A Comprehensive Analysis of Patient Journey

For the purpose of this assignment the patient will be referred as a patient X.This assignment involves the physical assessment and analysis of the medical history of a patient X, as they change from community-based medical care to acute care. Communication between care providers are a key factor in ensuring continuity of care as well as the provision of safe patient care. Miscommunication during patient transfers is common and often results in adverse patient outcomes. The focus will be on discussing the impact and importance of A-E assessment and use of communication tools during the transfer of patients with patient X scenario being the case of reference as shown in appendices. Impacts as a result of physical and psychological emergencies or elective surgery will also be outlined as well as the diagnostic tests needed.

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The World Health Organisation (2020) points out that there must be effective communication in acute care settings to support and enable the provision of safe patient care. Fealy et al. (2019) note that communication is especially important during clinical handovers as they involve transferring information about the patient as well as the responsibility for care. The activity is routine as it takes place at change in duty shifts and other clinical contexts like interdepartmental transfers or transfers from community to hospital care. Decisions to transfer patients are made after assessments of potential risks and benefits to the patient with indications including the need for higher levels of care or specialized intervention or investigation (Fealy et al., 2019). Such a decision is necessary for patient X as she was found collapsed on the floor with bleeding wrists and cigarette burns on her legs and arms. However, transfers and handovers are highly vulnerable to communication failures with actual and potential adverse patient events that lead to significant patient harm, missed or delayed diagnosis, inadequate treatment and medication errors (Purwanza et al., 2020).

Risks of acute care adverse events are higher when the patient has complex needs like patient X history of personality disorder and mental health issues as nurses are often unprepared for such complexities and communication is necessary (Avery et al., 2020). It is therefore important to carry out assessments before transfer to ensure effective communication is accurate with sufficient information. The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) assessment approach is a systematic method which is essential to evaluate immediate diagnosis and treatment of patients (Soltan & Kim, 2016). The approach is easy to use and can be effectively applied within the streets as shown in various medical emergency cases as well as outpatient, away from the hospital and anywhere outdoors to prevent advanced impacts and save the patient. In an acute hospital care setting, advanced A-E assessment practices employed by the staff members can secure more time and help the team to achieve better performance (Slotan & Kim, 2016). The A-E assessment tool is important as it objectively provides life-saving remedies and simplifies complicated medical cases into simple situations manageable by layman’s language. It plays the role of a common lifesaver assessment and treatment algorithm, by establishing a common skills platform for all treatment providers to be aware of any medical situation and helps to secure extra time to determine accurate diagnosis and effect treatment (Soltan &Kim, 2016). The assessment can therefore be lifesaving for patient X as she was bleeding profusely from the wrist cuts.

In acute care situations, communication tools like the SBAR have been implemented with the aim of improving nurse-physician communication with the role of the tool at handover being supported and highlighted by various specialties (Ozekcin et al., 2015). The Joint Commission, Agency for Healthcare Research and Quality (AHRQ), Institute for Health Care Improvement (IHI), and World Health Organization (WHO) recognize SBAR (Situation, Background, Assessment, Recommendation) as an effective communication tool for patients’ handoff (Shahid & Thomas, 2018). The communication technique is described as Situation: what is the situation, why are you calling the physician, vital signs, and any concerns? Background: what is the background information: reason for admission, medical history, current medication, allergies? Assessment: what is your assessment, clinical impressions, and genuine concerns? Recommendation: how should the problem be corrected, making suggestions, clarifying expectations? Shahid and Thomas (2018) point out that it provides a structured format to present medical information in a short and logical sequence and it is concise and easy to use and it has been found useful in communication styles that may differ between care settings. Patient X has been transferred from a community care setting to an acute care setting. SBAR can create a common mental model in communication within care providers which can reduce adverse events. Physicians have also reported that through SBAR, nurses create reports that are adequate regarding patients and are enough for making clinical decisions (Shahid & Thomas, 2018).

Nurses may face particular barriers during handover as they try to establish effective communication that can escalate care for transferred patients like patient X. Fealy et al (2019) found that uniqueness and diversity of the team, previous experience with the team as well as the environment in which communication takes place can all influence whether the required relationship is developed and fostered. Barriers can be physical as well as psychosocial. Physical barriers include distractions, lack of privacy, background noise and acoustics as well as environment qualities like lighting, temperature and seating (Fealy et al., 2019). Psychosocial barriers include the emotional state of the nurse and other parties, trust between and within members of the team, cultural expectations, beliefs, and personal values as well as resistance of new procedures (Young et al., 2018). Power distance perceptions is also a barrier that can be vital to effective communication between the nurse and other team members especially physicians. Physician and nurse communication has often been found to be one way in nature and this leads to ineffective communication (Fealy et al., 2019).

According to Arnold and Boggs (2019), nurses may also fail to be incorporated in the care and comfort plans, resulting in disagreements between the nurses and other healthcare staff members. Additional barriers include relatives having unrealistic expectation on patient recovery, difficulties in coping among nurses due to inadequate experience and education, low staffing levels as well as environmental conditions (Fealy et al., 2019). Differences in communication styles between nurses and other care providers have also been reported as barriers that lead to communication errors (Arnold & Boggs, 2019). Such as the patient X case were community nurse can have different communication styles compared to the acute care providers. Differences in training and reporting expectations between nurses and other practitioners can also affect communication (Arnold & Boggs, 2019).

