Clinical Emergency Response System | My Assignment Tutor

Assessment item 3 – Scenario Critique: Stroke back to top Value: 50% Due Date: 02-Jun-2021 Return Date: 24-Jun-2021 Length: 2200 words Group Assessment: No Submission method options: EASTS (online) TASK back to top Review the scenario provided (‘Mrs Sally Brown’) and respond to the following questions in the body of an academic paper. This task also requires you to review the provided best practice guidelines, research and literature regarding the recognition, escalation and management of clinical deterioration (e.g. Clinical Excellence Commission ‘Clinical Emergency Response System’ – CERS). Additionally, incorporating further peer-reviewed journal articles to support your rationale will improve your grade further.  Introduction (Recommended: up to 150 words) Provide a brief introduction to the concept of nursing care in the deteriorating patient;Introduce the context of your paper by highlighting the key aspects of the scenario provided;Outline the content of the body of your paper.   Body (Recommended: up to 1900 words) 1. RECOGNISE: Critique the recognition of deterioration in the scenario: Outline the specific clinical indicators of deterioration in the first stage of the scenario and justify specific points in time when a clinical review and rapid response should have been triggered, based on the indicators that you have identified, and  Describe how the pathophysiological changes that occur with an acute ischaemic stroke are linked to the clinical indicators of deterioration that you have outlined. 2. ESCALATE: Critique the escalation of deterioration in the scenario Evaluate the use of the CUSS and/or PACE communication tool(s) (as outlined in the resource below) to communicate assertively in the context of a person with clinical deteriorationOutline the key strengths in the nurse’s use of graded assertiveness when communicating with the doctor in the scenario provided. Propose at least two evidence-based methods the nurse could implement to improve the use of graded assertiveness in the scenario provided.  Hanson, J., Walsh, S., Mason, M., Wadsworth, D., Framp, A., & Watson, K. (2020). ‘Speaking up for safety’: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis. Nurse Education Today, 84, 104252. doi:10.1016/j.nedt.2019.104252 3. MANAGE: Critique the management of deterioration in the scenario Select one or moreof the following journal articles, outline the relevant ethical and legal considerations in the findings of your chosen study/studies and relate these findings to the final stage of the clinical scenario.  Journal articles to be used for this question (use at least one of the following): Cignarella, A., Redley, B., & Bucknall, T. (2020, Mar). Organ donation within the intensive care unit: A retrospective audit. Australian Critical Care, 33(2), 167-174. https://doi.org/10.1016/j.aucc.2018.12.006 Milross, L. A., O’Donnell, T. G., Bucknall, T. K., Pilcher, D. V., & Ihle, J. F. (2020, Mar). Exploring staff perceptions of organ donation after circulatory death. Australian Critical Care, 33(2), 175-180. https://doi.org/10.1016/j.aucc.2019.05.001Comadira, G., Hervey, L., Winearls, J., Young-Jamieson, J., & Marshall, A. (2015). Do you have a right to decide? Or do we have a right to acquiesce? Australian Critical Care, 28(2), 72-76. doi: http://dx.doi.org/10.1016/j.aucc.2015.04.004  In your response: Outline the relevant ethical and legal considerations of the article(s) you have selected  Note: ‘Relevant legal and ethical considerations’ include (but are not limited to): advocacy, autonomy, consent, justice, beneficence, non-maleficence, conflicting priorities (palliation vs organ protection) and surrogate decision-making Conclusion (Recommended: up to 150 words) Summarise the key points that you have covered in your paperComment on the significance of this paper in relation to your learning about the recognition, escalation and management of the deteriorating patientDo not include new information in this section Reference List (not included in word count) You need to ensure your Reference List is consistent with Page 2 of the following guide: https://cdn.csu.edu.au/__data/assets/pdf_file/0011/3371843/Charles-Sturt-University-APA-7-Referencing-Summary.pdf Intext citations and headings are included in the word count for this assessment. The reference list, title page, and headers and footers are NOT included in the word count. RATIONALE back to top SUBJECT LEARNING OUTCOMES This assessment task will assess the following learning outcome/s: be able