Essay on Health Care Companions: Necessity for Prolonged Cardiac Surgery Patients

Consistent measurement and recording of clinical observations are crucial necessities for assessing a patient and recognizing clinical improvement or deterioration. The prolonged LOS for cardiac surgery patients puts them at risk of infection deconditioning, delirium, and high costs of staying in the hospital. The increased demand for continuous observation of such patients, especially those above 65 years of age, has resulted in the emergence of Health Care Companions (HCC). The fundamental significance of having these health care providers is to lessen harm or injury that may occur to a patient either by falling through impulses or pulling that may remove tubes. Thus, the appropriate use of health care companions where they monitor and observe patients consistently is effective in enhancing the safety of patients. Health Care Companions require proper education on the nuances that concern delirium, dementia, and the relevant actions to undertake in engaging with the patient. However, there is inadequate information about communication between nurses and health care companions concerning the behavior of patients.

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There should be a comprehensive and efficient program that governs Enhanced Recovery After Surgery (ERAS) and ensure that patients recuperate without experiencing health complications or incurring expenses. The guidelines for ERAS are multimodal perioperative care programs that are specially formulated to attain early recovery of patients who have undergone surgical procedures. In doing so, the health care companions in the health institutions have to facilitate the reduction in the stress response after surgery and uphold pre-operative organ function. The effectiveness of such health care companions requires that they have adequate education on how to execute the care to patients. Thus, they need comprehension of issues such as anesthetic regimens and standardized analgesics, preoperative counseling, initial motivation, and optimization of nutrition. Even though the implementation of protocols of ERAS results in favorable outcomes, their execution has been quite slow. Every nurse looks forward to offering quality care to their patients. Therefore, health care companions must adopt the right measures by maintaining a healthy relationship with the nurses and get the correct information relating to the behavior of patients. For this reason, this project will offer a vivid description of the shifts of protocols in cardiac surgical practice by the use of King's framework to provide a pathway for extending quality care to cardiac surgery patients.

The core concept of the theory of goal attainment is that the patient and nurse interact and exchange information, determine targets, and undertake the necessary actions to attain the objectives. King's theory of nursing was introduced in the 1960s by Imogene King. The inspiration to develop the approach resulted from the philosophy professor who had asked King if she or her counterparts had formed a definition of the nursing act. In the pursuit of an answer to this question, she studied for years. She came up with a theory that takes into account the objectives of nursing, functions of nurses, and the mechanisms they can employ to enhance their knowledge to offer quality care for patients (Williams et al., 2018). Also, the theory holds that stress, roles, space, and time are the elements that impact the attainment of goals.

The conceptual framework developed by King comprises of three interrelating factors that include personal systems, interpersonal systems, and social systems, in ascending order. Personal systems are the smallest component and usually consist of individuals such as nurses and patients. The concepts contained in this system entail personal development, thinking, bodily outlook, self-identity, and proximity. It implies that the two parties engage in active interactions and work in unison in defining goals and engage in the right actions that will actualize their goals. The interpersonal system deals with small groups such as the family. Interaction between nurse and the family has its basis on concepts such as transaction, interaction, stress, communication, and role. On the other hand, the social system comprises large groups such as the society, and the concepts associated with it are power, organization, decision-making, authority, and status. Social systems include learning institutions such as universities, organizations, and hospitals.

The framework helps explain the phenomenon under study. According to King, the core mandate of nursing is to enhance or restore the health of the patient, and thus, both the nurse and the patient should set goals that concern the good health of patients. In doing so, the two parties may have to interact with other systems such as the family of the patient or other healthcare workers. For instance, the nurse may incorporate health care companions who aid in offering assistance to patients to ensure that they are free from harm or injury.

Health centers have different ERAS protocols implemented, such as the extubation time of post-op cardiac surgery patients. For example, some hospitals have their intubation time fixed at four hours, while others have it at six hours. However, giving these patients a long intubation period may result in them suffering from ailments such as a reduction in mobility, pneumonia, and a heightened increase in the usage of narcotics (Morad et al., 2019). Thus, having ERAS standards that are deeply rooted in evidence-based practices (EBP) may effectively enhance the quality of care, satisfaction of patients, mobility, and reduce the length of stay (LOS).

