...American Heart Association (AHA) created the National Registry of Cardiopulmonary Resuscitation (NRCPR) as an evidence-based hospital safety program that provides data derived from a multi observational sites [1]. Every year there are 370,000 to 750,000 hospital resuscitation attempts made in United States [2]. The data comprise comprehensive information related to the cardiopulmonary resuscitation (CPR) process, patients’ outcome, and characteristics of both the patients and the hospitals. The purpose of the registry data is to provide information that can be used to improve the outcomes of sudden cardiac arrest (SCA) patients and to update the protocol for CPR. Unfortunately, we do not have a similar national or...
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...Imagine a patient ask you to end his life. The patient has the right to do so because of the Do-not-resuscitate order. This order prevents health care providers to not do cardiopulmonary resuscitation (CPR) if the patient is near the end of his life. I will be horrified and distressed under this situation. In my understanding, a nurse acts as a sentry who watches over and protects the patient. Yet, the patient told me to kill him and abandon all my moral values. This is an extremely difficult decision to make because as much as I don’t want the patient to suffer from pain, I also don’t want to take away his precious life. However, is a third option available? A study was done to illuminate nurses’ experiences of being in ethically difficult situations in an emergency ward. “The child was pronounced dead with no effort made to do anything…I only felt that this was a terrible situation to be in…”(Langeland et al). The nurse in this situation felt vulnerable because there was nothing she could have done to save the child. Just like the previous scenario, as much as you want to save the patient, there was no other way but to respect the patient’s decision for death....
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...Senior Project 88% of Sudden Cardiac Arrest (SCA) cases occur in the victim's home. Roughly 70% of Americans do not know how to administer Cardiopulmonary Resuscitation (CPR), or have not kept up on the required training. 326,000 people in the United States are hospitalized due to SCA. In order to gain a better understanding of Cardiopulmonary Resuscitation one must know where it originated. The ten year period from 1950-1960 was a decade of improvement for resuscitation measures. Peter Safar, James Elam, and The United States Military were all contributors to the development of all forms of resuscitative revival. Elam and Safar were the first people to discover mouth-to-mouth resuscitation. Soon after CPR was developed. Over the last few...
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...combination thereof: “hands-only”; “compression-only”; chest compression-only”; “bystander”; “CPR”; “dispatcher”; and “neurological affect”. We initially restricted our search to peer-reviewed studies published in English between January 2004 and June 2014, but agreed by consensus to use a 2000 study located during a manual search of included study references. Results We identified nine Level II, III, and IV studies comparing “hands-only” CPR and “standard” CPR, published between 2000 and 2013, and occurring in the countries of Japan, London, Sweden and the U.S. All but one of the study results recommend that “hands-only” CPR is at least equal or superior to “standard” CPR. Conclusions Guidelines should be established to teach bystander “hands-only” CPR nationwide, to increase public awareness of the effectiveness of “hands-only” CPR and start to teach out-of-hospital “hands-only” CPR. Introduction Sudden cardiac arrest is the leading cause of death in the United States (Neumar, Barnhart, Berg, Chan, Geocadin, Luepker,… Nichol, 2011). According to the American Heart Association (AHA), “Each year, emergency medical services (EMS) assesses nearly 360,000 out-of-hospital cardiac arrests (OHCA) in the United States” (Neumar, et al. 2011). Bystander initiated cardiopulmonary resuscitation (CPR) could mean the difference between life and death in many of these victims. The 2008 AHA Science Advisory Committee for the Public approved...
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...Original article | Published 3 February 2011, doi:10.4414/smw.2011.13157 Cite this as: Swiss Med Wkly. 2011;141:w13157 Do not attempt resuscitation: the importance of consensual decisions A qualitative study Lorenz Imhofa, Romy Mahrer-Imhofa, Christine Janischb, Annemarie Kesselringc, Regula Zuercher Zenklusend a b c d Zurich University of Applied Sciences ZHAW, Institute of Nursing, Winterthur, Switzerland Department of Education, Training and Professional Development, Stadtspital Waid Zurich, Switzerland Institute of Nursing Science, University of Basel, Switzerland Department of Medicine, Pourtalès Hospital, Neuchâtel, Switzerland Correspondence: Lorenz Imhof PhD RN Zurich University of Applied Sciences Institute of Nursing School of Health Professions Technikumstr. 71 CH-8401 Winterthur Switzerland lorenz.imhof@zhaw.ch pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education. Key words: decision-making; multidisciplinary collaboration; end-of-life issue; resuscitation orders Introduction Since the 1980s, “do-not-attempt-resuscitation (DNAR)” orders have become common in medical practice. DNAR orders are given for 50–60% of patients who die a non-sudden death, with wide variations among countries. DNAR orders apply to only 19% of hospitalised patients in Italy, but to as many as 83% in Sweden and 86% in Switzerland [1, 2]. The frequency of DNAR decisions in...
