Being in charge in ITU Assessment Sample

Introduction - Being in charge in ITU Assessment

Reflection and reflective practice are considered as an important aspect of facilitating professional growth in the health and social care field. In health and social care, the reflective practice includes professionals critically analysing and evaluating their actions, experiences, and decisions to enhance learning and improve future practice. According to many researchers, reflective practice in health and social care is considered to be important as it allows professionals to maintain high standards, adapt skills to respond to the evolving challenges across the market and develop or learn new working skills that concentrate on continuous improvement (Fragkos, 2016). Through reflection and reflective practice, care workers can create strong multidisciplinary teams to make better use of their resources, and improve the social care commissioning processes and clinical decisions to ensure better patient outcomes (Rolfe and Freshwater, 2020).

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The healthcare landscape is considered as one of the evolving and dynamic realms, where moments of crisis demand the use of clinical expertise and leadership acumen.) have mentioned that in the critical care unit specifically, leadership can be defined by different dimensions including role allocation, clinical skills, communication skills, and leader behaviour like decision-making, being calm in crisis or being approachable to any situation (Sole, Klein and Moseley, 2020). This assessment aims to develop a reflective report on how I as a graduate student in the health and social care working field have developed the knowledge of adult critical care courses. Another purpose of this assessment is to critically reflect on the leadership implications through disseminating the chosen event of practice.

To meet the objectives of this assessment, a scenario of adult critical care has been taken into consideration. The case study is based on a patient who was admitted to the critical care unit after being diagnosed with hepatic encephalopathy or HE. Hepatic encephalopathy is a potentially reversible condition which can affect an individual with advanced liver dysfunction (Häussinger et al., 2022). This disorder can be characterised by neuromuscular and neuropsychiatric abnormalities that occur due to the production of toxic substances in the bloodstream, which ultimately impacts brain function. The common symptoms associated with Hepatic Encephalopathy range from minor disruption in mental function which can affect cognition, attention, and overall quality of life by leading the patient to the condition of ‘coma’.

For the reflective report, Gibb’s reflective model has to be used for this assessment. This reflective model can help an individual to highlight the experiences that I have gained through practical learning and can give scope to improve their skills essential to work in a critical care unit. Apart from that, in this assessment, the focus will also be given to exploring how the transformational leadership theory guides the dissemination of knowledge into clinical practice.

Main body

Description

For this reflective report a case study has been taken into consideration, whereas in in-charge of Area B, I have received an emergency admission from the theatre on the night shift. The patient initially was admitted to the hospital with stable vital signs and normal blood-gas levels with no signs of confusion. With time, that patient started deteriorating and was shifted to the intensive care unit with a Glasgow coma score of 15 and with unresponsiveness despite the application of naloxone. With the progression of time, a sudden drop in GCS score from 15 to 6 has been observed with signs of confusion. The patient at that time also showed laboured breathing and decreased rate in oxygen saturation level, which indicated immediate intervention of oxygen therapy. The blood gas analysis report showed a decrease in pH value with an increase in partial pressure of carbon dioxide which indicated the onset of metabolic acidosis and referred to the adjustment in ventilation support. Being a nurse in charge at Area B with minimal support during the night shift, I tried to apply my critical care training and knowledge to administrate necessary medical interventions like non-invasive ventilation, immediate application of oxygen therapy, and administration of fluid resuscitation and electrolyte management to stabilise the patient’s condition.

Considering the deteriorating condition of the patient, I bleeped the emergency response team, hepatology team and neurology consultant to carry out a quick review of the subjective data and test results of the patient and take swift action. After an in-depth review, I was asked to follow the haemorrhage protocol and I recommended the registered nurse to do so. However, she was unsure about the procedures. During this period, the patient underwent through liver function test, which showed a worsening condition of liver enzyme confirming the progression of hepatic decomposition. In such a condition, I was administered specialised liver support in coordination with the hepatology team. Endotracheal intubation was also performed under the supervision of the emergency team to secure the airway and provide mechanical ventilation support to the patient. I also asked the registered nurse to keep the patient under close monitoring process so that the medication dosage can be adjusted as per the vital signs, and symptoms.

