NRS-460 Benchmark – Case Study: Timothy Smith – Intensive Care Unit (ICU)

Upon arrival in the ICU, you discover Mr. Smith does not have a power of attorney.

Given that the power of attorney is absent, the first step is to determine the individual that is legally authorized to make decisions on matters related to his health. Hierarchically, the potential decision-makers include the spouse, his children that are above 18 years, his parents, siblings and then relatives (Levi et al., 2024). In the event that none of these family members is available, an alternative option would be engaging the court to appoint a guardian to make decisions or hasten decision-making.

These individuals range from religious leaders to community leaders. They may also take advantage of the networks they have established to engage people involved in delivery of social services, with information about Mr. Smith’s family members. The chaplain may comfort the patient, addressing the stressors that could be exacerbating the patient’s health issues. This may help stabilize the patient, improving their consciousness. Accordingly, the patient can be in a position to provide pertinent information about their kin.

Health care professionals often have to have difficult conversations with patients and families in the intensive care unit (ICU) regarding prognosis and outcomes.

Additional resources are ethics committees, which offer counsel and share knowledge that is helpful in confronting difficult ethical issues tied to decision-making. Addressing concern related to challenging conversations demands that the parties involved in this discussion effectively communicate. Maintaining clarity in how one communicates and emphasizing with the patient are some of the crucial considerations when engaging in these kinds of discussions.

In addition to these considerations, individuals involved in the conversations should support whatever they share with the patient with evidence, which essentially helps them to better understand the shared idea. Visually presented information on brochures can be accompanied with verbally communicated information to improve understanding.

While the patient can benefit from this intervention, they face the risk of experiencing impaired neurological functioning, which could hamper his ability to maintain normal motor functioning. With improperly done hematoma evacuation procedure, Mr. Smith is likely to develop infection, prolonging the duration of hospital stay.

The patient relies on respiratory support, and shows decline in level of consciousness. It is crucial that these factors be considered following the surgical interventions or when the patient is transitioning to the stage of long-term rehabilitation. The rehabilitation may focus on supporting the patient to regain the ability to maintain the required levels of physical and cognitive functioning.

Ethical considerations are an important part of nursing care but become especially vital when dealing with trauma patients considering the potential of poor prognosis.

The other consideration involves using an intervention with zero harm to the patient, which is consistent with the ethical principle of beneficence. Guided by this principle, a provider evaluates potential interventions, and opts for the most safe and effective intervention. Prioritizing palliative care as an intervention would be necessary if Mr. Smith has slim chances of recovering. With this approach to care, the provider prioritizes an intervention that alleviates pain, and stress, optimizing the quality of the patient’s life (Ramathuba & Ndou, 2020). Additionally, administering this kind of care results to the increase in the level of patient satisfaction in the sense that it aligns with his clinical case.

However, ignoring the curative aspect of treatment by purely focusing on addressing distress and pain raises concerns. It specifically leaves the family members struggling with guilt especially when they have to decide to have their sick kin receive palliative care and not curative care.   

Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs.

Involving Mr. Smith’s family during his journey of recovery can help him access the social support that he needs during this journey. This kind of support reduces loneliness including the distress linked to the feeling of being alone as one struggles with the disease.

Encouraging Mr. Smith to openly share his thoughts and concerns is crucial in meeting his psychosocial needs. By sharing details about his social needs, the patient can receive help such as connecting him with appropriate resources. These forms of support foster spiritual healing, translating to improved health outcomes.

BSN-prepared nurses have an understanding of system-based practice including implications of financial and economic considerations related to providing care.

With the prolonged duration of hospitalization which is possible given the severity of his health status, Mr. Smith will lose his livelihood because he will no longer be able work (Clarke et al., 2021). With the patient as the primary provider in his household, the loss of income will compromise the family’s financial freedom.

Analysis of Mr. Smith’s health status reveals that he will need to undergo sustained rehabilitation. With additional expenses, the family risk facing financial distress especially if the insurer does not cover the rehabilitation services. Even if the family manages to successfully finance Mr. Smith’s rehabilitation program, it will need to make changes to make necessary modifications to their home to support Mr. Smith’s mobility.

These new modifications come with extra financial burden. For Mr. Smith’s family, the idea of seeing him struggle with his condition can be a source of distress, impairing their concentration at work. This may result to reduced productivity at work.

What is the purpose of collaborating with the following when providing care for Mr. Smith? Explain the role of each team member’s competency and how they contribute to Mr. Smith’s care.

Respiratory therapists: Have to demonstrate that they are able to administer oxygen, analyze breath, and administer medications.

Interdisciplinary team collaboration is vital to the successful management of patients with complex conditions.

Explain what principles can be applied to facilitate effective team dynamics in a way that: (1) ensures that the role of each individual/team member is defined by his/her scope of practice; and (2) ensures that the delegation of work to team members based on roles and competencies is assigned without confusion for the team or patient. Your response should be a minimum of 200 words.

For the team to thrive, each member has to abide by the principle of mutual respect, ensuring that they acknowledge the perspectives of colleagues. Guided by this principle, every person in the team contributes knowing that their views matter in conversations centered on optimizing the quality of care delivered (Reiter-Palmon, Kennel, & Allen, 2021). By respecting each other, team members minimize the risk of conflicts which are known to prolong decision-making.

