Process Map of a Patient - Assignment Example

Process Map of a Patient Introduction: In nursing practice and related work, the ability to solve problem is critical to success. The nursing processis of utmost importance in any clinical care scenario. In order to correctly diagnose a problem, the nurse must first understand all the factors that can cause the problem. The nursing process is thus a problem-solving technique. It is organized to help the nurse logically approach situations that may lead to problems in the clinical area. It helps essentially to think about more possibilities about a given problem and consequently about more possible solutions (Brown, M.D. et al., 2007, pp. 1114-1119). Definition: Simply said, a process map is simply a way of setting out the stages involved in a patient care. In the clinical care setting, it also shows the relationship between different activities involved in the patient's journey through the clinical care. As a result, this can be stated that it talks about a pathway of clinical care that involves the protocol in the care setting. This protocol is designed in such a way that this would provide a framework to co-ordinate care for a specific population of patients. Those whose practice involves clinical areas, they use pathways to integrate knowledge from current research and maximize efficiency while maintaining patient's care. Thus it can be used to replace the traditional nursing care plan. Mapping is defined as a graphic or pictorial tool to arrange the key concepts (Kinsman, L., James, E., and Ham,J., 2004, pp. 184-196). In a female cardiac surgery unit, most of the patients are admitted for undergoing cardiac surgery. If it is a planned surgery, the patient is admitted to the unit after the investigations are done, and an appropriate plan has been in place. In the current management of patients undergoing elective cardiac surgery, there has been a trend of using a clinical pathway and map that lead ultimately to a protocol to manage such patients. This account is about a patient in one shift day during my clinical duty in a female cardiac surgery ward (Goodnough, L.T. et al., 2005, pp. 1858-1861). This patient was admitted to the ward with history of repeated angina pectoris. The patient was admitted to the ward for a diagnostic cardiac catheterization and necessary intervention if feasible. On admission, the patient was thoroughly examined for accurate assessment of vital signs, baseline cardiac and pulmonary examination, a baseline neurologic examination, and baseline vascular assessments. This author had to record the findings, and the resident medical officer performed the examination (Brasel, K.J., Lim, H.J., Nirula, R., and Weigelt, J.A., 2007, pp. 461-466). Most important were recording the rate and rhythm of the heart, the volumes of the pulse, looking for any irregularity of the pulse, blood pressure record, condition of the arteries in both the groins, and condition of the breath sounds. After being satisfied that these were within normal limits, the social worker joined this author for providing educational materials to the patient. It was an opportunity to explain the intended procedure and its rationale to the patient. Our unit has a printed brochure that explains the procedure and its rationale in layman's language. The social worker took the lead, and this author had to be present there. It took some time for the social worker to attend the patient, and the patient and family were anxious about the delay. They had information that on the face of chest pain in the setting of atherosclerotic coronary artery disease, especially when the patient is having continual chest pain despite administration of sorbitrate may pose a threat for the heart attack. The social worker was busy with another patient. Once she was done, she attended the patient and explained her disease to her. This author then took over and explained to the patient what is going to be done to her in the coming hours, and this was done in simple language. The protocol that is followed in our clinical area is admission after the patient is informed, and she provides consent. For this reason, I arranged a meeting immediately followed by this with the family members and the patient. I explained the procedure step by step in easy language and the benefits as to how it is going to help the patient. There is a small but possible chance of complications involved in cardiac catheterization, and the patient has the option of independent and free will to opt out of the procedure. This explanation happened in a conversational mode, where the patient and the family were given scope of asking questions about the procedure. This session lasted for about 30 minutes, and the patient and the family agreed to go ahead with the procedure. They expressed verbal consent, and then this author provided the patient with a written consent form where all these