20 credits at level HE5
With contemporary changes to the way that health care is delivered and a shift towards community based care, people admitted to hospitals are more acutely ill than ever before. Coupled with this there has been a shift from traditional approaches to intensive and high dependency care, defining “critical care” as a patient need and not a clinical area. As such, patients who are acutely ill can be supported in any area in the hospital and not just in a recognised critical care area. The boundaries between an individual patient's level of need is fluid and can often be blurred or invisible to the non critical care specialist allowing for unseen deterioration in the patients condition. This has the potential to create catastrophically poor outcomes for this group of patients. This has been clearly evidenced by numerous studies that illustrate suboptimal management of people with acute illness.
This module is designed to develop an evidence based knowledge of acute illness as well as the practical skills required to recognise and provide initial management of a person who becomes acutely ill. This module provides initial training as well as post qualifying education that supports the Department of Health modernising critical care agenda.
This module will focus on the recognition and management of acute illness shown by patients in all health care settings but particularly focusing on patients within the hospital. Skills required for the assessment, monitoring and management of the acutely ill patient will be taught alongside the require anatomy, physiology and pathology. Legal, professional and interpersonal issues such as leadership communication in emergencies and the importance of incident debrief will be integral and themed thought the module. The Airway Breathing and Circulation (ABCDE) of resuscitation will provide a framework on which students can develop a depth of knowledge and skills.
Within airway management students revise anatomy and develop competence in the use of basic and intermediate airway management devices. Familiarity with advanced airway techniques such as tracheal intubation and cricothyrotomy will be developed to enable students to assist medical staff in there instigation.
In breathing, assessment of respiratory function and efficacy will be examined. Physical assessment and investigations such as arterial blood gases will be explained and students will be expected to be able to perform a reliable assessment of a patient's respiratory function. Interventions consisting of pharmacological and physical support will be discussed and related to simulated patients. Non invasive and invasive ventilation will be explained and again related to the context of simulated patients.
Aspects of circulation covered will include electrocardiographic monitoring and automated external defibrillation in which students will be expected to demonstrate competence. Principles of intropic support will be explained as will the importance of fluid balance.
During the module students will build a short formulary of common drugs which have been encountered promoting an understanding of type, mode of action and function. Students will also be made fully aware of the Resuscitation Council protocols for adult advanced life support, and the management of peri-arrest rhythms so that they can contribute effectively to the emergency care of these patients.
During the module students will encounter a series of simulated patient scenarios which will be drawn from a virtual patient list. Each week students will encounter a new scenario that builds on learning from the previous week. Some scenarios will be table-top exercises with the majority being live simulations in which students will be expected to participate. Each scenario will present a series of challenges to assist students in relating theory to practice, encouraging them to interrogate there own understanding of the clinical circumstance that are presented to them. A principle problem will be identified in each scenario by students and this will trigger the development of skills in a given area. For example, if the patient's principle problem was an airway obstruction, then teaching around the management of the airway would follow appropriate to the student's role. A spiral curriculum will develop in which students encounter similar problems in the same domain to encourage reinforcement of knowledge and transferability of skills.
Each week students will receive directed study materials to complete prior to the next session. These will take the form of workbooks and reading materials. Some electronic resources will also be included. A number of fixed resource sessions and skills stations will also be integrated into the module where students will be taught key skills such as automated external defibrillation.
Formative assessment will take place each week in the form of short multiple choice test and extended matching questions designed specifically to assess knowledge from the directed study. Students will be constantly reflecting on their own performance in simulated scenarios and this will be guided by peer review and tutor feedback.
Summative assessment will be in the form of a multiple choice question paper specifically designed to assess knowledge of acute illness. Clinical and communication skills will be assessed via Objective Structured Clinical Examination (OSCE), where students will be expected to respond to a clinical scenario and manage the patient effectively with given resources.