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...Withholding Information 14 Informed Choice 17 Forcing Information Upon Patients 20 The Nurses Role 22 Conclusion 25 References 26 Appendix 27 Glossary of terms CPR: Cardiopulmonary Resuscitation. DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. NMC: Nursing & Midwifery Council. GMC: General Medical Council. BMA: British Medical Association. GP: General Practitioner Introduction The Aim of this module is to encourage me to enhance my personal and professional skills, to increase the efficacy of patient care and interaction. Also to make me more aware of the legal, professional and ethical implications of practice. The module allowed me to further develop my knowledge of these topics: Ethics & Accountability, Legal Aspects of Practice, finally Accountability & Professional Practice. I was then asked to submit an essay of 4500 words based on the following: “Critically analyse an aspect of care from your practice setting that encompasses the ethical, professional & legal role of the nurse. Issues of accountability should be incorporated into this essay”. Aspect of care The aspect of care I have chosen to include in my essay is the “Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)” Adult Policy 2010 (please see Appendix 1). I decided to choose this topic as there was a situation on my ward recently where a patient discovered a DNACPR form in the front of her nursing notes. The patient...
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... This state regulation explains that one of the nurse’s roles is to help patients make their choices concerning their health. Being an advocate by helping patients understand their options and giving them information on what they need to think through so they can weigh the outcomes and possibilities. Also, allowing them to express their feelings and informing the people they want to be involved in making decisions about their health. But not all times, patients are able to make decisions for their selves. Based on the case study about Mr. E’s situation, this state regulation suggests that advocating for this patient is essential especially he is hypoxic and mildly developmentally delayed. But unfortunately, the nurse is not able to fully make decision based on ethical principles and perform his/her nursing role. The nurse should have questioned the physician about the patient’s wishes whether Mr. E’s did not want a ventilator or cardiopulmonary resuscitation or let his younger brother decide for his medical condition. The nurse should have told Mr. Y about this as well and should have not just followed what the doctor has ordered. Also, Dr. K and the nurse both violate the Health Insurance Portability and Accountability Act (HIPAA) regarding the condition of this patient. The American Nurses Association (ANA) nursing code of ethics indicates that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient which includes...
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...I currently work in a large private hospital in the Dublin area. My area of practice is the theatre department and I work mainly in anaesthetics and the post anaesthetic care unit or (PACU). The innovation I plan to introduce is the implementation of the National Early Warning Score (NEWS) documentation into the PACU. The PACU is the last clinical area in the hospital to implement the NEWS documentation. This summer I spent three months working in the hospital's High Dependency Unit (HDU) which had already implemented the NEWS. While there I took part in the hospital's sepsis study day and learnt how to apply the scoring system in practice. When I returned to the theatre department I was asked by my manager to lead the implementation of the...
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...Improving Outcomes in Sepsis Patients in the Emergency Department Sepsis is a left threatening illness that affects millions of people each year. The Center of Disease Control reports sepsis as the 10th leading cause of death in the United States (V). For adults age 65 and over hospital admission because of sepsis have increased 48%. The body’s immune system switches into “high gear” which overwhelms the body’s normal blood flow and oxygenation of tissues throughout the body. This process, if not treated in time, can quickly lead to organ failure and death. Approximately one third of people diagnosed with sepsis die from it. The role of emergency departments throughout the country has become vitally important to the early detection and treatment of sepsis. With the implementation of sepsis protocols in the emergency department the mortality of patients with sepsis admitted through the ED is significantly lower. The word sepsis is commonly used to diagnose patients, but the debate continues as to the true definition. The word sepsis comes from the Greek meaning decay or to putrefy.” (A). Sepsis is a general term that is applied to patients that develop clinical signs of infection. Unlike other diseases sepsis is not diagnosed by the location or type of microbe involved in the infection. Some of the criteria used to diagnose sepsis are abnormalities of body temperature, pulse, respirations, and white blood cell counts. Some symptoms that are common in septic patients...
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...Emergency Medical Services: The Evolution Behind the System Russell Keogler CED 595: Project Seminar May 3, 2011 Dr. Richard Gatteau Abstract The purpose of this study is to determine the evolutionary process of the emergency medical services system. The research explores the impact of war and prominent military figures on the development of emergency medical services as well as civilian efforts made to establish emergency services within the public sector. The research also discusses the ways in which major medical advancements and various reports and acts of legislation played a crucial part in the development of the modern day EMS system. Overall, results show that the EMS system as we know it today is a fairly modern creation based on centuries’ worth of ideas and discoveries. Introduction In modern day America the three digits 9-1-1 signify an accessible lifeline for individuals in need of emergency medical attention. The vast system is accessible from any telephone line and provides emergency services to even the most remote locations of the country. However, in spite of the simplistic process to initiate services, the emergency medical system is very complex. Thousands of independent agencies working in different capacities must coordinate efforts to insure that the system runs efficiently. Without effective cooperation by organizations the system would undeniably fail to meet the expectations of those calling for medical aid (Limmer &...