to demonstrate a broad knowledge which links the underlying pathophysiology of serious cardiac, respiratory and neurological presentations to their clinical manifestations (NMBA 2.6, 3.1, 3.4, 4.1, 7.4).be able to apply theoretical knowledge, critical thinking and the use of best evidence to contribute to the planning and implementation of appropriate nursing interventions for the person experiencing a serious or life-threatening illness (NMBA 1.2, 2.5, 2.6, 3.1, 3.2, 3.3, 3.4, 4.1, 6.1, 6.2, 6.4, 7.1, 7.2, 7.4, 7.7, 7.8, 8.1, 8.2, 10.3).be able to analyse the legal and ethical considerations associated with the management of the deteriorating patient (NMBA 1.1, 2.1, 2.2, 2.3, 2.4, 2.5, 7.4, 7.5, 7.6, 9.3, 9.5).be able to communicate effectively with individuals, groups and members of the interdisciplinary team in the acute care environment (NMBA 1.2, 2.3, 2.4, 2.5, 5.1, 5.2, 5.3, 6.1, 6.2, 6.3, 7.4, 7.5, 7.6, 7.7, 9.1, 9.2, 9.3, 9.4, 10.2, 10.4) See further rationale relating to Case-Based Learning in Assessment Item 2 information.  GRADUATE LEARNING OUTCOMES This task also contributes to the assessment of the following CSU Graduate Learning Outcome/s: Professional Practice (Knowledge) – Charles Sturt Graduates possess the knowledge and understanding of the discipline and the nature of professionalism required for the given profession or discipline in contemporary societies. MARKING CRITERIA AND STANDARDS back to top CriteriaHD (85-100%)DI (75-84%)CR (65-74%)PS (50-64%)FL (0-49.5%)Mark1. Applies theoretical knowledge, critical thinking and best-evidence to interpret assessment data and critique the recognition of deterioration in the scenarioMost of the specific indicators of clinical deterioration have been outlined. Accurately justified most of the specific points in the scenario where a clinical review or rapid response should have been initiated, incorporating more subtle examples, based on best practice guidelines. Evaluated and synthesised sources to establish clear and accurate links between the underlying pathophysiology of stroke and most clinical manifestations evident in the scenario. (25 – 30 marks)The majority of the specific indicators of clinical deterioration have been outlined. Accurately justified most of the specific points in the scenario where a clinical review or rapid response should have been initiated, based on best practice guidelines. Synthesised sources to establish clear and accurate links between the underlying pathophysiology of stroke and several clinical manifestations evident in the scenario.(22.5 – 25 marks)Several specific indicators of clinical deterioration have been outlined. Accurately justified several specific points in the scenario where a clinical review or rapid response should have been initiated based on best practice guidelines.  Incorporated additional, current, peer-reviewed sources to establish clear and accurate links between the  pathophysiology of stroke and at least two of the clinical manifestations in the scenario. (19.5 – 22 marks)At least two specific indicators of clinical deterioration have been outlined. Accurately justified at least one clinical review trigger and one rapid response trigger at the correct points in the scenario. The readings provided have been used to broadly and accurately explain the links between the pathophysiology of stroke and at least two of the clinical manifestations in the scenario.(15 – 19 marks)Outline of clinical indicators in the scenario is vague or incorrect. CERS triggers have not been correctly justified. Critique is not supported with appropriate / sufficient evidence.There is no or minimal discussion of the underlying pathophysiology of stroke and how this links to the clinical manifestations in the scenario.(0 – 14.5 marks)/302. Applies theoretical knowledge, critical thinking and best-evidence to critique the escalation of deterioration and communication the scenarioThe use of graded assertiveness communication tools has been evaluated, with detailed and insightful rationales.Most key strengths have been outlined and several opportunities for improvement in communication within the interdisciplinary team have been justified.Credible, reliable, authoritative and relevant sources have been synthesised to create a nuanced and authoritative critique.(25 – 30 marks)The use of graded assertiveness communication tools has been evaluated, with detailed rationales. Most key strengths have been outlined and several opportunities for improvement in communication within the interdisciplinary team have been justified.  