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Background and Introduction

This article will discuss the A-E evaluation I conducted on Abish, an asthma sufferer, and how I handled the patient's predicament. ABCDE evaluation will be used in this study. ABCDE assessment is used for early detection, and successful first therapy can prevent further deterioration and purchase crucial time until a solid diagnosis can be made, saving both time and money (Resuscitation Council UK, 2021).

I will use Asthma that is severe and persistent can have a negative impact on the body's capacity to function normally (deForest and Thompson, 2012). Knowing the gravity of the situation and having a medical background, I want to build on my strengths by learning how to deal with any unpleasant incidences of this nature that may arise in the future, while also conquering my own weaknesses (Woods et al., 2012).

Gibbs Reflective cycle will be used in this essay. When a nurse utilises the Gibbs reflective cycle, they may get insight into their present practise as well as consider and gain knowledge about earlier interactions, allowing them to offer more attention in the future (Brsting, Kristensen, and Hanssen, 2020).

To ensure the anonymity of the patient in this essay, which is about a specific patient from my practise area, it is critical to address confidentiality concerns throughout the writing and editing process, from beginning to conclusion. According to the patient confidentiality NMC code 5.6, the patient will only be referred to as Rose (Department of Health, 2003; Nursing and Midwifery Council, 2018).

I want to learn how to cope with any future painful incidents of similar sort, while also overcoming my own flaws. Except for her gender and physical condition, which will remain private in order to foster conversation and understanding. While I hope to learn how to deal with any future unpleasant occurrences of this nature, I also wish to overcome some of my own anxieties and weaknesses (Tobiano et al., 2015). The case will be discussed in detail, and an assessment of how the lessons acquired might be used in my professional career will be included among the topics covered in this essay. The essay will also include a detailed discussion of the ethical and legal implications of the subject matter under consideration (NMC, 2019). This patient state will also be utilised to demonstrate my arguments and points throughout the text.    

ABCDE assessment

Airway- Partially clogged airways can cause changes in voice, loud breathing (such as stridor), and an increase in the amount of effort required to breathe when one's airway is entirely occluded. Untreated airway blockage can result in cardiac arrest in a matter of minutes. Whatever the scenario, any health care provider may do the head tilt and chin lift procedure described above to examine the airway and open it up if necessary.

Breathing- Difficulty in breathing. In the case of Rose respiratory rate was 28bpm, using accessory muscles. Using any of the settings, it is possible to estimate the breathing rate, examine movements of the thoracic wall for symmetry and the employment of auxiliary respiratory muscles, and percuss the chest to evaluate whether there is unilateral dullness or resonance.

ABCDE Assessment for Asthma Patients

Circulation- It is possible to measure the capillary refill time and pulse rate in any environment. When it comes to circulation disorders, the skin can provide important information. Lowering levels of consciousness and decreasing level of consciousness are all indications of diminished perfusion. Rose blood pressure was at the lower side 88/63mmHg  with a heart rate of 115bpm.

Disability- Rose was discovered prostrate in the roadway by a passing motorist, who immediately phoned for an ambulance. When the paramedics were checking Rose before transporting her to the hospital, they noted that she had an audible wheeze in her chest.

Exposure- No information regarding exposure was provided.

Each stage of the cycle is divided into six stages: a description of the issue, feelings about the situation, appraisal, reviewing what has been realised, determination, and a strategy for moving forward. The presentation will recall a criticism for a patient who was admitted to the clinic with a severe case of Asthma and who was treated there (Daniels et al., 2021).

The nurse is required to provide a full and succinct summary of the patient's medical history during this phase of the examination. Throughout this round of the examination (Sethares and Asselin, 2017). Participants in the study were admitted to the hospital due to respiratory difficulties, and the study's findings were based on the patients' own perspectives and experiences while in the hospital setting. Abish was 19 years old at the time of the event and was pursuing a bachelor's degree in physical therapy. Since she contracted the ailment as a child, she has been needed to use inhalers on a regular basis to keep it under strict control. The greatest flow rate she is capable of is 1,500 litres per minute (L/min). She would awaken in the middle of the night with a heaviness in her chest, which she attributed to strain and anxiety over her approaching examinations the next morning.

