Acute shock state remains one of the leading causes of death in the ICU environment. Therefore, a detailed analysis of the available means of preventing it is required. At present, IS and MAP are viewed as the most widely used tools. However, IS should be considered superior due to the time control options that it offers. By shifting from the traditional paradigm that encourages both MAP and IS to the one that stresses the difference between the two and provides detailed guidelines about the scenarios in which the use of either MAP or IS is considered more appropriate, one will be able to prevent the instances of ASH among the target population successfully. Therefore, designing the set of guidelines mentioned above and compelling healthcare experts to follow it is crucial to the further improvement of patient outcomes, as well as the promotion of a new and more efficient strategy for meeting patients’ needs, in general.
Clinical Problem Description: ASH Management
Description: ASH Management as a Healthcare Issue
Acute Hemorrhagic Shock (ASH) is among the key factors affecting the mortality rates in the U.S.; particularly, 2.3-4% of death cases in the U.S. are attributed to the ASH-related issues (Kahl et al., 2013). As a result, ASH can be viewed among primary reasons for concern in the contemporary nursing environment. Technically, any patient with a general type of trauma can be considered as a possible victim of ASH. However, the people that have been exposed to negative social, economic, or financial factors since childhood can be viewed as the primary risk group and, therefore, the target population of the study.
Importance: When the Patient’s Life Is at Stake
The significance of the research can be deemed as rather high. Seeing that ASH affects patients immediately and is likely to lead to death unless managed accordingly, there is a need to study the phenomenon and design the tools that will allow detecting the symptoms immediately and addressing the issue in an orderly and efficient fashion. A synthesis of the tools that are currently used to handle the issue will shed some light on the opportunities for improving the contemporary nursing strategies as far as the management of ASH is concerned.
Methodology: Systematic Search as the Essential Tool
The current study seeks to answer the following PICOT question: in ASH patients, does the use of the shock index (SI) methods allow for predicting the possibility of an acute shock (AS) than the measurement of the Mean Arterial Pressure (MAP) within the required time frame (i.e., two-three weeks)? The answer to the specified question is bound to serve as the foundation for improving the services provided to the target population.
The solution to the problem in question, i.e., the identification of the superior ASH management tool, was found by using the qualitative research method. Particularly, a general review of the recent studies, primarily, control trials, was conducted in order to determine the superior approach to addressing the issues of ASH. Ten articles were chosen from peer-reviewed journals to consider the effects of the identified approaches toward managing the needs of patients with ASH. The major findings of each study were explored, and the evidence both in favor and against IS and MAP was considered carefully to locate the tool that would help deliver the most impressive results. The rigor oof the identified method can be considered medium since the study provides an approximation of the research findings from all articles analyzed in the process. The validity of the research methods, in its turn, can be viewed as rather high since the chosen approach toward analyzing the phenomenon meets the existing scientific requirements.
The internal validity of the research is represented in the study due to the proper choice of the scientific method. Particularly, the identification of the available primary studies on the subject matter and the following analysis thereof comply with the primary concept of a qualitative study. Similarly, the external validity of the study is high since all of the pieces of data gathered in the course of the literature overview have been studied carefully, and the corresponding conclusions about the efficacy of the suggested methods (i.e., MAP and IS) has been determined accordingly.
Therefore, the choice of systematic search as the key research model can be deemed as rather successful. The use of the identified research model helped shed light on the current use of the two frameworks of ASH management and, therefore, consider the available pieces of evidence to determine which of the strategies was better. While the application of a quantitative approach would have provided more information about how the tools compare to each other, the current study, nevertheless, offers a range of data about the efficacy of applying the identified strategies in the context of a healthcare facility to manage the needs of ASH patients.
