Questions Related to Nursing Practice - Research Paper Example

? Clinical Journal Clinical Journal: Week March – March Basic Patient Report My experience in the surgical and orthopedic floors at the University of Texas, Medical branch has provided me with several events to ponder on for my development towards becoming an efficient professional nurse. Most of these patients were Hispanic, with little or no knowledge of the English language. One of the patients, a 36-year-old Hispanic male had undergone appendectomy, and was on fall precautions, due to the surgical procedure and the pain medications that were being administered. A yellow bracelet and socks were worn by the patient to provide warning of the falls precaution requirement for the patient. Issue Encountered I observed the patient walking in the unit, and also moving out of the unit, without being stopped by any of the staff nurses. The issues here are the negligence of a system put in place for patient safety, and the confusion in me whether to intervene or not. Ultimately, I did warn the patient not to ambulate in the unit and also out of the unit. Questions Related to Practice Evidence from a long-term study of a large number of post operative patients in surgical units shows that 1.6% of surgical inpatients have one or more postoperative falls, with significant morbidity risk (Church et al, 2011). A possible cause of this risk for falls in postoperative patients is the use of strong analgesics of the opiate and opiate-like group to provide pain relief. These pain medications carry a high risk of falls in patients, from dizziness that is caused by them (Vestergaard, 2008). Recognition of the fall risk in postoperative patients assists in putting in place systems to reduce the risk of falls for patient safety. Effective falls prevention systems in hospitals may be costly, but taking into consideration the higher economic costs to patients in terms of morbidity, length of stay in hospitals, and costs associated with it, falls prevention systems are useful in hospitals (Spetz, Jacobs & Hatler, 2007). In this hospital a yellow colored bracelet and socks has been introduced in the system for falls prevention, to warn nurses of the fall risk potential of the patient, and that ambulation has to be prohibited. Yet, none of the staff nurses paid heed to the requirements of the falls prevention system, negating the effect of the falls prevention system, and reducing the safety of the patient. Money is being spent by the hospital to enhance patient safety through the falls prevention system. What needs to be done is for the nurses to be conscious of the requirements of the falls prevention system, and be more vigilant to prevent postoperative patients with fall risk warnings moving around. Professional Growth I believe I am growing as a nursing professional through the experience of this event. I have learnt that there is the risk for falls in postoperative patients from the analgesics that are administered to them for pain relief. Systems for fall prevention are used for patient safety, which have to be adhered to, for effectiveness in the patient safety objective. I have also learnt that postoperative patients are likely to be unaware of the risk of falls from the pain medication that they take, and are likely to move around. It is the responsibility of the nurses to educate patients on these aspects, with the aim of making them desist from attempting to move around. Action and Non-action The postoperative patient on pain medications was moving around, though he was not supposed. The non-action part lay in none of the staff nurses taking any steps to prevent his moving around, which may have resulted in a fall. I communicated to the patient that he should not be moving around the unit, and got him back to his bed. In addition, I informed my preceptor of my experience. She took steps to convene a meeting of all nurses, where the discussion was on effective implementation of the falls prevention system that was in use in the hospital. Safety Risk Opiate and opiate-like pain medications administered to postoperative patients for pain relief carry a safety risk for the patients in the form of fall risk, through the dizziness that these patients may experience from these medications. Goals All the nurses were reeducated on the falls prevention system in use in the unit. The role of the nurses in the falls prevention system was emphasized in the reeducation of the falls prevention system. The goal was to ensure that the nurses were clear about the elements in the falls prevention system in use in the hospital, and went about performing their role efficiently, so as to reduce the potential for falls among postoperative patients of the unit. . Literary references Church, S., Robinson, T. N., Angles, E. M., Tran, Z. V. & Wallace J. I. (2011). Postoperative falls in the acute hospital setting: characteristics, risk factors, and outcomes in males. American Journal of Surgery, 201(2), 197-202. Spetz, J., Jacobs, J. & Hatler, C. (2007). Cost Effectiveness of a Medical Vigilance System to Reduce Patient Falls. Nursing Economics, 25(6), 333-338. Vestergaard, P. (2008). Pain-Relief Medication and Risk of Fractures. Current Drug Safety, 3, 199-203, Retrieved March 11, 2012, from Web Site: http://benthamscience.com/cds/samples/cds3-3.tar/0008CDS.pdf. Clinical Journal 2: Week 2 – March – March Basic Patient Report My next experience that I would like to