Janis (2016) argues that emergency or elective surgical operations pose significant physical and psychological impacts for surgical patients due to issues associated with prolonged recovery or permanent disability. Psychological anxiety and distress slow patients’ recovery as stress affects and reduce wound healing and interferes with the patient’s immunity (Hughes et al., 2017). Patient X had to undergo elective surgery to deal with the bleeding. The experiences of psychological distress such as depression or anxiety and fear of related issues like delayed recovery or long-lasting disability can result in negative patient outcomes. According to Raju and Reddy (2017), counseling services are necessary for surgical patients as well as their family members, mainly due to the psychological stresses associated with surgery. The stress of hospitalization disturbs the psychological and physical well-being of patients. Raju & Reddy (2017) report that lack of preparations for surgery, post-operative symptomology, negative beliefs and thoughts are significantly associated with psychiatric comorbidity. Pinto et al (2016) point out that psychological distress is among the complications associated with surgery and it is a significant predictor of the patient’s post-operative psychological outcome. Psychological distress due to surgical procedures increase the chances of physical impacts, this is because recovery rate is interfered with due to increased levels of depression and anxiety causing delayed wound healing and compromise immunity (Pinto et al., 2016).

Patient X has a history of mental issues as well as personality disorder and this can significantly impact her psychological state at the perioperative and postoperative periods. Depression risks are also identified as possible psychological complications of surgical interventions among patients who already have mental health issues (Ghoneim & O’Hara, 2016). The Mental Capacity Act (2005) (Alghrani et al., 2016) emphasizes the need for capacity assessments before provision of treatment and this can be relevant to patient X’s consciousness level. Involvement of a guardian or someone les with power of attorney in making decisions can ensure patient X gets the appropriate and required treatment.

The experiences of patient X in various care settings have been evaluated as well as the impact of acute care across care settings. Various communication and assessment tools like the SBAR and the ABCDE have been presented as well as their importance in ensuring effective transfer of patients in acute care. The nurse’s role in the acute care setting has also been presented and this has been emphasized in the areas of communication and continuation of care. Psychological and physical complications related to surgical interventions, especially among patients with histories of mental issues like patient X have also been discussed and the significance of diagnostic tests in the perioperative period emphasized.

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References

Alghrani, A., Case, P., & Fanning, J. (2016). The Mental Capacity Act 2005—ten years on. Medical Law Review, 24(3), 311-317.

Avery, J., Schreier, A., & Swanson, M. (2020). A complex population: Nurse's professional preparedness to care for medical-surgical patients with mental illness. Applied Nursing Research, 151232.

Fealy, G., Donnelly, S., Doyle, G., Brenner, M., Hughes, M., Mylotte, E., & Zaki, M. (2019). Clinical handover practices among healthcare practitioners in acute care services: A qualitative study. Journal of clinical nursing, 28(1-2), 80-88.

Ghoneim, M. M. and O’Hara, M. W. (2016). Depression and postoperative complications: an overview. BMC Surgery, 16, 5.

Hughes, O., MacQuhae, F., Rakosi, A., Herskovitz, I., & Kirsner, R. S. (2017). Stress and wound healing. In Stress and Skin Disorders (pp. 185-207). Springer, Cham.

Ozekcin, L. R., Tuite, P., Willner, K., & Hravnak, M. (2015). Simulation education: early identification of patient physiologic deterioration by acute care nurses. Clinical Nurse Specialist, 29(3), 166-173.

Pinto, A., Faiz, O., Davis, R., Almoudaris, A., & Vincent, C. (2016). Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. BMJ Open, 6(2), e007224.

Purwanza, S. W., Fitryasari, R., & Rahayu, P. (2020). Nurses Shift Handover Instrument Development Evaluation Using SBAR Effective Communication Method. International Journal of Psychosocial Rehabilitation, 24(09).

Raju, B., & Reddy, K. (2017). Are counseling services necessary for the surgical patients and their family members during hospitalization?. Journal of neurosciences in rural practice, 8(1), 114.

Shahid, S., & Thomas, S. (2018). Situation, Background, Assessment, Recommendation (SBAR) communication tool for handover in health care narrative review. Safety in Health, 4(1), 7.

Soltan, M., & Kim, M. (2016). The ABCDE approach explained. BMJ, 355.

World Health Organisation (2020). WHO principles for effective communications. https://www.who.int/about/communications/principles

Young, D. L., Seltzer, J., Glover, M., Outten, C., Lavazza, A., Manthey, E., & Needham, D. M. (2018). Identifying barriers to nurse-facilitated patient mobility in the intensive care unit. American Journal of Critical Care, 27(3), 186-193.

Appendix

Patient X is a female of 18 years. A care provider visiting to attend to her grandmothers’ leg ulcer finds her collapsed on the floor with bleeding wrists, and cigarette burns on legs and arms. The patient appears to be fitting with foam forming around her mouth and tissues that are dirty can also be seen with green sputum on them.

Primary and Secondary Adult Assessment

Identifying clinical deterioration early is vital for reduction of mortalities and prevention of subsequent cardiopulmonary arrest. Through close monitoring of physiological changes, patients who are deteriorating can be easily identified before the occurrence of serious negative events.

Patient Details

Primary and Secondary Adult Assessment

Airway Assessment

Airway Assessment

Do not move to breathing Assessment until Airway Patency is assured Breathing Assessment

Adequate ventilation is not ensured by patient airway. Breathing adequacy needs to be assessed.

Do not move to breathing Assessment until Airway Patency is assured Breathing Assessment Do not move to breathing Assessment until Airway Patency is assured Breathing Assessment

Circulation Assessment

Circulation Assessment

Disability Assessment

Disability Assessment

External/Exposure Assessment

External/Exposure Assessment

Full Patient Assessment

Full Patient Assessment

Goals

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