Professional Standards of Medical Practitioners - Literature review Example

Running Head: A REFLECTIVE REPORT A Reflective Report Client Inserts His/her Name Client Inserts Name of Institution Introduction Different medical care procedures are applied for different ailments. Specifically, a particular ailment will require a guided approach given the diagnostic background information about the patient in question. Necessary appraisal of the most applicable and effective techniques need to be specified by the medical practitioner attending to daily nursing care of the patient (Gastmeier et al., 2009, p. 2714; National Heart Lung and Blood Institute [NHLBI], 2012, p. 13-4). There is a big role to play and all the procedures adopted must be point specific and with an aim at successful rehabilitation of a patient’s health condition (Australian Nursing and Midwifery Council, [ANMC], 2005, p. 3). ANMC (2005, p. 3) underpins the essential attributes of a registered nurse and this is underscored later in this study. Essentially, this study focuses on what it costs a medical practitioner to provide and/or ensure proper management of the patient is put in place. There are two categories of measures which must be taken in this quest; supportive measures and palliative measures. Palliative measures target the disease itself and all measures taken in this regard are aimed at reducing adverse effects of the disease or treating it (Gastmeier et al., 2009, p. 2714). They include various therapies (Echols, Tillotson & Song, 2008, p. 166). The supportive measures address more of the person portion of the patient. As opposed to treatment of the disease, supportive measures address the abilities of a patient to feed himself or to perform other duties that are related to his current condition, his happiness side (we always aim to keep the patient happy) and the patient’s psychological understanding of his or her importance in the society. These include ensuring high self-esteem of the patient and hope that he is going to recover no matter the condition of the current situation (NHLBI, 2012, p. 16). Theoretically, the two categories of measures need to be dissipated simultaneously for a quick recovery of the patient in question. Providing appropriate management procedures is not as easy as it may appear. For example, the efficiency of the two categories of measures discussed above depends on a number of factors including accessibility of the patient (some patients are outpatients, others inpatients; some require intensive care while others require a light touch; others are disabled), the typology of the disease including the stage of a particular disease (Masterton, Galloway & French, 2008, p. 21), the collaborative initiatives of the society from or in which the patient lives and the technological capacity of the medical facility taking care of the patient. If a patient is presented to one’s care, there are a number of things to first clarify regardless of the condition of the patient. First, a history of the patient’s health conditions and their patterns over different times must first be collected (Masterton et al., 2008, p. 13). Then the current clinical symptoms are analyzed to try to locate the kind of disease the patient is suffering from. This may be coupled by a hypothetical overview of the possible causes of the disease and for every qualified medical practitioner; this is not a hard subject (Echols et al., 2008, pp. 167-170). Various tests are carried out and the results are analyzed quickly yet cautiously to suggest the correct therapeutic prescription for the patient (Masterton et al, 2008, pp. 7-9). As an incumbent medical practitioner, there is always enthusiastic feeling I experienced especially after a successful intervention and a full recovery of the patient was the climax (Abrahamian, Deblieux & Emerman, 2008, p. 4). There is always a call to save a certain life that is at stake. However, perfection in disseminating professional services is the ultimate goal. (ANMC, 2005, p. 2) lists a number of important professional requirements and procedures which every registered medical practitioner needs to conceptualize hand in hand with acquiring particular themes that enhance medical practice which is otherwise a delicate one. Mostly, positive results on the patient’s health conditions are expected and basically there is no room for chancing (Abrahamian et al., 2008, pp. 3-4). Categorization of Various Cases It is an absolute requirement for a nurse to display expertise and professionalism in attending to the wide array of ailments that may face a particular medical institution (ANMC, 2005, p. 3). According to ANMC (2005, p. 3), he or she is entitled to understanding the way to handle the different problems that he or she may certainly encounter including; Problems Related to Drug Abuse Patients suffering from an ailment whose occurrence was an aftermath of drug and substance abuse or aggravated by the harmful effects of drug abuse will need a slightly different approach from usual ones. Full treatment