Abstract
Scholars across the board have been persistent on the need for the near perfection of the concept of vital signs monitoring. Prior contributions to this field of knowledge all seem to bend towards correcting the wrongs that at times overwhelm the nursing practice, while at the same time constructing updates and ingenious suggestions towards the bettering of methods of monitoring vital signs. This paper cuts across the dimensions of nursing practice as applied in a reflective situation, and the evaluative outlook into the perks of vital signs monitoring as a physiological assessment process, its outcomes, and its repercussions both ways i.e. from the patient and from the nurse’s point of view. Some of the skills necessary in vital signs monitoring are elucidated in detail with regard to communication, observation, and recording of patient data. In broader terms, vital signs monitoring is ascribed as a tool of indulgence, in a certainly inevitable way, and has been contextually reinforced with information-rich text to make the reader understand the value of its importance.
Introduction
In fall of last year, as a student nurse in practice, I attended to a patient who was undergoing recurrent episodes of unwarranted heart palpitations while in his pre-season junior football league round ups. According to the patient, the palpitations would especially be severe during and after vigorous activity mostly on training sessions. This continued for almost a week and upon consulting his coach, the patient was advised to see a physician as promptly as possible. Thus, he came to the facility in which I was working; a privately owned, state of the art hospital with 24/7 emergency services, a non-waiting compliance rule, and a handful of highly skilled nurses and doctors. On admission to the hospital, I was immediately assigned this patient under the supervision of a senior nurse. I booked the patient in for a checkup of his vital signs.
About Vital Signs
Vital signs are said to be any form of undertaking meant to extract specific measurements with relation to the body’s most basic functionalities. Thresyamma (2005) maintains that since findings pertaining to vital signs are obtained from a patient’s vital organs, vital signs assessment is the most critical of all tests since it reveals even the slightest deviation in current organ condition. Vital signs are the central evaluation modus operandi applied in the monitoring of hospitalized individuals. Garber (2010) establishes that out of all the routine, repeatedly performed health monitoring activities, no other tool is more significant in the identification of emergent problems in the hospitalized patient than that of vital signs. The four major entities most commonly assessed in the vital signs registry are respiratory rate, body temperature, blood pressure, and pulse. While at the first stage of my healthcare provision, I carried out a series of activities to my patient while I explained to him what exactly was to take place in the monitoring of his vital signs. First, I used an axillary route thermometer . I placed it under the patient’s arm and I asked him to hold it in position under his armpits. I used a digital thermometer for this activity, and he was to hold it in position for about a minute. After this, I gave him yet another oral route digital thermometer, clarifying to him that temperatures recorded under the arms usually tend to be lower than the actual body temperature and hence tend to give less conclusive statements about body temperature. His body temperature for the two tests was 36°C and 36.7°C respectively. I then monitored his respiration rate for a span of 1 minute. This activity was however not made known to him as breathing patterns might be disrupted by psychological disturbances. I wanted to get a clear, concise number to work with – 14 breaths per minute was what I recorded. Cretikos et al. (2008) calls respiratory rate the vital sign that is oftentimes neglected in nursing practice. Respiratory rate measurements are important because it establishes the tidal volume fundamental for the diagnosis of respiratory diseases. Blood pressure, being in the scholarly list of vital signs, was also measured using an aneroid monitor and its accompanying stethoscope. Before beginning the activity, I made sure my patient took some rest for a few minutes so that his blood pressure would return to normal. I placed a cuff on his right arm and then squeezed repeatedly to obtain a rather tight grip. Blood pressure measurement was meant for recording the force at which blood in his vessels stressed the vessel walls. The two values obtained from blood pressure i.e. systolic and diastolic came back as 119/78. Next, I measured his pulse rate – this was meant to reflect on how well his heart was working, as well as to aid in the diagnosis of the cause for his unceasing palpitations. Additionally, I needed to establish his pulse rate in order to check whether blood flow in his blood vessels was regular. Further, the pulse rate would give me a predictive sign of his fitness level and general health. The procedure I employed was intense, and it required the use of a cardiac monitor since my patient’s major source of complaint seemed to emanate from the heart. His pulse rate was recorded as 75 bpm. Garber (2010) maintains that no significant variance exists between the methodologies used in monitoring the four outline vital signs between children and adults. However, all other vital signs other than these four have very great variances, not only between children and grownups, but also amongst children of different age groups. Garber (2010) thus insists on the importance of a nurse being aware of the age-specific requirements for vital signs monitoring in children before indulging in evaluations of these physiological assessments. Garber (2010) cites an instance on the pulse rate differential between children of different ages stating that at a younger age, pulse is at 140-160 bpm and as a child grows up, it