One Care Management Decision the Student in Practice - Case Study Example

Essay based on one care management decision the has made in practice this semester Introduction: A fifty-one year old white male was admitted into the urological ward late evening with the complaint of retention of urine, which was diagnosed as a result of a block in the bladder. Overnight the patient did not pass urine and a decision to relieve the distended bladder by employing a urethral catheter was taken Care Management Decision Making: The Marquis and Huston model of decision making makes veracity the focal point of the process and as such is a useful model in the care decision making process (Stanton, 2003). It consists of seven steps, namely identifying the problem, collating data for an analysis of the causes and consequences of the problem, exploring alternative solutions, selecting the appropriate solution, implementing the solution and evaluating the results (Judd, 2005). Identifying the Problem: Patient had been admitted with the complaint of retention of urine and overnight did not pass urine leading to abdominal discomfort and pain. Providing quality care is vital not only to the patient, but to the nursing professional as well (Hakesley-Brown & Malone, 2007). Hence addressing the problem of urine retention to relieve the abdominal discomfort and pain became relevant. Assessment of condition of the patient helps in identifying the problem faced. The next step is identifying those problems that have nursing solution and the order in which the solutions need to be applied. There are some problems that can be provided with an immediate nursing solution and some that require the knowledge and skills of other professionals in the healthcare delivery system (Faulkner, A. 1996). Urine retention could be chronic or acute. In chronic urine retention the ability to pass urine in small quantities remains and the build up of urine in the bladder is slow, with pain a less frequent possibility. In the case of acute urine retention there is no urine passed and is normally accompanied with pain (Kurasawa, Kotani, Kurasawa, Takama & Orimo, 2005). This suggests that the patient has a problem of acute retention of urine (AUR). Collating data for analysis: Acute retention of urine (AUR) is a common urological emergency, which is characterized by a sudden inability to pass urine associated with lower abdominal pain. There are several causes for AUR, as anything that blocks the flow of urine through the urethra can lead to AUR. Such blocks could occur as a result of the presence of stones in the bladder. Infection of the urinary tract is also a possible cause of urine retention. Nerve damage as a result of conditions like diabetes or multiple sclerosis can affect control over the bladder and cause AUR. In older men enlargement of the prostrate gland can lead to blocking of the urethra and urine retention (Thomas, Chow & Kirby, 2004). In addition there is emerging evidence that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of AUR in men (Verhamme, et al, 2005). There are two aspects in the consequences of AUR. The first is the progression of the condition itself that could lead to renal failure with the potential of losing the patient, and the second is the acute pain that results from the retention of urine. The management of the former has more relevance to the medical professionals, while the second has significant implications for the nursing professionals. (Patel & Chapple, 2006). Acute suprapubic pain is a distinguishing feature of AUR (Lekan-Rutledge, 2004). The two factors of ethical principles and rooting of nursing in care and comfort of patients, impinge upon nursing professionals to utilize the knowledge and skills that they possess in managing pain in their patients (Swenson, 2002). Exploring Alternative Solutions: The most common means for decompressing a urinary bladder is through the use of a urethral catheter (Osborne, 2000). However there are issues of discomfort caused by the insertion and presence of the catheter and mobility restraints on the patient besides the care required in the insertion of the catheter to maintain an aseptic condition. An additional issue is that patients may be averse to the use of the catheter due to embarrassment and reluctant to give consent (Pellatt, 2007). The alpha-blocker alfuzosin has been found to provide beneficial effects in the management AUR. However the beneficial effects are more in influencing successful outcomes of trial without catheter (TWOC) after catheterization rather than as an alternative for catheterization in decompressing the urinary bladder (McNeill & Hargreave, 2004). The other alternative is the use of devices that work by stenting open the urinary bladder neck and prostrate, which reduces the pressure that is required to start off micturition. Employing these devices requires skills that have not been acquired by nursing professionals yet (Emberton & Anson, 1999). There is also the alternative of not doing anything, but this runs against the grain of providing quality care by a nursing professional. A possible means to provide quality care through is available and the ethical principles that guide a nursing professional beneficence, malfeasance and justice require its use in alleviating the condition of the parent after taking consent from the patient respecting autonomy (Tremayne, 2005). Selecting the Appropriate Solution: The decision to use a urethral catheter turns out to be the right care management decision in the light of the analyses of the data. While the decision has turned out to be right for successful outcomes proper implementation of the decision is required, and as vital as making the proper decision (Pellatt, 2007). Implementing the Solution: The nursing professional needs in the first place to discuss and address patient consent issues inclusive sensitive issues like embarrassment to the patient (Pellatt, 2007). In employing the catheter, the nursing professional needs to ensure use of all skills to minimize discomfort to the patient and avoid injury to the urethra. The drainage of urine should be slow and not