A recent assignment to the Medical-Surgical Unit provided for a rewarding learning experience in the practice of rapid response in in-hospital cardiac arrest situations. The patient was brought into the Medical-Surgical Unit from the Operating Room. The vital signs of the patient were stable until arrival to the unit. Within a few minutes in the unit the patient began to complain of intense chest pains. The patient rated the intensity of the chest pains at 8 , from a scale of 1 to 10, with 10 being the strongest. The patient also began complaining of difficulty in breathing and was increasingly getting agitated. The vital signs were once again evaluated. Heart rate was 130-150 beats/minute. Blood pressure was 150/90. Through this thorough and careful monitoring and evaluation of the patient (Mimick and Harvey 2003), it was determined that the patient was very close to a full blown cardiac arrest. The bedside nurse was quick to alert the Rapid Response Team who arrived at the unit within 5 minutes (Lippincott, Williams and Wilkins 2007). The team proceeded to reconfirm the vitals that were recorded. It was concluded that the cardiac arrest may be averted through the administration of medication that stabilize the patient within minutes. The Rapid Response Team would have not been able to prevent the complete onset of the cardiac arrest if not for the vigilance of the bedside nurse. This case was easily averted because the conditions were deemed linear (Mimick and Harvey 2003). This only means the conditions of this case pointed to the obvious. However, in many instances, conditions remain ambiguous, particularly in the Medical-Surgical Unit, where patients are unable to articulate their conditions accurately. The nurses in this unit are left to assess the situation precisely to be able to provide care for patients before and after surgery (Medical-Surgical Nursing).
This reaction paper is meant to discuss and explain the importance of having the appropriate skills to identify subtle changes signaling deterioration in condition, particularly in the onset of cardiac arrest in Medical-Surgical patients. It is also meant to enumerate the lessons learned in having the opportunity to witness such an incident during nursing practice.
Identifying Subtle Changes in Patient s Condition
There are several important points to consider in assessing the onset of cardiac arrest (LeMone and Burke 2007). The bedside nurse should have the right skills to identify even the most insignificant change in a patient s condition. These skills are vital in order to accurately intervene before a situation becomes irreversible (White 2005). Almost half of all in-hospital cardiac arrests are reversible if only symptoms and signs are properly detected. Some signs are evident as early as 6-24 hours before the actual arrest (Fincher 2007).
The Australian Nursing and Midwifery Council, established in 1992 (ANMC), provides the guidelines to proper intervention of nurses in cases when prompt assessment of a precipitating condition is required. Particularly in Medical-Surgical Units, nurses have to play an important role in identifying subtle changes in a patient s condition (Mimick and Harvey 2003). In evaluating a patient s condition specifically in situations when initial information collected are indistinct rather than apparent, it is favorable to have well-developed skills in 1) assessment 2) clinical judgment and 3) decision-making (Mimick and Harvey 2003).
The sample case sited in the previous paragraphs showed the ability of the bedside nurse to take into account all the pertinent signs in the patient s condition (St. Luke s Hospital 2006). Even when the change in the patient s condition was abrupt, the nurse still followed the proper procedure in actual assessment. The nurse took the vital signs, asked the right questions to the patient and proceeded to observe for non-verbal indicators in the patient s behavior. The calm and methodic approach of the nurse allowed for a more objective assessment of an otherwise complex and critical incident. The Australian Nurse and Midwifery Council emphasize duty for care (ANMC) as one of the most important responsibilities of a nurse. Duty for care was practiced in this instance through the performance of thorough and comprehensive of the situation. After all, the patient s wellfare is the top most priority. This is a perfect illustration of how essential the skill in assessment is in patient care.
Through proper assessment of the patient s condition, the nurse was able to give a relevant prognosis. This called for a clinical judgment that undoubtedly proved something was wrong with the patient. There are several ways to determine the onset of cardiac arrest. Usually it is a combination of vital signs, behavior, and medical background of the patient and actual responses of the patient to diagnostic questions. In this case the nurse was able to put all these together to come up with the right conclusion. The Australian Nurse and Midwifery Council state that nurses may take corrective action independently, particularly in sudden and unsuspected situations. However, they are expected to do so within the ethical bounds of their profession. In this case, the nurse followed procedure to the letter. Even when the patient s condition pointed to the obvious, the nurse still made a fact-based clinical judgment.
The final skill demonstrated in the case sited is the ability of a bedside nurse to make the right decision. It is not enough to positively know what is wrong with the patient but it is equally important to identify what route to take in resolving the situation. The nurse in this instance chose to call on the Rapid Response Team. Hospitals form Rapid Response Teams specifically for prevention of many unexpected outcomes in patients condition (Fincher 2007). Rapid Response Teams are usually composed of hospital personnel who are trained to counter highly critical situations. The team should not be mistaken for the Code Team (Lippincott, Williams and Wilkins 2007), that which responds more for curative reasons than preventive. The nurse chose to alert the Rapid Response Team knowing that the onset of cardiac arrest may still be averted. The Australian Nurse and Midwifery Council requires nurses to always be abreast with new techniques and practices in patient care. Only a nurse who is well informed with the differences between a Rapid Response Team and Code Team would have known to choose this course.
Nurses have the responsibility to provide the best care for a patient in every circumstance. The most significant lesson learned in the above experience shared is that a nurse is essentially the first person to extend proper care to a patient. Therefore, a nurse should always be prepared for any unforeseen event in a patient s condition. It is not enough to know that vital signs are stable. It is not enough to be aware of sudden changes in a patient s condition. The nurse should also be equipped to make the right clinical judgment within the bounds of ethical guidelines. And make the right decisions in accordance to proper procedure, taking into consideration all that is lawful and appropriate even in highly critical situations.
Australian Nursing and Midwifery Council (2006). National competency standards for the registered nurse . Retrieved on March 8, 2008 from http://www.anmc.org.au/docs/competency_standards_RN.pdf
Fincher, C. (2007. Team effort-Rapid response. Community Memorial Health Systems presents a self-study module .
LeMone, P., and Burke, K. (2007). Medical-surgical nursing: Critical thinking in client care. Single volume, 4th ed. Prentice Hall.
Lippincott, Williams and Wilkins. (2007). Rapid Response Team on Major Clinical Outcome Measures . Critical Care Medicine. 35 (9): 2076-2082
Medical-Surgical Nursing. Retrieved on March 8, 2008 from http://www.discovernursing.com/jnj-specialtyID_263-dsc-specialty_detail.aspx
Mimick, P., and Harvey, S. (2003). The Early Recognition of Patient Problems Among Medical- Surgical Nurses. MedSurg Nursing.
St. Luke s Hospital fist in region to institute rapid response team (2006). Retrieved on March 8, 2008 from http://www.slhhn.org/body.cfm?id=28&action=detail&ref=242
White, M. (2005). Root Cause Analysis . University of Pittsburg Medical Center.