When the patient's asthma episodes first began, the doctor speculated that the season's low temperatures had a part in their onset. Additionally to these symptoms, the patient complained of chest discomfort and stiffness (Smith and Field, 2019). Throughout the procedure, she could be heard coughing and gasping, and her hands were making frenzied hand gestures. On the other hand, the patient was experiencing difficulty speaking with others on a consistent basis (Altinsoy, 2015). According to the evaluation findings, the patient's heart rate had significantly increased by that moment. Beta-agonists were administered via nebulizer to the patient to assist alleviate her symptoms to the point that she could resume taking some of her oral meds. In the meantime, I continued to administer therapy and monitor the patient's health, and I did not stop until the patient informed me that their health had returned to normal. As a result, it was my responsibility to explain to them how they could lessen the severity of an asthma attack in the future, if one occurred.

The nurse is requested to provide a self-reflective appraisal of their own thinking throughout this part. After our initial interaction, it was evident that the patient was in the midst of a potentially life-threatening crisis. The patient was not immediately admitted to the hospital, which I considered disappointing in light of the circumstances. Due to the fact that I did not feel entirely in control of the situation throughout the first few phases of therapy, I was concerned throughout the duration of the surgery, which was a good thing.

Using Gibbs Reflective Cycle for Self-Improvement

I got increasingly worried as it became clear that our first measures were failing to relieve their issue, which only grew worse as the patient's health deteriorated. Additionally, as the patient's symptoms became more severe, I became more worried. Fortunately, as the patient's health improved, I gained confidence in my abilities, and over time, I was able to handle the issue with increased confidence and competence. Nurses are urged to practise evidence-based nursing in order to guarantee patient safety and to enhance the overall quality of healthcare provided to the public.

Additionally, evidence may be used to establish the most cost-effective therapy possible while also making the best use of scarce resources (Esterhuizen, 2019). If evidence is defined as material that the nurse can cite as authoritative, rather than as an opinion or a preference to practise in a certain way, the nurse is on the correct road. Certain materials may be restricted in their accessibility, certain evidence may contradict other evidence, and the nurse may be required to make conclusions based on what has been learnt. To avoid misunderstanding, it is critical to understand that various types of evidence may be employed to accomplish a variety of different aims (Trollvik et al., 2012). For example, observational data on how patients experience disease can provide nurses with insight into how patients feel and what is most important to them in life. It cannot advise the nurse on the most effective methods of care to administer. Statistics, particularly those derived from thorough research, might aid the nurse in determining what causes a certain outcome and determining whether or not to modify the course of therapy.

As a consequence of my discoveries, I'll outline the benefits and drawbacks of the entire experience in this section, along with some advice. Apart from the healthcare team's immediate response to the issue and their ability to quickly and completely restore the patient to normalcy, various other aspects of the patient's experience stood out.

When asked how they felt about these characteristics, people with firsthand experience stated that they were "excellent." Additionally, I was able to create a nebulizer in a short amount of time, which aided in the reduction of sickness symptoms. As a consequence of the incident, my confidence in my ability to deal with it strengthened, and I was able to use my knowledge and experience to dealing with further situations of a similar sort in the months that followed. Despite this, there were some bad aspects to the case, including my initial apprehension about dealing with it and the patient's protracted wait for attention at the hospital, despite their urgent state. The temptation to declare that one type of evidence is better to all others (positivist) and that nursing should be built on this evidence can be strong (Tay et al., 2017).

Nursing as a scientific field is particularly appealing in instances when nurses wish to emphasise their profession's scientific nature and where precision in patient care is critical (Shiner and Howe, 2013). This alternative is particularly appealing in situations when the nurse must manage risk and defend conduct, particularly when the danger of lawsuit exists. Nursing requires a variety of different types of evidence, in large part because the nurse collaborates with others to make sense of health and disease. Due to the fact that each patient's circumstances and requirements are unique and vary significantly, it's difficult to give a single gold standard response for all conditions (Duroseau et al., 2021). As a result, the research being conducted in this field, which aims to make sense of what has occurred and to provide prospective solutions, is extremely significant.

