Exploring Nursing Expertise - Essay Example

Introduction: Application of the clinical reasoning techniques including problematic reasoning, theoretical reasoning and practical reasoning play a significant role in the recovery of patients from the state of illness into a healthy individual. The operational reasoning, research based reasoning including inductive reasoning, and dialectic reasoning in combination with all other efforts contributes in the treatment plan for the patient. Communication networks among the service delivery team provide a framework in structural arrangement facilitate in the process and will help in the creation of enabling environment for the execution of treatment plan. The communication networks have two major objectives as flow of information among all the stakeholders as in its original shape and understanding of the information as in its true spirit with a goal to work for the recovery of the patient. Application of clinical reasoning which is the process for the collection of cues by the nurses, planning and implementation of interventions, evaluation of the outcomes ,and reflection on and learning from the execution of the overall process with a primary task to ensure early recovery and health of the patient(Aiken et al,2003)(1). The following four concepts have been included in the study as: Concept 1: Physiological, clinical and general health conditions of Mr. James Smith, a patient of 52 years in the instant case needs application of five rights as part of his nursing care management strategy in the hospital where he has been admitted for treatment. Concept 2: The model of care used in terms of the nature of Mr. James Smith’s case as a care assignment with the support services will illustrate the demonstration of knowledge and expertise for Smith’s care. Concept 3: Effective clinical reasoning depends upon the ability of the nurses to collect the right cues form the case under consideration, to take the right action as in favor of the patient with a focused approach for the right patient at the right time and for the right reason. Concept 4: The nursing care strategy will assist all type of nurses including experienced as well as novice nurses for improving their performance in the discipline of nursing care as in favor of the patients for their early recovery with clinical satisfaction(Andersen, 1991)(2). During early life, the patient had played rugby league, received many injuries which had led to him having arthritic problems in both knees, , smoking 25 cigarettes per day (30 years); He was diagnosed with COPD 4yrs ago, was prescribed inhaled Salbutamol 200 micrograms (2 puffs) and Atrovent 21micrograms (2 puffs) every 4-6 hrs when required. Two months ago, he had persistent cough .The patient had signs of breathlessness; therefore, he had frequently visited the GP, and was medicated for hypertension and hypercholesterolaemia. He has also been diagnosed as having heart failure in the last two years, he had been prescribed Frusemide 40mg daily, Potassium 4000mg daily and Digoxin 250micrograms daily. Over the last six months he had been experiencing daily chest pain . Weight at the time of admission was 96 Kilograms and had lost 7 kg in the past week. Restricted bowl movement in last three days, redness under his left heel. His O2 sats are 88% and the doctor in the emergency department prescribed 24% O2 via nasal prongs. Oxygen therapy has been maintained to the patient at 24% via nasal prongs. Emotional state of the patient depressed, therefore, mobility is strictly restricted. Documented initial nursing assessment : Lack of mobility, feeling low in spirit, difficulty in breathing ,loss of interest in self care and poor appetite. In the case under review, initial nurse assessing Mr. Smith should be aware of early warning signs through the application of clinical reasoning skills with the Performance Based Development System(Banning, 2008)(3). Clinical conditions of Mr. Smith require immediate attention for the formulation of nursing care management plan for the patient. Early warning signs ,for example breathlessness ,hypertension, hypercholesterolaemia, daily chest pain over the last six months, lack of mobility ,feeling low in spirits , poor appetite, prescription of 24% oxygen via nasal ,shortness of breath coupled with decreased chest wall expansion and lost of 7 kg weight in the past week. All these early warnings indicate that Mr. Smith might have the chance for serious illness during his stay in the hospital. Clinical Reasoning (CR) coupled with the application of five rights has the potential initial nurse assessing for Mr. Smith in the case under review. Clinical reasoning is the process through which nurses make clinical judgments by selecting from available alternatives, weighing evidences and using skills like intuition through pattern recognition. Thinking strategies serve as vehicle for the adoption of a comprehensive nursing care plan for the description of the patient situation. Cues about the patient will serve as starting point for the whole process followed by reviewing the information, relationship of information, recalling knowledge, interpretation of the information, making inference, identification of the problem and selection of goals as part of the nursing plan. These thinking strategies are applied by all the nurses including the experts as well as novice nurses but with different approaches and non-observance of these instructions will have adverse effects on the health of