were documented. The patient signed this written consent, and then the stewardess gave the patient a set of dresses to be worn in the ward. The stewardess helped the patient in doing this, and the stretcher bearers helped carrying the patient to the assigned bed, and this author with the help of stretcher bearers transferred the patient to the bed. Thus, in this admission process, the patient went though 5 service providers, and the wait was usual. Apart from waiting for the social worker, there was no appreciable delay in this process. Although it may seem not very important, all these steps were very important for the patient, especially the patient education, explanation of the procedure, and signing of a consent form. Once the consent form was signed, the pathological laboratory and cardiac catheterization laboratory, and other relevant professionals were notified. The admission office was notified regarding admission, and the final version of the medical record with chart sheet that contained the signed consent form was generated. The laboratory technician came down to the ward, and she drew blood samples for routine tests. The patient was hooked to a continuous electrocardiographic monitoring, and the ECG technician took charge to perform a 12-lead EKG. The attending surgeon was informed about the patient, and as per his advice, the Department of Anesthesiology was notified. It took some time, since the Anesthesia Department is understaffed, and the resident showed up a little late. Meanwhile, we thought that a chest x-ray may better be done with a portable chest x-ray machine. The technicians in turn took about 45 minutes to attend the call, and after they arrived, they took a bedside chest x-ray. The final report would take time to come since there is a huge work load for both the departments, but the preliminary reports were noted to be within normal limits including ECG, blood biochemistry, chest x-ray, and preanesthetic checkup. After talking to the Cathlab, this author came to know that the patient is scheduled for the procedure of cardiac catheterization followed by intervention only after another 4 hours, and that would be towards the end of this author's shift. It was decided that the patient would be send to the Cathlab after another 3 hours. A call was placed to the pathological laboratory for reports, and they conveyed that the patient's data has been uploaded in the system. I arranged to take printouts of the same, and they were attached to the records. This patient was delayed here in the ward for two reasons. The first is her absence of symptoms at the time of admission. Stabilizing the patient before sending her to the catheterization laboratory is an important protocol, and the repeat vital signs were all within normal limits with continuous electrocardiographic monitoring demonstrating normal-looking ECG tracing. The paper ECG tracing has been reported by the cardiologist to be normal. The bedside cardiac enzymes were within normal limits, so were the liver function tests, CBC, and blood sugar and electrolytes. Thus it may be assumed that for all practical purposes, the patient is out of imminent danger for a catastrophic adverse cardiac event such as myocardial infarction. Although the delay is worrisome, it would not hamper the quality of care that the patient is receiving. It is perceived that the delay is frustrating for the patient and the family, but the ward staff has nothing to do to speed up the procedural part of the care. Although latest technologies have reduced the time required for intervention, the high intervention volume load is causing the patient to stay longer in the preoperative phase in the ward. This author decided to utilize this time by communicating with the patient. This communication was necessary to allay the anxiety of the patient, since our client is expected to be anxious like any other patient before the procedure. It was a smooth communication, and no new issues came up during the conversation except for this tiring waiting time and anxiety about what would happen after the procedure. This author initiated conversation about that, and gradually, the patient opened up to express her worries. When she asked about the possible complication that might happen to her, this author clearly elaborated that the chances of complications are there, but the incidence rates are low. As a result, the expected outcome in this patient is very good, and mortality rates are very low. Along with that I also mentioned that our facility has a collection of very efficient interventionalists in the panel. They are 6 in number, and the procedure needs meticulous precision. It also involves the anesthesiologists and radiologists to be present in the operating room. Although anesthesiologists are also 6 in number dedicated to our department, they have also additional duties of stabilizing the patients postoperation and if necessary