Literature Review
In the CCU setting, patients are especially vulnerable due to the vastly negative effects that specific external factors may have on their health status. The changes in end-tidal (ET) CO2 levels are particularly important to determine since they allow improving the opportunity for performing the return to spontaneous circulation (ROSC) in CCU patients in case of a heart attack or a similar dysfunction (Cook, 2016; Langhan, Kurtz, Schaeffer, Asnes, & Riera, 2014). Among the existing tools for ETCO2 evaluation, capnography is regarded as a possibly beneficial one. However, the proposed technique requires further assessments to ensure that it meets the existing quality standards and provides CCU nurses with the information required to make a proper choice and perform ROSC in a timely fashion.
The research questions that the studies under analysis seek to answer mostly concern the effects of capnography on the process of monitoring the levels of ETCO2 in patients whose state can be determined as critical. Particularly, the setting of the emergency room, the operating theater, or ICU is considered in nearly every study. It is remarkable that a significant number of articles focus on managing the needs of post-operative patients (Carlisle, 2015). The specified tendency can be explained by the exposure to a wide range of negative effects that may affect a patient’s ETCO2 levels and cause a heart failure, requiring the further application of capnography and similar tools or the successful ROSC. For instance, Cook (2016) studies the general outcomes of capnography in nursing, emphasizing the significance of the specified tool as the measurement technique and the identification of threats to vulnerable groups’ well-being.
Concerning the limitations of the studies under analysis, the choice of methodology can be seen as the weakest aspect of each. Although every study uses its design to its advantage, maximizing its benefits, a significant portion of research articles suffers from the lack of representation in their samples. By using convenience sampling as the most common technique, a large number of the authors succumb to the problem of generalizing research outcomes to reduce the related biased, creating a rather commonplace approach toward handling the issue of capnography in the selected setting. However, the specified issue can be addressed when introducing capnography as a tool into the setting of contemporary nursing. Specifically, the outcomes of the analysis can be generalized to ensure that the research results meet the needs of as many patients as possible. In addition, by generalizing the results of a study, one can contribute to the development of a uniform strategy for managing CCU patients’ needs. As a result, a standardized framework for performing capnography in the clinical setting can be devised.
When setting the strategy for deploying the specified device in the CCU setting, one should consider exploring the concept of capnography readings improvement. Although it is critical to teach nurses to decipher the information provided during capnography, it is also imperative to ensure that all available measures are taken to improve the readings. Because of the abundance of factors that may hamper the decoding of the analysis results, the introduction of additional tools for data management is critical. Thus, nurses will have to be instructed in accordance with newly developed guidelines to add a nebulizer properly during capnography. Particularly, the research by Vinay (2017) indicates that there is a threat of misplacing the nebulizer, thus impeding the process of interpreting the information. The identified threat may lead to failure to locate a change in ETCO2 levels in a patient. Thus, the possibility of performing ROSC properly will drop unless proper tools for capnometer reading are introduced. Moreover, nurses will need additional training to learn to interpret the information provided during the analysis of capnography results. Therefore, the specified subtheme should be deemed as critically important for the improvement of ROSC rates among CCU patients. While capnography is a powerful tool for increasing the chances of a successful ROSC, it needs to be applied with due skills and high levels of proficiency.
At present, several key concepts with the associated subthemes can be located in modern literature. Specifically, the phenomenon of ETCO2 levels as a theme and the ETCO2 and alveolar CO2 tension levels respectively require closer scrutiny (Cook, 2016; Jooste et a., 2018; Carmichael & DeRego, 2017). Another important problem raised in modern research in regard to the management of CCU patients’ needs and the use of capnography concerns evaluating capnography in regard to other tools for ETCO2 management and meeting the needs of CCU patients. For instance, the application of jet nebulizer compared to capnography deserves further exploration (Lam et al., 2017; Vinay, 2018). Furthermore, one may need to compare capnography to pulse oximetry in order to determine which method is superior.
The tools associated with the successful management of capnography processes should be seen as the next crucial theme that warrants discussion. Although capnography might be the perfect device for assessing patients’ state and locating ETCO2-related problems during ROSC, detailed guidelines for introducing capnography are critical (Langhan et al., 2014; Kerslake & Kelly, 2017). Therefore, it is necessary to study the strategies used to enhance capnography outcomes in the clinical setting. Smyrnios et al. (2015) also address the specified issue, pointing to the urgency of assessing the tools’ sensitivity in regard to tube placement in the CCU setting. Therefore, extraneous factors associated with the specifics of the proposed ETCO2 management devices are an important subtheme.
