Nursing Practice and Decision-Making - Essay Example

Nursing Practice and Decision Making Nursing Practice and Decision Making Background Mr. Singh, a 56-year-old man has had a long history of an acute infection. The chest pain that he has had for some time most probably attributes to several unknown factors that must undergo medical tests to ascertain. Having had the pain for a long time, chances are high that the patient could ignore the pains thereby enhancing the possible ailment into severe stages that may pose serious constraints in management. The aim of the decision making process is to discharge the patient from the hospital with a package of care that will enable him to be re-admitted to hospital again. First, there should be an established medical history and inventory of the patient. The inventory shall have specific concern on the condition he experiences. This shall involve critical analysis of previous diagnosis, treatment procedure, medication recommendations and follow-up checkups. Second, the nurses and the doctor-in-charge shall seek to identify and establish some of the individual decisions that the patient has been relying on in efforts to mitigate his medical constraint. It is important to establish a social scope of the patient. For instance, if the patient has been experiencing stressful life other than just the chest pain, the nurses should try to establish the strategies he uses to manage the stress. This is because the way he manages his stresses could as well act as enhanced risk factors towards severity of his ailment. This analysis shall call upon the patient to provide a detailed a detailed account of social background, including family and or relationship life (Jellema et al. 2014, p. 263). According to Sund-Levander and Tingstrom (2013, p. 28), problem solving strategies applied by nurses influence the outcome of good care. In the case, the nurse should also allow the patient to give an account of his future and or expected management plan for the ailment. This assists in understanding the patient’s views regarding his ailment whether hopeless, optimistic, overwhelmed or anxious. The patient’s overall feelings are important in the nursing as it could assist to eliminate any form of objection and or opposition to medication in the later stage (Heardman 2014, p. 33). According to Levy and Heyes (2012, p. 21), all the subsequent decision made concerning the management of the patient’s conditions at a later stage shall specifically borrow from the description of the medical history of the patient including all relevant decisions that the patient has had to make about his medical condition. The medics shall use very little information in planning and decision making outside that provided by the patient himself (Pirich & Rettenbacher 2006, p. 20). Integrity during nursing care is also important as promoted by Burman, Zakariassen and Hunskaar (2014, p. 265). In the case, integrity should form a vital part of the decision-making process. The concerned nurses should be competent and possess the necessary skills required of them to manage specific forms of medical conditions. Competency in carrying out the necessary tests should be a prerequisite for management of the patient’s medical needs. This shall call upon high degree of professional qualifications, sobriety and accommodativeness. Keenness to both physical and psychological details is necessary professional and technical input among the nurses and other medical practitioners. Mr. Singh’s condition requires intensive care and attention from the nurses; therefore, intensive testing procedures are highly recommended to the patient and with highest possible degree of care, lest the results become flawed thereby making the whole intervention process a failure. In addition, the nurses must ensure great care not to touch on pertinent social issue of the patient unless he so wishes to discuss them thereafter. In fact, after successfully retrieving relevant information regarding his social background and likely connection with the medical condition of the patient, the nurse should let it stop there. The patient is set to obtain high-level professional services by the hospital staffs especially from the nurses-in-attendance. Getting to the root and or likely causes/genesis of the medical condition would be vital to the overall management. Theoretical Concepts for the Interventions Planning and delivery of interventions require effective and realistic theoretical framework in order to attain success in the process of meeting the patient’s needs. Several theoretical frameworks come to play. The first perspective relates to The Anderson Behavior Framework. The framework suggests that health services’ coordination relate to three main concepts: the participants’ characteristics for coordination of care, resources necessary for enhancement of the care, and the participant’s needs for the coordination (Aston, Wakefield & Mcgown, 2010, p. 2). Second, there is the Donabedian’s Quality Framework that assesses the quality of care that exhibits absolute flexibility and ability to apply to many health care situations (Juvé-Udina, et al. 2014, p. 67). Third, there is The Organizational Design Framework that offers a wide range of relevant concepts for thinking about and coordination of patients care. It also assists in the simplification of the complexities associated with the effects of the actions by a number of participants on a wide range of coordination parameters. The framework uses the Wagners Chronic Care Model as one of the best approaches to seal the concreteness of its concepts in coordination of patients care (Aston, Wakefield & Mcgown, 2010, p. 2). The fourth framework is The Relational Coordination Framework that seeks to bring a clear understanding of the dynamics, rationale and significance of teamwork or collaboration in health care management. Its main aim is to focus specific attention on the relationship that exists between the health care participants and their patients, and their daily work endeavor (Bench, Day & Griffiths, 2013, p. 49). The general approach to application of the discussed theoretical frameworks involve: comprehensive assessment of the needs for coordination by reviewing of baseline features and or characteristics for any given setup; identifying options for bringing about improvement on the coordination; selecting and implementing best case scenario alternative; and monitoring and evaluation to establish the alternative’s effects on coordination and care. The nursing process would involve six key steps undertaken