Early Moblization

Improving the quality of discharge planning in acute care include addressing the lack of appropriate staff and patient education about appropriate planning for discharge (4). This includes implementing proper discharge teaching regarding signs and symptoms to seek medical attention, management and care of medical equipment, and access to community resources (4, 5). Other challenges are patients with complex comorbidities too difficult to discharge as well as lack of community supports and equipment for newly discharge patients and lack of rehabilitation and nursing home beds (4). Consequently, acute care units are pressured to vacate hospital beds in response to the growing elderly population. Hospital professionals tend to focus discharge teaching and preparation on medical areas such as diet, activity, treatments, and medications (5). Community referrals to appropriate services at the time of hospital discharge does not often happen contributing to poorer patient outcomes and re-hospitalizations

The many benefits of increasing mobility in ICU patients can certainly be measured by length of stay in the hospital, rate of Hospital Acquired Infections, and occurrence of skin breakdown, but when we consider the human factor in this equation it is simply the right thing to do.

The problem in this scenario is the challenges faced with trying to implement a new clinical pathway. This particular clinical pathway trying to be implemented is concerning ventilator-dependent patients who are discharged to home with home health care needs. These patients tend to have multiple health care needs beyond the ventilator and the new clinical pathway will establish a smooth transition from hospital to home, allowing for all the patient’s needs to be met. The challenges arise when trying to get all areas of the health care team to get involved. This especially includes the physicians that seem reluctant to follow a nurse’s guidelines. Not only are the physicians reluctant, the home health care representative will not be available to attend team meetings for a while. The new clinical pathway is due to be started in one month, so there is little time to get all parties on board.

The progress of my project to develop a nurse driven sepsis screening tool and an algorithm for implementation on the intensive care unit (ICU) for early identification and prompt treatment of septic patients has progressed remarkably well. I have been productive in gathering current guidelines for sepsis with the aid of my preceptor who is a critical care nurse practitioner on the ICU. With his help, I have been able to assemble key pieces of research to create a sepsis screening tool, and a treatment algorithm with sepsis resuscitation bundles. Extensive research has been conducted to integrate evidence-based practice in my project. I have also spent time with the unit educator, critical care intensivists, and my colleagues in brainstorming and collecting ideas about my project.

As the group leader, it is Olivia’s responsibility to manage this interdisciplinary team as they develop a critical pathway for patients with multiple complex needs. The main problem presented in this exercise is that Olivia must find a way to communicate to the group the importance of removing the critical pathway barriers to providing patients with the best possible care. Because this issue affects the care coordination of these debilitated patients, this problem belongs to everyone involved in the decision-making group as well as the

As a volunteer in the emergency room, I was exposed to various medical procedures performed by the technicians, nurses, physician assistants and physicians. I was surprised to see how a place that seems to be constantly chaotic can still give every patient the care they need. It was not until I spent more time volunteering in the emergency room did I realize that although it seemed to be chaotic, the healthcare providers had a well established routine along with teamwork. I was shocked when I saw a physician assistant delivering lunch to a patient, as this is usually done by the nurses or technicians. It was through this that I understood how teamwork is essential to providing excellent care. The health care professionals in this emergency room never pulled rank or established clear cut responsibilities, everyone just did what they could and this was how simple their routine was. They didn’t let their pride prevent them from what needed to be done, after all every healthcare worker only has one responsibility; and that is to care for the patient to their fullest

Relationships among workers in the ICU of Changeable Medical Center are at best, strained. In the past six months, the unit has expanded from 8 to 12 beds, changed to a different electronic health record vendor, and changed unit managers. Ten of thirty registered nurses have resigned or left, two of the remaining twenty are out on sick leave, and absenteeism is at a record high. As the new unit manager, you are looking for ways to improve morale and deal constructively with the many problematic relationship issues.