rapid, as rapid drainage of urine could lead to shock in the patient. (Emberton & Anson, 1999). Adhering to these cautions would lead to decompression of the urinary bladder in this patient with AUR and alleviation of discomfort and pain that resulted from it. In this manner it would be possible for the nursing professional to provide quality care to the patient in her charge. Evaluation of Care Management Decision: Much of nursing is oriented towards getting a patient better, and an evaluation of the care decision looked at from that perspective means reducing the dependence of the patient on nursing care (Faulkner, A. 1996). In this case decompression of the urinary bladder by employing catheterization resulted in alleviation of the discomfort and pain in the lower abdomen, which reduced the dependence of the patient on nursing care. Providing full recovery was beyond the scope of nursing care and required the intervention of medical professionals. Another manner of evaluating the success of a care management decision is from the satisfaction derived by the patient through the nursing intervention (Faulkner, A. 1996). In this case the alleviation of acute discomfort and pain experienced by the patient in the lower abdomen, as a result of the nursing intervention was instrumental in providing satisfaction to the patient. The final aspect of the evaluation lies in the suitability of the patient for any further medical or surgical intervention procedures that may be required in the treatment of the condition or disease. (Faulkner, A. 1996). In other words this means that nursing intervention strategies need to keep this outcome in perspective in the care management decision. From this perspective too the care management decision was right in that it made the patient in a better condition to comprehend the procedures required, interact and provide consent, and become a meaningful partner in the intervention decisions for the treatment of the condition. Discussion: The primary role of nursing in this case was the alleviation of the distress that the patient was experiencing. The right case management decision of employing catheterization was made and through the skillful use of catheterization the patient felt relief from the acute pain and discomfort. Secondary management of AUR involves either trial without catheter in one to three days with chances of up to forty percent success. In those cases not suitable for trial without catheter or failure of trial without catheter prostatic surgery is the intervention strategy (Fitzpatrick & Kirby, 2005). The secondary management involves other professionals in the healthcare system. In short we are looking inter professional collaboration in the care of the patient and management of the condition of the patient. The care management decisions at the primary stage should meld with the possible secondary management intervention strategies. In this case we see that the primary care management decision by nursing of catheterization for alleviating the pain and discomfort of the patient melds with the probable secondary intervention strategies of the other healthcare professionals, which may involve trial without catheter or prostatic surgery. Hence the nursing intervention strategy involved the use of the appropriate primary intervention of catheterization within the skill limits of nursing professionals to bring about relief in the acute condition for the secondary intervention strategies by other healthcare professionals to be employed for a successful outcome in the patient. Literary References Emberton, M & Anson, K. 1999, ‘Acute urinary retention in men: an age old problem, BMJ, vol. 318, pp. 921-925. Faulkner, A. 1996, NURSING: The reflective approach to adult nursing practice, Chapman & Hall, London. Fitzpatrick, J. M. & Kirby, R. S. 2005, ‘Management of acute urinary retention’, BJU international, vol. 97, no. 2, pp. 16-20. Hakesley-Brown, R. & Malone, B. 2007, ‘Patients and Nurses: A Powerful Force’, Online Journal Issues in Nursing, Medscape Today, [Online] Available at: http://www.medscape.com/viewarticle/553406 (Accessed on July 9, 2007). Judd, J. 2005, ‘Strategies used by nurses for decision-making in the paediatric orthopaedic setting’, Journal of Orthopaedic Nursing, vol. 9, no. 3, pp 166-171. Kurasawa, G., Kotani, K., Kurasawa, M., Takama, N. & Orimo, K. 2005, ‘Causes of chronic retention of urine in the primary setting’, Internal Medicine, vol. 44, no. 7, pp. 761-762. Lekan-Rutledge, D. 2004, ‘Urinary Incontinence Strategies for Frail Elderly Women’, Urologic Nursing, vol. 24, no. 4, pp. 287-302. McNeill, S. A. & Hargreave, T. B. 2004, ‘Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention’, The Journal of urology, vol. 171, no. 6, pp. 2316-2320. Osborne, D. M. 2000, ‘Managing patients with a distended bladder’, Clinical journal of oncology nursing, vol. 4, no. 2, pp. 103-104. Patel, A & Chapple, C. 2006, ‘Acute urinary retention: who is at risk and how best to manage it’, Current urology reports, vol. 7, no.4, pp. 252-259. Pellatt, G. C. 2007, ‘Urinary elimination: Part 2--retention, incontinence and catheterization’, British journal of nursing, vol. 16, no. 8, pp. 484-485. Stanton, K. 2003, ‘Nursing Management of End-of-Life Issues: Ethical and Decision-Making Principles’, American Association of Critical Care Nursing, [Online] Available at: http://www.aacn.org/__88256513000e5d06.nsf/0/de3836b4209f1b1488256d2600714112?OpenDocument&Highlight=2,elderly (Accessed on July 9, 2007). Swenson, C. J. 2002, ‘Ethical issues in pain management’, Seminars in oncology nursing, vol. 18, no. 2, pp. 135-14. Thomas, K., Chow, K. & Kirby, R. S. 2004, ‘Acute urinary retention: a review of aetiology and management’, Prostate cancer and prostatic diseases, vol. 7, no. 1, pp. 32-37. Tremayne, P. 2005, ‘What principals do nursing skills involve?’, in Staff Nurse Survival Guide: Essential question and answers for the practicing staff nurse, ed. John Fowler, Quay Books, London, pp. 39-70. Verhamme, K. M. C. et al. 2005, ‘NSAIDs May Double the Risk of Acute Urinary Retention in Men’, Archives of Internal Medicine, vol. 165, pp. 1547-1551. Read More