slows down and stabilizes at age 14-16. Further, respiratory rate is structured differently in children so that minute ventilation increases with upsurges in tidal volume as caused by respiratory complications. Respiratory rate thus increases and hence vital signs monitoring becomes intricate. Tachypnea, although underestimated, is a good means of establishing respiratory rate in children by having it measured for a whole minute, as opposed to 15 seconds then quadrupling it. The pertinence pertaining to the record, performance, and documentation of vital signs has upheld constancy ever since its foundation. The concept of vital signs has been viewed as a challenging field of clinical practice. Vital signs monitoring, has been proved through research, to not have any positive improvement in a patient’s physical worsening state especially in a timely manner. For this reason, the National Institute for Health and Clinical Excellence (NICE) has come up with a support document called the NICE clinical guideline 50 (CG 50) that is basically a set of performance principles, guidelines and instructions set for use by all nursing practitioners These sets of rules are mandated by the National Health Service for implementation and ensuring that they are adhered. One of the very fundamental requirements of a the CG 50 is that everyone performing the vital signs monitoring should be well trained and must have been certified as competent by a recognized health authority. Garber (2010) holds that vital signs are not only important in monitoring adults, but also noting a routine base in monitoring vital signs in children. Failure to take vital signs with utmost seriousness in the nursing practice could most likely mean putting the life of a patient at risk. After coming out perfectly healthy for all the four vital signs, further tests were carried out for the cost of the next one week, and it was finally established that I had an overactive thyroid gland that needed to be taken care of.
Nursing Theory
McKenna & Slevin (2011) boldly reclaim that “there is no such thing as nursing without theory”. They add that nursing as a practice will always retrace its foundations back to theory. Provided there exists a reason or purpose towards a nursing practitioner deciding to engage in a particular form of activity, there exists a form of theory. McKenna & Slevin (2011) state that theory, contrary to the stereotypical mindset spawning its modelling as that of an esoteric academic pursuance, is a ‘calling’ that every nurse is meant to indulge in. Further, McKenna & Slevin (2011) build on the fundamental relationship between practice and theory. However, they point out some flaws brooding from the complexity of this relationship, stating that theory and practice are broadly compartmentalized forms of knowledge, praxis, skills, propositions etc. McKenna & Slevin (2011) try to build up on the correlational congruence pertaining to theory and practice. They debunk the concept both ways: the explicatory, descriptive and predictive nature of theory in the nursing practice, and the probability of emergence of theory from the fundamentals of practice. McKenna & Slevin (2011) conclude that the universal is in the specific – the correlation between theory and practice is etched from how these two conceptual terms are defined. However, the emergence of theory from practice upholds null novelty, and has been captured by scholars in what has been defined as the grounded theory. Further, the obverse is also founded on academic grounds - McKenna & Slevin (2011) talk of meta-theorization in which nurses actively indulge in theorizing about theories. In general, nursing theories are split into 4: metatheory, mid-range, grand, and practice theories – each of the four contains subtheories which rightly describe how nurses arrive at selecting methods of practice. On the basis of vital signs assessment, the nurse will carry out a string of tests using standard setup methodology, and then harness the results displayed to extract meaningful information. Therefore, situation-producing theory of metatheory best describes the intentions of nursing practice to be conducted. This theory assigns varied actions that lead to precise results. In my case at the hospital, the senior nurse supervising me asserted that I used all the right tools and methods to establish the right course of action and to perform the vital signs assessment. However, the vital signs assessment has the demerit of not being thorough in establishing the root cause of a problem. It turned out that my patient was having an overactive thyroid, but the vital signs assessment could not dig that out. Insomuch as the vital signs are a good assessment tool for baseline measurement, they were inadequate in quantifying the lurking risk as well as identifying the actual patient need as in my case. In the accentuation of what can perhaps be termed as the most up-to-speed modeling of nursing theories, the medical model has gained firm ground in nursing practice. This model focuses on the importance of distinguishing nursing from medicine as proposed by Florence Nightingale. She (Nightingale) differentiated these two models as medicine being the ‘surgery of functions’ meant to foster the natural healing process of a patient, while nursing was the practice of providing the finest of conditions to allow for nature to heal a patient. Further, one of the most applicable nursing models in contemporary United Kingdom is the Roper-Logan-Tierney (R-L-T) Model of Nursing. It is structured around realism and the concept of accessibility and the activities of daily living (ADL). The R-L-T Model is made up of five dimensions – assessment, diagnostics, planning, intervening, and evaluating. Placing emphasis on the assessment bit, the nurse will make a patient assessment as soon as the patient arrives. Afterwards, medical data is recorded. Assessment (in this case being vital signs) is considered the starting point in nursing practice according the R-L-T Model.
