Introduction
A patient Aabish, who is a 19-year-old student was taken in by a stranger after she collapsed. She seemed very upset, and she can hardly communicate due to her breathing problems. This essay, will therefore first analyse the patient using the ABCDE approach. The ABCDE approach stands for Airway, Breathing, Circulation, Disability and Exposure (Thim et al., 2012). The rationale behind the use of the ABCDE approach is that it helps to identify the main health challenges, for a patient in a critical stage. It is clear that it is important to first stabilize Aabish’s life. From the assessment, first, Aabish is experiencing breathing problems as her SpO2 is at 88%. Normally, the same should be between 94%-98%, according to the National Institute of Care Excellence (NICE) (O’driscoll et al., 2017). Besides, her chest wheezing, shows that she is experiencing breathing problems. This is caused by the narrowing of the air tract, making it difficult for air to pass, and hence, the patient struggles to breathe, which results in wheezing. This can also be said to be a result of her Asthmatic condition. The main ethical-legal principle issue, in this case, is that even though Aabish is over 18 years, and can make her own decisions as far as medical issues are related, she currently experiences breathing problems, and hence cannot communicate effectively. One of the key principles is the right to autonomy, in which the patient can make decisions on her health, which in this case is impossible as she can’t communicate effectively. Finally, this essay will undertake an overall reflection of the experience with the patient, though without using any reflection tool.
Physiological Signs
The patient underwent a preliminary assessment where her vitals and other necessary tests were taken for the ABCDE approach. From the patient’s signs, there are several signs that point to abnormality. First, her oxygen saturation level is at 88%, whereas the normal rate should be between 94% -98%. Defined, oxygen saturation refers to the amount of oxygen in the blood at a particular point in time. A normal human should have a saturation rate of above 94% as per NICE guidelines (O’driscoll et al., 2017). At 94%, it means that there is sufficient oxygen in the body for oxygen in the bloodstream to be distributed to the body organs., for optimal function. The ultimate result is that they may fail to cause her death. Second, her heart rate is exceedingly high. For a normal human, the heart rate should be between 60, and 90 bpm (Avram et al., 2019). Aabish, however, has a heart rate of 115bpm, which shows that the heart is struggling to pump blood to the other body organs. This can be attributed to the breathing challenges the patient is facing, which causes her to breathe fast so as to pump blood to the other body organs. Third, is the capillary refill time (CRT). This refers to the heartbeat rhythm. Usually, a normal person’s CRT should be between 1 to 2 seconds. However, Aabish’s CRT is at 4 seconds which shows that the patient is experiencing challenges passing through her body capillaries.
This can be attributed to her breathing problems, as well as vasoconstriction. Defined, vasoconstriction is the state where the blood vessels in a patient reduce in diameter. In Aabish’s case, this can be said to have been caused by her asthmatic condition, as she was helped by a stranger when she was out in the streets (Mendes et al., 2003). This means she may have been exposed to cold which caused the vasoconstriction. The impact of this is that the normal blood flow rhythm is affected, and is slowed down, which best explains why her CRT, was at 4seconds, which signals poor perfusion. Fourth, her Respiratory Rate is at 28bpm, which is higher than the normal 12 to 20 (Chourpiliadis and Bhardwaj, 2021). This can be attributed to her breathing challenges, which are in a bid to compensate for the low oxygen levels in her blood, and vasoconstriction. Over and above her abnormal signs, Aabish also exhibited normal signs. First, her body temperature at room temperature was at 36 degrees Celsius, which is between the normal human rate. Second, her blood glucose concentration was at 4.5mmol/L, which is between the optimum range of 3.9 and 5.6mmol/L. Third, her blood pressure is at 88/63mmHG which is within the normal rate (Lin et al., 2014). As such, it is inherent that her abnormal signs are addressed.