of such a patient may involve more stages including intensive advisory initiative. For example, after recovery from an ailment, such patients need counseling and thus may be referred to a psychiatrist (Mizgerd, 2008, p. 76). Cases Related to Physical Disorders These are cases that include physical injuries, dislocation of particular body organs and infections of various body organs. Such ailments call for physical therapeutic measures hand in hand with proper supportive services. Cases Related to Stress and Depression Various patients may be experiencing stressful conditions. These conditions must not be ignored. They are known to cause heightened heart rates and even stroke (Echols et al., 2008, pp. 174-5). They are thus ailments of consideration too. Such patients may require continuous friendly company programs, programs that will help the patient to regain his or her self-esteem. These can include suggestions on the next step that a patient may take and intensive counseling topics that may help the patient appreciate himself or herself and start a fresh, happy life. The Old and Disabled These are conditions that may accompany a particular disease and make the health conditions of such a patient to worsen. These types of people require to be handled with care as many show depreciated immunity levels especially invalids. They need maximum company because loneliness directly makes such patients’ health conditions deteriorate rapidly (Echols et al., 2008, pp. 166-9). Case Example To well illustrate the necessary measures to take as a medical practitioner, it is better to recount on a particular case of personal experience. The patient discussed below is a real case. First Glimpse at the Patient; Overview A 34 years old man came as a new patient. The patient wore tiredly giving-up face and indications from experience point of view implied that the patient needed rest immediately. He was repeatedly coughing producing yellowish sputum. He was rapidly breathing and this indicated that either he was experiencing shortness of breath or hard burning chest pains that could not allow proper breathing or both and this readily suggested a high heart rate. On assessing the past history of the patient, the patient was found to be a widower for the past three years and an addicted cigarette smoker. He also produced distant wheezing sounds. The patient was also working in a cement industry as a casual laborer. Previously, the patient had suffered from an unspecified kind of flu. From which he had recovered quickly. From such information, the immediate conclusion was that the patient was suffering from a particular respiratory disorder and that the patient was in critical stages of the ailment, whichever it was. He thus required intensive care but the very first thing was to ensure proper ventilation prevailed. Various diagnostic tests were carried out and the results included a blood pressure of 133/80mmHg, a heart rate at 87 bpm, 29 respirations per minute and temperature at 38.2oC. An electrocardiogram (ECG) test carried out indicated that the patient was experiencing intermittent chest pains. A Chest X-ray Scan results indicated lung infections. The blood test indicated that the patient was suffering from bacterial pneumonia while the room oxygen concentration stood at 46%. The sputum test indicated that the patient had lung infections (Mizgerd, 2008, p. 77). Palliative Measures Taken on the Patient The first step was to try and deduce the major problems the patients was experiencing (Tintinalli, Ruiz & Krome, 2008, pp. 88-90). The mere look on the patient actions indicated that the patient was experiencing shortness of breath from the deep breathing and fatigued body plus the high blood pressure. The patient thus required some help to help him gather more oxygen. The high body temperatures indicated fever evidence (Echols et al., 2008, p. 173). The patient was also experiencing intermittent chest pains that were further aggravated by the repeated deep coughing. The therapies immediately prescribed were related to either supply of oxygen or reduction of chest pains. The concerns of the medical practitioner seemed to concentrate on any efforts to ease breathing capacity of the patient. Specific Therapies and the Rationale behind their Prescription Oxygen therapy was given using nasal prongs at 98% concentration. Nasal prongs are considered as effective to supply fresh and highly concentrated oxygen to the lungs (Kubicka, Limauro & Darnal, 2008, pp. 82-3). Though most medical suggestions imply that nasal prongs are uncomfortable (Kubicka et al., 2008, p. 84), their efficiency and effectiveness are first given credit. This therapy was given with a hope that it would bring along improvements on various aspects of the patient’s condition. First, the implication of the direct delivery of oxygen to the lungs via nasal prongs is that the patient no longer struggles to breathe (Kubicka et al., 2008, p. 87). Oxygen is a vital element of inclusion for enhancement of quick recovery of the patient and an ideal medical