Critical Care Essentials: Elaine Bromley Case and Coroner's Report Assessment Answer

Elaine Bromiley Case and Coroner's Report

The Elaine Bromiley Case’s Brief Overcome and Outcome

The Elaine Bromiley case entails a 37-year-old lady who died as a result of an attempted routine operation of the sinus at xx clinics. Apart from a history of fused cervical vertebrae, where the neck was slightly restricted with movement and x2 caesarean section 4 years ago which was known prior to her intended surgery, Mrs. Bromiley had no other significant past medical history. She was also an occasional drinker and a nonsmoker. 

Mrs. Bromley came to the xx Clinic on the morning of 29^th March 2005 having fasted as a prerequisite for the intended elective surgery for septoplasty and functional endoscopic sinus. Her vital observations were within satisfactory limits, heart rate of 81 and saturating 98% on room air however, there were no records of her blood pressure or a period of pre-oxygenation just before sedation medication was introduced.

To commence the surgery, anesthesia was introduced intravenously to sedate Mrs. Bromley and the preferred way to secure her airway was through a laryngeal mask airway as per the team. As soon as she was sedated, the team immediately tried securing her airway. After two attempts with two different-sized laryngeal masks, they were unsuccessful as Mrs. Bromiley’s jaws were clenched too hard. Mrs. Bromiley's saturation had begun to deteriorate to less than 90%and increased her heart rate, they decided to ventilator through a bag and mask with minimal success (Bromiley, 2023). The doctors decided to try and intubate her using a laryngoscope however that was also deemed to be hard as the larynx anatomy was not in sight. After nearly 25mins an insertion of the intubating laryngeal mask improved and saturations rose above 90%, blood pressure and heart rate were also at considerate levels. Both doctors agreed to abandon the surgery and let Mrs. Bromiley wake by herself in recovery. Mrs. Bromiley deteriorated whilst in recovery and they decided to send her to the intensive care unit where she passed away 13 days later.

Situational Awareness, Critiquing the Evidence, and the Nurse’s Role to Care and Assess the Deteriorating Patient, Elaine Bromiley

Situational awareness is considered the ability to perceive and comprehend the context of another individual's surroundings, with the aim of making sound decisions, engaging in appropriate actions, and remaining prepared and alert. The analysis also states that it is characterized as a crucial skill in various fields, and this is especially in the medical field where poor situational awareness has at times contributed to relatively bad outcomes (Gluyas & Harris, 2016). Hence why in the context of Elain Bromiley, a lack of situational awareness of a medical team leads to a tragic outcome that could have been mitigated.

Situational awareness can also be considered a potential skill and competence that is required to be obtained by nurses within the critical care unit for making sure patient safety. Taking the approach of distributed situational awareness or DSA, the converging factors related to the case can be examined better that results in causing fixation errors along with elaborating the opportunities missed by the nurse or the anesthetist without just taking into the notice of patient monitoring as evaluated by the situational awareness or SA model for escaping fixation. In the maximum areas of the case, the oxygen saturation level of the patient had been found as very low (Cohen, 2013). But this data was available in the display of monitoring including activation of the audible alarm and this information’s complete importance constituting the desaturation extent or time length which was found not registered rapidly as necessary to carry out successful management. Anesthetists get only alerted by alarms and monitors to the issue’s existence yet they are not willing to alter the former to find an ultimate solution.

As per evidence from the inquiry report, after six to eight minutes of the condition taking place, one among various nurses identified the situation’s seriousness and called up the unit of intensive care or ICU for reserving a bed specifically for the client (Cooper et al., 2014). When all consultant anesthetists were informed, the patient had been dismissed along with canceling the bed. The circumstance’s seriousness had also been recognized by the practitioner of the senior operating unit and at the same time taking steps by requesting the assistance of a tracheotomy kit, yet this thing was found to be ignored. Thereafter, it was mentioned by another two team members that it was known to them what was required to occur within this circumstance like the surgical airway’s application but they did not feel the necessity for speaking up (Knowledge Rcvs, 2023). In addition, from the perspective of traditional situational awareness, getting the analysis focuses on the anesthetist reflects situational awareness as an endeavor of a person (within the head). Therefore, interactions of team members in the overall unit seem redundant.