Interventions
The first intervention is that the patient should be helped stabilize her breathing, and to ease her chest, which is the root cause of most of the abnormal signs. The first member of a multidisciplinary team to be called will be a pulmonologist who specializes in respiratory and breathing-related issues. This is because the patient has a lot of intervening factors including her exposure to the cold, and her pre-existing asthmatic situation, which results in the need for a specialist, who can give a multifaceted approach to the issue. The second is a psychologist. Aabish attributed her current challenges to anxiety, which results from fear of failure in her forthcoming examinations. This means that Aabish was in emotional distress. To help Aabish deal with the condition, she needs a psychologist who will listen to her, and help her deal with her anxiety (American Psychological Association, 2016). Apart from listening to her, a psychologist could advise her on steps to take in order to ease the anxiety, for instance, through exercising. The rationale for the interventions is that the patient should be able to deal with specialists and professionals who can best help her manage her condition.
This is because, in Aabish’s case, there are many factors that compound, and hence there is a need for a multi-faceted approach. For instance, her breathing challenges may be related to asthma, her exposure to cold, or her anxiety, and hence, having a specialist who can look into patient signs, and identify the challenges is crucial (Willian and Carel, 2018). Besides, as a medical student, I am only supposed to do medical procedures or offer medical help under supervision. This is because I do not have sufficient training, and experience to handle patient issues from a holistic point of view. For instance, as a second-year student, I am not allowed to offer any IV medications or any ABG tests. However, I may be able to help in first aid to help deal with the challenge for instance through helping Aabish sit uprightly, and comfortably while easing her clothing. This is because, as her body temperature is at room temperature, it means that she may not be experiencing much cold. As such, by helping ease her clothing, she can be able to breathe properly, and easily. This will be done, as preliminary first aid measures to help the patient, as the multidisciplinary team is called in.
Ethical-Legal Principles
Ethical considerations are important for every health care provider. The ethical values provide a universal code of conduct that provides a practical basis for which patients like Aabish should be attended to. The ethical principles that health professions should adhere to are the principles of justice, the principle of autonomy, beneficence, nonmaleficence, accountability, fidelity and veracity. Most of these principles applied to Aabish’s scenario while some failed to apply as a result of the complications that arose from her case. The following ethical legal principles are applied to the clinical assessment scenario of the patient; First, is the principle of beneficence. It states that it is the physician’s obligation to act for the sole benefit of the patient. It is also the obligation of the health professional to protect and prevent harm to the patient (Nora and Junges, 2021). This principle is applicable in Aabish’s scenario as she was found collapsed in the street by a passer-by. As a result, the health professionals had to act for her sole benefit. Additionally, the principle of beneficence out-rules the principle of autonomy in this scenario. This is so because Aabish is struggling to breathe and is unable to talk in full sentences. As such, she is not able to make independent decisions based on her health issue. The principle of autonomy only works if the patient is able to make independent decisions (Saad, 2018). In this case, the patient cannot due to her complications.
The other principle that works best for Aabish’s scenario is the principle of veracity. Health professionals are required to be truthful in all circumstances. The nurses involved in providing health care to the patient are ethically required to tell the truth about her condition (Delpasand, 2019). When the patient’s parents arrive in the hospital, they should be truthfully informed of their daughter’s condition. They should also be informed of the procedures that the patient has already undergone, and the procedures that she will undergo. Additionally, the patient will be prepped for the procedures that she will undergo and why they are the best approaches.
The principle of accountability also plays part in this scenario in that in case of a mishap, they must be prepared to accept personal and professional consequences (Varkey, 2021). Due to their lack of sufficient training, expertise and experience students should not handle patients at high risk, without supervision. As such, the health professionals in charge of the Aabish shall not allow the students to provide express care for the patient. The health professionals in this scenario will, therefore have to take accountability for Aabish’s care. Important of all, the principle of nonmaleficence should be practised in this scenario. Some health professionals may be impatient with her upset, and as such may harm the patient while helping her calm down. Health caregivers are ethically required to help the patient to calm down (Kadivar et al.,2017). While doing this, the principle of nonmaleficence should be upheld because calming someone down is at times frustrating. She should be helped to calm down as she is upset. Additionally, her situation worsens if she remains upset, which may impair her response to treatment.
