USA Medical Center - Essay Example

Introduction The experiences described in this paper are those that occurred at the Medical-Surgical Step-down Floor (sometimes referred to as the med-surg floor or the 6th floor), University of Alabama Medical Center (USA Medical Center or USAMC). This floor is divided into 35 patient rooms. Most of the patients seen in this floor are trauma step-down patients from the Emergency Room (ER), the Operating Room (OR), and the Intensive Care Unit (ICU). USA Medical Center is the only hospital in Mobile, Alabama with a trauma center. It caters to trauma patients from as far as Biloxi, Mississippi. It is considered as the primary regional referral center for the panhandle of Florida, southern Mississippi, and south Alabama. The Medical-Surgical Step-down Floor has a 5:6 nurse/patient ratio per shift. Aside from the nurses administering care 24 hours a day, seven days a week, the 6th floor carries a staff of doctors who are on-call 24 hours a day. Objective 1 While in the 6th floor, the student nurse cared for a trauma patient who had a serious radial vascular injury from hitting a glass window. He came in from the OR after undergoing: Repair of vascular injury and verve repairment at right upper extremity. The student nurse noticed at one point that the patient had soaked his bulky dressing. The student nurse called the attention of her preceptor who also checked on the patient. The patient was then brought back to the OR for a repeat of the procedure to repair his vascular injury. After several hours, he was brought back to the 6th floor and back in the care of the student nurse. While caring for the patient, the student nurse noticed that the patient registered a fever of 101 degrees Fahrenheit. After checking the patient’s chart for medication orders, the student nurse gave him two Tylenol tablets (350 mg x 2). His temperature dropped to 98.6 degrees Fahrenheit. However his temperature spiked to 102.1 degrees Fahrenheit several hours later. The student nurse informed her preceptor who then paged the doctor for advice and was subsequently ordered to administer Motrin 400 mg PRN (as necessary). The student nurse was also able to help care for a very uncooperative patient. He was brought in by his sister who found him abandoned in an alley with a stab wound on his right lower leg. He had a history of drug abuse. He could not exactly remember how he got his injury and was suspicious of every one in the hospital. He thought, we all meant to do him further harm. The student nurse was ordered to do an in-and-out catheter for a urine screen on the patient. The patient did not want to cooperate. He was twitching and jerking his leg, and he screamed every time the student nurse came near him. The student nurse informed her preceptor of the situation. The preceptor then requested the doctor for a restraint order to do the in-and-out catheter. The doctor cleared the order. After putting restraints on the patient, the student nurse asked the preceptor’s assistance in conducting the procedure. Objective 2 Responsibility is a characteristic which is expected of all healthcare professionals. Each member of the healthcare team has his own responsibility to fulfill. The nurse is inherently bound to be responsible and accountable for patients in her care. Responsibility and accountability have different manifestations in the healthcare profession for the different healthcare workers. Accountability is assuming responsibility for one’s own actions. It is a legal obligation and in health care it is also an ethical and moral responsibility (Moore, 2008). On the other hand, responsibility pertains more to the characteristics of reliability and dependability (Potter, 2005). The responsibilities of a nurse revolve around performing basic tasks like assessing the patient at the start of every shift, carrying out doctor’s orders, administering medications, monitoring vital signs, and giving pertinent health teachings to patients and their family members. These responsibilities differ based on the area of assignment of the nurse and the scope of the nurse’s training and practice in said area. The accountability of the nurse is based on the performance of her responsibilities. Failing to perform her basic tasks-her responsibilities-in patient care could possibly make her legally accountable for her actions. For example, failing to carry out a medication order would hold her legally accountable for her inaction. The nurse in the step-down unit has various tasks and responsibilities. She is an educator, a communicator, caregiver, patient advocate, and manager (Potter, 2005). In performing the role of a caregiver, the student nurse is responsible for bedside care. She takes care of the patient’s hygiene, which includes oral care, hair care, bed baths, nail care, changing the patient’s clothes, linens, and dressing. She assesses the patient’s condition at the beginning of each shift and continues to do so regularly during the shift. As caregiver, she is responsible for administering medication to the patient. In the case of the patients in the 6th floor, the student nurse is responsible for administering regular pain medication to her patients. All these tasks were managed well under the student nurse’s shift. As a manager, she performed necessary bedside care and regular assessment while administering due medications in order to make efficient use of her time and energy. This reduced the necessity of having to return to a patient every now and then to perform individual tasks. This saved her time and energy for other patients and other responsibilities. In being a patient advocate, the student nurse in the Medical-Surgical step-down unit ensures that the patient’s legal rights are observed. These legal rights include the right to accept and refuse care, to refuse to sign consent forms, to