The focus of this module will be on medical management. Trauma care will be discussed where there is significant risk to the patient eg cervical spinal care but trauma management is not the focus of this module.
when you have successfully completed this module you will:
to demonstrate that you have achieved the learning outcome you will:
|1.||Describe the patho-physiological changes that occur during acute illness||
1.1 Describe the normal physiologic compensatory response to illness
1.2 Display a detailed knowledge of all types of shock and how this can be influenced by different factors.
1.3 Recognise Indicators of decompensation
1.4 Be able to state the normal values of physiologic markers that are used in monitoring of the acutely ill
|2.||Assess and monitor a patient evaluating stability and analysing potential for deterioration
2.1 Systematically assess and reassess patients at risk in light of interventions and evaluate their efficacy for a given patient
2.2 Demonstrate ability to synthesise the significance of changes in an individual patient in relation to their clinical circumstance and current therapeutics.
2.3 Decide on an appropriate management plan based on assessment and clinical circumstances
as appropriate to own role
|3.||Demonstrate initial management and stabilisation of individuals displaying deterioration in clinical condition.
3.1 Prepare environments & equipment for the care of the acutely ill
3.2 React to deteriorations demonstrating appropriate clinical judgement
3.3 Undertake agreed clinical activities as instructed to do so by appropriate colleagues with a view to supporting respiration and circulation.
3.4 Describe the main groups of pharmacological agents used in the management of acute illness demonstrating a basic understanding of dosage, delivery, indication, contra-indication and side effects.
3.5 Continue care and monitoring plan as identified by appropriate colleagues
|4.||Demonstrate the co-ordinated management of a patient in a peri arrest and arrested states in accord with ones scope of practice||
4.1 Initiate resuscitation attempts where appropriate coordinating initial response
4.2 Secure patient's airway and provide respiratory support using basic and intermediate aids
4.3 Assess the need for and where appropriate defibrillate patients using an automated external defibrillator safely.
4.4 Assist medical staff in the provision of advanced life support.
|5.||Function professionally in collaboration with other members of the health care team in responding to the needs of an acutely ill individual in a legal and professional manner.||
5.1 Show a clear knowledge of the roles of individual who could be involved in the management of an acutely ill person and recognise the need and urgency of referral to an appropriate individual.
5.2 Analyse and reflect own practice in light of current evidence whist acknowledging personal limits of understanding and performance.
5.3 Demonstrate effective communication and leadership in the emergency / urgent care scenario that include the transfer and recording of complex information accurately.
5.4 Support those significant to the acutely ill individual demonstrating respect and sensitivity at times of stress or bereavement
5.5 Use strategies to manage your own stress associated with supporting the acutely ill
Your achievement of the learning outcomes for this module will be tested as follows:
|Description||A two part written paper. Pass achieved with 70% correct responses a.Part 1: Response to Patient Case Studies b.Part 2: Multiple Choice Questions||Objective structured clinical examination, a.Management of two clinical scenario b.Hand over of patent & documentation of care given c.Self reflection on performance in one of the clinical scenarios||The Completion of Competencies In Practice|
Before taking this module you must have successfully completed the following:
You cannot take this module if you are taking or have taken:
Adam, S. Osborne, S. (2005) Critical Care Nursing Science and Practice Second Ed. Oxford Medical Publications, Oxford.
Bassett, C. Makin, L. (2000) Caring For The Seriously Ill Patient. Arnold, London.
Bray, J. Cragg, P. Macknight, A. Mills, R. (1999) Lecture Notes on Physiology Forth Ed. Blackwell Publishing, London.
Forrest, K. Cramp, P. Cooper, N. (2006) Essential Guide to Acute Care. Blackwell Publishing, London
Harrison, R. Daly, L. (2006) Acute Medical Emergencies, 2nd edition. Churchill Livingstone, London.
Jevon, P. Ewens, B. (2001) Monitoring the Critically Ill Patient (Essential Clinical Skills for Nurses). Blackwell Publishing, London
Leach, R. (2004) Critical Care Medicine at a Glance. Blackwell Publishing, London.
Moore, T. Woodrow, P. (2004) High-Dependency Nursing Care: Observation, Intervention and Support. Routledge, London.
Nolan, J. Greenwood, J. Mackintosh, A. (2001) Cardiac Emergencies a Pocket Guide. Arnold, London.
Sprigings, D. Norwitz, E. Chambers J. (2001) Acute Medicine: A Practical Guide to the Management of Medical Emergencies. Blackwell Publishing, London
Woodrow, P. (2005) Intensive Care Nursing: A Framework for Practice. Routledge, London.
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