Geriatric Critical Care in the Emergency Department

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Table of Contents

Description of the Case
Feelings
Evaluation
Analysis
Conclusion
Action Plan
References

Description of the Case

The patient was an 83-year-old gentleman that has been experiencing specific health problems for the past three weeks. This situation was new to him as he is an independent person with no prior history of other medical conditions requiring urgent treatment. The principal symptom of the patient was shortness of breath, which led to the hospital visit. After conducting an X-ray survey, acute pulmonary edema with right-side lower lobe pneumonia was diagnosed. The patient’s state’s principal indicators included a temperature of 38.6, a heart rate of 140 bpm, a blood pressure of 108/56, and a respiratory rate of 33.

Moreover, the elderly man was diagnosed with COVID and blood gas in respiratory acidosis. In accordance with his health condition, he needed to be intubated due to the inability to use the machine for further continuous positive airway pressure (CPAP) therapy. He also needed to inform the doctor in the hospital’s intensive care unit about such circumstances. According to the assessment of medical personnel, the patient was not that distressed and could go to a general ward. With the consideration of all the given conditions, the doctor explained his situation and possible options to him.

Feelings

I managed to influence the outcome for the patient and convinced the doctor to change the initial decision, which was to refuse intubation. As he explained to the elderly man, in the case of the provision of intubation, it would take time to get him off the ventilator. Therefore, the doctor did not consider it appropriate to use intubation. However, there were other facts to examine, and I felt that it would be wrong to exclude specific ethical concerns corresponding to ICN and APHRA codes of ethics. Hence, the effectiveness of multidisciplinary teamwork is conditional upon the correspondence to the mentioned ethical standards.

The patient was puzzled when he was not given enough time to think. The doctor simply stated that he does not want to be on life support. I considered it as a hasty decision and talked to him about the circumstances of the patient’s life who catered for his wife and was quite an independent person (Sabeghi, Nasiri, Zarei, Tabar, & Golbaf, 2017). All in all, I was happy to have been the patient’s advocate.

Evaluation

On reflection, I realized that it is vital for medical personnel to cooperate in terms of making decisions on the care provided for patients. In the case of the elderly patient, I managed to employ the model of closed-loop communication allowing participants to clarify the correspondence of an original message to its interpretation by the recipient (Salik & Ashurst, 2019). According to this approach, the receipt of information by the patient should be verified by the medical personnel so that he could make an informed decision on the preferred option of care provision.

However, from the point of the fact given above, the actions of the doctor can be viewed as unprofessional. He did not give the patient enough time to think or process the received information on further treatment and decided without his consent. It was seen by the reaction of the elderly man who did not understand what the absence of intubation means for him and what harmful consequences it might bring. My suggestion to explain to the patient the meaning of the doctor’s suggestion changed the situation.

Analysis

After deciding on the patient’s intubation, he was admitted to the intensive care unit, and this is a positive outcome considering his condition. The importance of such measures is defined by the possibility that the general ward will not take him on high flow. His medical condition and previous history allowed the medical personnel to choose this type of treatment. In this situation, the correct choice of further care of the patient was possible on the grounds of cooperation between the doctor and me as a registered nurse. My contribution to the success of this experience was the consideration of all of the circumstances of the man’s life as well as the idea to provide him with extensive information on available options and their consequences.

In the context of a hospital, it is vital to ensure effective communication between patients and medical personnel. For this purpose, various verbal communication tools are used, and one of the most suitable options for such cases is known as iSoBAR (Redley, Bucknall, Evans, & Botti, 2016). In the case of the elderly patient, it was critical to ensure its safe transfer to ICU with the provision of sufficient information on his condition and the choices he made being aware of their circumstances. This type of checklist allows medical personnel to facilitate communication between them in terms of patients’ diagnoses and other specificities.

In the case of the wrong decision, it would result in less satisfaction of the person due to the lack of understanding of the provided options. Moreover, such a situation would worsen the communication between him and the medical personnel, which is crucial for further decisions regarding the treatment. It would also impose additional risks due to the absence of intubation when it is needed.

Conclusion

In the process of provision of healthcare services to elderly patients, I have learned about the importance of cooperation when making decisions on the choice of available options with consideration of various circumstances. As a result, I improved my communication skills, which are vital in terms of discussing the issues with other doctors and nurses. They would help me in my future work as a registered nurse in negotiations and multidisciplinary team meetings. This experience allowed me to define my future learning direction. I performed relatively well in the situation requiring the use of communication skills but I need to adopt the models allowing me to develop them.

Action Plan

To enhance my communication skills, I intend to learn the approaches allowing nurses to respond quickly to changes. The next target is to study the practical implementation of such models of behavior as DRSABCD (Colbeck et al., 2018). This model includes the actions in the case of unfamiliar situations, and it would be helpful with such patients with unpredictable outcomes of treatment. Its use is critical for clinical care nurses in emergency departments as they have to be able to timely adjust to any emerging complications.

References

Colbeck, M.A., Maria, S., Eaton, G., Campbell, C., Batt, A.M., & Caffey, M.R. (2018). International examination and synthesis of the primary and secondary surveys in paramedicine. Irish Journal of Paramedicine, 3(2).

Redley, B., Bucknall, T.K., Evans, S., & Botti, M. (2016). Inter-professional clinical handover in post-anaesthetic care units: Tools to improve quality and safety.International Journal for Quality in Health Care, 28(5), 573–579.

Salik, I., & Ashurst, J. V. (2019). Closed loop communication training in medical simulation. [StatPearls].

Sabeghi, H., Nasiri, A., Zarei, M., Tabar, A. K., & Golbaf, D. (2017). Respecting for human dignity in elders caring in perspective of nurses and elderly patients. Medical Ethics Journal, 9(32), 45-70.

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