Results of the Investigation: Strategies and Limitations
The analysis of the articles mentioned above showed that, to meet the needs of the patients that can develop ASH, a healthcare expert must take every factor that may possibly affect the patent’s well-being into account and examine the environment and the patient’s record carefully. Therefore, a comprehensive assessment of the situation is highly recommended. Therefore, the SI approach as the most comprehensive tool for managing the needs of the target population is recommended. That being said, one must also give credit to the SI-based techniques since the suggested approach helps quantify the analysis results and, thus, provide the foundation for making forecasts about the possible changes in the patient’s health status. Furthermore, SI should be considered as the most appropriate tool for detecting the possibility of ASH since the consumption of drugs may contribute to a steep rise in shock levels, according to one of the studies (DeLano & Schmid-Schonbein, 2014).
That being said, some of the studies indicated clearly that the application of a single tool for determining the patients’ propensity toward the development of ASH is not enough. For instance, Bougle, Harris, and Duranteau (2013) insist that all approaches toward the identification of the ASH threat should be applied accordingly, and that a healthcare expert must not refute the possibility of ASH unless every possible opportunity for identifying it is exhausted.
It should be noted, though, that the approach that encompasses every possible strategy for measuring the threat of ASH has its problems, according to some of the studies. For example, the research conducted by Berger et al. (2013) declares that the use of both tools, as well as the introduction of other frameworks into the analysis, is bound to lead to a steep increase in the time taken for the measurement process. As a result, the threat of the patient developing ASH in the meantime rises to a considerable degree.
Therefore, there are clear indications that the application of the IS framework is the most appropriate way of addressing the threat of ASH development. While the suggested technique has its problems, it still helps detect the factors that may lead to the ASH development with the greatest precision (Mehta et al., 2014). Therefore, the specified method must be promoted as the foundation for a new and improved framework. Moreover, the introduction of the latest technological advances must be viewed as a necessity given the opportunities for reducing the time that they offer. As a result, the chances of saving the patient’s life and improving the quality of the provided services can be created (Sterling, Jones, Coleman, & Summers, 2014). Researches, however, also point to the fact that the SI framework has certain flaws compared to MAP. For instance, while being less time-consuming, it may deliver less accurate results than the MAP framework (Kim et al., 2013). As a result, the threat of making an error increases with the application of the strategy. It could be argued, though, that the introduction of technological innovations into the identified area may serve as the means of improving the SI tool. Particularly, the focus on using the latest models of the required devices can be viewed as the way to increase the accuracy of the measurements and, thus, make the test outcomes easier to interpret (Kahl et al., 2013).
One must admit that some of the studies also stress the importance of using MAP as one of the tools for testing the patients’ propensity to ASH (Michel et al., 2016). Indeed, refusing from the use of the tool in question altogether does not sound reasonable. Instead, some authors suggest that the framework could be used in the instances that do not require immediate actions. The identified solution seems quite plausible. Indeed, claiming the MAP tools to be completely inadequate as the device for determining the possibility of ASH development in a patient would be wrong. The framework does offer certain benefits, such as the chances to reduce the blood loss, yet in the cases when time is of the essence, it must not be preferred to IS (Johnson et al., 2014; Chuang et al., 2016).
Therefore, most of the recent studies indicate that SI should be viewed as the superior method of identifying the threat of ASH. While MAP should not be underrated, it is still considered far too flawed. SI, however, could also use significant improvements, especially as far as its accuracy is concerned. The specified problem, however, can be approached from a technological perspective.
Confidence in Research
The fact that all of the studies used for the analysis meet the inclusion criteria should be viewed as the essential strength. Indeed, all of the sources included in the research have been published recently and, therefore, provide up-to-date results that allow for gathering only the relevant information and using the data that can improve patient outcomes considerably. Thus, the information retrieved in the course of the analysis can be viewed as credible.
The choice of clinical trials as the sources of data should also be considered a strength of the research. There is no need to stress that using primary research results as the foundation for the further analysis is a necessity. Therefore, focusing on clinical trials as the backbone of the study helped retrieve only the relevant results and come up with the suggestions that would improve the quality of services offered to ASH patients significantly.
