Introduction – Description of inpatient setting
- Key services and personnel
- How the department is supported by other departments
Identification and description of two trends impacting the setting
Evaluation of trends
- Ways to capitalize on trends
This presentation embraces a research of a clinical setting and how it has contributed towards improvements in health care generally across the nation and world. From research the setting identified to be described is the intensive care unit of hospitals. Trends pertaining to its evolution will be highlighted, evaluated and applications projected for future adaptations.
Health Care: Case Study
Description of inpatient setting (Intensive Care Unit)
Intensive care unit is the clinical setting identified for this discussion. It is described as ICU; critical care (CU); Intensive Therapy Unit (ITU) or Intensive treatment unit (ITU). Typically, services provided by these departments include specialist nursing care, which is not found on the regular medical, surgical or pediatric wards because patients admitted to this unit need more attention than those in the normal ward settings (McMillan & Hyzy, 2007).
Precisely, these patients admitted to intensive care units many have obtained serious injuries, experienced cardiac arrests or some other life threatening condition. Key personnel within the department include nurses trained in intensive care interventions and doctors. Support equipment includes ventilators, cardiac support machines or some other devices not installed on the other wards. This unit supports other wards when patients are transferred from the ward or emergency unit. In this way the workload on other wards is reduced. These wards cannot provide such skilled nursing care for patients in medical surgical crises requiring one to one care (McMillan & Hyzy, 2007).
Further descriptions of this unit highlighting functions supportive of other wards point to the fact that some hospitals may have one intensive care unit for all patients while some have more. Those with one do not support the workload on other wards as effectively. Others which operate a neonatal, cardiac, psychiatric, and post-anesthesia, support all these services more efficiently. The nurse-patient ratio is usually one patient to one nurse per shift. Doctors specializing in the particular condition requiring intensive care intervention are among the key personnel within this unit. Additional specialist services provided include application of mechanical ventilators to facilitate breathing when there is an endotracheal tube or a tracheotomy insertion. Cardiac monitors such as telemetry; external pacemakers; defibrillators; dialysis equipment for renal problems are also used to as care interventions (McMillan & Hyzy, 2007).
Other devices required for constant monitoring of bodily functions are also used as care interventions. These include feeding tubes; a web of intravenous lines, nasogastric tubes, suction pumps, catheters, drains, and specially prescribed drugs to treat the primary conditions associated with the hospitalization process. Pain reduction mechanisms include medically induced comas, sedation, analgesics (McMillan & Hyzy, 2007).
Identification and description of two trends impacting the setting
Bray, Wren, Baldwin, St Ledger, Gibson, Goodman and Walsh (2010) identified a change in staffing trends for intensive care units. This is the first trend identified in intensive care unit function as it pertains to this study. The researchers argue that while since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient; there need to be some changes in the twenty-first century staffing interventions. Importantly, critical care has changed drastically since this standard was established (Bray, Wren, Baldwin, St Ledger, Gibson, Goodman and Walsh, 2010).
It was the first time in British nursing history that three professional organizations collaborated in redesigning critical care staffing standards. Previous research endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N); the Royal College of Nursing Critical Care and In-flight Forum established the evidence based framework for these standards. The new standards protocol revealed that there is substantial evidence supporting the need for a higher number of registered nursing staff to patient ratio. Consequently, when more nurses were caring for one patient there was marked improvement in safety and productive patient outcomes (Bray et.al, 2010)
The second trend for this discussion relates to intensive care units around the world. This trend came about in response to two major changes influenced by patient characteristics and management. Analysts have cited that the impact has demanded current trends to be altered and newer ones embraced. Precisely, a description of the trend shows where it has been influenced by the introduction of an early invasive strategy in acute coronary syndromes treatment, which facilitates early recuperation and reduces the need for extensive intensive care intervention (Hasin, Danchin, Filippatos, Heras, Janssens. Leor, Nahir, Parkhomenko, Thygesen, Tubaro, Wallentin, & Zakke, 2005). .
While early recuperation of patients facilitates efficiency; cuts costs and helps in workload on regular wards there was a significant increase in older critically ill patients who require complex intensive care. This is the other trend identified an increase in critically ill elderly stay in intensive care units beside increase in staffing one patient per patient (Hasin, et.al, 2005).