privacy, to obtain a copy of their medical records, to not be discriminated on the basis of their race, color, national origin, gender, sexual orientation or disability. They have the right to be treated with respect and dignity. As a patient advocate, the student nurse made sure that the patients understood the procedures and the medical care that they would be agreeing to once the consent forms were signed. She guided the patients and their families during admission to ensure that they understood what they were agreeing to. In her shift in the 6th floor, the student nurse was given a ‘continue home medication’ order by the doctor on a patient who was about to be discharged. This order was against hospital policy and more importantly was potentially harmful to the patient. The order was not specific. The patient may not be able to discriminate which of his home medications to continue. He may be continuing home medications which are harmful to his condition. This order also transfers the burden to nurses of having to clarify this order with the doctor and the patient (Medication Safety Alert, 2001). As a nurse-educator, the student nurse in the 6th floor has the responsibility of helping the patients and their families understand their injuries, diseases, and the care and medical intervention necessary to ensure their speedy recovery. As an educator, the nurse may have to explain to the patients and their families the disease process using terms they can easily understand and relate to. This will help the patient understand the restrictions on his diet and activities, why he is taking the medicines he is taking, and why he needs to exercise. It helps engage the participation of the family in the patient’s care. As the student nurse is fulfilling this role, she is also fulfilling her role as a communicator. Good communication skills are needed in order to put across the message to patients on the importance of understanding the essentials of patient care. The student nurse applied these roles well in the discharge of the patients. She explained to her patients what they should not do while recovering from their injuries, the importance of taking their medications, and the signs to look for in their injuries that should prompt them to return to the hospital for consult. Objective 3 Theory traditionally represents a kind of knowledge that is the generalized distillation of observations for the purpose of explaining other observations (Weiler, 2005). Theoretical knowledge is based on premises that explain the existing facts about a particular phenomenon or subject matter. These theories evolve through repeated confirmatory information gathered on the subject matter. Traditionally, nursing has been a discipline that has based most of its teaching and learning principles on observed knowledge-knowledge based on experience, not so much on scientific principles (Venes, 2005). In recent years, it has adapted a more evidence-based practice. It has also attempted to apply a more scientific theoretical foundation and mathematics is becoming an integral component of nursing (Kalofissudis, 2002). It has also made strides in incorporating research with bedside clinical practice (Kim, 2000). In the clinical exposure, the student learns to apply the theories and the empirical knowledge she needs to care for the patient. In the 6th floor, the student nurse learns to regularly monitor fluid levels on a patient with a wound vacuum system (otherwise known as wound vac or wound vacuum). The student nurse monitored the fluid levels of a patient who had a motor vehicle accident (MVA). He was undergoing rehabilitation when an infection on his lower lumbar was detected. He was admitted into the 6th floor for monitoring and he came in with a wound vacuum. The student nurse detected that the fluid levels in the wound vacuum was reaching critical levels, the container draining the wound needed to be changed. The student nurse also noted other possible signs of infection in the wound area. The student nurse reported the situation to her preceptor who then requested the doctor for an order to change the wound vacuum. After obtaining the necessary doctor’s orders, the Wound Care Service at the 4th floor was called in to change the wound vacuum. The student nurse then continued to monitor the wound vacuum level of the patient. She applied the aseptic technique in assisting the Wound Care Team in cleaning the patient’s wound. The example given in Objective 7, in managing the illness of the elderly cancer patient with sacral decubitus ulcer, the student nurse understood all too well the importance of movement in preventing decubitus ulcers. Decubitus ulcers are common with elderly patients who are ill; also it is common in areas with a bony prominence and with ill patients who stay in one position for long periods of time. Infection in these areas is usually due to neglect and lack of regular hygienic care. In the care of the student nurse, the patient was log-rolled every 2-3 hours to prevent other ulcerations. The patient was kept clean and dry. The pressure sore was cleaned regularly. Further signs of infection were monitored. Elderly patients who do not have the proper attention in assisting their mobility and regular hygienic care usually suffer from sacral decubitus ulcers. Explaining to the patient and his family that simple changing of positions and regularly changing clothes can help prevent infection and decubitus ulcers will assist in gaining cooperation in patient care (Revis, 2008). Objective 4 Historical The University of South Alabama Medical Center (USAMC) was originally built in 1830 as a city hospital on St. Anthony Street. It was originally named City Hospital of Mobile. In order to help administer to the sick, the founding fathers of the institution decided to hire a matron. This act was one of the