With open communication, everyone is presented with information related to the goals and milestones. This increases awareness of the mistakes made, compelling team members to put in more efforts. Combined with the other two principles, the adoption of this principle to inform team dynamics is likely to translate to improved care outcomes.       

1. Discuss the importance of each member of the interdisciplinary team communicating their information in a professional, accurate, and timely manner when treating Mr. Smith. Your response should be a minimum of 150 words.

An example is the SBAR framework which provides a structured model of informing communication. Guided by this framework, the leader of the team has to consistently and regularly update their colleagues, ensuring that everyone is constantly aware of the intervention objectives.

This is necessary for a successful collaboration. With this kind of communication, still, it is possible to win the buy-in of other members of the team, which ensures that the team moves in a common direction as it addresses the patient’s needs (Anderson, Lavelle, & Reedy, 2021). With shared knowledge of expectations and goals, the team spends less time making decisions which is not the case when the expectations fail to align.

As a principle, equity emphasizes fair treatment of every member of the team. In team dynamics context, this principle compels the leader to ensure that they fairly distribute resources to team members, and delegate tasks based on one’s expertise, and in a fair manner. Applying this principle in team dynamics ensures that everyone has equal chance of participating in preparation and implementation of the intervention plan. Inclusion pertains to incorporating the divergent opinions into the decision-making process.

There are specific considerations that nurses should be aware of when taking care of patients in the ICU.

Factors that directly interfere with sleep quality, and which cause long hours of wakefulness are equally the known causes of the disorder. In addition to the aforementioned symptoms, manifestations like restlessness and drowsiness are common with ICU psychosis. However, the condition is associated with other manifestations that are included in the existing diagnosis guidelines.

Reducing the screen time including the use of smartphone during bedtime should be stressed especially when educating the patient about the relationship between the quality of sleep and the risk of psychosis.

It is equally important to recommend avoidance of the unnecessary sedative drugs because excessive and prolonged use of these drugs substantially increases the risk of psychosis due to their mechanisms of actions in which they alter certain aspects of the neurotransmission processes.

If a patient is on sedatives on the ground of medical reasons, it is imperative that the use of these sedatives be monitored so that prompt actions can be taken in case of serious side effects that may lead to psychosis.

Mr. Smith’s reliance on the mechanical ventilation is a potential source of distress, which if left unmanaged can significantly limit the functioning of the brain considering that stress is one of the factors that hasten the development of psychosis. This stress may also stem from the clinical conditions linked to being treated in a stressful setting, in which the patient constantly interacts with providers.

However, the choice of the medication used to enhance breathing may interfere with the brain’s message processing mechanisms, increasing the risk of psychosis. These are factors that a provider should consider when working with Mr. Smith.

Anderson, J. E., Lavelle, M., & Reedy, G. (2021). Understanding Adaptive Teamwork In Health Care: Progress and Future Directions. Journal Of Health Services Research & Policy, 26(3), 208–214. Https://Doi.Org/10.1177/1355819620978436.

Clarke, L., Anderson, M., Anderson, R., Klausen, M. B., Forman, R., Kerns, J., Rabe, A., Kristensen, S. R., Theodorakis, P., Valderas, J., Kluge, H., & Mossialos, E. (2021). Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities. The Milbank quarterly, 99(4), 974–1023. https://doi.org/10.1111/1468-0009.12536.

De Luca, E., Cosentino, C., Cedretto, S., Maviglia, A. L., Bucci, J., Dotto, J., Artioli, G., & Bonacaro, A. (2022). Multidisciplinary Team Perceptions of The Case/Care Managers’ Role Implementation: A Qualitative Study. Acta Bio-Medica : Atenei Parmensis, 93(3), E2022259. Https://Doi.Org/10.23750/Abm.V93i3.13371.

Levi, B. H., Dimmock, A. E., Van Scoy, L. J., Smith, T., Kunzler, B., Foy, A. J., Badzek, L., & Green, M. J. (2024). What Counts as a Surrogate Decision?. The American Journal of Hospice & Palliative Care, 41(2), 125–132. https://doi.org/10.1177/10499091231168976.

Mullin, A. E., Coe, I. R., Gooden, E. A., Tunde-Byass, M., & Wiley, R. E. (2021). Inclusion, Diversity, Equity, and Accessibility: From Organizational Responsibility to Leadership Competency. Healthcare Management Forum, 34(6), 311–315. Https://Doi.Org/10.1177/08404704211038232.

Ramathuba, D. U., & Ndou, H. (2020). Ethical Conflicts Experienced By Intensive Care Unit Health Professionals In a Regional Hospital, Limpopo Province, South Africa. Health SA = SA Gesondheid, 25, 1183. Https://Doi.Org/10.4102/Hsag.V25i0.1183.

Reiter-Palmon, R., Kennel, V., & Allen, J. A. (2021). Teams in Small Organizations: Conceptual, Methodological, and Practical Considerations. Frontiers in psychology, 12, 530291. https://doi.org/10.3389/fpsyg.2021.530291.