In addition, studies show that nurses need to locate tools for monitoring capnography results in the post-op setting. The specified issue is linked directly to the problem of improving capnography results in the clinical context since it provides a chance to improve nurses’ awareness of the alarms that capnography provides, as well as administering the necessary actions to implement successful ROC in the realm of a CCU. Moses (2018) states explicitly that the current policies regarding the application of capnography require immediate reconsideration due to the lack of instructions regarding their use in the post-op setting. The alterations to the existing framework for capnography application imply determining a set of standards that will need to be met in order to deliver quality services. In addition, nurses will need to receive proper education and training that will allow them to apply the designated instructions properly. Particularly, it will be necessary to ensure that nurses apply the specified instructions properly to locate the problems in the patient’s ETCO2 levels and address the issue at the onset of its development. As a result, ROSC will be performed successfully, and the probability of returning the spontaneous circulation will rise exponentially.
Moreover, the nurse education subtheme and the need to create the platform for teaching the essence of capnography application appears in arrange of other studies, signaling that there is a significant knowledge deficiency in a large number of experts. For instance, Pella et al. (2018) stress the need to develop a set of standards for capnography application along with a comparison of the effects of capnography and pulse oximetry in the clinical setting. The fact that new instructions will require substantial training and a shift in the current approach toward performing key actions in the CCU setting implies that additional training should be provided to nurses.
Whitaker and Benson (2016) expand the specified idea, elaborating on the issue of improving the existing standards and guidelines of the use of capnography. Specifically, the study provides the subtheme of nurse education, as well as the idea of reconsidering the current capnography standards. The specified change is particularly important for the CCU setting, in which nurses have to make decisions fast. Therefore, future studies in the specified realm will have to be focused on the redesign of the current standards and the selection of improved strategies that allow nurses to use capnography properly. Since the current monitoring strategies do not imply the use of capnography as an intrinsic element of identifying a change in a patient’s ETCO2 levels, it will en necessary to redesign the existing approach and introduce the key stages of capnography in it. While being restricted to four primary steps, capnography will require a significant alteration in the current framework of TCO monitoring.
In turn, Carlisle (2015) posits that the process of monitoring capnography outcomes will require a shift in the current organization of nurses’ work. Similarly, Kersklake and Kelly (2016) raise the topic of improving the current guidelines for implementing capnography in the CCU environment. For instance, the authors of the study posit that the process of establishing the capnography trace and deploying the proposed technique to locate the threats to a patient’s ETCO2 levels requires completing four key stages.
Although the idea of reducing the instructions for capnography as a guide for nurses to four steps seems to be an instance of oversimplification, the specified subtheme deserves to be mentioned. Specifically, one must give Kerslake and Kelly (2016) credit for introducing methods for measuring capnography and incorporating different types of analyzers into the CCU setting. The specified instruction for nurses is of particularly big importance since the current CCU environment lacks detailed instructions on the application of capnography and, therefore, one needs to design a support system for nurses. The discussion of the analysis techniques, in turn, enables nurses to evaluate the existing approaches critically and select the one that will be the most suitable in a specific setting.
In addition, it is noteworthy that a range of studies points to the superiority of capnography over other tools for monitoring a patient’s well-being in the CCU context. For instance, Carlisle (2015) presents capnography as superior to pulse oximetry, which, according to the author, provides significantly fewer chances to perform successful ROSC in the CCU context. Specifically, it is specified that “Continuous capnography detects signs of compromised ventilation earlier and more effectively than either visual respiratory assessments or pulse oximetry” (Carlisle, 2015, p. 202). Thus, the role of capnography in the CCU setting should be regarded as very important.
The identified subtheme should gain particular significance since it provides both opportunities and numerous challenges for nurses. Due to the introduction of a new source of information, namely, visual elements, into the setting where nurses have to focus on every possible detail, the use of capnography can be regarded as a threat to the efficacy and accuracy of nurses’ actions. With the increase in the number of issues to which nurses will need to pay attention in the clinical environment, the probability of a medical error rises exponentially. As a result, the quality of care may be questioned. Encouraging nurses to develop the skills associated with the management of capnography as a process that will be needed to maintain control over a patient’s well-being during the surgery should be seen as particularly important. It is critical to ensure that nurses are aware of the key characteristics based on which capnography can be defined as successful. Thus, nurses will receive an opportunity to evaluate their performance independently and build the required skill set will become even more possible.
However, the described way of integrating capnography into the clinical environment and the CCU setting also implies giving nurses a chance to analyze the available data in depth. With the rearrangement of roles and responsibilities in the nursing setting, one will acquire the ability to monitor the changes in patient data, while other nurses will focus on managing other tasks associated with the CCU setting. As a result, the probability of detecting the factors that may influence a patient’s pressure and heartbeat will be identified at a very early stage of development. Consequently, with appropriate measures undertaken, the threat of failing to perform ROSC on a CCU patient will be reduced to a minimum.
