In my observation this past week, I had an opportunity to observe a 68-tear-old woman in critical care who was hemorrhaging due to aggressive blood pressure problems, and the critical care nurse who had her as a patient. It was a trauma situation, very critical, but not necessarily an emergency. The procedure was to very quickly identify the nature of the problem and then take steps to remedy it so that it was no longer critical.

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I was assigned to the Trauma Critical Care Unit at Beth Israel Deaconess Medical Center. There I learned that patient safety and positive patient outcomes were the stated goals of all treatment efforts at the hospital, and that these were achieved by using teamwork, collaboration, and effective communication. Critical care is, of course, a step down from intensive care, but still is very much concerned with acute health problems.

The patient presented with acute onset headache, nausea and emesis with subsequent right visual deficit and sensory aphasia in HTN, HLD, CAD, and impaired glucose tolerance. She had a moderately large right parietal lobar intraparenchymal hemorrhage. Her blood pressure was 200/120.

A critical care nurse has many responsibilities, including patient assessment. Among these responsibilities with this specific patient are to perform a diagnosis based on the patient’s clinical profile, evaluate vital signs and previous lab results so that in an emergency, measures can be taken to intervene where necessary, monitor all equipment associated with the patient, monitor patients for changes in their status so that appropriate interventions can take place efficiently and effectively, collaborate with other healthcare people to revise and refine treatment plans when the patient’s needs require, analyze data from observation, and assist doctors with procedures. These are among other responsibilities as well.

At a very basic level, the nurse’s responsibilities are based on a rationale that holds that patient safety and positive patient outcomes are the driving motivation for the nurse’s work. Keeping this in mind, these responsibilities have a very specific rationale.

Patient Assessment—an assessment and continuing reassessments are crucial if the patient’s health is to be maintained and improved. Information provided by a team member can be useful in an assessment too, as well as collaboration with others outside the unit, such as the lab or reports from examinations such as MRI, for example.

Perform A Diagnosis Based On The Patient’s Clinical Profile—an appropriate and accurate diagnosis is critical for the most appropriate treatment and interventions to be performed. It is the best way to keep a nurse from guessing. Teamwork is important here, too, from others who provide the information, including the intake nurse, who provides the medical history.

Evaluate Vital Signs And Previous Lab Results—this provides information about a patient in real time, while also allowing real time results to be compared with previous results. Teamwork is crucial here to, for example, nurses working on another nurse’s off-days, or at night. All information gathered is a part of the ongoing body of information about the patient that helps to inform the nurse of what is going on. This includes collaborating with lab people.

Monitor All Equipment Associated With The Patient—equipment malfunctions, and functioning equipment is critical for providing the nurse with accurate information upon which she will base her diagnoses. Teamwork is important here, too, as when a team member finds a problem with a piece of equipment that is faulty. In ac collaborative sense, the nurse depends on this happening in other departments, or with maintenance.

Monitor Patients For Changes In Their Status—status changes can either be positive or negativem but the negative ones signal something that needs medical attention, whether simply monitoring or something more direct. Status changes happen at all hours, and these must be monitored and charted accurately by other team members.

Collaborate With Other Healthcare People—collaboration is extremely important. As knowledgable as a nurse might be, she doesn’t know everything. Others can provide insights, expertise, or simply physical help that just might be the thing needed in a trauma situation

Analyze Data From Observation—this can be from any source: a patient’s chart, telemetry, direct observation, information from the patient himself or herself, family, others in the critical care unit
Assist Doctors With Procedures—another example of collaboration

Constant communication is crucial between team members and collaboratively as well. Charting is the most common form of communication, especially across departments, and across shifts. Anything out of the ordinary, either positive or negative, needs to be communicated. I’m thinking, for example, of a stroke patient whose paralysis is just beginning, and who feels that seeking help to go to the bathroom isn’t enough to bother a nurse about. But in this case, the patient is a serious fall risk. That he didn’t ask for help and should have is a matter of great concern for the nursing team, and this information needs to be communicated as soon as it’s discovered. The patient, too, who politely thought that a nurse shouldn’t be bothered needs to be communicated with so that he will understand the danger involved and that “bothering” nurses is not only ok, but expected.

At all events, patient safety is mandatory. Procedures are in place to address fall risks, patient ulcers, patient nutrition, and so on. But there is the constant challenge of, first of all, getting patients to understand that they are an important part of the effort to keep them safe, by not, for example, attempting to walk when they shouldn’t, and by reporting as soon as possible any changes that are not visible and that won’t show up on any test or piece of equipment, like, for example, developing pressure ulcers that need to be treated.