Ethical and Legal Implications

This phase of the cycle involves doing an evaluation of the current condition of care and communicating the results to all stakeholders engaged in the process. Only due to the medical personnel' prompt response was the situation brought under control and the patient's condition stabilised. Following testing of the nebulizer used to treat the patient, it was determined that it was helpful in lowering the patient's signs and symptoms (Yuen, Thomson and Gardiner, 2018). Following a comprehensive assessment, it was determined that the patient's health had worsened as a result of extended exposure to extremely cold weather conditions. Due to the severity of the attack, it is probable that their asthma inhaler was less effective than it would have been in a normal situation. Throughout my professional development, I developed a greater appreciation for the need of delivering health care in a tranquil and pleasant setting. I gradually realised that efficient communication was a vital component of competent therapy.

Conclusion

During this stage of the process, you will have the opportunity to reflect on your experience and analyse what you might have done better. You will also be offered examples of what you could have done better. When the patient's symptoms initially appeared, she should have been transported to the hospital as quickly as possible in order to avoid them from developing further. A respiratory device, such as an asthma inhaler or another respiratory device, should be prepared and ready to use in the event of an asthma attack or other breathing difficulty. According to the guidelines, a patient's respiratory problems should be addressed as soon as feasible during the early phases of treating an asthma attack in order to lessen the possibility of long-lasting repercussions (Williams et al., 2017). Based on my prior meetings, I should have approached the situation with more confidence and calm at the outset of the conversation. I did not. I felt personally accountable for the situation that had arisen as a result of my own actions. The success of any healthcare professional is dependent on the ability of employees to communicate effectively with one another, as I've learned from my own professional experience in the industry.

The preceding section will discuss the examples obtained in the previous section, as well as how those illustrations should be applied to future practise as a consequence of the experiences in the following area. To be productive in future practise, one must have an unwavering confidence and faith in one's capacity to handle every imaginable event that may come throughout one's professional career. Along with helping to the future improvement of response times in emergency circumstances, this will aid in offering solace to patients who are suffering from excruciating misery as a result of their sickness (Hunter, Butler and Gibbs, 2021).

Correspondence between medical service professionals and their patients, as well as between medical service professionals and members of their patients' families, will receive increased emphasis in the future (Cooper et al., 2015). If nurses want to be successful in their endeavours, they must be well prepared for any and all clinical crises that may occur (Pinnock et al., 2017). It is necessary for both the patient and the medical care provider to collaborate in order to complete the time-consuming process of treating asthma at home successfully. Collaboration with a range of persons and organisations is critical for determining desired destinations and developing a plan for reaching those goals. Patients suffering from asthma should get patient education as part of their treatment approach, since it is a critical component of their overall care and concern.

Case Study: Abish, a Severe Asthma Sufferer

The patient and family should be educated about asthma symptoms (chronic irritation), the purpose and side effects of drugs, asthma triggers to avoid and how to prevent them, as well as the right inward breath technique. Guidelines on the most efficient method of appropriately using top stream observation equipment should be supplied to the patient and their family members, depending on the scenario (Turner et al., 2016).

Determine how the patient approaches modern instructional assets that are suitable for their conclusion, fundamental reasons, instructional level, and social heritage, among other factors. Attendants are responsible for educating patients about the necessity of sticking to approved therapy, ensuring their safety, and organising follow-up visits with medical care experts. Guidelines outlining the most effective method for carrying out an activity plan, as well as when and how to seek competent support, should be included in any quiet training programme established (Robinson et al., 2020). Patients who are suffering from the negative repercussions of repeated sensitization intensifications may benefit from having a medical caregiver visit them at home to do a sensitivity assessment and detect any allergens present in their environment variables (Philip et al., 2020).