However, this overall situation was hectic for me as a nurse in charge of the night shift of Area B. The lack of proper hands-on experience with ventilation, administration of vasopressor therapy, and knowledge about haemorrhage protocol by the registered nurse of Area B made it difficult for me to control the scenario effectively.

Feelings

Throughout this scenario, I experienced a whirlwind of emotions, ranging from anxiety and extreme pressure to a sense of responsibility, and urgency. Managing a critically ill patient with minimal support during the night shift had given me scope to test my skills and resilience, the lack of proper in-hand experiences with ventilation, vasopressor therapy, and haemorrhage protocol among the registered nurses who were on duty during this time added difficulty in the situation. Despite the challenging situation, coordination with the emergency team compiled with the hepatology team has helped me to administrate specialised liver support to the patient, to help him from recovering the deteriorating situation and restore his health and well-being. The urgency of the situation required quick decision-making and precise execution of medical intervention, which highlighted the importance of continuous training and preparedness for all nursing staff. This experience also underscored my commitment towards the health and well-being of the patient, crisis management ability, and teamwork skills which as a whole helped me to overcome from this complex situation, when I had limited resources at the intensive care unit of Area B.

Evaluation

Reflecting on the scenario, that I as a nurse in charge of area B was faced with the critical health condition of a patient with HE, I have acknowledged the strengths, and weaknesses of my response, along with the areas for improvement. The actions taken by me to restore the health of the patient with suspected hepatic encephalopathy, I recognised that my hands-on knowledge about critical care and necessary therapeutic skills are a strong foundation. My ability to manage acute respiratory distress and metabolic acidosis condition, application of therapies like oxygen therapy, non-invasive ventilation therapy, and fluid resuscitation to stabilise the patient condition at the primary level can be recognised as one of the strengths to provide patient-centric, and comprehensive treatment and support to the patient any emergency situation. Additionally, rapid decision-making can also be considered as my other strength. Considering the case scenario, and the entire situation at my area B (lack of in-hand knowledge about therapeutic intervention by the nurse, limited resources and support), I tried to make quick decisions and was able to execute them effectively. Calling to the emergency team to maintain coordination with different healthcare professionals and mobilising the emergency response team promptly were critical to managing the rapid deterioration of the patient. Based on such scenarios, coordination, and effective communication have helped me to ensure that all the relevant healthcare professionals were informed about the current condition of the patient and involved them in the patient’s care plan signified my ability of comprehensive healthcare management ability (Burgener, 2020).

However, despite all these strengths, I struggled with delegation of tasks under pressure, specifically when I realised that my on-duty registered nurse has lack of knowledge about critical health care practice and certain protocols. This added to the overall stress and complexity of the situation. This incident has also revealed the gaps between the hands-on experiences and theoretical knowledge of the on-duty registered nurse, particularly about the application of certain therapeutic interventions and haemorrhage protocols. This highlighted my weakness in preparing my team for emergency care support under my supervision.

Considering my strengths and weaknesses, it can be stated that there are several areas which need improvement, specifically team development, and delegation. In hindsight, I overlooked that my on-duty nurse has lacked of essential knowledge, and protocols necessary to support the patient in the intensive care unit. In such a scenario, as a nurse in charge, I have to focus on improving the preparedness, training and development session simulation of the entire nursing staff, specifically for the emergency and intensive care unit of the hospital ward.( Kowalski et al., 2020) This training process should include airway management, administration of vasopressors, non-invasive, and mechanical ventilation, and care protocols.

I have the need to work on my delegation skills, particularly under high-pressure scenarios. Establishing clear roles and responsibilities within the team. Here as a nurse in charge, it will be my responsibility to set up clear roles within the team and ensure everyone is comfortable with their tasks. This can enhance the overall effectiveness of the critical care process and reduce the stress in emergency situations. Reviewing and updating the clinical protocols for managing hepatic encephalopathy or any emergency or critical situation at the intensive care unit can ensure that all the staff are aware abut the latest technologies and best practices. This includes ensuring that emergency response procedures are clear and accessible to all the team members.

As a whole, the incident that I faced during my night shift was a significant learning experience which highlighted my strengths, and weaknesses as a nurse in charge as well as helped me to identify the areas for improvement. By addressing the identified weakness and focusing on continuous professional and skill development, I can enhance my ability to manage complex and high-pressure situations effectively in future or while facing similar situations in upcoming times.