Credible, reliable, authoritative and relevant sources have been combined to support positions taken and forming a compelling critique.(22.5 – 25 marks)The use of graded assertiveness communication tools has been evaluated, with clear rationales. Several key strengths have been outlined and several opportunities for improvement in communication within the interdisciplinary team have been justified.  The critique is consistently supported with credible, reliable, authoritative and relevant sources.(19.5 – 22 marks)The use of graded assertiveness communication tools has been broadly evaluated, with minimal rationale provided. Some key strengths have been outlined and at least two opportunities for improvement in communication within the interdisciplinary team have been justified. The critique of the communication of nurses in the scenario is based on a reading provided.(15 – 19 marks)Less than two improvements in communication within the interdisciplinary team provided or the improvements proposed are incorrect, lack detail, or poorly justified. Response contains numerous unsupported assertions (large sections of text are missing citations where unoriginal ideas have been used) or sources are generally not credible, reliable, authoritative or relevant.(0 – 14.5 marks)/303. Applies theoretical knowledge, critical thinking and best-evidence to critique the management of deterioration in the scenario.Incorporated several relevant ethical and legal considerations with specific examples from the scenario. Response is insightful, detailed and concise, using subtle aspects of the scenario to accent the complex and challenging nature of nursing care throughout the organ donation process.Synthesised the findings of the selected article(s) with other appropriate sources.(17 – 20 marks)Incorporated several relevant ethical and legal considerations with specific examples from the scenario. Response is insightful and detailed, using subtle aspects of the scenario to accent the complex and challenging nature of nursing care throughout the organ donation process. Contrasted the findings of the selected article(s) with other appropriate sources.(15 – 16.5 marks)Incorporated several relevant ethical and legal considerations with specific examples from the scenario. Response is clearly relevant to the key issues in the clinical scenario. Detailed links to the findings of the selected article(s).(13 – 14.5 marks)Relevant legal and / or ethical considerations have been broadly yet accurately outlined. Response is broadly relevant to the key themes of the clinical scenario provided. Broad links to the findings of the selected article(s). (10 – 12.5 marks)Legal or ethical considerations have not been accurately outlined. Response is not relevant to the key themes of the clinical scenario provided. Response is superficial or vague. Response does not incorporate any of the reading materials provided.(0 – 9.5 marks)/204. PresentationIntroduction provides a vivid contextualisation for the reader to the concept of clinical deterioration and the key elements of the task or the scenario. Submitted a paper with no more than 1-2 minor errors in spelling or punctuation. Sentence structure and paragraph structure are consistently correct throughout. The conclusion clearly summarises the key findings of the critique and the significance of the paper on the learning process, and does not introduce new information. (8.5 – 10 marks)Introduction provides a vivid contextualisation for the reader to the concept of clinical deterioration and the key elements of the task or the scenario. There are 1-2 notable errors in spelling or punctuation Sentence structure and paragraph structure are consistently correct throughout. The conclusion clearly summarises the key findings of the critique and the significance of the paper on the learning process, and does not introduce new information.  (7.5 – 8 marks)Introduction clearly contextualises the reader to the concept of clinical deterioration, the key elements of the task or the scenario. There are 3-5 notable errors in spelling, punctuation, or sentence structure. Paper generally flows as a well-developed piece of academic writing. The conclusion clearly summarises the key findings of the critique and does not introduce new information. (6.5 – 7 marks)Introduction broadly contextualises the reader to the concept of clinical deterioration, the key elements of the task or the scenario. There are more than 5 notable errors in spelling, punctuation, or sentence structure but this has not affected the meaning of the text. There is an adequate structure to the paper but paragraph structure requires further improvement. The conclusion broadly summarises the key findings of the critique and does not introduce new information.  (5 – 6 marks)Introduction does not adequately contextualise the reader to the concept of clinical deterioration, the key elements of the task or the scenario. There are more than 5 notable errors in spelling, punctuation, sentence structure or paragraph structure and this has affected the meaning of the text. The conclusion includes new information that has not been covered in the body of the paper, or fails to adequately summarise the key findings of the critique. Paper does not meet presentation requirements as detailed in subject outline. (0 – 4.5 marks)/105. APA 7th edition referencing styleUse of citations consistent throughout to support your writing. Formatted your citations following APA referencing conventions for in-text citations, with no errors. Formatted your reference list following APA referencing conventions, with no errors.  (8.5 – 10 marks)Use of citations consistent throughout to support your writing. Formatted your citations following APA referencing conventions for in-text citations, with inconsistent minor errors. Formatted your reference list following APA referencing conventions, with inconsistent minor errors.  (7.5 – 8 marks)Use of citations consistent throughout to support your writing. Formatted your citations following APA referencing conventions for in-text citations, with consistent minor errors. Formatted your reference list following APA referencing conventions, with consistent minor errors. (6.5 – 7 marks)Consistency of citations is mostly adequate throughout. Several notable errors in citations, but most citations are accurate. Several notable errors in reference list, but there is a clear attempt to maintain referencing conventions. (5 – 6 marks)Citations do not match reference list. Substantial errors within the in-text citations. Substantial errors within the reference list. Reference list not on a new page.  (0 – 4.5 marks)/10Academic Integrity Assessment will be submitted to TURNITIN by the Subject Coordinator. Students can submit their assignments to TURNITIN before uploading to EASTS.Turnitin report indicates a clear attempt has been made to adhere to academic integrity and referencing conventions, and avoid plagiarism. It is evident that the student has taken steps to show respect for and acknowledge others’ work appropriately, as per the CSU Academic Integrity Policy.SYTurnitin report indicates the student has not adhered to the Academic Integrity Policy. USSY / USTotal /100 Glossary of Terms Comment onState your views based on what you have read, researched by other means or learnt in lectures and tutorials.Critically analyseProvide an in depth examination of the strengths and weaknesses of the ideas/arguments in the assessment question/statement supported by evidence.DescribeProvide an account of; outline the features of an issue, event or process.JustifyGive reasons in support of conclusions drawn.OutlineProvide a general description or summary of the main features.SummariseBriefly outline the main features / arguments. Don’t include related details or examples Source: https://cdn.csu.edu.au/__data/assets/pdf_file/0007/463381/Common-Instruction-Words.pdf PRESENTATION back to top Scholarly papers, reports, or other similar assessment items must be ‘word processed’ (must be a Microsoft Word Document) and not handwritten. A template has been provided to guide your presentation in this assessment. Use of this template is highly recommended but not essential.  Requirements include:  Leave 2 cm margins and double line space your work;Use 12pt font, unless otherwise indicated;Number all pages;Insert student name and number in header or footer of every page of every assignment; andInclude a title page that includes the subject name and code, title of the assessment task, due date, lecturer’s name, student’s name and student’s number;Dot points, images, lists and tables are NOT to be used for this assessment. All writing must be presented in appropriate academic conventions (in paragraphs).  