A Critical Analysis Of The

A Critical Analysis Of TheThis essay leave present a reflective account of talk sk balefuls in practice whist under victorious judicial decision and news report taking of two intensifier Cargon endurings with a similar condition. It all(a)ow for endeavour to seek all told aspects of non communicative and communicative communicating styles and reflect upon these argonas using Gibbs reflective cycle (1988).Scenario A Mrs pile, 34, a passenger in a road traffic collision who was not wearing a seatbelt was impel through the windscreen resolveing in multiple facial nerve wounds with extensive facial swelling which carryd her to be intubated and sedated. She soon has cervical spine immobilisation and is awaiting a secondary trauma CT. Mr James was also compound in the accident.Scenario B Mr James, 37, husband of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and or ientated but currently dyspneal and requiring high group O concentrations.Patients who atomic number 18 admitted to Intensive rush atomic number 18 typically admitted due to serious seedy health or trauma that may also ask a say-so to develop manners threatening complications (Udwadia, 2005). These uncomplainings are commonly unconscious(p), have limited movement and have sensation deprivation due to sedation and/or disease processes. These critical conditions rely upon modern technical support and invasive procedures for the purpose of monitoring and enactment of physiologic functions. Having the ability to impellingly communicate with patients, colleagues and their close relatives is a radical clinical skill in Intensive care and central to a skilful nursing practice. Communication in Intensive Care is so of high importance (Elliot, 1999) to provide information and support to the critically ill patient in order to reduce their anxieties, stresses and preserve sel f identity, self esteem and reduce social isolation (Joo 2009, Alasad 2004, Newmarch2006). Effective parley is the key to the collection of patient information, delivering quality of wish and ensuring patient safety.Gaining a patients history is one of the most important skills in medicine and is a foundation for both the diagnosis and patient clinician tattleship, and is increasingly universe undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is crucial (Carr, 2005). Often the patient is transferred from a ward or department indoors the hospital where a comprehensive history has been taken with documentation of a full examination investigations, functional diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this main course if it was not appropriate to do so. Where available pat ients medical notes potty provide essential information.In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and intubation, effective communication is restricted and obtaining a comprehensive history would be inappropriate and almost certainly unsafe. The breast feeding Midwifery Council promotes the importance of keeping clear and accurate records within the Code Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). indeed if taking a patients history is unsafe to do so, this required to be documented.Breathing is a fundamental life process that usually occurs without conscious thought and, for the healthy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial trauma by its self is not a life threatening injury, although it has often been accompanied with other injuries such as traumatic brain injury and complications such as air authority obstruction. This may have been ca practised by further swelling, eject or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. at bottom scenario B, Mr James had suffered multiple rib fractures causing difficulty in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the chest, accounting for everyplace half of the thoracic injuries from non-penetrating trauma (Middleton, 2003). When ribs are fractured due to the nature and site of the injury there is potential for underlying organ contusions and damage. The consequence of having a flail chest is pain. Painful expansion of the chest would result in inadequate ventilation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effi caciously. These combined increase the bump of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003).The key issue of Intensive Care is to provide patients and relatives with effective communication at all times to ensure that a holistic nursing approach is achieved.Intensive care nurses care for patients predominantly with respiratory failure and over the years have taken on an extended role. They are evaluate to examine a patient and interpret their findings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a fleshly assessment and collect the patients history in a systemic, professional and sensitive approach. Effective communication skills are one of the many essential skills involved in this role.As an Intensive Care nurse, introducing yourself to the patient as soon as po ssible would be the first step in the history and assessment taking process (Outlined in Appendix A). Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in conformism with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually to a greater extent helpful in fashioning a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, Exposure/Examination (ABCDE) assessment process is widely used. It is essential for survival that the type O is delivered to blood cells and the oxygen hatfulnot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported external from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approach that all team members use and allows for rapid assessment, continuity of care and the reduction of errors.C ommunication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, cores, opinions, speech and thoughts are transferred by different forms. Basic communication is achieved by speaking, sign language, body language mend and nerve centre contact, as engineering science has developed communication has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication Verbal and non verbal.Verbal communication is the simplest and speedy way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, understood and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Zastrow, 2001). Key verbal features of communication are made up of sounds, words, and language. Mr James was alert and orientated and had some ability to communicate h e was breathless due to painful fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must(prenominal) be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions mint allow breathless patients to communicate without exerting themselves. unappealing questions such as is it painful when you breathe in? or is your breathing feeling worse? can be answered with non verbal communication such as a shake or nod of the head. pickings a patients history in this way can be time consume and it is essential that the clinician do not make assumptions on behalf of the patient. Alternatively, encouraging patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of communication. Sign language and symbols are also included in non-verbal communication. Non verb al communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al2000, Alasad2004). Body language, posture and physical contact is a form of non verbal communication. Body language can convey vast amounts of information. Slouched posture, or folded arms and go through legs can portray negative signals. Facial gestures and expressions and eye contact are all different cues of communication. Although Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles.A patients stay in Intensive Care can vary from years to months. Although this is a temporary situation and many patients will make a skinny recovery, the psychological impact may be longer pass awaying (MacAuley, 2010). When sympathize with for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care units to enable patients to be tolerable of ventilation. It aims to allow comfort and synchrony between the patient and ventilator. Poor sedation can pop off to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. Over sedation can range to ventilator associated pneumonias, cardiac instability and prolonged ventilation and Intensive Care derangement. Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). Every day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increased risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008) Within this stage of sedation or delirium it is insufferable to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the foot that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and understand conversations around them and respond emotionally to verbal communication however could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). Neurological precondition would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore important to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communication and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dress ing changed and secondly a caring touch holding Mrs James hand to explain where she was and why she was there is an good example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of public lecture to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) however as previously mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been. If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of co mmunication process as the Intensive Care environment in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication support can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of hands and arms making gestures and handwriting frustration and difficult. Patients may also be attached to monitors and infusions resulting in restricted movements which can head teacher to patients feeling trapped and disturbed (Ashworth, 1980). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The Univers ity of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care.This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a unit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of concern. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From overal l research (Alasad 2004, Leigh 2001, MacAuley, 2010 Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further education within Intensive Care may be required to improve communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contribution that others offer to improve patients care.