practitioner will need to know the physiological benefits that are tagged to oxygen therapy. This is because for any outcomes from such a practice, the practitioner is solely the one to be held accountable (ANMC, 2005, pp. 7-8). With the correct supply of oxygen, vital organs of the body resume normalcy in terms of their functions. The brain for example requires freshly oxygenated blood for normal functioning (Kavanagh, 2006, pp. 568-9). Low levels of oxygen in the blood therefore lead to poor functioning of the brain with the end effect being occurrence of confused state of the patient. In a struggle to supply enough oxygen to the brain from an oxygen-poor blood, the heart rate speeds up so as to pump blood as many times as possible (Kavanagh, 2006, pp. 569-570). Therefore, there is a chance of lowered heart rates what with the oxygen therapy in place. Oxygen also serves as a reactant during the breakdown of food substances and compounds to release energy for the patient to utilize (Kavanagh, 2006, pp. 575-7). Reduced struggle for oxygen also reduce the pains experienced especially in the ribs (Gastmeier et al., 2009, pp. 2717-8). In response to the chest pains, analgesia was prescribed for the patient. The role of analgesia is to reduce sensitivity to the pain while keeping the patient conscious (Drugs and Therapy Bulletin, 2003, p. 8). The patient was injected with 10 mg of morphine after every four hours. The patient was expected to show signs of reduced pains as morphine is known to reduce especially the blood pressure, a condition that leads to relaxation of chest blood vessels. However, the giving-up nature of our patient here may lead to a tendency of increasing the rate of the analgesia intake beyond the prescribed limit if the patient is allowed to take analgesia by himself say as an outpatient (Drugs and Therapy Bulletin, 200,. pp. 5-6), a problem that has severally been evident among poorly monitored patients across various medical facilities (Gastmeier et al., 2009, p. 2718). There is therefore need for close monitoring of the patient behavior and this was well conducted in recognition of the pains the patient was going through and which could lead to such temptations. Overdose could lead to further complications. Reduction of the pain means that the patient is more comfortable and this is marked by ease of breathing (Spellberg & Talbot, 2010, pp. 151-2). Physical therapy was also recommended and this took the form of exercises. The exercise was in particular ensuring that the patient changed positions severally. The position of the patient determines the ability to manipulate various organs and thus facilitate their functioning. For example placing the head of the patient higher than the rest of the body likely enhances processes like peristalsis during feeding. Lungs also expand with ease and this means ease of breathing. Sometimes the patient would be asked to sit, move around and/or lean on walls. All these positions make the lungs to be loose and easy to manipulate. In response to lung infections, the patient was put under treatment using humidified nebuliser. This ensured direct smear of antibiotics to the infected lungs (The royal free hampstead, 2009, pp. 6-7). The antibiotics prescribed were mixed with a saline solution of 1% concentration and the latter targeted to thin the sputum and the fluid perhaps covering the alveoli of the lungs (Spellberg & Talbot, 2010, pp. 157-9). This ensured that the lungs were internally cleared but one problem stood firm; the patient was a smoker and this meant that the lungs were possibly internally covered with carbon coating (Ambrose, Bhavnani & Ellis-Grosse, 2010, p. 109). Therefore the patient was also injected with vitamin E that was allegedly believed to solve the puzzle though slightly (Tintinalli et al., 2008, pp. 45-6). The description above only gives an overview of what a patient requiring intensive care needs. There are many more activities omitted for example the daily cleaning of the prongs. Be as it may, the medical practitioner delights if he or she is taking care of a cooperative patient (Tintinalli et al., 2008, pp. 57-61). It is practically impossible for a nurse for example, to take care of everything but he or she has a call to perform to his or her best level. So what does the nurse do if the patient is uncooperative? Is he or she entitled to quit and leave the patient to take care of himself or herself? No. The nurse is at all costs expected to ensure that the patient cooperates, but how? There are a number of ways to ensure that the patient cooperates as underscored hereunder as supportive measures. Supportive Measures I learnt that there are more duties that a nurse or the medical practitioner attending to the patient must perform whether supervised, prescribed or not (ANMC, 2005, p. 2). Looking keenly at the patient in question, one can easily deduce that his blood was perhaps containing large amounts of carbon compounds due to the intensive smoking habit of the patient (Tintinalli et al., 2008, pp. 29-32). The