Conclusion

Throughout this report, I have addressed in depth all of the critical factors that must be considered while diagnosing and treating an asthmatic patient. To assist me in supporting my main points of emphasis throughout the report, I will use this document as a reference. On the patient's behalf, an A-E examination was performed in order to assess the patient's condition. In the same manner that a medical attendant may review and learn from prior experiences, as mentioned in this examination of the Gibbs intelligent cycle, a medical attendant can learn from their present practise as well as their previous experiences. As previously noted in the prior review of the Gibbs intelligent cycle, this will help them to communicate more effectively in the future as a result of this. Six steps comprise each segment of the cycle, as follows: a description of the issue, feelings about the situation, examination, analysis of what has been discovered, assurance, and a strategy for moving forward. This should be a self-intelligent analysis of their own contemplations while viewing the event, which should be presented by them on their own time. While going through this part of the process, I will be able to reflect on my previous experiences and judge what you may have done to improve the situation. During this step of the procedure, you will be informed about the nature of the situation. The patient should have been taken to the clinic as soon as the unfavourable effects were recognised, rather than waiting until they had become much worse before going to the clinic. 

References

Alcantara, J., Alcantara, J.D. and Alcantara, J. (2012). The chiropractic care of patients with asthma: a systematic review of the literature to inform clinical practice. Clinical Chiropractic, 15(1), pp.23–30.

Altinsoy, B. (2015). Pulmonary Hypertension in Chronic Lung Diseases. Güncel Gö?üs Hastal?klar? Serisi, 3(1), pp.127–135.

Lessons Learned and Application in Healthcare

Børsting, T.E., Kristensen, N. and Hanssen, I. (2020). Student nurses’ learning outcomes through participation in a clinical nursing research project: A qualitative study. Nurse Education in Practice, p.102727.

Broadhead, R. (2019). Continuing professional development in numeracy skills for non-medical prescribers. Journal of Prescribing Practice, 1(4), pp.174–175.

Cooper, V., Metcalf, L., Versnel, J., Upton, J., Walker, S. and Horne, R. (2015). Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalence: a UK-wide, cross-sectional study. npj Primary Care Respiratory Medicine, [online] 25(1). Available at: https://www.nature.com/articles/npjpcrm201526.pdf [Accessed 18 Feb. 2020].

Daniels, L., Barker, S., Chang, Y.-S., Chikovani, T., DunnGalvin, A., Gerdts, J.D., Gerth Van Wijk, R., Gibbs, T., Villarreal-Gonzalez, R.V., Guzman-Avilan, R.I., Hanna, H., Hossny, E., Kolotilina, A., Ortega Martell, J.A., Pacharn, P., de Lira Quezada, C.E., Sibanda, E., Stukus, D., Tham, E.H. and Venter, C. (2021). Harmonizing allergy care–integrated care pathways and multidisciplinary approaches. World Allergy Organization Journal, 14(10), p.100584.

deForest, E.K. and Thompson, G.C. (2012). Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department. Nursing Research and Practice, 2012, pp.1–13.

Department of Health (2003). Confidentiality: NHS Code of Practice. [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf.

Duroseau, Y., Beenhouwer, D., Broder, M.S., Brown, B., Brown, T., Gibbs, S.N., Jackson, K., Liang, S., Malloy, M., Romney, M., Shani, D., Simon, J. and Yermilov, I. (2021). Developing an emergency department order set to treat acute pain in sickle cell disease. Journal of the American College of Emergency Physicians Open, 2(4).

Esterhuizen, P. (2019). Reflective Practice in Nursing. 4th ed. London: Learning Matters ; Thousand Oaks, California.

Hunter, F.K., Butler, T.D. and Gibbs, J.E. (2021). Circadian rhythms in immunity and host?parasite interactions. Parasite Immunology.

Klasnja, P. and Pratt, W. (2012). Healthcare in the pocket: Mapping the space of mobile-phone health interventions. Journal of Biomedical Informatics, 45(1), pp.184–198.

NMC (2019). Regulators Unite to Support Reflective Practice across Health and Care. [online] Nmc.org.uk. Available at: https://www.nmc.org.uk/news/press-releases/joint-statement-reflective-practice/.

Nursing and Midwifery Council (2018). The Code Professional Standards of Practice and Behaviour for Nurses and Midwives Nursing and Midwifery Council. [online] NMC, Nursing and Midwifery Council, p.8. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.

Philip, K., Cumella, A., Farrington-Douglas, J., Laffan, M. and Hopkinson, N. (2020). Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey. BMJ Open, 10(9), p.e040951.

