Rincy Johnson Cardoze

• Royal Surrey County Hospital (RSCH), NHS Foundation Trust's Critical Care Unit, incorporates general adult intensive care and high dependency. The ICU has 28 beds, admitting over 1,400 patients a year from various specialties, which include hepatobiliary, upper gastrointestinal, gynecology, urology, maxillofacial patients, as well as emergency medical and surgical admissions. It is one of only a few ICUs in the country to have its own dedicated patient gym.
• The ICU beds are managed and staffed by a collaborative and effective multidisciplinary team, along with a specialized team of nurses called 'The Outreach.' The service reduces cardiac arrests, as well as the morbidity, mortality, and hospital stay of high-risk patients.

In accordance with the standards set by the NMC (Nursing and Midwifery Council) of England, I, as a registered and competent nurse, perform the following activities:

• Continuous Monitoring: Ensure a comprehensive handover that addresses all aspects from airway to elimination, while consistently monitoring vital signs, neurological status, and laboratory results in critically ill patients.
• Early Detection of Deterioration: Recognize early indicators of patient deterioration and quickly escalate care, prioritizing patient safety at all times. Following the principle that prevention is better than cure, a specialized post-operative care protocol is implemented for each specialty. This includes mobilization, deep vein thrombosis prophylaxis, dietary management, analysis and removal of drain outputs, and daily sedation assessments, with extubation planning for patients on invasive ventilators. As a bedside nurse, I have effectively recognized early warning signs and escalated concerns to the Nurse-in-Charge and the team via priority calls and ward rounds. This involved ruling out deterioration through laboratory investigations, facilitating transfers to scanning rooms, and arranging bedside X-rays when necessary.
• Assessment of Complex Cases and Management: Perform comprehensive assessments, including the interpretation of arterial blood gas (ABG) results, analysis of cardiac rhythms, and management of advanced life support systems. Administer medications and treatments, such as IV drugs, blood products, sedatives, pain management therapies, and other prescribed interventions.

Manage ventilators and respiratory support by operating mechanical ventilation systems, assisting with intubation procedures (including the application of cricoid pressure), and implementing respiratory therapies. This includes preventing hyper-oxygenation and adhering to specific targets for patients with conditions like COPD and asthma. Collaborate with the research team to apply evidence-based practices in patient recovery, such as proning techniques for ARDS and COVID-19 intubated patients.

• Focusing on physical and psychological aspects equally, I support patients and their families in navigating challenges encountered in the ICU, such as ICU-induced delirium, by facilitating family visits and keeping them informed about the patient’s condition. Encouraging families through various means, and motivating them, upon discharge, to engage in follow-up clinic programs where patients can share their ICU experiences, and express their emotions. Additionally, our dedicated ICU psychologists and nursing team provide support by maintaining a patient diary for ventilated patients, allowing them to reflect on the difficulties they overcame once they have recovered.
• Engaging in research: Collaborating with the ICU research team has always been an engaging and exploratory experience. Currently, our team is focusing on studies related to metabolic acidosis, community-acquired pneumonia, sepsis, acquired acute kidney injury (AKI), and several other topics.
• Being an empathetic carer and professional leader, providing wound care, collaborating with dieticians and speech and language therapists (SALT) to coordinate nutrition plans, securing IV access, performing catheter assessments, and conducting blood draws, including venipuncture, are fundamental aspects of my role. Additionally, preventing central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) through strict adherence to line care bundles, as well as conducting quality improvement audits, is a key responsibility. I also prioritize continuous professional development, staying current with the latest research, best practices, and evidence-based guidelines in critical care nursing.
• Shift Supervision: Oversee the care of multiple patients during a shift, ensuring that all needs are addressed, and proper documentation is maintained.
• Team Coordination: Collaborate with other nurses and healthcare providers to ensure seamless patient care, and efficient operation of the ICU.
• Crisis Management: Lead or support team responses to emergency situations (e.g., priority call/code blue, rapid response).
• Mentorship: Offer guidance and mentorship to students, including acting as a practice assessor, supporting them in achieving their goals, and providing feedback to the university. Additionally, assist supernumerary nurses, preceptorship, and orient new staff to the ICU environment, protocols, and patient care practices.
• Engaging in quality reassurance: All care has been delivered in accordance with NMC standards and in compliance with trust protocols, including infection control, medication management, and information governance policies, with a focus on maintaining the confidentiality of patients and their families or next of kin. Additionally, ethical decision-making and end-of-life care are prioritized, with families provided with resources such as bereavement leaflets to guide them in afterlife care. Participation in quality improvement audits, and adherence to admission and discharge criteria, are also integral parts of the care process.
• Educate patients and families: Educate families about the patient’s condition, prognosis, treatment options, and expected outcomes. Provide emotional support during difficult times, and clearly explain procedures and interventions to both patients and their families in a way they understand, offering reassurance, and addressing any questions.
• Operate Complex Equipment: Skillfully operate advanced ICU equipment, including ventilators, cardiac monitors, infusion pumps, dialysis machines, and other life-support devices. Troubleshoot equipment issues and make necessary adjustments to ensure the highest level of patient care.
• Continuous education and ICU training courses: I have actively pursued both online and offline training courses, including Adult Basic Life Support, Equality and Diversity, and more. I am grateful to RSCH for providing career development opportunities, such as the fully funded ICU course. This course has deepened my understanding of the significance of evidence-based practice, allowing me to apply updated theoretical knowledge to my practical skills, ultimately improving patient care.