The interpersonal system is vital in regulating aspects such as stress, which could negatively affect the recovery of a cardiac surgery patient. Some patients may experience anxiety due to the high level of funds required to undergo the treatment and the cost of care afterward. Besides, stress may affect the homeostasis of a person resulting in complications after the surgery.

Moreover, the framework guides each phase of the project. For instance, the nurse and the patient may agree on the best preoperative nutrition to ensure that patients do not stay for long in the hospitals and even incur high costs of care. More so, poor diet for patients undergoing cardiac surgery puts patients at risk of complications, increasing their stay at the hospitals. The nurses need to offer precise information and counseling during the preoperative period and intervene in their lifestyles. The significance of such action is to boost the mental and physical wellbeing of the patients by employing proper diet, exercise, reduction in smoking, and intake of alcohol (Fleming et al., 2016). All these are vital in ensuring that the patient is well prepared for the surgery to avoid the chances of complications happening. Besides, they lessen the chances of bleeding, anemia, cardiac and respiratory dysfunctions, and surgical wound infections.

Besides, the framework helps identify the variables under study as every transaction that takes place between the nurse and patient has to be documented for clinical practice by the nurse. Putting the goal in writing is vital in modifying the goal attainment process and easing the communication between nurses and their colleagues and others. The aspect of early recovery after cardiac surgery comprises a couple of interventions during the entire process (Kolodziej et al., 2019). ERAS is vital as if facilitates the restriction of neurohumoral reactions to the surgery, lessens LOS, lower risk of complications, enables people to resume their daily activities and enhance their satisfaction in leading a quality life.

The framework guides in the identification of variables that should be measured in the study. As the researcher focus on promoting communication between the nurse and the patient. Medical practitioners should lessen the premedication of cardiac surgery patients by the use of benzodiazepines, which have the probability of causing delirium in patients. The nurse may consider the use of drugs that do not have morphine but still aid in the reduction of pain.

Conclusion

All in all, the framework argues that the human being is social and rational and thus could perceive, set goals, make choices, and attain the goals. An individual has three essential requirements, which are the need for quality care to safeguard from illness, the need for comprehensive information on health, and the need for care when one cannot aid themselves in performing various tasks. Health comprises of dynamic experiences that a person goes through in life and thus should involve consistent changes of the stressors that exist in the internal and external environment. The nurse is a constituent of the patient's situation. Despite the enhanced surgical procedures, perioperative care, and anesthesia, cardiac surgery is still linked to prolonged in-patient stay after surgery, as well as an increase in the rate of morbidity.

References

Fleming, Ian; Garratt, Claire; Guha, Ranj; Desai, Jatin; Chaubey, Sanjay; Wang, Yanzhong; Leonard, Sara; Kunst, Gudrun. In: Fleming , I , Garratt , C , Guha , R , Desai , J , Chaubey , S , Wang , Y , Leonard , S & Kunst , G (2016). Aggregation of marginal gains in cardiac surgery: feasibility of a perioperative care bundle for enhanced recovery in cardiac surgical patients. Journal of Cardiothoracic and Vascular Anesthesia, 30(3), 665-670.

Kolodziej, T., Maciejewski, T., Mendrala, K., Darocha, T., Weglarzy, A., Budziarz, B., ... & Kucewicz-Czech, E. M. (2019). Enhanced recovery after cardiac surgery. Kardiochirurgia i torakochirurgia polska= Polish journal of cardio-thoracic surgery, 16(1), 32.

Morad; Aad, Georges; Abreu, Henso; Arnold, Hannah; Hallewell, Gregory David; Hamacher, Klaus; Hamal, Petr; Hamano, Kenji; Hamilton, Andrew; Hamity, Guillermo Nicolas; Han, Kunlin; Han, Liang; Han, Shuo; Hanagaki, Kazunori; Arratia, Miguel; Hance, Michael; Handl, David Michael; Haney, Bijan; Hankache, Robert; Hanke, Paul.(2018). Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. European Journal of Cardio-Thoracic Surgery, 54(3), 491-497.

Williams, J. B., McConnell, G., Allender, J. E., Woltz, P., Kane, K., Smith, P. K., Bradford, W. T., Engelman, D. T(2018). On e-Year Results from the First US-based Enhanced Recovery after Cardiac Surgery (ERAS Cardiac) Program. The Journal of Thoracic and Cardiovascular Surgery, 157(5), 1881-1888 doi:10.1016/j.jtcvs.2018.10.164