Introduction
Historically, most of the patients who suffered cardiac arrest far from hospital setting have experience high deaths and morbidity. Research has also found that the increased temperature resulting from the brain injury or ischemia evidently aggravates the level of damage to the brain and also contributes to prolonged hospital stay. The process and duration of recovery is directly correlated to the temperature of the body. In investigational studies show that the increased temperature (hyperthermia) increases oxygen free radicals and causes cell membrane to become more permeable. This causes the membrane to be unstable and as a result this causes an abnormal electrical depolarization. It’s estimated that even with as little increase in temperature as 0.5°C, a very big zone of the brain is injured or there is significant neuronal loss (Diringer et al, 2004, p. 1492; Zeiner et al, 2001, 2008)
Description
During the post cardiac arrest period, the elevated temperatures greatly add to the impact of ischemic brain damage. Research has shown that by reducing the brain temperature by few degrees Celsius would alleviate the level of the damage (Zeiner et al, 2001, 2008). This is the induced hypothermia and it greatly improves the recovery of the neurological damage. Since 1950’s medical practitioners have used deep hypothermia in sustaining patients through some selected surgical processes (Abella et al, 2005, p. 182). However, in 2002, there was greater development and some trials in Europe and Australia were conducted where the process of induced hypothermia was applied to lower the temperature of patients who had just suffered cardiac arrest. After publication of the process it was adopted for use for post-cardiac arrest patients.
Therapeutic hypothermia is hence described as “the purposeful decreasing of core body temperature to between 32°C and 34°C during the first twelve to twenty-four hours following a cardiac arrest attack” (Nolan et al, 2003, p. 119). The reduction in temperature (hypothermia) lowers the body metabolic rate and as a result the amount of oxygen being consumed is reduced (Abella et al, 2005, p. 185). This reduction of metabolic is very critical in primary care or preventative medicine and in this case it protects the body from active chemical reaction that takes place with reperfusion injury. Reduced temperatures also decreased the production of nitric oxide as well as other neurotoxins hence protecting the body from losing the brain cells (Abella et al, 2005, p. 185). This process also allows the blood brain barrier to experience favorable factors for it to recover its normal function and reduce cerebral edema.
Strategic Plan
The use of induced hypothermia for cardiac arrest survivors is still new. A particular case study stimulated the researcher’s interest in the subject. I will therefore request permission to do a literature search on the recent research that addressed this topic (McManus et al, 1998, p. 1562). Basically, the peer reviewed journals will form a larger part of the materials for study. I will search internet articles by use of key words typed and logged to the search engines to find sources that addressed therapeutic or induced hypothermia for cardiac arrest patients.
In order to encourage cooperation and contribution from other researchers to the current change of practice to evidence-based practice, I will involve several experienced practitioners of critical care in the search for six weeks. Those research articles will be distributed to other practitioners in emergency departments and to cardiologists. Protocols used in hospitals will be assessed, compared and summarized for later discussion but this will be done informally between nurses and the researcher under guidance of the mentor (McManus et al, 1998, p. 1562).
After the six weeks, the nurses who were involved, myself and my mentor will develop a protocol that will offer the latest healthcare guidelines for the patients that survive cardiac arrest. The mentor will re-assess the protocol and then suggest it to practitioners. Basically the protocol is likely to be authentic because I will take notes and comments during the meeting with practitioners he/she will interact with. The research will also consult medical directors at every step or the research to ensure the study is focused to the purpose and used correct data (McManus et al, 1998, p. 1562).
Feasibility Statement
The development of a protocol for a therapeutic hypothermia procedure for patients in post cardiac arrest is feasible by this approach. Basically the major principle issues being that the subject is till new and there is ongoing research about the topic hence it support new knowledge and evidence-based practice (Zeiner et al, 2001, 2009). The approach also uses methodologies of existing tools that are easier to use in any study. Definition of the hypothermia concept to the effect of cardiac arrest is valid medically. The research shall adhere to the require study standards available in concept and literature.
Having a well defined protocol will provide healthcare providers with a guideline for planning and preparing for the service. This includes mixing drips and anticipating the task before patients actually arrive at the facility. This also supports that healthcare practice and education must an ongoing and progressive venture.
Professional Outcome
Nursing is a demanding job and requires a great deal of sacrifice in terms of courses taken and the time to research and better performance for competence at career. Due the experiences in class and dedication to clinical practice, I know I have gained enough experience for this course. I have spent time studying evidence based practice in nursing and practical ventures like maintaining hypothermia in post cardiac arrest patients have encouraged me to think critically and make decisions based on medical evidence.
The strengths I have gained in studying this course include better communication whereby I can communicate medically, use medical parlance and based my rationality of evidence from scientific research. I believe that I have attained the required qualities in nursing which include critical thinking, organization, emotional stability, resilience, planning and broadmindedness.
I discovered that adaptability is very important in nursing because the condition of the patients on a working environment can change in a blink of an eye. As a nurse, one is require to be prepared to handle emergencies and unexpected situations. Critical thinking is also a very important factor and this is a major competence in nursing because one has to be in a position to act fast and identify concise solution from the accurate decisions. This has to be reached even in conditions when there is no time. Emotional stability is not just a competence but a survival strategy because in nursing, one is faced with situations that are very emotional like loss of zeal to live by patient of people grieving when they lose a loved one.
Future interests will be to venture in neonatal care. I intent to specialize in social studies and childcare and Due to my dedication to the pediatric and newborn care I will have the zeal to explore and gain more experience in the venture. I strongly believe that this is the area I should focus in future after attaining my degree. I love facing challenges and the goal in set for myself is to work under high stress environment like nursing. I will go for further studies in childcare management and I also believe that nursing is a secure job where I will always have a chance to learn and grow.
Role of the Mentor
The work of the mentor will be to supervise the research and probably assist in doing the complex tasks like analyzing data and interpretation. This is to help boost the confidence of the student researcher so that the job can be executed efficiently. The researcher may feel inadequately prepared for the study but the mentor helps to ensure that the researchers feels supported by being taught critical thinking skills and application of previously acquired knowledge. The mentor will also train the researcher on the best methodology of study, good communication skills and other requirement for the project.
Reference List
Abella, B.S., et al. (2005), Induced Hypothermia Is Underused After Resuscitation from Cardiac Arrest: A Current Practice Survey, Resuscitation, 64 (2): 181–186.
Chitty, K. (2005). Professional nursing: concepts & challenges. Philadelphia, PA: Elsevier Health Sciences.
Diringer, M.N., Reaven, N.L., Funk, S.E., Uman, G.C., (2004), Elevated Body Temperature Independently Contributes To Increased Length Of Stay In Neurologic Intensive Care Unit Patients, Crit Care Med, 32; 1489–1495.
McManus, R.J., et al. (1998), Review of the usefulness of contacting other experts when conducting a literature search for systematic reviews, BMJ 1998; 317: 1562
Nolan, J.P., et al, (2003). Therapeutic Hypothermia after Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation, Circulation, 108: 118 – 121
Zeiner, A., et al. (2001), Hyperthermia After Cardiac Arrest Is Associated With an Unfavorable Neurologic Outcome, Arch Intern Med, 161(16): 2007–2012