The need for introducing capnography as one of the tools for managing the process of ROSC in people placed in the CCU environment also implies addressing the subtheme of providing nurses with detailed instructions concerning the use of capnography in the CCU setting. Specifically, rigid guidelines have to be designed in order to prevent medical errors and help nurses to use capnography to its maximum capacity. Particularly, it is imperative to outline the key stages of monitoring, including the management of the relevant tools. The described issue is paralleled with the concept of nurse education as one of the crucial aspects of improving the current framework for addressing the needs of patients in the CCU setting. The lack of opportunities for introducing nurses to the idea of consistent learning and the development of new skills in regard to addressing the needs of CCU patients is a rather problematic issue that could be seen as one of the key subthemes addressed in recent studies (Langhan et al., 2014). Therefore, there is the need to incorporate the principles of continuous learning and especially interdisciplinary practice into the current CCU setting (Pella et al., 2018).
The issue of interdisciplinary collaboration is, in fact, one of the primary concepts that have been rendered in some of the studies under analysis (Cook, 2016). Therefore, the issues associated with addressing nurse communication and, particularly, the promotion of an unceasing dialogue and knowledge sharing between nurses can be regarded as critical (Jooste et al., 2018). Therefore, encouraging the connection between nurses within the CCU setting, as well as ensuring that no conflicts occur between nurses and other healthcare staff members, is critical to the successful delivery of appropriate services, which in this case involve ROSC. Since a patient’s life hinges on the efficacy of collaboration between nurses in a multidisciplinary setting, the next subtheme that concerns negotiation and conflict management has to be explored. Although the specified theme appears only once in the selected articles, it nonetheless has a tremendous impact on the patient outcomes due to the opportunities that it provides.
Particularly, the promotion of nurse education is likely to affect the overall environment of the CCU positively and increase the chances to deliver the best services possible to the vulnerable demographic. It is critical for nurses to receive proper instructions and develop the ability to utilize the recently developed skills in the clinical setting, particularly, the CCU environment. Although the existing studies do not provide specific recommendations concerning the promotion of education among nurses, it can be assumed that the identified step can be accomplished by providing nurses with detailed instructions concerning the types of capnography and the circumstances in which each type should be applied. For instance, it is strongly recommended to incorporate both blinded and open capnography arms techniques into the process of nurse education to ensure that they can select an appropriate framework in a specific setting (Pella et al., 2018). Studies show that nurse education needs to foster the ability to select an appropriate method for addressing patients’ needs and locating the immediate threats to their well-being, which capnography provides.
Overall, the review has shown that capnography is viewed as a very useful way of measuring ETCO2 levels. The specified tool is particularly important in handling the scenarios that involve ROSC since capnography allows noticing the slightest changes in the ETCO2 levels. As a result, the outcomes of ROSC become significantly better, with the chances for rescuing a patient rising consistently. Therefore, there are strong indications in the existing literature that capnography has to be incorporated into the contemporary CCU environment to ensure improved quality of care. The specified ideas can be regarded as the extension of the subthemes of life support and basic life support as the mechanisms for improving the quality of ROSC.
Therefore, there are strong indications that capnography should be applied to managing the problem of RISC in CCU patients. Because of the wide array of factors affecting the chances for survival among CCU patients suffering tom a heart attack, the ability to locate a threat at a comparatively early stage and address it respectively is crucial. Capnography, in turn, provides such an opportunity by offering a way of monitoring the slightest changes in the ETCO2 levels in patients. Consequently, the proposed device should be integrated fully into the CCU setting, with detailed instructions being provided to nurses for coordinating capnography with ROSC-related procedures. With the introduction of a cohesive leadership framework and the promotion of change in the CCU environment, the successful use of capnography in managing ROSC is expected. As a result, the number of cases involving fatal outcomes will drop significantly.
Concerning the recommendations for further research, one should focus on the evaluation of capnography as a means of improving ROSC. Particularly, the methods of teaching nurses to utilize capnography in the clinical setting and especially in the CCU context will need to be studied. In addition, it is necessary to study the issues that may occur during the implementation of capnography in the CCU context. Because of the importance of performing capnography properly and locating the threat of heart failure immediately, one will need to explore all possible hindrances that may occur during the specified process and determine the ways of addressing them respectively. The specified step will contribute to a rise in the efficacy of capnography in the CCU environment and the introduction of the appropriate tools for monitoring the process.
Overall, the problem of capnography use during RODC needs to be studied in depth. While there is evidence that supports the application of the proposed technique in the ROSC setting, it is necessary to determine the methods of integrating it into the existing instructions for performing RISC, as well as teaching nurses to monitor the changes in capnography records. With the introduction of the specified changes in the design of CCU nursing, one will be able to promote change in the identified setting.
Research Article Chart
References
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