Week 1 Content Flashcards
What is Acute Care?
Acute care is the (DEFINITION NEEDED)
NICE: Emergency and Acute Medical Care in Over 16s
NICE Quality Statements
Published September 2018
Statement 1: Ambulance services have specialist and advanced paramedic practitioners.
Statement 2: Adults who are admitted with undifferentiated medical emergencies are assessed and initially treated in an acute medical unit.
Statement 3: Adults admitted with a medical emergency have a timely consultant assessment and review.
Statement 4: Adults admitted with a medical emergency have a structured patient handover during transitions of care.
What do we class as Acute Care?
- Emergency care
- Urgent care
- Short term stabilisation
- Pre hospital care
- Critical care
- Trauma care
- Acute care surgery
Why is it so essential to consider effective team working and communication within the Acute care setting?
It’s essential that we recognise how different environments and stressors impact on how people communicate. Acute presentations normally bring about a degree of anxiety from both the patient and the staff members.
As nurses we have to consider the situation, presenting complaint, history and environment to be able to provide effective communication and more importantly to be able to gather information from our patients to perform a thorough assessment.
Our initial assessment provides us as clinicians important information to triage and make informed decisions on what happens next with our patients. In acute presentations situations may change suddenly and quickly, nurses are in a position to make continuous assessments and update and change plans of care.
Factors to consider when working in an acute care environment
External Factors:
Weather, seasonal illness, major incidents, health education, community service provision, volume, government targets
Internal Factors:
Hospital pressures, winter bed crisis, long waiting times, staff crisis, volume and demand, staff skill, funding, communication, team working
ABCDE - Acute Assessment
A B C D E
A irway
B reathing
C irculation
D isability
E xposure
ABCDE is a quick and effective tool which healthcare professionals can use to make an assessment which aids the prioritisation of care.
Barriers to communication in an acute setting …
- Language
- Cardiac arrest
- Pain
- Confusion
- Anxiety
- Stress
- Reduced consciousness
- Learning disability
- Mental health
- Cognitive impairment
- Intoxication (drugs and alcohol)
SBAR - Effective Handover Tool
S ituation
B ackground
A ssessment
R ecommendations
Safeguarding - Types of abuse
- Physical abuse
- Emotional abuse
- Sexual abuse
- Child sexual exploitation
- Female genital mutilation
- Radicalisation
The ABCDE approach underlying principles …
- Use the ABCDE approach to assess and treat the patient.
- Do a complete initial assessment and re-assess regularly.
- Treat life-threatening problems before moving to the next part of the assessment.
- Assess the effects of treatment
- Recognise when you will need extra help. Call for appropriate help early.
- Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously.
- Communicate effectively - use the SBAR or RSVP approach.
- The aim of the initial treatment is to keep the patient alive, and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis.
ABCDE Approach - First Steps
Resuscitation Council UK Guidelines
- Ensure personal safety. Wear apron and gloves as appropriate.
- First look at the patient in general to see if the patient appears unwell.
- If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed. Shake them and ask “Are you alright?” If the patient responds normally then they have a patent airway, is breathing and has brain perfusion. If they speak only in short sentences, they may have breathing problems. Failure of the patient to respond is a clear marker of critical illness.
- This first ‘Look, Listen, Feel of the patient should take 30 seconds and will often indicate if a patient is critically ill and there is need for urgent help. Ask a colleague to ensure appropriate help is coming.
- If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) START CPR according to the resuscitation guidelines. Feel for a pulse to determine if the patient has a respiratory arrest. If there are any doubts about the presence of a pulse, START CPR.
- Monitor the vital signs early. Attach a pulse oximeter, ECG monitor and a non-invasive blood pressure monitor to the patient as soon as possible.
- Inset an intravenous cannula as soon as possible. Take bloods for investigation when inserting the intravenous cannula.
Acute care and the challenges this presents to families …
Acute care poses enormous physical and psychological challenges for both the person experiencing the illness and their family members. Families members will experience a whole range of emotions such as fear, distress, anxiety, aggression etc.
Role of the nurse in working with families …
Although the nurse-patient relationship constitutes the heart of nursing car, nurses and other health professionals often fault acknowledge families expertise and concerns, leading to mistrust on the part of families and a guarded alliance with health professionals.
Common problem areas and dissatisfaction from family members include …
- Insufficient family involvement
- Lack of information sharing
- Lack of emotional support
- Lack of discharge planning
Family-centred care in acute care …
- Care, dignity and compassion for all
- Enables other family members to be involved
- Healthcare being planned around the whole family
- Health professionals recognising the important role families play in a patient’s treatment, planning of care, concordance etc
- Reduces anxieties for all and can reverse the negative impacts of hospitalisation , illness and improves patient satisfaction
Types of assessment tools used in acute care …
- Capacity assessment
- Informal assessment
- Vital signs
- Social situation
- Safeguarding
- Significant others
- Physiological measurement
- Written
- Verbal