Multidisciplinary Team Communication
A multidisciplinary team comprises individuals with various but complementary talents and experiences. Their communication preferences and techniques, however, may differ. In the absence of effective communication, the team’s ability to reach its objectives may be hindered (Dobrozsi et al., 2019). As a result, setting objectives and implementing plans to enhance communication are critical.
Working Together as a Team
A successful outcome is guaranteed because interdisciplinary teams draw on the expertise and experience of all team members. Members of a team may help each other make better decisions by exchanging knowledge. A patient’s experience may be better understood if healthcare personnel communicate well because they cannot all see him simultaneously. Building a culture where individuals consistently share clear, succinct, specific, and accurate communications is one-way project leaders may encourage cooperation (Wang et al., 2018). One’s chances of getting a response increase when he or she makes a clear, complete, and polite request.
Team Obstacles to Overcome
Many circumstances, including exhaustion, stress, diversions, and personality features, make it difficult for individuals to communicate successfully. In a diverse team, this might lead to misunderstandings and conflict. In order to avoid these issues, project team leaders should encourage all participants to remember the importance of good communication in multidisciplinary teams and take the extra time to consider different viewpoints, select their words carefully, and remain calm even during stressful work periods (Moussa et al., 2020). Allow the team members to express themselves in whatever way they choose.
Expertise of Use
Participants in team-building and role-playing exercises may improve their communication abilities. According to the Work zone, having fun makes it easier for people to get along and communicate (Ellis & Sevdalis, 2019). For example, courses that teach team members how to be more aggressive, listen more intently, and negotiate can enhance overall team productivity. Speaking one’s mind without being confrontational is assertiveness. In order to show knowledge, active listening entails paraphrasing what one hears, whereas practical negotiating abilities allow one to find a compromise in a challenging circumstance. These factors aid a multidisciplinary team’s success.
Communicating with Next of Kin
In handling patients in an interdisciplinary team, it is important to develop important strategies for communicating any issues with the next of kin. In this case, the following strategies will be used in communicating with Aabish’s next of kin. First, having a single team member communicate with the patient. It is important to select a team leader, who will communicate any issues to the patient’s family, to avoid contradiction, and confusion. In this case, by dealing with one individual, the handling medic can be able to detect any emerging issues throughout the communication. Second, it is important to remain professional, and culturally sensitive. Sometimes, patient’s families could be angered and frustration because of the patient’s deteriorating health. As such, it is important that a medic who is communicating with the family does not lose their cool. Besides, it is important be aware of issues which are culturally sensitive to the patient’s culture, so as to steer around them with care. Lastly, it is important that the team remains honest with the family, while being careful, considerate, and empathetic.
Overall View
Overall, the ABCDE assessment is an important tool in addressing the patient’s challenges, especially those facing breathing challenges and are in life-threatening situations. Through the assessment, it was possible to deduce that the patient is experiencing breathing challenges, which has, in turn, affected the blood oxygen saturation levels. Furthermore, it allows for a multifaceted analysis of the patient’s signs, and symptoms, which helps narrow down the patient challenges to be addressed. Through the engagement of the other members of a multidisciplinary team, it helps ensure that the patient’s treatment is holistic and patient-centred. Even though Aabish is over 18 years, it is critical that her family is called in during the evaluation, and to help in the making of any decisions. As already stated, Aabish cannot communicate easily, and hence it is important that her family is there to help her. Besides, there could be a situation where a life-risking procedure may have to be carried out, and as such, there is a need for the involvement of family members (Jazieh, Volker and Taher, 2018).
Conclusion
The ABCDE strategy is an effective clinical tool for the early evaluation and treatment of patients in acute medical and surgical crises, covering both prehospital first-aid and in-hospital therapy. Prioritizing first-line treatment options is easier with this tool, which helps assess a condition’s seriousness. The ABCDE strategy will improve teamwork and patient outcomes if more people are aware of and skilled in it. It is essential to initially stabilize the patient’s most life-threatening disorders before moving on to the next crucial system to achieve some clinical improvement to gain time for further therapy and a diagnosing procedure. Afterward, the team repeats the A-E evaluation process to see whether any clinical traits have improved or worsened. Ethical guidelines state that students will not be expected to handle patients in resus on their own, but a grasp of the stages included in an A-E evaluation before their first placement in the emergency department may assist them in following the procedures.