When the perspective of distributed situational analysis is considered, the analysis focus makes alterations to the cognitive system which is distributed in characteristics and also comprises these interactions. Therefore, it makes situational awareness an evolving system's property as a whole. The scenario has made it evident that the DSA can be linked with the nurse or anesthetist yet it is not incorporated within them. Rather it can be considered it evolves from various types of interactions taking place in the distributed system of cognition. Hence, the DSA initiative placed would give focus on the manner distribution of the information knowledge is carried out all over artifacts and people instead of making existence solely (Fioratou et al., 2015). For instance, making the availability of the tracheotomy kit as one kind of external artifact which is a knowledge or information source may also not be considered enough (Parush & Campbell, 2017). Further, it is important to make good communication and know the effectiveness of situational awareness within the clinical care setting to enhance outcomes for the patient successfully.

The lack of effective and coordinated communication within the case resulted in the taking of the life of Elaine Bromiley. The patients' requirements in that critical situation were not clearly communicated by any of the team members although everyone knew what was required to be done. The team failed to look that the patient needed a stable airway while making attempts to intubation of Mrs. Bromiley. A greater cognitive flexibility degree is necessary for getting adapted to an emerging event as the airway difficulties case elaborated above. Past-held beliefs are required to be released by anesthetists in a flexible way when a proper balance is not maintained between their expectations and the circumstance. Moreover, the focus must be placed with regard to the process of re-evaluation which can be attained by making interaction and communication as recommended by the framework of DSA (Swift, 2021). The need is encapsulated within the scenario of Elaine Bromiley for improved communication taking place between distributed cognitive systems' several components for safe and effective patient management.

Alterations Required for Bringing Situational Awareness Among Nurses within the Clinical Care Setting

 From the point-of-view of distributed situational awareness, to have or acquire situational awareness is basically directing personal interactions' course with the atmosphere toward the objective. It is specifically from this type of bidirectional procedure to search for information as well as take actions within the critical care unit accordingly by gaining situational awareness. The attention of the anesthetist is mainly required to evaluate the vital signs and conditions of the patient so that this kind of unforeseen or death circumstances can be avoided like in the case of Mrs. Elaine Bromiley. It is also a necessity for nurses to well-know that they are the interdisciplinary team’s equal members; therefore, they should voice their concerns and issues respectfully during the time of making sure that they serve as advocates for patient safety. It is vital to understand well that they are nurses and have the responsibility to evaluate the safety of the patient along with influencing their outcomes positively (Avalos et al., 2021). This will include making sure that they shall not only be present at the patient's bedside to perform tasks yet also ensuring actively that the provision of evidence based care and treatment for the patient is available.

The scenario makes it clear that evidence-based care had not been offered to the patient particularly when the decision came out for wheeling the patient as she was not having the ability for sustaining a stable airway and getting shifted to the room of recovery where it was expected that she would get awaken spontaneously (Boggatz, 2019). It is indicated by the evidence-based practice that a greater care level is required by the patient with regards to knowing the availability of vital things and the way of its administration within the recovery room. The lack of communication between the patient and the nurse as it took place in the scenario needs to be improved through person-centered care. It gives focus on the social framework where relationships are obtained as the basis to provide health care services. Person-centered care provides major emphasis on the patient’s individual, social and emotional preferences instead of just considering her present medical conditions (Fioratou et al., 2015). With the help of patient-centered care tools and taking assistance from the medical framework, the needs and care of the patient would be the key basis to assess and evaluate the nurse and the entire multidisciplinary team.