Analysis

The dynamic nature of the healthcare delivery within an intensive care setup needs swift and astute clinical assessment to address the operational and therapeutic needs of the patient. Upon analysing the case scenario, it can be stated that the assessment of a critically ill patient signifies the development of a team comprised of appropriately skilled and trained clinicians with the knowledge about structured ABCDE or airway, breathing, circulation, disability and exposure formate (Sole, Klein and Moseley, 2020). This facilitates the priority of providing the necessary support and therapeutic administration to restore the health of patients who are undergoing through life-threatning problem or illness.

Considering the case scenario, it can be demonstrated that during the night shift in Area B, it was seen that the admitted patient was deteriorating rapidly, as the airway was compromised which necessitating the endotracheal incubation to secure and ensure effective ventilation. Breathing became laboured, and oxygen saturation level was fallen rapidly which prompted the immediate application of oxygen therapy and non-invasive ventilation, whereas vasopressor and fluid resuscitation therapy were essential to mitigate hemodynamic instability and stabilise heart rate and blood pressure. Considering these situations, it can be stated that in the intensive care unit, nurses should equipped with essential knowledge, skills and resources to provide urgent health support to the dying patient and ensure his restoration of health (Kowalski et al., 2020). In such an emergency, as a nurse, it should be important to follow the four themes of the COPE (Code of Practice for Ethics) to maintain a code of conduct, professionalism, and code of ethics in the healthcare setup (Wainwright and Pattison, 2020). These four themes are respect for the person, commitment to quality of care, integrity and accountability, and collaboration and teamwork (Chadwick and Gallagher, 2020).

When it comes to working as a nurse in charge in a critical care unit, the importance of leadership can never be denied. According to Robbins and Davidhizar, (2020), an effective leadership approach is an important aspect in emergency care units and nursing practice due to the stress, dynamic nature of the health care services, and the changing needs of the patient. With effective leadership, it can be ensured that patient safety is one of the key priorities, specifically in critical situations where rapid decision-making and coordinated action are the primary urgency. Considering the case study, where the patient's condition was deteriorating rapidly, the role of leadership was evident in several ways. For example, being a nurse in charge, it was my responsibility to make essential and informed decisions quickly based on the patient's condition and share information with another healthcare professional promptly. The role of swiftly mobilising the emergency response team, coordinating and informed communication with specialists and managing complex interventions signify the importance of practising an effective leadership approach in critical care units. According to Fernandez et al., (2020), in the current time, when the healthcare needs and industry are changing dynamically, the hierarchy of organisations must implement a transformation leadership approach in real-time practice. One of the key roles of a transformational leader in nursing is to improve patient care and outcomes, inspire and motivate other nurses and enhance the work environment for staff, and ensure overall health and outcome of patient and organisational success (Robbins and Davidhizar, 2020). Alsabri et al., (2022) have mentioned that the main purpose of transformational leadership is to engage individuals in recognising and pursuing a common goal in healthcare which is patient safety, and restoration of patient health and well-being. Furthermore, transformational leadership in the emergency care unit can foster a culture of safety and collaboration. It involves setting clear protocols, supporting the team members, and ensuring continuity in communication. As per the case study, the lack of experience among the staff highlighted the need for strong leadership to address the knowledge gap and ensure adherence to best practices in critical care support for the patient. A transformational leader in the emergency care unit can guide and support the team, and as a nurse in-charge. With transformational leadership skills and approaches I could ensured that the deteriorating condition of the patient was managed effectively through prompt decision-making, and intervention of appropriate medical supports (Collins et al., 2020) .

Effective leadership can be evident through the involvement of staff in the decision-making process, the organisational ethos, and the leadership style exhibited by the organisational leaders. Considering the case scenario, when the on-duty nurse had limited knowledge about technical or therapeutic administration, being able to think about other ways and support the patient by swiftly mobilising the emergency team was a vital decision. The primary determinant of care quality is the level of proficiency among the nursing staff in making solid and informed decisions for the health and well-being of the patient.