REQUIREMENTS back to top Referencing Correct and consistent referencing is an important component of producing professional and credible academic work. Marks will be awarded for high quality referencing. Please refer to the following text for information on how to reference your paper: American Psychological Association (APA). (2020). Publication Manual of the American Psychological Association (7th ed.). APA. Students may also access CSU’s Academic Referencing Tool (ART) which provides detailed referencing examples for the referencing style – APA 7. This resource can be accessed through the CSU Library. Text-matching In the School of Nursing, Midwifery and Indigenous Health, all written assessments are processed through TURNITIN by the markers, after the student has submitted their work. TURNITIN is a plagiarism checking service which checks the assessment for unoriginal content and improper citation. Students are encouraged to use TURNITIN for themselves. TURNITIN has a pre-emptive education function which students may use to check their own work prior to submission. Students are encouraged to use TURNITIN to support them in their learning. NRS312 Essential Nursing Care: Managing the Deteriorating Patient Mrs Sally BrownNRS312 Assessment 3 Material // Case Scenario (Sally Brown) ii Disclaimer (please read before reviewing the scenario): The following scenario has been developed to support completion of Assessment Item 3: Deteriorating Patient Scenario Critique for NRS312 in the 202130 session. In this scenario, a patient is admitted to hospital for an elective procedure and experiences an acute ischaemic stroke. The scenario has been based on aspects of several real cases and has been reviewed by academics and clinicians to ensure that it is authentic to the clinical context portrayed. Written by Evan Plowman – 2020, updated 2021 Reviewed by: Maryanne Podham, Patience Moyo, Katie Piper, Keden Montgomery, Sue Slater, Renee McGill © Charles Sturt University NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 1 Scenario: Mrs Sally Brown Background Mrs Sally Brown is a 73-year-old retired school principal, admitted to a large, rural hospital for an elective Total Hip Replacement (THR) of her left hip. Mrs Brown lives alone, but meets with friends regularly and has three adult children and several grandchildren. 02/02/2020 – 0800 Mrs Brown presents to the hospital in preparation for the procedure. The following information is collected during the admission: Vital Observations: • BP 135 / 90 mmHg • HR 90 bpm (regular pulse) • RR 18 bpm • Temp 36.7°C • Sats: 96% (RA) • Alert • Denies pain Further Assessment: • Baseline ECG performed – Sinus Rhythm – nil abnormalities detected • Height: 162cm • Weight: 71kg • BGL: 7.2mmol/L Medical History: • Osteoarthritis (OA) • Diabetes Mellitus Type II (diet controlled) • No known allergies • Left Total Knee Replacement (2010) • Previous smoker (10-15 cigs/day for 25 years, quit 15 years ago) • 4-5 glasses wine per week • Nil illicit drug use • Moderately sedentary lifestyle (occasional gardening but no regular exercise) • Mobilises with walking stickNRS312 Assessment 3 Material // Case Scenario (Sally Brown) 2 02/02/2020 – 1145–1355 Mrs Brown undergoes an uneventful THR operation of her left hip. Her observations remain stable throughout the procedure. The operation is complete within two hours. 02/02/2020 – 1355 – 1635 Mrs Brown’s observations are also within normal ranges throughout her time in the PostAnaesthetic Care Unit (PACU). Post-operative blood pathology (EUC, FBC, LFT and CMP) is collected and all results return within normal limits. Post-operative orders from Orthopaedic Surgeon: • Thrombo-embolic Devices (TEDs) / Sequential Compression Devices (SCDs) • PCA (morphine) for pain relief – Pain Team review in 1/7 • Anti-coagulation as charted (Clexane) • Deep-breathing / Coughing exercises • RIB until XR and review by Physio • Strict fluid balance chart / IDC • IVF as ordered • IVABs as ordered • Dressing to remain intact • Neurovascular observations • Wound drain check 4/24 02/02/2020 – 1835 Mrs Brown is transferred from the PACU to the Surgical Unit. Vital Observations: • BP 121 / 87 mmHg • HR 95 bpm • RR 16 bpm • Temp 36.0°C • Sats: 98% (NP 4L/min) Urine output is checked on admission – 250mLs since the conclusion of the operation. Observations charted hourly for 4 hours and ‘between the flags’ (all observations remain similar to those given above) Mrs Brown using her PCA well to control her pain (rating the pain 2/10). Mrs Brown denies nausea. The neurovascular observations of the left leg includes: strong pulses, minimal swelling, and normal colour, movement, warmth and sensation . All post-operative orders are followed The evening shift RN also performs a full physical assessment, assists Mrs Brown to have a post-operative wash in bed and gives education about the PCA and how to use it. NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 3 02/02/2020 – 2200 The