University Critical Care Nursing: Joshua Hamilton PBL Case Analysis

This assignment presents a detailed analysis of the Joshua Hamilton PBL case study, focusing on critical care nursing. The student addresses key insights from PBL sessions, emphasizing the importance of timely diagnosis, proper treatment, and effective time management in accident scenarios. The assignment identifies critical factors influencing patient outcomes, including proper diagnosis, emergency trauma care, and ICU admission. The student reflects on the interventions, teamwork, and potential areas of concern within a multidisciplinary team, such as resource limitations, staffing issues, and behavioral dynamics. The analysis also covers learning points from various topics including ICU environment, breathing, circulation, ED trauma call, delirium, ICP, and sedation, and the impact on quality patient care. The student also reflects on team performance and suggests improvements for future PBL experiences, providing a comprehensive overview of the case and its implications for nursing practice.

1. What two insights you learned from the two PBL sessions for this case? How does this
insight contribute to quality patient care?
From the two PBL sessions, I learned that-
i) In the case of a fatal accident, the right diagnosis and primary treatment are very much
essential. An accident is always a sudden emergency, and the situation of the patient can be
very critical right after the accident. In the case of Joshua, the ambulance officers Alayna
Cahill & Marvin D’Cruz reached the accident location as early as possible and properly
diagnosed the possible injuries of Joshua, which helped to jumpstart the right treatment after
bringing him to the Hospital.
ii) Another insight which I also noticed is time management. In case of any accident, the most
important thing is saving time and utilize the time properly. After the accident of Joshua, he
was first taken to the nearest Hospital and later on shifted to another hospital by helicopter
because of his terrible physical condition. He was given ventilation at the time of his journey
to the second Hospital. This shows that proper time management is very much necessary in
case of an accident.
I think this learning will help me a lot to provide better patient care. From these two PBL
sessions, I understood what can be a possible accident scenario and what needs to be done as
a nurse at the time of an accident. These sessions will help me to handle a real-life accident
scenario more efficiently.
2. Patients are often complicated. Describe 3 of the major factors identified in this case,
which will determine the success of this patient's outcome? This could include medical
diagnoses or nursing diagnoses.

The three major factors which can determine the success of the patient’s outcome are-
i) Proper diagnosis of the patient’s physical condition as soon as possible. Through proper
diagnosis, medical officers can understand that how much injured the patient is and what type
of treatment the patient need.
ii) In the case of fatal accidents, the patient should be carried by emergency trauma care
ambulances, which are highly equipped with emergency medical instruments like oxygen,
ventilation, etc.
iii) After reaching the hospital, the patient should be taken to the ICU facility on an
immediate basis. Besides it, trauma team members need to be ready to handle any injury.
They also need to learn the mechanism of injury to understand and plan effective care (Jones,
2019).
3. Given the interventions designed by your group, do you feel every decision was
underpinned by logical clinical sense? Was there anything you think should have been
designed differently? Was there anything brought up by students in other groups in
your room or who you have spoken to since your PBL session which you missed and
would have contributed to your group discussion?
As per I went through the PBL sessions, I found that everything was done in a very quick
and well manner. The medical officers checked Joshua after reaching the accident spot and
immediately took him to the hospital where he was given necessary emergency treatments.
As Joshua was seriously injured so for the better treatment, he was transferred to another
hospital through helicopter to save time. He was sedated, intubated and ventilated at the
Hospital where he was taken first. With that, his parents were also informed right after the
accident. I think all the steps which were taken were right and quick.

