Wk 1 End of Life Care Flashcards
What are the practice standards of a critical care nurse?
- Evaluate quality & effectiveness of nursing practice
- Reflect on standards, laws, and regulations
- Acquire & maintains current knowledge
- Interact and contribute to peers
- Serve as patient advocate
- Collaborate with health care team
- Use clinical inquiry & integrates research into practice
- Consider factors related to safety, effectiveness, and cost
AACN Synergy Model:
What are the characteristics of a critical care patient?
a. Resiliency
b. Vulnerability (Nurses are in charge so advocate for the pt bc they are vulnerable)
c. Stability
d. Complexity
e. Resource availability
f. Participation in care
g. Participation in decision making
h. Predictability
What are bundles of care?
Bundles are evidenced-based practice-interventions done as a whole to improve outcomes
VAP, Sepsis, CVC (Central venous catheters aka “Central lines”) are common bundles
What is SBAR?
- Situation-Presently going on with the patient
- Background-What brought them in, History
- Assessment-Pertinent body system assessment, don’t forget vitals!
- Recommendation-Nurses do recommend! Interventions, treatments
What is CUS?
- I’m Concerned
- I’m Uncomfortable or I am unsure of the situation
- This isn’t Safe or I want to ensure the safety of the patient
What are common patient stressors in the critical care environment?
- Loss of privacy
- Artificial lighting
- Noise
- Lack of meaningful stimuli
- Pain (Tubes and lines may not be painful but they can be uncomfortable)
How might the environment be modified?
• Pain: look for nonverbal cues such as HR, RR, etc
• Encourage comfort measures such as hand holding by family, etc
What strategies can be implemented to address patient stressors in the critical care setting?
Talk to the patient!!
Also screening for PTSD
___ situations provide greatest risk for communication breakdown
Handoff
Family wishes and concerns:
How can critical illness affect the whole family?
- Emotional distress
- Financial bankruptcy
- Family influences the patient’s recovery
Often medical personnel is annoyed by family, but they are important for patient recovery and also for past medical hx of patient
Family wishes and concerns:
Assessment of the family includes?
STRUCTURAL
• Internal structure (immediate, decision-makers)
• Designating a spokesperson - Be aware of HIPAA. Be careful of who is who. In ICU, there is always a health care proxy. Get the paperwork and a phone number in case of an emergency! Only give the PIN to 1 or 2 family members
DEVELOPMENTAL
• Stages, tasks, and attachments
• Different stages of development, thinking, reasoning, maturity level
FUNCTIONAL
• Interaction with one another
How can the nurse aid in communication with the family?
- Don’t forget to listen, acknowledge and express empathy to the family.
- It is okay if you do not know the answers to the family’s questions.
- Don’t ever tell a new diagnosis! Leave to the physician.
What are some nursing interventions for the patient and their family?
- Remaining near the patient
- Receiving assurance
- Receiving information
- Being comfortable
- Having support available
- Facilitate visitation
- Provide accurate and realistic information
- Encourage family involvement in patient care
- Consider family presence during procedures
- Consider family environment and support
Most of the ethical issues faced in the critical care setting are related to one of these 4 areas:
- Informed consent and confidentiality
- Withholding or withdrawal of treatment
- Organ and tissue transplantation
- Distribution of health care resources
Warning signs to recognize an ethical dilemma:
- Emotionally charged situations
- Significant change in patient’s condition
- Confusion about facts
- Hesitancy about what is “right”
- Deviation from customary practice
- Need for secrecy regarding proposed actions
What are the roles of a nurse r/t ethical dilemmas?
ADVOCACY
is primary nursing role
• Autonomy - Right of self-determination concerning medical care
(Alert & Oriented or Confused?)
• Duty to prevent harm, remove harm, and promote the good of another person
• Nonmaleficence - Not to intentionally inflict harm
JUSTICE
Fair distribution of health care resources
VERACITY
Truthfulness
FIDELITY
Be faithful to commitment
CONFIDENTIALITY
Respect for right to control information
When can a patient implement their autonomy? not implement their autonomy?
autonomy = alert and oriented
no autonomy = confused and/or sedated