smoking habit as well may have accrued from stressful conditions after divorce or otherwise separation. Working at the cement factory indicates high chances of infection and/or respiratory disorders (The British Society for Antimicrobial Chemotherapy [BSAC], 2004, pp. 6-9). I mean, there are a lot of comments one can easily heap on such a patient’s condition but the problem is how to solve the various problems identified because other than those requiring palliative interventions, other problems are more personal. One has to device the angle from which to tackle them (Gastmeier et al., 2009, p. 2715). Here, ability to study and interpret the psychological dynamics of the patient is ultimately required as an important theme for various medical practitioners. Take a case of the smoking habit for example; the person engulfed in the habit has a particular value attached to it. A nurse will be required to befriend the patient however unfriendly he or she (the patient) is. This starts by examining the patient’s likes and dislikes and may take even performing various duties many a time so that he or she feels you are the closest companion. At this point, the patient will try to be loyal. The patient in question for example was approached this way since he was somehow uncooperative. He was intensively advised on how negative effects of smoking habit can impact on his life. Examples of other patients with similar problems were shown so as to establish a strong conviction to the patient. A patient believes in a friendly caterer and therefore any registered practitioners need to always find for a happy mood (Gastmeier et al., 2009, pp. 2716-8). On the issue of divorce, the patient was referred to a counselor within the medical facility. The patient was also advised to find another job as quickly as possible so that he could leave a kind of work that can possibly heighten the rates of respiratory infection. Providing tutorials to the patient and his or her friends and family members on how to handle the patient while in and out of the medical facility is another role of importance that say nurses must preferably accomplish. Supportive literature materials, pamphlets for example, civic overview and/or basic tips on how they should conduct themselves (Ambrose et al., 2010, pp. 106-7) around the patient and for proper use of the medicine provided are some of the fundamental things to give. Sometimes, exercise is also taken as a supportive measure (Tintinalli et al., 2008, pp. 38-40). This includes mechanically supporting the patient as he or she moves around. Other measures that are supportive include feeding the patient, cleaning the patient and monitoring his or her progress. My personal contribution served a great purpose as complementary to the overall recovering of this patient which he did quite well. What I cannot forget is the irritating feeling that the patient expected too much from us. For performing various duties, even if he had the ability, he neglected. At a particular point, the patient complained about too many drugs and almost refrained from taking them. To be frank, one feels like quitting the profession at such a point. All the named activities can only be successful if the medical practitioner attending the patient conceptualizes and adheres to the necessary and approved code of medical practice (NHLBI, 2012, p. 4). Such attendees therefore are required to possess various themes or qualities as discussed below. Professional Standards of Medical Practitioners There are many different bodies which are entitled to govern the practices of various medical practitioners worldwide. ANMC is one of these and controls the nursing practices in Australia. According to ANMC (2005, p. 3), a registered medical practitioner, preferably the nurse is expected to portray competence especially in the provision of nursing care as reflected in the registering authority’s license to standards and codes with respect to care of the patients. He or she is expected to act dependently, or as the prevailing patient’s condition may require, interdependently where accountability and self-initiated discipline are the core entities to govern the nurse’s actions. He or she is expected to delegate various duties to junior nurses among other health care workers while giving the correct and pre-conceptualized directions which must be in line with the education and training of enrolled nurses (ANMC, 2005, pp. 5-6). Ultimately, success or achievement is marked by the recovery of the patient (Abrahamian et al., 2008, pp. 9-10). Certainly, all this care is directed towards amelioration of the patient’s condition. This requires that the practitioner specializes in and perfects his or her professional background information content while understanding the gravity of any flaw say in choosing a wrong procedure (BSAC, 2004, p. 3). He or she therefore is required to recognize and respond appropriately to unsafe or unprofessional practice (ANMC, 2005, pp. 3-4) A competent nurse’s practices are marked by his or her adherence to the nursing