RN on the evening shift gives clinical handover to Jeremy, the night shift RN allocated to Mrs Brown. This handover includes: all of the assessments and care given to Mrs Brown up until this point, the post-operative orders from the orthopaedic team and the RN ensures that all care has been documented appropriately. Vital Observations (recorded just prior to handover): • BP 115 / 80 mmHg • HR 92 bpm • RR 18 bpm • Temp 36.6°C • Sats: 95% (NP 4L/min) • Pain in hip 2/10 (managed with PCA) The evening shift RN comments that “Mrs Brown’s daughter was a bit concerned that she was ‘not herself on the phone’ but I have assured her that this is common after such a big operation and she is on some pretty strong pain killers”. Jeremy becomes quite busy at the beginning of the shift with numerous antibiotics due for other patients and several patients requiring analgesia. 03/02/2020 – 0045 Jeremy comes into the room to visually check on Mrs Brown. Mrs Brown only responds to verbal stimuli but becomes more awake over the next 15 minutes. Initially Mrs Brown is under the impression she is in her own home and does not recognise or trust Jeremy at all. Mrs Brown knocks over her cup of water. Mrs Brown complains of numbness on her right side (which she is lying on). Jeremy assists her to carefully reposition onto her back (supine position) and explains that “it is common to experience numbness when you don’t move around as much as normal”. Mrs Brown moves slowly and only agrees to Jeremy’s requests reluctantly. Jeremy also explains that “it is normal to get a bit confused in hospital due to the analgesia, anaesthetic and the unfamiliar environment”. Jeremy checks the IVF (running at 125 mLs/hr, with patent cannula in left hand), empties the urinary catheter bag (650mLs drained since last checked), checks the wound dressing (clean, dry and intact), measures the output in the wound drain (minimal haemoserous fluid), checks the PCA (minimal use over the past few hours), checks the neurovascular observations (colour, warmth, movement and sensation normal on left leg) and ensures Mrs Brown is able to reach her nurse-assist button and a new cup of water. 03/02/2020 – 0200 Vital Observations • BP 185 / 100 mmHg • HR 125 bpm • RR 22 bpm • Temp 36.2°C • Sats: 96% (NP 4L/min)NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 4 Initially, Mrs Brown is very difficult to rouse and Jeremy is unable to wake her without painful stimuli. Mrs Brown responds to a trapezius pinch verbally (mumbling) but wakes up more over the next few minutes. Mrs Brown then complains of a ‘bad headache’. Jeremy informs the in-charge nurse of Mrs Brown’s blood pressure and headache and then calls the Resident Medical Officer on call for the hospital overnight. Hello Doctor, My name is Jeremy and I am the RN caring for Mrs Sally Brown in the surgical ward this evening. I have taken her blood pressure and found she has a systolic BP of 185mmHg. She has no history of hypertension and she also has a headache. I was hoping you could give me a phone order for paracetamol and I will recheck her blood pressure in the next hour or so. I am also hoping you can come up and do a clinical review when you are able to . Thanks Jeremy. I am happy for you to administer oral paracetamol and initiate the first dose yourself. I will chart PRN paracetamol when I come down. I agree that this blood pressure is quite high. The after-hours Registrar is caught up in ED and I will want to discuss this with them so we can make a more definitive plan then. I am also busy with another patient where I am. I am happy to give the paracetamol and chart this myself, but I think it is important that you come to review her within 30 minutes please. I am a little bit worried that her blood pressure is so high. Please keep checking the blood pressure and I will be there as soon as I can.NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 5 Thank you, Doctor. I will do this and hope to see your shortly. The Resident Medical Officer becomes busy with other patients and does not arrive in the Surgical Unit. Jeremy continues to perform hourly blood pressure checks and documents the following: 03/02/2020 – 0300 • BP 190 / 104 mmHg 03/02/2020 – 0410 • BP 198 / 115 mmHg 03/02/2020 – 0505 • BP 220 / 145 mmHg 03/02/2020 – 0555 Jeremy enters the room to check vital observations again. Mrs Brown is mumbling and incomprehensible. Jeremy notices Mrs Brown’s face is drooping on the right side and she does not appear to understand what Jeremy is saying to her. When Jeremy is not speaking to Mrs Brown, her head slumps