present pertains to a 20-year-old male Hispanic patient. He was admitted for a gun shot injury. Among the medications he was taking were the three medications in bottles that he had been taking at home, in addition to what had been prescribed for his present condition. Of the three medications that were continuing from home, two were pain medications. He was on additional pain medications from the hospital. The charge nurse queried the staff nurse on the pain medications being taken by the patient in addition to what was given by the hospital. She claimed she had not seen any medications, even though they were clearly visible on the window adjacent to the patient. Issue Encountered There were two issues pertaining to the lack of diligence demonstrated by the staff nurse with regard to patient safety issues. The first issue is the likelihood of overdose of pain medications for the patient, from the combinations of pain medications that were continued from home and the additional pain medications given by the hospital. Another problem with regard to patient safety is the possibility of another patient taking the pain medications left exposed on the windows, and the risks associated with it. The probability of another patient taking the exposed medications was high as there were four patients to a room. The poor communication between the patient and the staff nurse may have been the result of a language gap, as the patient was fluent only in Spanish. Questions Related to Practice There are three issues that are related to nursing practice from this event. The first issue is the high risk for overdose of pain medication, concurrent use of pain medications prescribed for home use earlier and the pain medications prescribed for managing pain resulting from the gunshot injury. The second issue pertains to the possibility of other patients in the room administering the exposed pain medications without a prescription and the related consequences for patient safety. The third relates to patient education on pain medication dosage requirements. Pain medications are of different types, with some like methadone having a slow rate of metabolism. When pain medications are used in combination, it is essential to evaluate the various pain medications and adjust dosages to the appropriate levels. Failure to do so could lead to systemic toxicity, the affects of which may not be seen for a few days, which would have implications for the safety of the patient and economic costs for the patient, through extended hospital stay (Toombs & Kral, 2005). Patient education on pain medications is essential, and must be communicated in a way that patients understand it. This may be more difficult when dealing with patients from other cultures with limited knowledge of the local language. In the absence of proper understanding of keeping within the dosing limits of pain medications, patients are quite likely to take extra pain medications, in case they feel dissatisfied with the pain medication therapy put in place for them (Galanti, 2008). Professional Growth This incident has brought my attention to the issue of medication overdose in hospitals, the influence of medications prescribed for home use in medication overdose in hospitals and the role that nursing can play in the prevention of medication overdose in the hospitals. This has been a revealing incident that has opened my eyes to aspects of patient care and patient safety that I need to be aware of as a professional nurse. Action and Non-action I discussed my observations with my preceptor, who accompanied me to the patient, and the two of us went through a routine of educating the patients in the room on the necessity for adhering to pain medication dosages. She also secured the pain medications from the patient through an understanding with him. She did not approach the concerned staff nurse on the issue, but instead in the weekly meeting brought up the issue of ensuring that pain medication dosages are kept to the appropriate levels, securing pain medications, and also the need for educating patients on keeping to pain medication dosages. Safety Risk When patients are not educated on the risks associated with pain medications, there is always the possibility of pain medication overdose, with their reaching out for readily available pain medications, and taking them if they do not get the desired pain relief from the pain medications administered to them by the nurses. Goals Appropriate patient education on pain medication and ensuring that pain medications over the prescribed amounts were not readily accessible to patients were the goals. Literary References Galanti, G. (2008). Caring for Patients from Different Cultures, Fourth Edition. Philadelphia, PA: University of Pennsylvania Press. Toombs, J. D. & Kral, L. A. (2005). Methadone Treatment for Pain States. American Family Physician, 17(7), 1353-1358. Clinical Journal 3: Week 3 – March – March Basic Patient Report This week the event that has caught my mind is the incident pertaining to the 32-year-old Hispanic male patient admitted for a right ankle fracture. The intervention included an external fixation for the right ankle fracture. When I met the patient, he complained that he had been pressing the call light for assistance, since the fixator was leaking, against the norm. There was no response to his calls for assistance using the call light. I examined the fixator. I found that there was drainage, and