Pinnock, H., Barwick, M., Carpenter, C.R., Eldridge, S., Grandes, G., Griffiths, C.J., Rycroft-Malone, J., Meissner, P., Murray, E., Patel, A., Sheikh, A. and Taylor, S.J.C. (2017). Standards for Reporting Implementation Studies (StaRI) Statement. BMJ, p.i6795.

Resuscitation Council UK (2021). The ABCDE Approach. [online] Resuscitation Council UK. Available at: https://www.resus.org.uk/library/abcde-approach.

Robinson, R., Barber, K., Jones, G., Blakey, J. and Burhan, H. (2020). Exploring the relationship between generalised anxiety/depression scales and asthma-specific quality of life/control questionnaires in a specialist asthma clinic. Journal of Asthma, pp.1–9.

Sethares, K.A. and Asselin, M.E. (2017). The effect of guided reflection on heart failure self-care maintenance and management: A mixed methods study. Heart & Lung, 46(3), pp.192–198.

Shiner, A. and Howe, A. (2013). Professional learning during the transition from trainee to newly qualified general practitioner. Education for Primary Care, 24(5), pp.346–354.

Smith, B. and Field, L. (2019). Nursing care : an essential guide for nurses and healthcare workers in primary and secondary care. Abingdon, Oxon ; New York, Ny: Routledge.

Tay, T.R., Lee, J., Radhakrishna, N., Hore-Lacy, F., Stirling, R., Hoy, R., Dabscheck, E., O’Hehir, R. and Hew, M. (2017). A Structured Approach to Specialist-referred Difficult Asthma Patients Improves Control of Comorbidities and Enhances Asthma Outcomes. The Journal of Allergy and Clinical Immunology: In Practice, 5(4), pp.956-964.e3.

Tobiano, G., Marshall, A., Bucknall, T. and Chaboyer, W. (2015). Patient participation in nursing care on medical wards: An integrative review. International Journal of Nursing Studies, 52(6), pp.1107–1120.

Trollvik, A., Eriksson, B.G., Ringsberg, K.C. and Hummelvoll, J.K. (2012). Children’s participation and experiential reflections using co-operative inquiry for developing a learning programme for children with asthma. Action Research, 11(1), pp.31–51.

Turner, P.J., Baumert, J.L., Beyer, K., Boyle, R.J., Chan, C.-H. ., Clark, A.T., Crevel, R.W.R., DunnGalvin, A., Fernández-Rivas, M., Gowland, M.H., Grabenhenrich, L., Hardy, S., Houben, G.F., O’B Hourihane, J., Muraro, A., Poulsen, L.K., Pyrz, K., Remington, B.C., Schnadt, S. and van Ree, R. (2016). Can we identify patients at risk of life-threatening allergic reactions to food? Allergy, 71(9), pp.1241–1255.

Williams, M.T., Effing, T., Paquet, C., Gibbs, C., Lewthwaite, H., Li, K., Phillips, A. and Johnston, K. (2017). Counseling for health behavior change in people with COPD: systematic review. International Journal of Chronic Obstructive Pulmonary Disease, Volume 12, pp.2165–2178.

Woods, E.R., Bhaumik, U., Sommer, S.J., Ziniel, S.I., Kessler, A.J., Chan, E., Wilkinson, R.B., Sesma, M.N., Burack, A.B., Klements, E.M., Queenin, L.M., Dickerson, D.U. and Nethersole, S. (2012). Community Asthma Initiative: Evaluation of a Quality Improvement Program for Comprehensive Asthma Care. Pediatrics, [online] 129(3), pp.465–472. Available at: https://pediatrics.aappublications.org/content/129/3/465 [Accessed 14 Oct. 2020].

Yuen, E.Y.N., Thomson, M. and Gardiner, H. (2018). Measuring Nutrition and Food Literacy in Adults: A Systematic Review and Appraisal of Existing Measurement Tools. HLRP: Health Literacy Research and Practice, 2(3), pp.e134–e160.

Zacharowski, K. and Spahn, D.R. (2016). Patient blood management equals patient safety. Best Practice & Research Clinical Anaesthesiology, 30(2), pp.159–169.

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