the patients(Clarke, and Aiken, 2003)(4). The early warning signs as in the case of Mr. Smith, if missed, could lead to the dangerous pathway as all of these are vital cues for the formulation of effective nursing plan for the patient. The following nursing actions and communications are proposed to the health care team throughout Mr. Smith’s stay in the hospital: a) Description of the facts about the clinical ,physiological and physical conditions of the patient and their monitoring at regular intervals for implementation of clinical instructions as advised by the physicians and the medical faculty in the hospital for the patient; b) Collection of the cues relating the patient with all necessary details, review and analysis of the available information for designing a suitable nurse care strategy for the subsequent period in the hospital; c) Application of “five rights” by the expert as well as novice nurses as part of the clinical reasoning. These five rights include the collection of right cues which are identifiable physiological or psychological changes experienced by the patient, right patient as in the case under review is Mr. Smith who is at risk of critical illness and any serious event could has adverse impacts on his health and life, right action as in the shape of behavior following on from a judgment or decision, the right reason to avoid multiple implications with ethical support and the right patient as in the form of Mr. Smith. d) The synthesis of facts to make definite diagnosis of Mr. Smith’s problem with the consideration of clinical and early warning signs like pulmonary congestion, acute heart failure, O2 sats at the level of 88% and the administration of Oxygen therapy at 24% via nasal prongs, description of the requirements that the patient will be monitored through vital signs after each six hours for stabilization of the patient. Initial record of the patient will help in the formulation of nursing plan with the participation of the experienced nurses as in the leading role and the novice nurses as to support the nursing plan as in its true spirit. e) The overall nursing plan will focus on the strategy as objective based strategy with a focused approach with a specific cause of action which includes vigilance and dedication for the implementation of nursing plan for arresting and rehabilitation of health of Mr. Smith though medication, clinical procedures and care from the concerned staff in the hospital. f) The proposed course of action will facilitate in the recovery of the patient, periodic review by the experts through the participation of all the stakeholders will help in the achievement of the desired results. The results in the shape of positive vital signs will serve as encouraging signals for the medical team for continuation and subsequently termination of the medical aid with satisfactory result in the shape of recovery of the patient. Any sign of abnormality will be reported by the nursing staff in the shape of notes to the medical team with the remarks that the situation has not improved (Ebright et al. 2003) (5). The same note will serve as s signal for making necessary changes in the treatment plan along with a modified nursing plan for the patient. Application of the process will serve as a model nursing plan for its replication in the health care establishments for the recovery of the patients in satisfactory manner(Hardy et al,2002)( 6). Conclusion: Clinical Reasoning which relies on five rights is a process by which nurses make clinical judgments by selecting from the available alternatives, weighing the evidences, using their own intuition and through pattern recognition. Application of five rights in case of Mr. Smith will help in the clinical reasoning to the nurses of both types including experts as well as Novice nurses for the implementation of the nursing plan as part of the model care for its application. These five rights include the right cues, right patient, and right time for making necessary arrangements, right action in the shape of judgments or decisions for initiation, execution and termination of the nursing plan for the patient. Application of all these elements including right cues will yield positive results in the shape of improved vital signals as in favor of the patient within shortest possible time. Implementation of the plan will deliver improved results during first three days of the treatment including satisfactory signs in the shape improvement in breathing, increased mobility, high in spirits and improved chest wall expansion with signs of clinical satisfaction. References: 1. Aiken, L., Clarke, S., Cheung, R., Sloane, D., Silber, J., 2003. Educational levels of hospital nurses and surgical patient mortality. JAMA 290 (12), 1617–1620. 2. Andersen, B., 1991. Mapping the terrain of the discipline. In: Gray, G., Pratt, R. (Eds.), Towards a Discipline of Nursing. Churchill Livingstone, Melbourne, pp. 95–124. 3. Banning, M., 2008. Clinical reasoning and its application to nursing: concepts and research studies. Nurse Education in Practice 8, 177–183. 4. Clarke, S., Aiken, L., 2003. Failure to rescue. American Journal of Nursing 103 (1), 42–47. 5. Ebright, P., Urden, L., Patterson, E., Chalko, B., 2003. Understanding the complexity of registered nurse work in acute care settings. Journal of Nursing Administration 33, 630–638. 6. Hardy, S., Garbett, R., Titchen, A., Manley, K., 2002. Exploring nursing expertise: nurses talk nursing. Nursing Inquiry 9 (3), 196–202. Read More