The additional revenues that were collected due to increase in ICU capacity by 20 beds enhanced the total ED revenues by 10%.4 The efficiency of care delivery is decreased when patients are diverted to other hospitals, they have to wait for long period to receive care or if they are placed on the floors where they do not belong. This is seen often due to delay in discharging patients.3 These delays and inefficiencies are the primary cause of decreased satisfaction among patients, their families, hospital employees, and physicians. They also result in avoidable increases in patient length-of-stay, reduced quality of care, and lost or diminished hospital revenue.3

The final standard under communication is the performance of a “time out” before a procedure. There are also elements of performance that must be met to be in compliance for this standard. The first is conducting a “time out” before every procedure. This is met by the Universal Protocol Policy. The Universal Protocol Policy also meets the next bullet point of standardizing “time out” for Nightingale Hospital and having them started by an elected team member with the involvement of team members. The third element of performance is performing a “time out“ between a change of people performing a procedure on a patient. This is unfortunately not met by any protocol in the information provided by Nightingale Hospital. Having team members agree the correct patient identity, the correct site, and the correct procedure to be done on a patient is the next element of performance. The final element of performance is the documentation of “time outs”. Though there are no policies bases on the information given from Nightingale Hospital of “time outs”, there is a graphical analysis of “time outs” hospital wide indicating

This paper address the lack of communication between interdicinplnary staff and the patients they care for also the significance of the care giver when patient enter an ICU setting. There are several problems that can occur to patient in an ICU setting when communication between collaborative care is broken down. The biggest issue can be death when this happens or even patient injuries which are two of the biggest concerns when it comes to care of patients. “Notably, when asked to evaluate interprofessional collaboration, nurses consistently rate is lower than doctors, suggesting discipline-specific perspectives on the nature of collaboration (Baggs, Miller, Sexton,2002).” Showing that nurses and physicians are where the problems seems to lye

Healthcare in the United States is changing which has given rise to new hurdles that must be overcome. One of the issues that we are currently facing in many tertiary facilities is the need for set criteria involving intensive care unit admissions and discharges. Throughout the country the total number of intensive care unit (ICU) beds are on the rise, but the current supply still outnumbers the demand (Cognet & Coyer, 2014). The cost of staying in an ICU is continuing to increase with technology, and there are limitations that insurance companies and the government have set forth to the number of days a patient can reside there dependent upon his diagnosis and condition. Intensive care units will continue to undergo strain due to high census, and decisions to discharge patients will be effected (Wagner, Gabler, Ratcliffe, Brown, Strom, & Halpern, 2013). Typically, the decision to have a patient occupy an ICU bed is based upon whether or not they are sick enough to be there or if they are well enough to be discharged to a progressive care unit (PCU) or medical surgical unit (Meyer, 2003). A progressive care unit is a step down from an ICU, but has stricter criteria for admission than a medical surgical unit based upon the patients medical status. Not all facilities offer a PCU, but the need for this level of care is continuing to rise with the number of ICU admissions increasing. Standardized guidelines for patient placement in

The first subacute care is transitioning, and they are units are typically located on a hospital campus, or near the hospital and operated by those highly intensive hospital units keep necessary care close during the patient’s transition. Next type of subacute care is owned and operated by hospitals, or nursing facilities and those patients require a lengthened amount of attention as ongoing therapies or monitoring apply to these patients. The third category is termed chronic subacute care, which is useful for patients requiring a ventilator or intravenous therapy services and the typical length of stay is 60 to 90 days, where either they pass away or are transferred to a lower level of care. Lastly is the long-term care transitional subacute care as it is for patients with complex medical problems who require intensive care before transitioning home or to another care facility and tend to be hospital-based. It is appropriate that sometimes Postacute care can be useful and follow subacute

This is a reflective essay based on a event which took place in a hospital setting. The aim of this essay is to explore how members of the Multidisciplinary Team (MDT) worked together and communicate with each other to achieve the best patients outcome.

During the team formation, a number of challenges manifested. Firstly, it was the fact that there were nurses from other units. Hence, there were fears that they may not be well informed with procedures undertaken in our unit. However, this challenged was effectively addressed by assigning the nurses from other units a nurse from our unit to help her during the emergency period.

The purpose of this paper is to explore the theories of Sister Callista Roy and Virginia Henderson. Sister Callista Roy’s Adaptation Theory and Virginia Henderson’s Need Theory both play an important role in nursing today. Both theorists have written theories that can be used in a critical setting as well as multiple other practice areas. I will compare the similarities of each theory as well as contrast the differences. Both theories will be looked at and a plan will be developed to put them into my practice as an ICU nurse.