in the ICU. Thus there is a relative scarcity of these doctors, and this might be the possible cause of the delay. When she asked how many days, she needed to stay after the surgery, I found that it is better that her course of hospitalization stay be reviewed with her. In our facility, the post-procedure protocol varies depending on the patient's procedure, whether it is cardiac catheterization only or cardiac catheterization and intervention combined. In both the cases, the patient is brought to the postanesthesia care unit where assessment of vital signs, ECG, femoral puncture site edema or bleeding, patient's comfort, airway and breathing pattern are done. Continuous monitoring of oxygen level with oxygen saturation monitoring and oxygen supplementation as indicated are done routinely in these patients (Ochroch, E.A.et al., 2006, pp. 868-875). Control of blood pressure, nausea and vomiting, and pain are done with pharmacotherapy. Technicians, nurses, anesthesiologists, and junior physicians are all involved in such encounters. In case of a simple catheterization, usually, the patient is fit to be discharged within 23 hours. If there is an intervention, usually the patient is on blood thinning medications in the drip. Within 24 hours, this drip is over, and the patient is discharged to the ward or discharged home (Rigberg, D.A., Dorafshar, A., Sridhar,A., Quinones-Baldrich, W., and Moore, W.S., 2004, pp. 941-946). When it was time, I rechecked the laboratory data and saw whether they were appropriately attached to the record sheet supposed to be accompanying the patient to the catheterization laboratory. All the values were within expected range, so this author decided to notify the attending surgeon about the findings anyway. When everything was checked to be in place, this author accompanied this patient to the cathlab holding area and handed over the patient to the circulating receiving nurse of the cathlab. My shift was over after this, and as expected, the patient will be attended by the nurse who would take over my duty. It is to be noted that, before transferring the patient to the cathlab, the patient was dressed with sterile gown and cap and socks. The stewardess did this change, and the trolley bearers carried the patient to the cathlab with me alongside the patient. It is important to implement early mobilization to prevent venous thromboembolism (Segal, J.B., Streiff, M.B., Hofmann, L.V., Thornton, K. and Bass, E.B., 2007, pp. 211-222). All these activities have rationale that has been explained, and as a result, these are designed to satisfy the patient's needs to fulfill the protocols for cardiac catheterization and interventions. In my opinion even the smallest of the activities has significance in patient care and outcome of the hospitalization. Therefore, nothing can be termed as low priority. As per current practice, these are the bare minimum necessary steps that would be required in any facility. Thus the process map that has been delineated here all comprise of segments that are high priority. The time was wasted in steps where this author had to wait for the laboratory technicians, social worker, and operating room notification to come. This is mainly due to sparse resources and high workload of these professionals. Some steps were longer because longer time necessary for the results to be obtained, some steps were longer because appropriate professional was not available to follow the process map immediately. However, this author made best use of time by communicating with the patient that could go a long way to alleviate the anxiety of the patient which is nothing less important. Reference Brasel, K.J., Lim, H.J., Nirula, R., and Weigelt, J.A., (2007). Length of Stay: An Appropriate Quality Measure Archive of Surgery; 142: pp. 461 - 466. Brown, M.D. et al., (2007). Implementation of an Emergency Department-based Transient Ischemic Attack Clinical Pathway: A Pilot Study in Knowledge Translation. Academic Emergency Medicine; 14: pp. 1114 - 1119. Goodnough, L.T. et al., (2005). Detection, Evaluation, and Management of Anemia in the Elective Surgical Patient. Anesthesia Analgesia; 101: pp. 1858 - 1861. Kinsman, L., James, E., and Ham,J., (2004). An interdisciplinary, evidence-based process of clinical pathway implementation increases pathway usage. Lippincotts Case Management; 9(4): pp. 184-196. Ochroch, E.A.et al., (2006). The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor. Anesthesia Analgesia; 102: pp. 868 - 875. Rigberg, D.A., Dorafshar, A., Sridhar,A., Quinones-Baldrich, W., and Moore, W.S., (2004). Abdominal Aortic Aneursym: Stent Graft vs Clinical Pathway for Direct Retroperitoneal Repair. Archives of Surgery; 139: pp. 941 - 946. Segal, J.B., Streiff, M.B., Hofmann, L.V., Thornton, K. and Bass, E.B., (2007). Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline. Annals Internal Medicine; 146: pp. 211 - 222. Read More