This lead to the establishment of a task force led by the European Society of Cardiology Working Group on Acute Cardiac Care. They reviewed this trend and made some modern resolutions considered to be comprehensive recommendations regarding structure, organization, and function of the modern ICCUs with distinct adjustments for intermediate cardiac units. A major recommendation was that cardiologists and cardiac nurses must have additional training to manage patients with acute cardiac conditions. They should be the only ones to staff cardiac intensive care units (Hasin et.al, 2005).
Recommendations regarding organization of the unit embodied a department head and certiﬁed cardiologist. For the first 12 beds one physician for every six beds. When there are more than 12 beds one physician for every 8 beds. The recommended nurse-patient ratio is 1.8 nurses per bed. Additional non-nursing staff should include a secretary and full time nursing assistant; dietician, computer expert; ventilation technician, social worker, physiotherapist, porters, and cleaners (Hasin et.al, 2005).
Infrastructural recommendations included equipping the unit with up and down head and leg positioning beds with oxygen, vacuum, and compressed-air intakes. All bed must be X-ray accessible. One bed should be reserved for patents with contagious diseases and kept in an isolated section of the unit. Other important sets of equipment were volumetric pump/automatic syringe; mechanical respirators; intra-aortic balloon pump; pacemaker deﬁbrillator (Hasin et.al, 2005). This is a description of modern trends in intensive care units across the world as it pertains to staffing and organizing for a longer stay of critically ill elderly patients within intensive care units.
Evaluation of trends
Two major trends were identified in the foregoing literature analysis. One pertained to distinct staffing issues in various intensive care settings. The other related specifically to organization and function in cardiac intensive care units for a longer stay of critically ill elderly. Staffing generally has been an issue in nursing care. Therefore, it is no surprise that the trend is not just for an increase in nurse patient, but importantly, quality staffing in intensive care units across the world.
Gallesio, Ceraso and Palizas (2006) have contended that despite many significant advancement in medical science and intensive care evidence based practices such as mechanical ventilation, renal replacement therapy, antimicrobial therapy and hemodynamic monitoring the quality of services do not reach every patient who needs it (Gallesio, Ceraso & Palizas, 2006). Hence, trends advanced by Bray’s (2010) team of researchers as well as Hasin (2005) are relevant to this evaluation.
Intensive care is costly, especially, when patients are on cardiac support for long term periods as identified by Hasin’s (2005) task force group. The elderly is quickly becoming a critical group requiring this intervention for prolonged periods. Intensive care was not meant to be long-term care and trends have been to reduce this hospitalization time through efficient nursing techniques; adequate equipment and improvement in quality of care through specialization and reorganization of units to meet twenty-first century demands for critical care.
Ways to capitalize on trends
Obvious trends projected in this discussion pertained to staffing quality and numbers as well as redesigning infrastructure to eliminate long-term intensive care among the elderly. As a health care administrator a way to capitalize on these trends first is by encouraging nurses to specialize in intensive care nursing. Hasin’s (2005) task force recommended 1.8 nurses per bed. Distinctly, this is requiring more nurses to manage the unit. Besides, there is an issue of specialization in various aspects of intensive care.
Maybe the emerging trend of elderly patients remaining longer in intensive care than younger ones could be because nurses functioning in this unit are not adequately trained or experienced in geriatric management. Thus, ways of taking advantage of this trend is to advocate for a specialization in older adult intensive care units with nurses and physicians trained in geriatrics. This is expected to address trends in staffing changes as well as early recuperation form the elderly while in intensive care.
Bray, K. Wren, I. Baldwin, A. St Ledger, U. Gibson, V. Goodman, S., & Walsh D (2010). Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses. The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum. Nurs Crit Care, 15(3); 109-11
Hasin, Y. Danchin, N. Filippatos, S. Heras, M. Janssens, U. Leor, J. Nahir, M. Parkhomenko, A
Thygesen, K.Tubaro, M. Wallentin, C., & Zakke, I. (2005). Recommendations for the structure, organization, and operation of intensive cardiac care units. The European Society of Cardiology
Gallesio, A. Ceraso, D., & Palizas, F. ( 2006). Improving quality in the intensive care unit setting”. Crit Care Clin. 22 (3): 547–571
McMillan, T., & Hyzy, M. (2007). Bringing quality improvement into the Intensive care unit. Critical Care Medicine. Society of Critical Care Medicine and Lippincott Williams & Wilkins. 35(2), S59–S65