According to Pranitasari (2020), leadership can be defined as a function of understanding oneself, developing a clear vision which can effectively be communicated and establishing trust with others to motivate people to achieve a common goal. On the other hand, Benmira, S. and Agboola, (2021) offered a more straightforward definition, where leaders are defined as someone who can be followed by others. While these definitions differ from each other, they are both valid. As a whole, healthcare leadership can be defined by a broad range of roles and responsibilities that involve more than just managing the healthcare organisation. In any emergency in a healthcare setup, the foremost roles of a leader must be setting a goal, and identifying challenges. Motivating staff, stimulating resource allocation and ensuring patient outcomes. Transformational leadership occurs when leaders engage with their staff in pursuit of jointly helping goals (Labrague and Obeidat, 2022).

Considering the case scenario, it can be stated that by adopting transformational leadership, it could be easy for the nurse in charge to guide the team through a complex situation with composure and decisiveness. This leadership style can facilitate effective communication encouragement for collaboration with multidisciplinary teams, and foster a proactive approach to problem-solving (Labrague and Obeidat, 2022). Therefore, considering the entire case scenario, and my role as a nurse in charge, transformational leadership was best whether it came to administrating critical intervention and executing the therapeutic administration in collaboration with a multidisciplinary team or ensuring the stability of the health and well-being of patients despite limited resources.

Conclusion

Reflecting on the overall case study, it can be stated that teamwork, leadership, and effective coordination and communication within a multidisciplinary team are important for emergency healthcare. Despite encountering substantial obstacles such as resource constraints and staff knowledge deficiencies, it is considered to be important for anurse in charge toexhibitperseverance and the ability to maketimely decisions. The incident highlighted the significance of ongoing training and readiness for nursing personnel, especially in critical circumstances. Through self-reflection, the nurse recognized specific areas that require development, including the need to enhance delegating abilities and provide comprehensive training for the team. In the end, this tragedy provides a significant chance for future critical care managers to learn and improve.

Action plan

Considering the overall scenario, a nurse in charge it can be stated that an action plan should be established on key areas for improvement to overcome a similar situation if arises in future.

Firstly, as a nurse in charge, the focus will be given to the training and development process. As a nurse in charge, I realised a gap in hand-in knowledge and adherence to health care protocol among nursing staff. In this scenario, the implementation of regular simulation training sessions for every nursing staff in the emergency team, on critical care protocols should be carried out. Secondly, the focus will also be given to team preparedness by clearly defining and setting up roles and responsibilities within the team to enhance the delegation of skills (Zaki et al., 2024). The establishment of a clear communication channel is also essential at the workplace for rapid coordination with the emergency team and specialists during critical care incidents (Burgener, 2020). Lastly, continuous evaluation of my own skills, and knowledge, development of my own leadership skills, practical knowledge and attributes are essential to strengthen my commitment to delivering the best possible care and support to the patient in an emergency care setup.

Recommendation for future development

Several recommendations for future development can be proposed to augment the clinical acumen and leadership skills through reflective practice.

• Implementation of specialised hepatic encephalopathy supportive care training in the nursing training process to deepen the expertise and skills among the nurses to manage liver-related complications.
• Encouragement to the hospital staff for ongoing education and taking part in workshops for continuously developing professional skills. The nursing staff will be encouraged to stay updated about new technologies and interventions to increase patient outcomes.

References

• Alsabri, M., Boudi, Z., Lauque, D., Dias, R.D., Whelan, J.S., Östlundh, L., Alinier, G., Onyeji, C., Michel, P., Liu, S.W. and Carlos Jr, A., (2022). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: a systematic review.Journal of patient safety,18(1), pp.e351-e361. .[online] available at: https://journals.lww.com/journalpatientsafety/fulltext/2022/01000/impact_of_teamwork_and_communication_training.56.aspx
• Benmira, S. and Agboola, M., (2021). Evolution of leadership theory.BMJ leader, pp.leader-2020. .[online] available at: https://bmjleader.bmj.com/content/leader/early/2021/01/08/leader-2020-000296.full.pdf
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Author Bio

Saul Carter   4 years | Masters

Hi! I am Saul and I have done a master's in Medical Science from Edinburgh University. I have also published 100+ research papers that have received great recognition in academics. I assure you that I will write your assignment, dissertation or thesis with the same professionalism. I am aware of the high standards of UK universities and I craft assignments accordingly.