profession’s codes of ethics and conduct (ANMC, 2005, p. 4) especially when it comes to personal values and attitude dynamics between the caring nurse and the patient. He or she must accept all individuals and attend to their clinical and psychological needs simultaneously regardless of their race, culture, religion, age, gender, and sexual preference, physical or mental state (ANMC, 2005, p. 4). He or she has to ensure that attitudes of one are not at all imposed on other people (ANMC, 2005, pp. 7-8) in the process. It is of paramount importance for example, to learn what the likes and dislikes of the patients are. Rather than getting angry on uncooperative patient for example, it becomes more ethical from the medical ethics point of view to find a new and safe way to address the patient (Edwards, Peterson & Andrus, 2007, p. 299). All the said duties cannot be well accomplished without integration of particular stakeholders’ aid (NHLBI, 2012, pp. 6-7). The family members of the patient are an example. This includes the friends of the patient (NHLBI, 2012, p. 4). As a matter of fact, many of outpatients do not receive the required rehabilitative attention by the public as well as to some extent, family members. This is however not what it is supposed to go. Such patient requires maximum attention, stigma-free. The patient also has a role to play (Edwards, Peterson & Andrus, 2007, pp. 296-8). According to me, the patient should for one, heed the directives from the caterer and learn to appreciate the care given by reciprocating with cooperation. He should be made to understand that all measures taken are for ameliorating his condition. In our patient’s case, the requirements by the ANMC were superbly followed only that there were temptations to fail to understand the uncooperative status of our patient. This is where my attitude took the wrong route. Conclusion Management of a patient requires absolute devotion because at times one may feel to let off the handle especially when the patient turns uncooperative. All the duties I undertook were successful but I reckon I have to adjust control of my temper for even more successful results in future. References Abrahamian, F.M., Deblieux, P.M., & Emerman, C.L. (2008). Health care-associated pneumonia: Identification and initial management in the ED. Am J Emerg Med 26, pp. 1–11. Ambrose, P.G., Bhavnani, S.M., Ellis-Grosse, E.J., & Drusano, G.L. (2010). Pharma-cokinetic- pharmacodynamic considerations in the design of hospital-acquired or ventilator- associated pneumonia studies: look before you leap! Clin Infect Dis. 51(1), pp. 103–1104. Australian Nursing and Midwifery Council [ANMC]. (2005). National Competency Standards for the Registered Nurse. A review of the national competency standards for the registered nurse, DICKSON ACT 2602 . pp.1-8. Echols, R.M., Tillotson, G.S., Song, J.X., & Tosiello, R.L. (2008). Clinical trial design for mild- to-moderate community-acquired pneumonia—an industry per- spective. Clin Infect Dis 47(3); pp. 166–175. Edwards, J.R., Peterson, K.D., & Andrus, M.L. (2007). NHSN Facilities. National Healthcare Safety Network (NHSN). Am J Infect Control, 35, pp. 290–301. Gastmeier, P., Sohr, D., Geffers, C., Ruden, H., Vonberg, R.P., & Welte, T. (2009). Early- and late-onset pneumonia. Antimicrob Agents Chemother 53, pp. 2714–2718. Kavanagh, B.P. (2006). Hypercapnia; permissive and therapeutic. Munerva Anestesiol, 72, pp. 567-576. Kubicka, Z.J., Limauro, J., & Darnal, R.A. (2008). Heated humified high flow nasal cannula therapy. Pediatrics, 121, pp. 82-88. Masterton, R.G., Galloway, A., & French, G. (2008). Guidelines for the management of hospital- acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for An- timicrobial Chemotherapy. J Antimicrob Chemother 62, pp. 5–34. Mizgerd, J.P. (2008). Lung infection- a public health priority. PLoS Med. 3, pp. 76-78. National Heart Lung and Blood Institute (NHLBI). (2012) People Science Health. Retrieved from Drugs and Therapy Bulletin. (2003) Pain management: IM prn is a pain in the “arm”. Shands at the University of Florida. 17(4): pp. 3-9 Spellberg, B., & Talbot, G. (2010). Recommended design features of future clinical trials of antibacterial agents for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Infectious Diseases Society of America, American Thoracic Society, Society of Critical Care Medicine, American College of Chest Physicians. 51(1), pp. 150- 170. The British Society for Antimicrobial Chemotherapy. (2004) Chemotherapies for respiratory infections. J Antimicrob Chemother, 62: pp. 5–34. The royal free hampstead. (November 2009) NHS trust. Policy for: neburised drugs (adults). Guideline for the administration of drugs via nebuliser. Retrieved from http:/www.royalfree.nhs.uk/documents/Equality_GUIDELINEFORTHEADMINISTRAT IONOFDRUGSVIANEBULISER.doc Tintinalli, J.E., Ruiz, E., & Krome, R.L. (2008) Emergency Medicine: A Comprehensive Textbook / American College of Emergency Physicians. (6th ed.). New York: McGraw- Hill. 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