forward and she makes audible expiratory sounds with each breath. Jeremy immediately initiates a rapid response and calls out for help from another RN. Vital Observations: • BP 224 / 151 mmHg • HR 110 bpm • RR 28 bpm • Temp 36.8°C • Sats: 89% (NP 4L/min) Jeremy applies an oxygen face mask (Hudson Mask) at 6L/min. The two nurses reposition Mrs Brown into a supine position and gently support her mandible with a jaw thrust manoeuvre. The Rapid Response Team (RRT) arrives within 5 minutes. The Medical Registrar performs a full neurological assessment and determines the clinical signs suggest Mrs Brown is experiencing a stroke. Mrs Brown is transferred urgently to radiology for a head CT, confirming the diagnosis of an acute ischaemic stroke. END OF STAGE 1 (Responses to Question 1 and 2 must be focused on the scenario up to this point) NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 6 Stage 2 – Response to Question 3 must be based on the following section of the scenario . 03/02/2020 – 0900 Following the diagnosis of an acute ischaemic stroke, thrombolysis is administered to Mrs Brown with little effect. Mrs Brown becomes unresponsive to pain and is intubated with an endotracheal tube to support her airway. Mechanical ventilation is used to support her breathing. Mrs Brown is admitted to the Intensive Care Unit. Invasive monitoring is commenced as well as several medications to support her organ function and for comfort. The Intensive Care Team contact Mrs Brown’s person for contact (her daughter, Tanya) and they explain what has happened. Over the following day, Mrs Brown’s three children arrive (travelling from various distances) to be together and to support their mother. Despite the efforts of the healthcare team, Mrs Brown continues to deteriorate, becoming unresponsive to pain when sedation is discontinued . 04/02/2020 – 0900 Tracy is an RN working in the ICU and caring for Mrs Brown. Keeping her body stable requires a number of complex nursing assessments and interventions. Tanya and her siblings, Michael and Kristin, are very stressed, eager to understand what is happening at all times and distressed about the level of uncertainty in Mrs Brown’s prognosis. The ICU team performs a ‘Multi-disciplinary round’ where the medical team involve other members of the healthcare team (including Tracy) in a discussion of the current issues and plan moving forward. This discussion also includes Mrs Brown’s family. After a thorough assessment and discussion between the healthcare team, Dr Vincent (Intensive Care Specialist) and Tracy sit down and discuss the current situation with Mrs Brown’s family. Dr Vincent explains that Mrs Brown’s brain has been deprived of oxygen for several hours and has become irreversibly damaged. Tracy assists in communicating with the family in a way that is relatable and compassionate. The discussion ends with Dr Vincent asking the family to return after lunch to discuss further about the possibility of withdrawing the treatments that are keeping Mrs Brown alive. After the initial family discussion, Dr Vincent asks Tracy to access the Organ Donation team in NSW and arrange resources and support to open a discussion later in the day with Mrs Brown’s family. While Tracy has undertaken training in relation to organ donation, she has never been involved in the process directly and is apprehensive. 04/02/2020 – 1400 A second family meeting transpires between Tanya, Michael, Kristin, Tracy and Dr Vincent. The discussion begins with Dr Vincent confirming that Mrs Brown’s condition has remained very similar to the morning with a further small decline and explaining that the current treatment has become futile. Tanya explains that she does not believe her Mum would have wanted to suffer as she is, with no hope of improving. There is consensus in the group that withdrawing treatment later in the day is the best option. Tracy offers pastoral care or members of the clergy to attend if this is Tanya’ s NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 7 preference (which she declines). Dr Vincent asks the family to spend as much time as they need with Mrs Brown and to notify Tracy when they are ready to meet again. Dr Vincent mentions that they would like to discuss the possibility of organ donation but would discuss this in detail at the next meeting. Dr Vincent explains that this conversation will take place with a different doctor to ensure that there is separation between the decision to withdraw life-sustaining treatment and the decision to donate Mrs Brown’s organs. The family members thank