4. When considering working in a multidisciplinary team on this case, were there areas
of professional concern, which could have been addressed at the staff level?
Multidisciplinary teamwork is a process, complex in nature, where professionals from
different areas work together on a particular healthcare scenario by sharing knowledge and
skills. While working in a multidisciplinary team in the area of healthcare, the main
professional concerns which could have been addressed at the staff level are-
i) Lack of resource: Sometimes, medical staffs may face problems in case of any emergency
if the medical equipment is not sufficient. Lack of highly modified ambulance or oxygen
cylinder can create major issues.
ii) Staff shortage: In multidisciplinary teamwork, each staff has a different role, and they need
to be highly professional to fulfil their role efficiently. Sometimes the lack of proper staff
may also create hurdles in front of the team (Ennion and Rhoda, 2016).
iii) Behavioural issue: In multidisciplinary teamwork, every staff has a different set of mind
and behaviour. Sometimes ego and behavioural issues may create uneasy distances between
staffs, which may affect in work also.
5. Four topics were considered in skills for these two weeks: (week one) ICU
Environment / ICU Airway, Breathing, Circulation. (week two) ED Trauma Call,
Delirium. ICP, Sedation & Inotropes. State one learning point from each topic. How
will this learning contribute to quality patient care?
ICU Environment / ICU Airway- ICU airway is mainly used for a critically ill patient. It has
four types of algorithm which are- i) Main Algorithm ii) Crash Algorithm iii) Difficult airway
algorithm and iv) Failed airway algorithm (Liolios, 2019).

Breathing- In case of a critically ill patient, a nurse must need to check whether the patient is
breathing and what is the oxygen saturation.
Circulation- Blood and other respiratory circulations are very important for a seriously
injured patient. Right after an accident, if the medical officer notices that the patient is having
problems in circulation, then he should provide necessary artificial medical equipment to
continue the circulation.
ED Trauma Call- Emergency Department (ED) Trauma call is a process applied by many
hospitals to improve high-risk patient outcomes. ED trauma call activated when a high-risk
patient admitted into the emergency or when the ambulance clinician informs to the
emergency department about the arrival of such a patient (Ozemedicine.com, 2014).
Delirium- Delirium is a form of serious problem related to mental abilities. In a result of this
problem, patients become more confused while thinking and become less aware of the
environment. This also includes behavioural changes (Mayo Clinic, 2018).
ICP- Because of serious brain injury from an accident, the pressure inside the skull may
increase rapidly and can be very dangerous for the patient. This highly dangerous condition is
called intracranial pressure (ICP). This form of brain issue is very dangerous, and it requires
immediate treatment (Anon, 2019).
Sedation & Inotropes- Sedation helps to decrease pain and inotropes are a type of agent
which alerts the force of muscular contractions. While negative inotropes deteriorate the
force of muscular shrinkage, positive inotropes do the opposite.
This knowledge and learning will help me to understand the condition and situation of a
critically injured patient quickly. I also can take a prompt response if I have a better
knowledge about these things.

6. You worked in teams, did your team work well? What could have worked better, if
anything?
As per my knowledge, I think my team worked well and gave their best. Though I must admit
that we have a lack of knowledge and practical experiences, but still we did our best and
learned a lot of new things.
7. Please add any suggestions you may have to help us continue to improve the PBL /
Skills experience
As I am still learning a lot of new things in healthcare, I think everything is going well. The
PBL skills are very well organized, and currently, I have no suggestion to improve the PBL/
skills experience.

References:
Anon, (2019). Increased Intracranial Pressure (ICP) Headache. [online] Available at:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/increased-
intracranial-pressure-icp-headache [Accessed 28 Aug. 2019].
Ennion, L. and Rhoda, A. (2016). Roles and challenges of the multidisciplinary team
involved in prosthetic rehabilitation, in a rural district in South Africa. [online] Dovepress.
Available at: https://www.dovepress.com/roles-and-challenges-of-the-multidisciplinary-team-
involved-in-prosthe-peer-reviewed-fulltext-article-JMDH [Accessed 28 Aug. 2019].
Jones, L. (2019). Responding to trauma: Your priorities in the first hour. [online]
Nursingcenter.com. Available at: https://www.nursingcenter.com/journalarticle?
Article_ID=845534&Journal_ID=606913&Issue_ID=845514 [Accessed 28 Aug. 2019].
Liolios, A. (2019). Airway Management in the Intensive Care Unit: The Difficult Airway.
[online] Medscape.org. Available at: https://www.medscape.org/viewarticle/443567
[Accessed 28 Aug. 2019].
Mayo Clinic. (2018). Delirium - Symptoms and causes. [online] Available at:
https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386
[Accessed 28 Aug. 2019].
Ozemedicine.com. (2014). ED major trauma call. [online] Available at:
http://www.ozemedicine.com/wiki/doku.php?id=trauma_call [Accessed 28 Aug. 2019].