in a chronological order. It starts with the assessment of the patient’s data collected after the initial tests and investigations then actual diagnosis of the ailment based on the analyzed medical data. Diagnoses are a representation of the nurses clinical judgment concerning the exact or likely medical condition of the patient seeking medical assistance. To ascertain the accuracy of the diagnosis, the nurse should attain consistency between defining characteristics identified and the predisposing risk factors present within the patient. There are possibilities for multiple diagnoses depending on the ailment levels of the patient (Juvé-Udina, et al. 2014, p. 67). An analysis of the identified ailment then follows the two preliminary steps before proceeding on to the step of planning on how to manage it. At the planning level, there shall be decision made by and among the relevant personnel – nurses, doctors-in-charge, and the hospital administration. However, this process should also take into account the views of the patient (Dabney & Huey-Ming, 2013, p. 360). In a situation where the nurses shall diagnose number of ailments in a patient such as Mr. Singh’s, he/she should prioritize which diagnose to manage first and last in that order. Prioritization depends on the severity and potential for enhanced chances for harm. After laying down adequate plans and strategies regarding the patient’s medical intervention, the nurses shall have to implement the plans. Implementation shall involve the actual intervention applied to the patient with a view to combating the diagnosed ailment. Then there must be evaluation of the intervention to ascertain strict adherence to the set recommendation to the latter (Aston, Wakefield & Mcgown, 2010, p. 2). Patient’s Complex Needs The patient under study has a wide range of medical condition. He is one of those may patients requiring intensive care from the nurses. He has been diagnosed with a number of medical conditions that may not fair on well without critical adherence to medical procedures as prescribed by the nurses after the analyses, diagnosis and planning. Detection of a patient’s risk signals is imperative in nursing care (Despins, Scott-Cawiezell & Rouder, 2010, p. 466). This situation couples with a number of social constraints that he goes through such as depression and stress. Critically, the nurses need to adhere to strict health ethics and morals as per the legal framework provided by the hospital administration and the national government (Grosen et al. 2014, p. 7; Holt& Convey, 2012, p.52). First, he has been going through a stressful life after he lost his job two years down the line. His stressful life also attribute to his divorce and family separation between him and his kids and wife. Stress is a predisposing factor for a number of chronic ailments including heat attack, high blood pressure and obesity. This condition may not require much-complicated scientific pieces of evidence to ascertain its existence and initiate intervention. Rather, the nurses must act fast to mitigate his condition to prevent further effects (Chrash, Mulich & Patton, 2011, p. 533). Preliminary results may indicate that Mr. Singh might have acquired the medical condition from his social livelihood means and pattern. Situation awareness is vital in enhancing decision-making and patient outcome (Stubbings, Chaboyer & McMurray 2012, p. 1444). Second, Mr. Singh’s medical history predisposes him to the risks of exhibiting complex medical conditions that are very sophisticated. Documentation of clinical care forms an imperative aspect of safe clinical care (Tower et al. 2012, p. 2918). It is imperative to document Mr. Sign’s three major medical conditions – hypertension, hyperlipidemia and type 2 diabetes, all of which are associated with an individual’s life style and social wellbeing. These are conditions that may become worse if poorly managed and spillover into an individual’s future life. Death is inevitable for such individuals in the case of failure to adhere to effective care, treatment and management to from the diagnostic stage. Third, besides Mr. Singh’s medical history and social life that both predispose him to related medical constraints, his diagnosis neither become similar to any of the his medical history nor his perceived social life. For Mr. Singh, this merely complicates medical issues. As it stands, he stands vulnerable to a number of ailments. The medical conditions that feature in his medical history have the tendency to recur over time. For instance, diabetes of whatever type does recur and its actual management does require intensive medical care. Besides, Mr. Sing’s smoking habit also enhances his vulnerability and risks to more complicated medical conditions. According to Goethals, Dierckx de Casterlé and Gastmans (2012, p. 1205), the nurses and doctors on duty must haste to make informed decision on what to do to save the situation of the patient. Effectively made decision at this level would serve to reduce, at least by some percentage, the likelihood for the patient’s health deterioration (Stochkendahl, et al. 2008, p. 8). It would be crucial in the mitigation of subsequent health constraints attributed to the present conditions. In addition, effective decision-making employed by the nurses shall establish a basis for effective treatment and car management. If poorly or unprofessionally made, the decision may merely haunt the nurses and make it cumbersome to manage the medical attention of the patient. Cerit and Dinç (2012 p. p. 52), support the application of ethics and morals as prescribed by the medical profession codes of conduct exhibited by the nurses and doctors. Decision shall precede a range of options that the medical practitioners can pursue in managing the patient’s condition (Centre for Clinical Practice, 2010, p. 7). They shall have to develop a clear understanding of each of the alternatives, critically analyzing the pros and cons for the same to, finally, come up with most desirable options to pursue. Poorly made decision would merely worsen the patient’s medical condition. It would also undermine the reputation of the nurses and the medics within the hospital since many shall remain questioning their professional and technical competence in the broad field of nursing and medicine (Kilpatrick 2013, p. 170). Based on the stressful condition, the nurses should make a medical recommendation for the patient to obtain psychiatric management by qualified professional. The aim of the intervention remain unchanged – treatment of diagnosed medical