pioneer moves to establish organized women nursing in collaboration with the doctors employed by the hospital. A medical college was later established near the hospital. Most of its medical and nursing staff joined the Civil War. This prompted the founders to employ the Sisters of Charity to manage the hospital. The good sisters later started a school of nursing in the hospital. The hospital was later moved to its present location. Throughout the years, the hospital survived bankruptcy; the Sisters of Charity faced unjustified charges of misappropriation later revoked; name changes; and many other major and minor alterations. This hospital grew into the present 406-bed acute care facility that now serves as the primary teaching hospital for the University of South Alabama College of Medicine. It serves as the major referral center for southern Alabama, southern Mississippi, and portions of northwest Florida. It offers centers for Level I trauma, burns, cardiovascular disease, strokes, and sickle cell disease (The Hospital Story) Political Inherent in the medical and nursing profession are the policy and decision-making skills. Politics is not just confined to the government; it is a necessary part of the healthcare industry. Within this industry, there is a chain of command that is usually followed in order to establish policy changes. The nurse is an integral part of the policy-making process. She can put forth suggestions and problems based on her own experiences to the administration. These hospitals and healthcare professionals also live by the laws and policies set by the state, the federal government, and their own respective professions. The Nursing Practice Acts establishes the standards of nursing practice in the different states. The Patient Rights to Self-Determination are also in place to protect patient welfare. These policies are in place in order to ensure that the nurse performs her duties as a caregiver and a healthcare professional. Social & Cultural Mobile, Alabama ranks as the third most populous city in South Alabama. Most of its residents are Caucasians and African Americans. There is a small population of Hispanics and Asians in the area. USAMC caters to the general public regardless of their race, social, religious, and economic status. The hospital employs professionals and staff of various races and academic backgrounds. As long as applicants have the needed expertise and qualifications to contribute to the hospital, they are welcomed into the healthcare and support staff. The hospital represents a melting pot of races and expertise all contributing to exemplary patient care. There is a healthy coordination between and among the different healthcare professionals in the care of the ailing patient. Technological The hospital is outfitted with the latest in medical innovations for efficient patient care. The different services offered by the hospital in the following areas as a Level I Trauma Center, Burn and Wound Center, Cardiovascular Disease Center, Comprehensive Sickle Cell Center, Regional Stroke Center, Radiation Oncology Center, and Radiology Center, contain the necessary technological advancements, equipment, and professional care in order to competently serve patients in these areas. USAMC is equipped with the latest in laboratory testing and diagnostics. Pyxis machines are available in every unit in order to efficiently deliver the medications to the patients. These machines help prevent errors in the administration of medications and help reduce hospital workload. The hospital departments and units are able to communicate well with each other through the intranet. The intranet helps healthcare givers access patient information necessary for administration of care. Ethical and Legal Nurses have ethical and legal responsibilities to their profession and to their patient. The nurse must be highly conscious of her actions in the care of her patients. She must fulfill her nursing responsibilities as set by the Nursing Practice Act as applied to her state and respect patients’ rights. She must respect the patient’s right to refuse treatment, to refuse consent for medical intervention or procedure, to provide privacy during certain procedures to be undertaken on their person, and to be accountable for the legal consequences of their actions or inaction. The American Nurses Association is the most-respected organization and gathering of nurses in the pursuit of ways to improve the profession and improve patient care. Economic The USAMC is a public hospital. Since its inception, its core objective was never one for profit. As a result, the nursing care given to the patient revolved around what the patient needs the most to improve his welfare without thought for hospital cost or profit. The patient’s financial worries are reduced and he can concentrate on just getting better instead of thinking about how he will settle his hospital bills. It is a common site to see homeless patients being cared for in the hospital. The student nurse at one point cared for a homeless patient. She was able to concentrate on providing efficient care to the patient without the hospital administrators and financial managers advising her on how to reduce hospital cost. Environmental Florence Nightingale stressed too many times the role of the environment in patient care. Many theorists have referred to the environment as inclusive of physical space, the social environment, the psychological environment or the spiritual environment (Shaner, 2006). A simple change of environment can make a big difference to the patient’s well-being. It can reduce monotony in the routine of his daily hospital care. Keeping the hospital premises and facilities clean can also reduce the spread of infection and microorganisms. Objective 5 The student nurse is aware of her role in health care