The suggested approach, however, also has its weaknesses. For instance, the fact that most studies focused on a rather narrow range of issues needs to be brought up as one of the primary flaws of the chosen method. As a result, there is a possibility that the information received from the studies had to be generalized too much. Furthermore, most of the articles considered in the course of the research did not take the alternative solutions to the problem of ASH into account or glanced over them. Therefore, a more profound analysis of the issue could be considered a necessity so that a more detailed analysis of the differences between SI and MAP could be carried out, and a more accurate assessment of each tool’s efficacy could be made. Nevertheless, the confidence in the results is rather high.
Summary of the Solutions: How ASH Can Be Approached
Based on the outcomes of the analysis, a more detailed design of the intervention for improving healthcare experts’ skills of managing ASH should be provided. Despite the fact that the superior method has been selected, it needs further improvements. Thus, the identification of the strategies for making the SI assessment more successful should be viewed as the next priority.
Furthermore, an elaborate guide for nurses as far as the application of the ASH management strategies is concerned must be provided. Unless a rigid set of rules and requirements is designed, the quality of care cannot possibly be improved. Therefore, it is crucial that a step-by-step guide for meeting the needs of ASH patients by using SI and the associated practices should be provided. Furthermore, healthcare experts must be offered a detailed guide that specifies the steps needed to be taken when managing the needs of patients that are under the threat of developing ASH. Preventing the instances of the disease is crucial to the further improvement of the quality of care and the management of the patients’ needs.
Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A…. Shapiro, N. (2013). Shock Index and early recognition of sepsis in the emergency department: Pilot study. The Western Journal of Emergency Medicine, 14(2), 168–174.
Bougle, A., Harris, A., & Duranteau, J. (2013). Resuscitative strategies in traumatic hemorrhagic shock. Annals of Intensive Care, 3(1). Web.
Chuang, J. F., Rau, C. H., Wu, S. C., Liu, H. T., Hsu, S. Y., Hsieh, H. Y…. Hsieh, C. H. (2016). Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: A cohort study. PloS One, 11(12). Web.
DeLano, F. A., & Schmid-Schonbein, J. W. (2014). Pancreatic digestive enzyme blockade in the small intestine prevents insulin resistance in hemorrhagic shock. Shock, 41(1). Web.
Johnson, B. D., Helmond, N. V., Curry, T. B., Buskirk, C. M. V., Convertino, V. A., & Joyner, M. J. (2014). Reductions in central venous pressure by lower body negative pressure or blood loss elicit similar hemodynamic responses. Journal of Applied Physiology, 117(2), 131-141
Kahl, J. E., Calvo, R. Y., Sise, M. J., Sise, C. B., Thorndike, J. F., & Shackford, S. R. (2013). The changing nature of death on the trauma service. The Journal of Trauma and Acute Care Surgery, 75(2), 195-201.
Kim, J. A., Choi, J. Y., Yoo, T. K., Kim, S. K., Chung, K., & Kim, D. W. (2013). Mortality prediction of rats in acute hemorrhagic shock using machine learning techniques. Medical & Biological Engineering & Computing, 51(9), 1059-1067.
Mehta, R. H., Cox, M., Smith, E. E., Xian, Y., Bhatt, D. L., Fonarow, K. C., & Peterson, E. D. (2014). Race/ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy. Stroke, 45(8). Web.
Michel, P., Wähnert, M., Freistühler, M., Laukoetter, M. G., Rehberg, S., Raschke, M. J., & Garcia, P. (2016). Acute transfusion-related abdominal injury in trauma patients: a case report. Journal of Medical Case Reports, 10(2), 294-299.
Sterling, S. A., Jones, A. E., Coleman, T. G., & Summers, R. L. (2014). Theoretical analysis of the relative impact of obesity on hemodynamic stability during acute hemorrhagic shock. Archives of Trauma Research, 4(3). Web.