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... In the case study, the nurse is facing ethical as well as professional dilemma regarding the patient’s rights. The nurse’s role in this case study is to, work according to the Maryland state regulations and nursing standards; But as per Maryland nursing standards, she is not working as an advocate for her patient, Mr. E at this situation (Code of Ethics - the Division of State Documents, 10.27.19.02). The patient already signed advanced directive against life saving measures almost seven years ago, at the time of admission to a nursing home, with the help of patient advocate; but Dr G. is planning patient care in opposition to Mr.E’s active advance directive and his expressed objections to the medical care. There are numerous issues to consider in this case study. The nurse has to review her professional role according to code of ethics and nursing standards in relation to advance directives and medical power of attorney. The nurse also has to consider the patient’s right to privacy and confidentiality according to HIPPA Policy. The issues in contemporary healthcare facilities are sometimes the statues can be vague, and issues can be in conflict with own personal beliefs in most areas. A) State Regulations and Nursing Standards of practice There are specific Maryland state regulations and nursing standards regarding patient rights in this case study. However, the most relevant regulation is that, the nurse...
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...|CognitiveLevel||3rd Ed. Page References| |Recall|Application|Analysis|Totals|| I. PATIENT DATA EVALUATION AND RECOMMENDATIONS|11|14|1|26|| A. Review Data in the Patient Record|4|||4|| 1. Patient history e.g.,• present illness• admission notes• respiratory care orders• medication history• progress notes• diagnoses• DNR status• patient education (previous)|||||pp 33, 82, 47| 2. Physical examination relative to the cardiopulmonary system e.g., vitalsigns, physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177| 3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47| 4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197| 5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163| 6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177| 7. Monitoring data|||||| a. fluid balance|||||pp 139-140| b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196| c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196| d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143| e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175| 8. Cardiac monitoring|||||pp 35-45, 158-163| ...
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...| | |Course Project | |Flaws in Advance Directives, Living Wills, and Power of Attorney | Introduction A Living Will is a form of an advance directive that is a “legal document that describes those treatments an individual wishes or does not wish to receive should he or she becomes incapacitated and unable to make medical decisions” (Pazgar, 2007, p. 378). Normally in a Living Will an individual would also indicate another individual as his or her power of attorney in the legal document; however, it is not necessary for a living will to be created with a power of attorney or a power of attorney to be created with a living will though it is highly recommended to do so. This is due to the fact that each has its flaws and each could compensate for one another though in reality it could create more conflicts too. For a physician or any other healthcare provider to go against a patient’s autonomy means that there are many legal problems these physicians may face because...
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...Comprehensive Simulation Reflection Seven seconds… The heroin coursing through his veins. Empty bottles and track marks provided an escape. A 38-year old Caucasian, male found on the bathroom floor by his nine-year-old daughter. This simulation provoked the need to prioritize nursing assessments and interventions for a patient presenting with a heroin overdose and alcohol toxicity. Genetic and genomic considerations were taken into account regarding substance addictions. By evaluating the life of another, personal strengths and weaknesses were discovered. Twelve minutes… The time spent lying on the bathroom floor. The patient was found unconscious. Cardiopulmonary Resuscitation (CPR) occurred and Narcan was administered. Pinpoint pupils,...
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...of Cardiovascular Event Risk Pushpa Larsen, ND [pic]Ralph Holsworth, DO, recently shared a story with me about a patient he had in Colorado many years ago. He was an intern in a Denver hospital when he admitted a patient diagnosed as having a blood clot in his leg. Dr Holsworth started him on low-molecular-weight heparin subcutaneous injections concurrently with warfarin sodium. He worked the patient up for congenital thrombophilias, cancer, hypothyroidism, and other conditions, and consulted with hematology-oncology on the case. When the patient’s prothrombin time–international normalized ratio exceeded 2.0, Dr Holsworth was instructed by hematology-oncology to discharge the patient. A few minutes later, Dr Holsworth’s pager buzzed. His patient had just collapsed in the parking lot. He rushed down to the emergency department, where cardiopulmonary resuscitation was in progress and assisted in the code. The patient was pronounced dead after several attempts at resuscitation. A mandatory autopsy revealed that the patient had a major pulmonary embolism, resulting in his sudden death. It was not until several years later that Dr Holsworth learned of the role of whole blood viscosity (WBV) in the formation of thrombi. Dr Holsworth recalled that his aforementioned patient had been discharged with normal vital signs and laboratory test results that provided no indication of the evolving danger. Dr Holsworth later became one of the world’s leading experts in the use of blood viscosity in a clinical...
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