This hands, and said goodbye. So What

Thisessay is about a skill undertaken in clinical practice, the underpinningevidence that supports its technique and necessity, and my introspectiveanalysis on my approach to the skill. The skill I chose was measuringrespiratory rates, number of breaths taken in a minute, during patientobservations. Through my reflective account, and research into literature, Iintend to have better understanding of its purpose, as well as evaluate my ownexecution, and identify areas of success and improvement.

Allnames used in this essay are pseudonyms, as to protect the identities of thepatients involved, in correspondence with the conduct of confidentialitydictated by the Nursing and Midwifery Council (NMC, 2015). What?Iapproached Connor, in freshly sanitized hands and new gloves, on the acute carebay for his 1 hourly observations. He recognised the observation trolley as hisparticular bay is for concentrated care; familiar with the procedure, he beganreadying himself for the sphygmomanometer cuff.

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But as per The Code (NMC,2015), I still made sure to ask if he was okay with me performing the routinechecks. Once consent was granted, I placed on the cuff and finger pulseoximeter. I used the tympanic to take his temperature, and began running theobservation machine. As the cuff began to fill, Connor became relaxed andtalkative – which I find makes watching his chest rise and land very difficult.I mentioned to him that the results will be more accurate if he fully relaxed.This made him stop talking and look into his lap; his breathing was notaffected by talking or laughing, but he was not conscious of me measuring hisbreaths either, so they were natural. I looked at my watch and counted breaths,quickly glancing down again to check if the minute had passed.

On the 60 secondmark, I removed all the paraphernalia, wrote all his results into his NationalEarly Warning Score (NEWS) sheet, threw my gloves into the clinical bin,sanitized my hands, and said goodbye. SoWhat ?          Respiratoryrate is one of the first vital signs to falter when change in the patient’shealth is occurring. Although observation of pulse oximetry can also detectdecline in health, analysis of its results is not as widely understood; makingrespiration observation paramount in detecting any change before it becomesserious (Smith et al, 2011).

Tachypnoea, abnormally rapid breathing, is one ofthe most prevalent indicators of impending cardiac arrest in hospital settings.Being aware of this change in respiration allows quick access to intensivecare, and ultimately prevents the catalyst that could result in organ failureor even death. However, respiratory rate is the least measured of the vital signs(Elliott, 2016).

In a study of 41 British nurses through anonymous questionnaire,most reported a lack of time (real or perceived) that inhibited them measuringbreaths for 30 seconds. Some did not believe respiration measurement wasimportant, or thought it was for particular patients (Philip et al, 2013). Educationinto its importance is vital and time must be taken to observe respiration.          Toensure the reading is correct, however, it is best not to alert the patientthat you are measuring their breathing.

It incurs demand characteristics. If Ihad told Connor I needed him to stop speaking so that I could measure hisbreathing, he would have tried to regulate his breathing in a way that would beunnatural. I would not have an accurate image of his reflex breathing, but oneof the breathing he feels is good. Some nurses on my ward even suggested with shallower,harder-to-see breaths, holding their hand for the pulse and bringing it totheir chest.

This way, I would be able to feel the chest landing with each exhalewhere I may not have been able to see it.           Aregular respiratory rate is between 12-16 breaths per minute in an adult atrest, but can be affected by respiratory issues such as Chronic ObstructivePulmonary Disorder (COPD) (University of Rochester, 2018). COPD includes bronchitisand emphysema, and is effectively constant shortness of breath (COPD Foundation,2018). It is important to be aware of the patient’s COPD status and always noteit on their NEWS paperwork, as it alters the analysis of the respiratory rate.A rate that would read high for a patient without COPD, may be the regular ratefor a patient with. An important part of assessing vitals is being aware of thepatient’s baseline. Regular observations, especially frequent ones onpost-operative care wards, are to monitor change, not predominantly health. Apatient suffering chronic pain is likely to have a higher blood pressure than withinthe regular range (Bruehl et al, 2005), and a person with an infection couldalso have an abnormally high temperature as fevers inhibit the bacteria or virus’ssurvival (Plaza et al, 2016).

No person is admitted to hospital in perfecthealth. Therefore, recognising each patient’s baseline in correspondence to theirdiagnoses of new or pre-existing conditions is important. From there, you canbe aware of a COPD patient’s 20 breaths per minute, understand it is high, buthave explanation.

When their next observation reads 25 breaths per minute, it willbe high enough to flag, because it is not only abnormal for a regular rate, itis abnormal to them. Measuring respiratory rate fluctuation is in order to monitorchanges in the patient’s health. Therefore, it is extremely important that allentries of rates are true. Vague guesstimates and false recordings can changethe image of the patient’s health. Writing a number similar to the previousrecording to save time might result in the patient’s tachypnoea beingdiscovered in the next reading, and viewed as an instant spike. It may havebeen gradual but the second reading was false, and the diagnoses of what iswrong will not have accurate symptoms to evaluate.

Failure to recordinformation correctly, and falsifying data has resulted in a conduct andcompetency hearing for a nurse before (NMC, 2017). It is extremely dangerousand knowing the importance of the NEWS I would never make results up for anyreason.           Breathsare better counted over a minute than 30 seconds. Though some literature dictatesthe rate at 30 seconds qualifies as a measurement 


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