evaluation of the drainage showed that it had saturated half of the pillow case. The shift that I was on started at 7.00 AM, and the time of my visit to the patient was 11.00 AM. The assigned staff nurse had not called on the patient since the start of the shift. Issue Encountered There were two issues relating to patient care by nurses in this event that I have brought up. The first issue is with regard to the lack of response by the nurse to the calls for assistance by the patient, using the call light facility provided. The second issue pertains to the lack of regular rounding by staff nurses to enhance patient care. Questions Related to Practice Call lights have become indispensable in the units of hospitals. It is one of the features of transition from the old wards in hospitals to new wards practices. It is the call lights that enable the dispensing of keeping a close eye on patients, to assess their care needs and watch out for their safety, which was a feature of wards in the years gone by. However, the efficiency of the call light system for patients to alert nurses about their care needs is drastically reduced, when nurses look upon the call light alerts as intrusions into their job routines and time management of the work assigned to them. Yet, in the current ward system, the call lights remain the only communication system between the staff nurses and their patients, with the patients totally dependent on the call lights to alert nurses for any of their requirements (Medscape Education Nurses, 2008). Rounding of units by nurses assists in ensuring that the needs of the patients, other than the clinical needs are met. The focus of the rounding by nurses on meeting patient personal needs means that during these rounds, finding out whether they wish to visit the toilet, or need a drink of water, or an extra pillow, and the like should be the intention. Moreover, rounding should happen on a regular basis during a shift, for example on an hourly basis. Regular rounding by nurses assists in enhancing patient confidence in the nurses and nursing care received, and reduction in call light use by patients (Steinbinder & Scherer, 2010). Evidence from a hospital study confirm that the concept of nurse rounding does increase patient satisfaction, and reduce their use of call light through this build up of confidence in nursing care (Whipps Cross University Hospital NHS Trust, 2010). Woodard, 2009, investigated the effects of 2hourly rounding by the charge nurse in a medical-surgical unit, with emphasis on pain, potty, position, and presence, on patient confidence and call light usage by patients. The findings of this investigation showed that there was a marked increase in patient confidence and safety, and a marked decrease in call light usage by patients (Woodard, 2009). Professional Growth I have become aware through this incident that there are two perspectives to patient care, namely the clinical need and the personal needs of patients. I will be prone to take care of the clinical needs and not be aware of their personal needs. It is through the rounds that I make that I can become aware of their personal needs, and gain the confidence of patients in me. Frequent use of the call light is not just an alert of patient needs, but also an alert to me that I need to improve patient confidence in me, by being more attentive to the personal needs of the patients. Action and Non-action I mentioned the incident to my preceptor. The action she took was to ask me to read articles or books on nurse rounding and the use of call lights by patients. In addition, during the weekly meeting she brought up the issue of the requirement for regular timely rounding by the staff nurses, with the emphasis on personal requirements of the patients. She made no mention of the lack of attention of call lights. Safety Risk The lack of regular rounding by nurses and inattention and lack of response to call lights increase the risk of nurses not becoming aware of changes in the condition of the patients, with the consequence of failure for quick response or intervention to the changed condition. Goals The goal was to ensure that rounding of nurses was on a regular basis, focusing on the personal needs of the patient, so that the frequency in the use of call lights reduces. Literary References Medscape Education Nurses. (2008). ‘Ring for the Nurse! Improving Call Light Management’. Retrieved March 18, 2012, from, Medscape Web Site: http://www.medscape.org/viewarticle/570242. Steinbinder, A. & Scherer, E. (2010). ‘Creating Nursing System Excellence through the Forces of Magnetism’. In Kathy Malloch & Tim Porter-O’Grady (Eds.), Introduction to Evidence-Based Practice in Nursing and Health Care (pp.235-275). Sudbury, MA: Jones and Bartlett Publishers. Whipps Cross University Hospital NHS Trust. (2010). ‘Proactive Patient Rounding: Developing Nursing Practice to Improve the Quality of Patient Care’. Retrieved March 18, 2012, from Web Site: http://www.fons.org/Resources/Documents/Project%20Reports/PFProactivePatientRoundingNov2010.pdf. Woodard, J. L. (2009). Effects of Rounding on Patient Satisfaction and Patient Safety on a Medical-Surgical Unit. Clinical Nurse Specialist, 23(4), 200-206. Clinical Journal 4: Week 4 – March – March Basic Patient Report My incident for a learning experience this week is with regard to a 20-year-old-hispanic male patient. He was in hospital owing to a recurrent infection site to right fracture. The