Journal Entry – Delivering Contextual Care

Question: What are some of the complexities in identifying a deteriorating patient? Identify, describe and reference an assessment tool that you could use in on your placement to identify deterioration in a patient under your care? Answer: Complexities in identifying a deteriorating patient Hospital patients can experience unexpected physical deterioration that may result in death in majority of the cases. In several acute cases, the deterioration occurs very fast and hence it becomes difficult for the health professionals to detect the symptoms of deterioration (Levett-Jones and Bellchamber, 2012). In case no observations are made for a long period then the health professionals are no able to detect vital changes in a patients health. In cases of patients suffering from cardiopulmonary arrests, the sign of deterioration that occurs 24 hours before the arrest hence the urgency of these types of diseases makes it difficult for the professionals to identify the symptoms (Kelly, 2010). Around 90% of the deteriorations occur due to absence of formal documentation of the observations like temperature and pulse rates, BP, respirations and oxygen intakes. Moreover, the lack of co-operation on the part of the patients especially in case of aged patients may also pose as a barri er to the effective detection of the deterioration symptoms. The complexities generally arise due to environmental and cultural influences, complex relationship between the nurse and the medical staff, experience of the health care professional about the concerned disease symptoms and the quality of training and education given to the medical professionals ( Hlebec, 2012). Assessment of an effective tool for identification of deterioration symptoms in a patient Majority of the hospitals are seen using Early warning score (MEWS) method in order to determine the degree of illness of the patient. This system is based on the monitoring o four important health aspects of each individual namely the blood pressure, heart rate, respiratory rate and body temperature (Scully, 2012). The observations recorded are compared to the normal rates to generate a combined result, which indicates the present physical status of the patient. If the combined score exceeds 5 then in medical terms the patient is in a critical condition and is suggested to be admitted to an Intensive care unit for emergency monitoring. However, there is no prevailing standard score in this system and the medical institutes tend to vary the same with the varying disease symptoms (Luxford, 2012). The increasing score helps the medical professionals to detect the deterioration symptom in the patient and adopt emergency strategies accordingly. The system also has a single observation pa rameter where if the score of a single parameter among the four parameters increase the medical professionals attend to the patient immediately taking that for a sign of rapid deterioration. However, the use of the MEWS is also not effective in maintaining the health record of the patients. The major drawback of the system is the lack of co ordination from the patients. Moreover the global implementation of the system had not yet been formulated hence it is difficult for all the hospitals to make effective standard score for judging the situations of the patients. However since the method has helped in reducing the level of complexities involved with identifying of the deterioration rate hence majority of the medical institutions have effectively adopted the system (Agiro, 2011). Reference list Agiro, A. (2011).Determinants of productivity in hospital-based rural health clinics. Orlando, Fla.: University of Central Florida. Hlebec, V. (2012). Contextual factors of home care utilization in Slovenia.Slovenian Journal Of Public Health,51(2). doi:10.2478/v10152-012-0014-z Kelly, C. (2010). An Interdisciplinary Mobility Program in the Acute Care Setting.Journal Of Acute Care Physical Therapy,1(2), 73. doi:10.1097/01592394-201001020-00011 Levett-Jones, T and Bellchamber, H, (2012) Medical-Surgical Nursing in LeMone P, Burke, KM, Dwyer, T, Levett-Jones, T, Moxham, L, Reid-Searl, K, Berry, K, Carville, K, Hales, M, Knox, N, Luxford, Y Raymond, D, Medical-Surgical Nursing:Critical Thinking in Client Care, 1 (2), Pearson Australia, NSW, pp. 3-9 Luxford, Y, (2012) Assessing in Berman, A, Snyder, SJ, Levett-Jones, T, Dwyer, T, Hales, M, Harvey, N, Luxford, Y, Moxham, L, Park, T, Parker, B, Reid-Searl, K and Stanley, D, Kozier and Erbs Fundamentals of Nursing, vol. 1, (2nd edn), Pearson Australia, NSW, pp. 212-230. Scully, N, (2012) Critical Thinking and the Nursing Process in Berman, A, Snyder, SJ, Levett-Jones, T, Dwyer, T, Hales, M, Harvey, N, Luxford, Y, Moxham, L, Park, T, Parker, B, Reid-Searl, K and Stanley, D, Kozier and Erbs Fundamentals of Nursing, vol. 1 (2nd edn), Pearson Australia, NSW, pp. 197-210.