some fundamental facts like the guide-line based on scientific evidence, structural analyzing design, and theories which are relevant to concern critical condition etc. Such thought provoking application could provides fundamentals of nursing care in health care system for critically ill patient. Although various fields are still not in focused related to which may be proven as significant key factor in future for this concern.

References-

Betamethasone/temozolomide. (2012). Reactions Weekly, &NA;(1420), p.13.

Blevins, E. (2008). Exploring nurses’ knowledge and attitudes regarding hand hygiene and general practice guidelines.

Brown, K., Swigris, J. and Fischer, A. (2012). Interstitial Lung Diseases and Autoimmune Lung Diseases, An Issue of Immunology and Allergy Clinics. London: Elsevier Health Sciences.

Davies, H. and Leslie, G. (2012). Acute Kidney Injury and the Critically Ill Patient. Dimensions of Critical Care Nursing, 31(3), pp.135-152.

Elliott, D., Aitken, L. and Chaboyer, W. (2012). ACCCN’s critical care nursing. Chatswood, N.S.W.: Mosby/Elsevier.

Jevon, P. and Ewens, B. (2012). Monitoring the critically ill patient. Chichester, West Sussex: Wiley-Blackwell.

Kuehn, B. (2012). Pneumonia Vaccine. JAMA, 307(8).

McDonagh, D. and Micheli, L. (2012). FIMS sports medicine manual. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Missioncare.org.uk, (2015). Care Home London | Nursing Care Homes | Residential Care Homes | Nursing Homes. [online] Available at: https://www.missioncare.org.uk/ [Accessed 13 Mar. 2015].

Scott, P. (2012). Inhalation pneumonia (aspiration pneumonia) in adult cattle. Livestock, 17(7), pp.17-19.

Taunton, W. (2015). Welcome to Horizon. [online] Horizoncare.org. Available at: https://www.horizoncare.org/ [Accessed 13 Mar. 2015].

Urden, L., Stacy, K. and Lough, M. (2012). Priorities in critical care nursing. St. Louis, Mo.: Elsevier/Mosby.

White, K. and Dudley-Brown, S. (2012). Translation of evidence into nursing and health care practice. New York: Springer Pub. Co.

Winkelman, C. (2013). Mechanisms for Muscle Health in the Critically Ill Patient. Critical Care Nursing Quarterly, 36(1), pp.5-16.

Yao, F., Malhotra, V. and Fontes, M. (2012). Yao & Artusio’s anesthesiology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

York, N. and Kane, C. (2013). Caring for the Critically Ill Patient With Tuberculosis. Dimensions of Critical Care Nursing, 32(1), pp.6-11.