the team for the effort and for the discussion and return to Mrs Brown’s room to spend time with her. 04/02/2020 – 1600 A third family meeting transpires between Dr Hill (another ICU Specialist), Tanya, Michael, Kristin, and Tracy. Dr Hill opens the discussion by explaining that organ donation is an ‘optin’ process in Australia and can only take place if Sally is a registered organ donor and her family consents to the donation taking place. Dr Hill explains that there are two types of organ donation and that Sally is a suitable candidate for organ donation after circulatory death (DCD). Dr Hill and Tracy explain that the donation being proposed would involve withdrawing the ET tube and the medications supporting Sally’s vital organs but leaving the analgesia and low level sedation running for comfort. The team explains that Sally’s body would be unlikely to keep her heart beating for more than a few minutes after the tube and medications have been withdrawn. Michael raises a concern that his mother had been raised as Catholics and was taught that organ donation was not something that the church approved of. Michael acknowledges that he didn’t think that religion played a big part in Sally’s life but wanted advice about how to proceed as he had read conflicting information in social media posts. Kristin contends that Sally no longer considered herself a Catholic and did not hold strong views against organ donation; in fact she was in support of organ donation. The team mentions that Sally is a registered organ donor on the national register. Tanya explains that Sally had added herself to the register after an education session at work but did not discuss her preferences in detail. Tracy assures Mrs Brown’s family that the team will continue to support them and provide excellent nursing care to Sally, both in supporting her body until the withdrawal of treatment, minimising discomfort and treating her body with dignity. Dr Hill determines that Sally is not able to consent to organ donation in her current condition and instead gains consent for the procedure from Tanya and with consultation with Michael and Kristin. The meeting ends with Dr Hill explaining that the organ retrieval team will take around two hours to arrive and they will arrange an operating theatre. The discussion is documented in Mrs Brown’s medical record and the consent form is signed by Tanya and Dr Hill. Mrs Brown’s family return to her room to be with her again. 04/02/2020 – 1600 1800 A number of actions take place to ensure the perfusion continues to Mrs Brown’s organs. This includes the continuation of invasive ventilation, and the administration of inotropes. Several tests are also conducted, including a series of blood pathology samples collected. Tanya asks why the organ donation has not yet gone ahead. Tracy explains that theatres are occupied with emergency surgery and assures Tracy that it won’t be too much longer, but is unable to give a specific time. NRS312 Assessment 3 Material // Case Scenario (Sally Brown) 8 04/02/2020 – 1945 Dr Hill advises that the theatre is ready and the team are ready to perform the procedure. Tanya, Michael and Kristin accompany the team with Mrs Brown to theatre. Mrs Brown is extubated, and the inotropes are ceased. Sally’s breathing and pulse continue for approximately 25 minutes. Tracy provides comfort for the family and provides reassurance that the analgesia and sedation are keeping Sally comfortable. 04/02/2020 – 2015 Mrs Brown is declared deceased. Her family say goodbye to her and leave the theatre. The organ donation takes place. Sally’s heart and lungs are damaged as a result of hypoxia and are not viable for transplantation but her liver, kidneys, pancreas, heart valves and corneas are all able to be transplanted to save several lives and improve the quality of life for several other people. Tracy debriefs with her Clinical Nurse Educator the following shift and expresses that the experience was challenging physically and emotionally but she was glad to be involved and to support Sally and her family in this situation. End of scenario This scenario includes elements that you may find confronting. In particular, you may have been involved in similar events in your personal, professional or study experiences. If you are distressed by the scenario, please contact the Subject Coordinator to discuss and consider contacting the CSU Student Counselling service (free and confidential) – https://student.csu.edu.au/services-support/health-wellbeing/counsellin

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