promotion, maintenance, illness care, and rehabilitation. In the care of the patient, the nurse should also give health teachings to the patient in health care promotion and maintenance. During the student nurse’s shift she cared for a patient with gastrointestinal (GI) bleeding. The patient had a history of drug abuse and was at times belligerent. The student nurse spoke calmly with the patient about his condition-the causes of the GI bleeding, the aggravating and possible contributory factors that may worsen the bleeding, and what the patient can do and change in his lifestyle to help gastrointestinal healing. With a greater understanding of his condition, the patient was able to appreciate the importance of stopping if not reducing his alcohol intake. During the discharge of this patient, the student nurse reiterated the importance of reduced alcohol intake alongside a healthy diet and exercise. Illness care is a large part of the nursing role in the care of the patient. Nursing care is administered based on the needs, the injuries, and the illnesses that the patient manifests. In the course of the student nurse’s practicum in the step-down unit of the USAMC, she prepared and administered IV and oral medications, she cared for patients with Jackson-Pratt (JP) drainages, she checked wounds for possible infection or bleeding and administered general bedside care. The student nurse cared for a patient with a fractured femoral neck. She was an elderly patient who came from the Operating Room after undergoing partial hip surgery. The student nurse administered bedside care to the patient, changed hospital gown and linens when they became soiled, and gave bed baths and oral care to the patient. This helped reduce the discomfort of the patient. Rehabilitation is a necessary part of patient care. This helps return the normal functions of the body system. Rehabilitation is based on the injuries and illness that the patient is recovering from. Some rehabilitation activities may not be suited for some patients. Exercises to recover muscle tone and strength may not be applicable to all patients. The student nurse cared for an MVA patient who came in from the Trauma Center after a knee-replacement surgery. The student nurse helped the patient regain mobility by referring to the doctor’s notes on possible activities that may be tolerated by the patient. The student nurse then helped the patient stand at the bedside while partially bearing the patient’s weight on the operated leg (left). She also helped the patient through hip-strengthening exercises and assisted range on motion activities. Objective 6 The step-down unit of hospitals is one of the welcome additions in healthcare. This unit has helped to decongest the population of patients in the Intensive Care Units, the ERs, and the ORs, while still giving the care that these patients need in order to recover or in between surgical interventions. An article in the Archives of Surgery has discussed lengthily the importance of Step-down units in hospitals. “Opening an SDU resulted in a significant increase in the overall severity of the SICU population. [The] creation of an SDU managed by surgically trained intensivists may optimize the use of a hospitals resources, permit the expansion of emergency or tertiary care services, and improve outcomes for critically ill surgical patients (Eachempati, 2004). This study also established the care needed for patients in this unit. The care of patients is a little less intensive as that needed if they were in the OR, ER, or ICU, hence the necessary vigilance on the part of the healthcare givers in the administration of their duties and responsibilities. Objective 7 Nursing leadership, management and teaching are important and necessary roles for efficient patient care. The student nurse at this point is being guided by the nurse preceptor. The student nurse assists her preceptor in the discharge of different nursing responsibilities in the unit. These activities include checking wound vacuum levels, monitoring pain threshold levels of patients, monitoring JP drainages, and receiving and making shift and progress reports from and to incoming charge nurses. These activities are in preparation for the larger leadership role that the student nurse would play in the future. Managing care for patients who require various nursing interventions are necessary challenges that nurses face. It is a test of management skills to properly fulfill nursing duties to patients who require special care. At one point during her shift, the student nurse had to care for patients who were just being admitted into the 6th floor and who needed special documents for procedures that they would later undergo. One patient had to undergo radiology treatment at the Cancer Center, and the other would later be admitted into the OR to have a pigtail put in. Special forms had to be prepared before they could undergo the procedures. During the shift, pain medications also had to be administered to these patients. The student nurse managed to finish the forms needed while administering due pain medications and monitoring pain threshold. Many patients do not understand their illnesses or injuries and the disease process. As a result, they sometimes do not take to heart cautions or warnings that the nurses or doctors give about their conditions. The student nurse cared for an elderly patient with colon cancer. The patient was experiencing abdominal pain and had a decubitus ulcer on his sacrum. The student nurse explained to the patient and the family the importance of keeping the patient clean and dry and to move his position on the bed every 2-3 hours. The student nurse explained the disease process to the patient and his family, how to prevent further ulcerations, the diet of the patient, and how to prevent further infection of the decubitus ulcer. In understanding