conditions while mitigating the likelihood for subsequent related ailments. Interventions are important when making decisions on intravenous drugs administration (Dougherty, Sque & Crouch, 2012, p. 1302). Relevant Local Community Services Promotion of community-based health care services is a crucial perspective in the management of community health. It is especially imperative if well implemented, by the relevant stakeholders. Engaging family members in decision-making is particularly important (Watts, 2011, p. 2363). Deployment of Community Health Workers (CHWs) within the community helps in creation of awareness and prospective patients’ education and awareness. The government can undertake preventive measures for several ailments by accessing community members faced with health constraints vulnerabilities. Such health constraints include poor dieting and exercise, social pressures and environmentally initiated pressures. Within the community, there exist structures put in place to cater for the needs of the community. There exist community care legislations measures that aim to streamline community-based health care services at grass roots. Nutritional education is important in the health sector. Several medical constraints emanate from poor or inadequately administered nutritional plan. For example, overreliance on fast foods put people at risks of obesity, overweight and heart attack. Poor nutrition and imbalanced food structure also result to nutritional-related constraints. As such, it is advisable to both the government and the policy makes to design policies and legal frameworks that support effective community learning and care concerning nutritional education. (Lubbe & Roets 2014, p. 58). Community interventions should also incorporate peer education and one-on-one learning from one another. Certain predisposing factors of major ailments such as stress and depression attribute to social styles of living (Keighley, 2012, p. 181). People staying within the community such as Mr. Singh experience a wide range of social constraint. When he says that he has had a stressful life for quite some time until he got into smoking cigarette, it is possible to assert that he has a series of social life constraints. Most probably, if he had had a peer counselor or mentor within the community whom he could approach without strain, he could not have had to get involved in the unhealthy behaviors as such. Mr. Singh, like others, requires intensive psychological and mental assistance and mentorship to assist him accept and embrace the importance of life despite the negativities. It is imperative to establish system of community – health worker network to bring closer to the community, a rich set of information regarding health management, including the dos and don’ts. Dignity in the provision of health care is vital for desirable patient outcome (Gastmans, 2013, p. 148). Most communities in the developed nations possess vast amount of resources – human capital, physical resources, and social capital. However, the mere absence of emotional assistance from one another and locally established health care management interventions put the community at vulnerable conditions for any related disease invasion such as chronic heart attack and depression (Cummins et al. 2013, p. 3). Therefore, carefully set strategies by the government in collaboration with the public health management sector would assist in developing the best options for community training, capacity building ad awareness creation concerning acute medical conditions, their possible prevention, management treatment. The conditions include heart attack, depression, stress, acute cardiovascular pains and respiratory constraints (Burman, Zakariassen & Hunskaar 2014, p. 7) Role of Nurses in Systematic Assessment Nurses play a crucial role in systematic assessment of medical conditions presented in the hospitals for management. Their role starts to feature from the very moment the patient seeking medical attention arrives at the hospital. First, the nurse plays an active role in assessment of the patient as they get into the hospital. This endeavor aims at identifying the preliminary diagnosis before further complex medical tests and procedures come in. these may include such aspects as body temperatures, any inconsistent but abnormal physical features. Second, a nurse has a central role in the planning and decision making regarding medical interventions to offer to the patient (Keighley, 2012, p. 181). However, planning stage should incorporate even the opinion and perception of the patient him/herself. Planning entails outlining of the medical and other relevant interventions to be undertaken to mitigate the patient’s conditions. Usually, diagnosis of the actual ailment or medical condition precedes the planning process. From the diagnosis stage, it is expected that the actual constraint shall have been identified, a range of alternative interventions developed, and the best applicable intervention picked for application in managing the constraint (Cerit & Dinc, 2013, p. 3). Access to patient identifiable information should be on a strictly need to know basis. All people with access to patient identifiable information should be aware of their responsibilities. According to Kilpatrick (2013, p. 168), decision-making is a complex process in nursing care. The nurse is the central nerve of care provision to the patients. They are the key care providers to the patients and must possess crucial skills and expertise in managing the patients. The fourth aspect during the evaluation involves engaging the nurse in monitoring and evaluation of the health care provided (Walker & Lachman, 2013, p. 63) It is recommended that he/she takes part in the assessment of what he/she participated in doing, as he/she understands where, what, and how the care was provided. Research findings promote participation as encouraged in shared decision-making in nursing care (Jane OSullivan & Rae 2014, p. 18). Bibliography Aston, L., Wakefield, J., & Mcgown, R 2010, The student nurse guide to decision making in practice. Maidenhead, Open University Press. Bench, S, Day, T, & Griffiths, P 2013, Effectiveness of Critical Care Discharge Information in Supporting Early Recovery From Critical Illness, Critical Care Nurse, 33, 3, pp. 41-52. Burman, R, Zakariassen, E, & Hunskaar, S 2014, Management of chest pain: a prospective study from Norwegian out-of-hours primary care, BMC Family Practice, 15, 1, pp. 1-13. Centre for Clinical Practice. (2010). 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