References
American Psychological Association, 2016. Beyond worry: How psychologists help with anxiety disorders. American Psychological Association, 19, pp.1-2.
Avram, R., Tison, G.H., Aschbacher, K., Kuhar, P., Vittinghoff, E., Butzner, M., Runge, R., Wu, N., Pletcher, M.J., Marcus, G.M. and Olgin, J., 2019. Real-world heart rate norms in the Health eHeart study. NPJ digital medicine, 2(1), pp.1-10.
Chourpiliadis C, Bhardwaj A. Physiology, Respiratory Rate. [Updated 2021 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537306/
Delpasand, K., Afshar, L. And Tavakkoli, S.N., 2019. The Ethical Principles In Pharmacist-Patient relationship. Journal Of Clinical & Diagnostic Research, 13(3).
Dobrozsi, S., Trowbridge, A., Mack, J.W. and Rosenberg, A.R., 2019. Effective communication for newly diagnosed pediatric patients with Cancer: considerations for the patients, family members, providers, and multidisciplinary team. American Society of Clinical Oncology Educational Book, 39, pp.573-581.
El-Dalati, S., Cronin, D., IV, J.R., Shea, M., Weinberg, R., Washer, L., Stoneman, E., Perry, D.A., Bradley, S.F., Bradley, S.F. and Burke, J., 2020, October. 713. The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team. In Open Forum Infectious Diseases (Vol. 7, No. Supplement_1, pp. S407-S408). US: Oxford University Press.
Ellis, G. and Sevdalis, N., 2019. Understanding and improving multidisciplinary team working in geriatric medicine. Age and Ageing, 48(4), pp.498-505.
Jazieh, A.R., Volker, S. and Taher, S., 2018. Involving the family in patient care: a culturally tailored communication model. Global Journal on Quality and Safety in Healthcare, 1(2), pp.33-37.
Lin, J.D., Chen, Y.L., Wu, C.Z., Hsieh, C.H., Pei, D., Liang, Y.J. and Chang, J.B., 2016. Identification of normal blood pressure in different age group. Medicine, 95(14).
Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., and Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of medical ethics and history of medicine, 10, 15.
Mendes, E.S., Pereira, A., Danta, I., Duncan, R.C. and Wanner, A., 2003. Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids. European Respiratory Journal, 21(6), pp.989-993.
Moussa, M.L., Sofyani, H.A., Moussa, F.L., Alblowi, B.H., Oqdi, Y.A., Khallaf, S., ALHarbi, H.S. and Albarqi, A., 2020. Effectiveness of Multidisciplinary Team Members in A Complex, High-Risk, And Stressful Critical Care Unit (CCU). Indonesian Journal for Health Sciences, 4(2), pp.99-107.
Nora, C.R.D. and Junges, J.R., 2021. Patient safety and ethical aspects: scoping review. Revista Bioética, 29, pp.304-316.
O’driscoll, B.R., Howard, L.S., Earis, J. and Mak, V., 2017. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 72(Suppl 1), pp.ii1-ii90.
Saad, T.C., 2018. The history of autonomy in medicine from antiquity to principlism. Medicine, health care and philosophy, 21(1), pp.125-137
Thim, T., Krarup, N.H.V., Grove, E.L., Rohde, C.V. and Løfgren, B., 2012. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International journal of general medicine, 5, p.117.
Jazieh, A.R., Volker, S. and Taher, S., 2018. Involving the family in patient care: a culturally tailored communication model. Global Journal on Quality and Safety in Healthcare, 1(2), pp.33-37.
Varkey, B., 2021. Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), pp.17-28.
Wang, Y.Y., Wan, Q.Q., Lin, F., Zhou, W.J. and Shang, S.M., 2018. Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International journal of nursing sciences, 5(1), pp.81-88.
Williams, T. and Carel, H., 2018. Breathlessness: From bodily symptom to existential experience. Existential medicine.
write