There is a requirement for a potential and skilled nursing leader in the team who would be able to handle this kind of critical situation within time. Nursing leadership takes a vital part to enable person-centered care quality in the clinical care emergency unit. It will be effective to teach communication practices and skills to other nurses so that both patient safety and clinical outcomes can be enhanced within the healthcare setting. This quality of the nurse leader also plays a vital role to develop and cultivate a work atmosphere that sets the basis to maintain a safety culture where all members of the team will be able to share their concerns regarding the patient as well as opt for their safety without having any fear (Cooper et al., 2014). Nurses should be positioned for supporting and creating effective process changes and systems in the facilitation of practices thereby also getting the opportunity to discuss patient safety. When an optimal practice atmosphere is set within clinical care, it can bring in enhanced performance of the overall healthcare organization.

Also, to improve communication between all support staff, team members, nurses, and doctors, a team-building exercise creation is important that would provide an allowance to the entire team within the care unit for practicing communication during the time of any kind of emergency situation (Parush & Campbell, 2017). In-service activities are required to be enhanced in this situation where doctors and nurses will be able to observe one another as the interdisciplinary team’s equal members. It is vital to understand that there is no independence of communication skills considering situational awareness due to the fact that information within the displays is required to be laid out and grouped in a better way. Furthermore, communication taking place between all members of the team is also needed to obtain an improved structure so that it precisely gets to the issues and thereafter to its actual and valid solution (Gluyas & Harris, 2016). Offering and training for certain corrective protocols are equally necessary as they serve as a good strategy to enhance situational awareness along with avoiding fixation mistakes and finally enhancing patient safety.

References

Avalos, J., Roy, D., Asan, O., & Zhang, Y. (2021). The influential factors on nurses’ situation awareness in inpatient settings: A literature review. Human Factors in Healthcare, 1, 100006. https://doi.org/10.1016/j.hfh.2022.100006

Boggatz, T. (2019). Person-centred care and quality of life. Quality of Life and Person-Centered Care for Older People, 449–466. https://doi.org/10.1007/978-3-030-29990-3_7

Bromiley , M. (2023). The case of Elaine Bromiley - EMCrit project. emcrit.org . https://emcrit.org/wp-content/uploads/ElaineBromileyAnonymousReport.pdf

Cohen, N. L. (2013). Using the abcs of Situational Awareness for Patient Safety. Nursing, 43(4), 64–65. https://doi.org/10.1097/01.nurse.0000428332.23978.82

Cooper, D. S., Klugman, D., Kinstler, A. J., Nelson, D. P., & Muething, S. (2014). The Cardiac Intensive Care Unit and operating room continuum: Quality and safety in the cardiac intensive care unit. Pediatric and Congenital Cardiac Care, 91–104. https://doi.org/10.1007/978-1-4471-6566-8_6

Fioratou, E., Chatzimichailidou, M. M., Grant, S., Glavin, R., Flin, R., & Trotter, C. (2015). Beyond monitors: Distributed situation awareness in anaesthesia management. Theoretical Issues in Ergonomics Science, 17(1), 104–124. https://doi.org/10.1080/1463922x.2015.1106620

Gluyas, H., & Harris, S.-J. (2016). Understanding situation awareness and its importance in patient safety. Nursing Standard, 30(34), 50–60. https://doi.org/10.7748/ns.30.34.50.s47

Knowledge Rcvs . (2023). Situational Awareness: A vital skill to ensure patient safety. RCVS Knowledge. https://knowledge.rcvs.org.uk/news-and-events/features/situational-awareness/

Parush, A., & Campbell, C. (2017). Situational awareness and Patient Safety. AORN Journal, 106(5), 433–433. https://doi.org/10.1016/j.aorn.2017.08.006

Swift, H. (2021). Encouraging situational awareness in nursing students. Back to top. https://www.wolterskluwer.com/en/expert-insights/encouraging-situational-awareness-in-nursing-students#:~:text=It%20can%20easily%20be%20defined,is%20with%20a%20deteriorating%20patient.

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