Wockhardt Hospitals provide a wide array of healthcare services, covering both medical specialties and super-specialties, and have treated lakhs of patients, including in-patients and out-patients, since their inception. The Critical Care units at Wockhardt Hospitals integrate multiple specialties and advanced technologies, offering critically ill patients a real chance of survival. These include multidisciplinary ICUs, as well as specialized ICUs for post-cardiac surgery patients, stroke patients, post-transplant patients, infectious disease patients, and dedicated units for neonates and pediatric cases.

I spent three years working in the Adult Medical ICU (MICU) as an entry-level nurse, and I am thankful to the organization for giving me a strong foundation in critical care.

My duties and responsibilities included:

• Patient Monitoring and Assessment: Continuously monitor vital signs, neurological status, and lab results of critically ill patients.
  Recognize early signs of deterioration, and escalate care as needed.
  Perform comprehensive assessments, and collaborate with the healthcare team to adjust care plans.
• Managing Life-Support Equipment: Proficiently operate and troubleshoot advanced ICU equipment, such as ventilators, infusion pumps, cardiac monitors, and dialysis machines.
  Ensure proper functioning and adjustments of life-support systems to optimize patient outcomes.
• Administering Treatments and Medications: Administer prescribed medications, blood products, sedatives, and pain management treatments promptly and accurately. Monitor patient responses, and adjust treatments as needed to ensure optimal care.
• Patient and Family Education: Educate patients and their families about the patient's condition, treatment options, and expected outcomes.
  Provide emotional support to families during difficult times, offering clear explanations of procedures and interventions.
• Collaboration with a Multidisciplinary Team: Work closely with doctors, physiotherapists, dietitians, and other healthcare professionals to ensure comprehensive care.
  Participate in multidisciplinary rounds to discuss patient progress, and adjust care plans.
• Infection Control and Quality Improvement: Enforce infection control measures to prevent healthcare-associated infections, including CLABSI and VAP.
  Follow established patient care protocols, such as line care bundles, and other prevention strategies.
  Contribute to quality improvement audits, and support compliance with clinical guidelines.
• Crisis Management and Emergency Response: Effectively respond to emergency situations, including code blue and rapid response events. Take the lead or provide support in managing critical incidents, and ensuring the stabilization of patients in distress.
• Continuous Professional Development: Pursue continuous learning through training courses, workshops, and evidence-based practices to remain current with the latest research and best practices in ICU care. Actively contribute to fostering a culture of continuous improvement and excellence in patient care.

I was also given the opportunity to demonstrate my teaching abilities as a Nurse Educator, actively participating in staff training during the National Accreditation Board for Hospitals and Healthcare Providers (NABH) audit. Additionally, I briefly served as an Assistant Infection Control Nurse, which allowed me to attend a professional conference, further enhancing my knowledge and expertise.