patient complained of numbness, and tingling around the site of the fracture, and also the inability to move the toes. In addition, the site was visibly swollen and warm on touching. I tried to locate dorsalis and posterior tibia pulses during my examination of the patient, but failed in my attempts. So, I tried using Doppler, but failed again in my attempt to locate the pulses. My preceptor also could not find the pulses, but on my asking mentioned that it was there, but it was just hard to hear, and moved on. Issue Encountered The preceptor plays a critical role in the development of student nurses into full fledged and efficient registered nurses. This role is in acting as the link between the knowledge gained through formal classrooms in educational programs and the required skills development to put this knowledge into practice in hospital settings. In this role, the preceptor functions as a role model for providing clinical instruction, coaching, and support, based on the individual needs of the student nurse (Gaberson & Oerman, 2010). Evaluating the evidence on nursing preceptor-student dyads in professional practice, Mohide and Mathew-Maich, 2007, inform us that through the interaction with the preceptor on daily practical clinical experiences, students derive invaluable insights on real life experiences in real time, which is not forthcoming from their faculty tutor for the period of their course. A key benefit derived from such an educational approach relates to the reciprocal learning derived from it, as “each gains understanding of the others specific competencies and individual approaches” (Mohide & Mathew-Maich, 2007, p.36). The issue here is that the preceptor had failed me in my individual need of clinical instruction, coaching, and support in taking weak pulses, which left me without a proper understanding of this aspect of my requirement of professional skills. However, nursing students need to understand that their preceptors have other competing demands other than merely catering to the skill development needs of students under their tutelage. These competing demands and heavy patient demands in the current hospital environments increase the demands placed on the time and energy of the preceptors, increasing the work stress that they experience. Furthermore, preceptors do not receive any extra compensation for the added effort they make in the clinical education of student nurses (Gardner & Suplee, 2010). This may act as a de-motivational factor for the preceptors already under stress from their work load. The other issue that I would like to present here pertains to the lack of hand-hygiene maintained in the rooms that house four individuals. The charge nurse had not implemented a system of wearing gloves or hand washing that carried the risk of transmission of infections from one patient to another, which is relevant to the patient with recurrent infection. Evidence from clinical studies have shown that hand washing and wearing of gloves by nurses are key elements in preventing the infection transmission in hospital settings (World Health Organization, 2009). Professional Growth I have learnt that I need to appreciate the contributions made by my preceptor towards my development as a professional nurse, and not contemplate on the failing she displays as a human. She is under pressure as a professional in attending to her duties, and yet has accepted to guide me on the path towards competence and proficiency in my job functions. Furthermore, she derives no extra benefits, except my appreciation, for this extra burden she has chosen to carry. Action and Non When I informed her that I was still not confident of taking weak pulses, and the use of the Doppler for the same, she did not say anything. A day later she came to me, and told me to accompany her. She took me to the same patient, and with a lot of patience made me conversant with taking weak pulses and using the Doppler for the same. She continued with the same till I told her I was confident. She just smiled at me and walked away. Based on my information that hand hygiene was poor in the unit. She put up posters on the how to maintain hand hygiene and its efficacy in reducing transmission of infection from patient to patient. I asked her why this was not discussed at a meeting. She told me that there would be better results by keeping nurses aware of hand hygiene, rather than discussing it. Safety Risk Poor hand hygiene could result in passing infection from one patient to another by nurses. The additional infection burden could lead to poorer outcomes with patients, and also increase their length of stay in hospitals. Goals The goal was to ensure hand hygiene and enhance the quality of hand hygiene in the unit, thereby reducing the possibility of transmission of infection by nurses. Literary References Gaberson, K. B. & Oerman, M. H. (2010). Clinical Teaching Strategies in Nursing, Third Edition. New York: Springer Publishing Company, LLC. Gardner, M. R. & Suplee, P. D. (2010). Handbook of Clinical Teaching in Nursing and Health Sciences. Sudbury, MA: Jones and Bartlett Publishers. Mohide, E. A. & Mathew-Maich, N. (2007). Engaging nursing preceptor-student dyads in an evidence-based approach to professional practice. Evidence Based Nursing, 10(2), 36-40. World Health Organization. (2009). ‘Patient Safety’. Retrieved March 18, 2012, from Web Site: http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf. Read More