Nursing Reflection on Acute COPD Exacerbation Care Outside ICU

This nursing reflection paper analyzes a case involving a patient with an acute exacerbation of COPD who was admitted to a general ward due to ICU bed unavailability. The paper utilizes Driscoll's model of reflection to examine the complexities of providing care in this setting, including the involvement of a multidisciplinary team comprising ICU nurses, clinicians, respiratory therapists, and house managers. The focus is on addressing respiratory acidosis, preventing hyperinflation, and correcting hypoxemia through mechanical ventilation (MV) and non-invasive ventilation (NIV). The reflection discusses the goals of MV, different airflow techniques, and the use of NIV outside the ICU, highlighting the importance of comprehensive interventions and the role of a Rapid Response Team (RRT). The paper references several studies that support the use of NIV in such scenarios and emphasizes the ethical considerations faced by nurses in managing these complex cases.

Running head: NURSING REFLECTION
NURSING REFLECTION
Name of the Student
Name of the University
Author Note

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The paper aims at reflecting on an incident on setting an acute care outside ICU for a patient with
acute exacerbations of COPD using Driscoll model for reflection.
What:
The intensive care unit ICU offers a continual program of care of severely ill patients
with regeneration potential or who are at risk of life. In the last few decades, demand for beds
correlated with the decreased mortality of admitted patients has grown substantially in this
sector. In addition, the complexity of diseases and the number of chronic diseases have
also increased. Patient care in hospital wards outside the ICU has become a common reality in
hospitals around the globe (Urizzi et al., 2017).
An exacerbation often represents an extreme situation in which health care workers have
a high level of patient control and power. Patient participation is often in the form of non-
involvement through exacerbation. It was very important for the participating nurses to approach
the patients with a delicate approach. Ethical dilemmas is often challenging for the nurses
(Kvangarsnes et al., 2013).
A patient with acute condition was admitted in the emergency department for acute
exacerbation of COPD. However, due to the lack of bed availability in the ICU his care was set
up in a general ward unit bed. A number of team members were included in the care regimen.
The ICU nurses, clinicians, respiratory therapists and house managers were a part of the team
and key caregivers for him (Silva et al., 2015).
So what:
The goal was to address respiratory acidosis while preventing more hyperinflation by
protecting the airways, and by correcting hypoxemia. The best way to achieve this is to mix a

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lengthy expiratory time with a small amount of slow mechanical ventilation (MV). There is a
good level of permissive hypercapnia, while bronchial toilet and bronchodilatation–typically
with a mixture of IV / NA–boost alveolar ventilation. MV's goals included alleviating respiratory
work and improving gas exchange while preventing further lung or breathing injury. To achieve
MV goals, the positive pressure ventilation support needed to interact synchronously with the
negative pressure generated by the respiratory muscles. Different airflow techniques were in
place to improve patient ventilation timing in stationary settings (e.g. aided or relative modes)
(Myers et al., 2019).
Now What:
The immediate approach for improving safety is the treatment of those patients with
regular comprehensive interventions and the help of a Rapid Response Team (RRT). Such
patients need mechanical ventilation, medicine with vasoactive consequences and intrusive
treatments. This is due to high cost of care and likely an increase in adverse events. Enhanced
non-invasive ventilation (NIV) is used in patients with acute respiratory insufficiency (ARF).
While ICUs are the safest place to treat patients with NIV, the worldwide shortage of intensive
care beds and forced the NIV application outside the ICU is extremely common. The enhanced
confidence in the technique, the ability to handle ARF in a more sensitive environment, and
psychological and economic factors help to implement a NIV outside of the ICU, which was
reinforced by the positive results of earlier pilot studies (Brambilla et al., 2019).

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References
Brambilla, A. M., Prina, E., Ferrari, G., Bozzano, V., Ferrari, R., Groff, P., ... & Bresciani, E.
(2019). Non-invasive positive pressure ventilation in pneumonia outside Intensive Care
Unit: An Italian multicenter observational study. European journal of internal
medicine, 59, 21-26.
Kvangarsnes, M., Torheim, H., Hole, T., & Öhlund, L. S. (2013). Intensive care unit nurses’
perceptions of patient participation in the acute phase of chronic obstructive pulmonary
disease exacerbation: an interview study. Journal of advanced nursing, 69(2), 425-434.
Myers, L. C., Faridi, M. K., Currier, P., & Camargo Jr, C. A. (2019). ICU utilization for patients
with acute exacerbation of chronic obstructive pulmonary disease receiving noninvasive
ventilation. Critical care medicine, 47(5), 677-684.
Silva, A. C., Oyama, C. B., Grion, C. M., Rodrigues, E. H., Urizzi, F., Cardoso, L. T., ... &
Talizin, T. B. (2015). Caring for critically ill patients outside ICUs due to a full
unit. Critical Care, 19(2), P19.
Urizzi, F., Tanita, M. T., Festti, J., Cardoso, L. T., Matsuo, T., & Grion, C. (2017). Caring for
critically ill patients outside intensive care units due to full units: a cohort
study. Clinics, 72(9), 568-574.