Family-centered care
With the element of child patients being largely inevitable, the concept of family-centered care is outlined in the embodiment of healthcare and vital signs for patients. Kuo et al. (2012) call family-centered care a partnered methodology applied in healthcare that involves decision making that encompasses both the patient’s family and the medical practitioner. The principles indelibly captured in the concept of family-centered healthcare include information sharing, respecting and reverence of prevalent differences (marked by key social factors like language and culture), partnering and collaboration, negotiating, and family as well as community based care. Owing to the fact that the patient’s results came back with significantly serious health issues, his relatives, including his biological parents had to be involved in the decision making process on whether he was to undergo the thyroid extraction surgery or not.
As I am from the UK, Professional Regulation rules state that the Nursing & Midwifery Council (NMC) is responsible for enforcement and implementation of protocol in the nursing practice. Obligation and culpability means the nurse practitioners are accountable for their everyday actions as well as role-playing responsibilities as is stipulated in the contract of employment. Each and every practitioner under whom a patient is hospitalized has the duty to take care of the patient. This is exactly what I gave out when the patient was admitted to the hospital and I gave my patient all the procedural details I thought he ought to know about, as well as the complications prevalent. Each and every patient, and in more severe cases, where a patient requires high medical attention, has a right to fair treatment and respect – this is an obligation of all practitioners to the patients to treat them with dignity and esteem. Confidentiality should be upheld so that personal patient data is kept confidential, unless in a case like mine where family-centered care had to be made part of my treatment regime. Communication skills are also tools that a practitioner needs to understand what a patient is trying to express. Non-verbal communication involves facial expression and posture – the nurse looked all the more friendly due to his calm and relaxed looking posture and a smiling face – this left me feeling at ease with him. Verbal communication begins at first contact, and what the mood is set at that first meeting, determines the environment for the entire session with the nurse and practitioners. Open vs. closed questioning is a strategic way of acquiring data from a patient for a more accurate assessment of their illnesses and health problems. While open-ended questions target lifestyles and human activities such as dieting, closed questions are meant to establish certain drug effects and reactions towards certain modes of treatment. Observation skills on the other hand are every nurse practitioner’s tool. Lomas & West (2009) wrote in an article concerning a survey, that 20 cases out of a possible 830, developed deteriorative complications in the event that their vital signs monitoring was poorly performed. Some of the other observation factors include open wounds, bruises, urine output through catheter etc. Observations are classified as subjective – those reported by a specific patient (e.g. “I have a sore throat”), and objective – those reported by many and hence are not biased in evaluation. My patient’s symptoms were subjective, because he did not have specifics that could guide the nurses to a solid diagnosis. Finally, recording skills are required among all practitioners to be able to keep a track record of all patients they see. This recording of information can either be in electronic form e.g. a database, or in form of physical documentation.
Conclusion
Vital signs cannot be ignored by whatsoever means, as they are, in a literal sense, what hold the life of a patient. Nurses and practitioners alike need to be aware of the dos and don’ts of vital signs monitoring and in their quest to save human lives in emergency and surgery rooms, this knowledge would go a long way in hosting better healthcare stratagems into place.
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