these concepts, the patient and his family were able to understand and appreciate discharge instructions from the nurse and the doctor (Weiss, 2007). Objective 8 The student nurse collaborates with other healthcare providers for the efficient care of the patients. A team of doctors, other nurses, medical students, pharmacists, dietitians, respiratory therapists, medical technologists, and other healthcare givers are a necessary part of the hospital healthcare team. The student nurse provided care for a 63-year old male who underwent total knee replacement three weeks prior to admission. The patient was being readmitted for infection. He had a wound vacuum. In the course of monitoring the wound vacuum level, the student nurse was able to judge that the wound vacuum container was reaching critical levels. The student nurse informed her preceptor, who then informed the patient’s doctor and requested for a wound vacuum change. After getting necessary orders, the Wound Care Team at the 4th floor was notified. They came in to clean the wound and change the wound vacuum. The student nurse also worked with the patient’s physical therapist during the rehabilitation exercises. She consulted with the therapist on advisable activities and exercises that may she can do with the patient. Objective 9 Observing proper ethics and morals are a necessary part of the nursing practice. It may make or break a nurse and the nursing profession as a whole. The basic tenets of any profession hinge upon the morals and ethics that are practiced or not practiced by its members. One of the basic practices of good ethics is following proper channels in the chain of command. As a student nurse, it is very important to have to report and check with the preceptor possible interventions needed for the patient. The student nurse must not ignore the authority of the preceptor over her. The student nurse consulted with her preceptor every now and then and properly cleared procedures before undertaking them. She reported to her preceptor first before consulting with the doctor or she let her preceptor be the one to consult with the doctors. Following this process did not prevent her from making independent decisions. She judged patient situations accurately on her own, only that, she did not act on her observations without checking with her preceptor. A legal dilemma that she encountered was when faced with a ‘continue home medications’ order, she refused to take and carry out such order from the doctor. This was against hospital policy and was not in the best interests of the patient. She clarified the order with the doctor who specified which medications would be continued by the patient. Objective 10 The policies and procedures of the Medical/Surgical step-down unit can be seen at the nurse’s station. It can also be accessed through the hospital intranet. It specifies procedures in patient care, hospital administration, and healthcare team roles/functions/responsibilities. It clarifies the necessary duties of the healthcare team in the administration of care to the patient. It also sets up the procedures to be followed by the team in various situations surrounding patient care. Conclusion After 100 hours of training in the Medical/Surgical Step-down Unit, the student nurse feels that she has learned so many skills in the care of the trauma step-down patient. The student nurse, with great help from her preceptor, was able to fulfill most of the objectives and goals of the practicum. She feels that she has learned the necessary skills in this area to be later considered for work in this unit. She knows she can still improve on these skills and learn more theories and pertinent information to be a really competent Medical-Surgical Step-down unit nurse. Reference Eachempati, Soumitra. (2004). The Effect of an Intermediate Care Unit on the Demographics and Outcomes of a Surgical Intensive Care Unit Population. Archsurg Archives. Retrieved June 14, 2008 from http://archsurg.ama-assn.org/cgi/content/full/139/3/315 Kalofissudis, Slvan. (2002). The Theory of Nursing Knowledge and Practice. Retrieved June 14, 2008 from http://www.nursing.gr/theory/Holistic.htm. Kim, M. (2000). Evidence-based nursing: connecting knowledge to practice. Chart. 97(9). 4-6. Moore, Colleen. Professional Accountability. BellaOnline. Retrieved June 13, 2008 from http://www.bellaonline.com/articles/art57183.asp Orders to Continue Previous Meds Continue a Long Standing Problem. (2001). Institute for Safe Medication Practices: Medication Safety Alert. Retrieved June 14, 2008 from http://www.ismp.org/newsletters/acutecare/articles/20001101.asp?ptr=y Patient Rights Program. (n.d). Boston University School of Public Health Law Department. Retrieved June 14, 2008 from http://www.patient-rights.org.com Potter, P., & Perry, A. (2005). Fundamentals of Nursing. St. Louis: Elsevier Mosby. Revis, Don. (2008). Decubitus Ulcers. Emedicine. Retrieved June 14, 2008 from http://www.emedicine.com/medtopic2709.htm. Shaner, Hollie. (2006). Environment as a Phenomenon in Nursing: Reflections from Nursing Theorists. Nightingale Institute for Health and Environment. Retrieved June 14, 2008 from http://www.nihe.org/environmental/html The Hospital’s Story. Retrieved June 14, 2008 from http://www.usouthal.edu/usamc/story Venes, D., & Taber, C. (2005). Tabers Cyclopedic Medical Dictionary. Philadelphia: F.A. Davis. Weiler, Hans. (2005). Theory and Practice: Dichotomies of Knowledge. Annual Meeting of the Comparative and International Education Society: Stanford University. Retrieved June 14, 2008 from http://www.stanford-edu/~weiler/Texts05/CIES_paper.pdf. Weiss, Barry. (2007). Removing Barriers to Better, Safer Care: Health Literacy and Patient Safety-Help Patients Understand. AMA Foundation. Retrieved June 14, 2008 from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Read More