Clinical Reflective Journal Entry - Essay Example

 Clinical Reflective Journal Issues Encountered I was placed in the neurological floor at the of Texas Medical Branch. During this experience I encountered two areas of focus. First, the physician discharged an African American female. The patient had a large tumor that needed to be removed. However, her surgery was canceled and the patient was discharged because she failed to comply with her physician’s specific regulations. In essence, the patient had continued taking her IV and began to wander around the hospital. My perception of the situation is that the patient was not mentally competent. In these regards, her cognitive functioning has notable disabled she was not stable or mentally in control of her faculties. The patient also seemed confused. She was wearing a yellow risk fall bracelet, which is generally indicated of the aforementioned conditions. During the woman’s stay, the nursing staff and the physicians permitted the woman to exit the hospital unit a number of times. Later, the nursing staff encouraged the physician to discharge the patient because, from my perspective, it appeared they did not want to be burdened with the challenge of watching and managing her erratic behavior. It is my opinion that the patient should not have been permitted to exit the hospital unit because of her cognitive and physical instability. For the same reasons, I believe that it was wrong that the patient was discharged from the entire hospital. My fellow classmate was privy to the events that took place and she agreed with my assessment of the events. The second issue concerned a Caucasian male. This patient was leaving his hospital unit and it was clear that he demonstrated a significant risk of falling. Upon witnessing this, I offered to help the patient, however he rejected my offer of help. Instead, the patient chose to use his wheelchair. He then exited the hospital unit, and similar to the early patient was discharged from the hospital by the physician. After witnessing these two events – the woman and then the man leaving – I asked the staff nurse if these patients were permitted to leave their rooms. In response to my query, the nurse responded that they, in-fact, were permitted to leave, as the hospital was not permitted to hold them in their hospital units. Upon learning this information, I notified that nurse that the woman look clearly cognitively impaired, and that the man was about to fall. In response to my query, the nurse indicated that despite these factors, she was still not permitted to hold the patients in their hospital units. While I lack the legal and ethical background to accurately determine if the nursing staff and physician truly were not allowed to hold the patients in their hospital units, from an outside and common sense perspective it appears that the nursing staff did not function to their full professional capacity. It’s clear that these patients were mentally or physically impaired and that permitting them to freely leave the unit posed a risk to themselves, as well as a liability risk to the hospital. Furthermore, the patients were housed on the neurological floor because of cognitive dysfunctioning. Ultimately, it seems overwhelmingly apparent that the nursing staff at the University of Texas Medical Branch should have taken more vigilant action in response to these patients. Professional Growth In terms of growth the experience revealed a number of important elements for my professional career. One of the most pervasive experiences I came to recognize was the cynicism many of the nursing staff experienced in relation to the hospital’s laws. I recognized that simply allowing individuals that were cognitively impaired to walk outside of their hospital room and outside the ward did not make practical sense. In addition, I believe that on some level that the nursing practitioners also recognized the general absurdity of such practices, yet they did so with a healthy dose of cynicism towards the hospitals practices. Rather than attempting to fight the rules and regulations, which would ensure that the hospital could not be run in an orderly way, the nurse practitioners cynically followed the rules. I came to recognize that a number complications arise if medical professionals attempted to restrict patients from leaving the hospital. One of the most overriding such concerns is that physically restraining an individual from leaving the hospital unit requires significant structural changes within the hospital, as the nurse cannot simply restrain the patient themself else the hospital be held financially liable for harm that may be caused. The second prominent issue is that the hospital demonstrates a conflict of interest if they were to be given the ability to restrict the patient from leaving their unit. This way hospitals management could encourage and pressure physicians to more stringently restrict patients from checking out as a means of increasing patients fees and charges to insurance companies. One of the main professional growth experiences I attained was that my role as a nurse practitioner is not one that is a reformer of overriding rules and that while I may disagree with their functional value and attempt to take steps to ensure that they are changed, I still must function and adhere to the rules. In another sense, I recognize that oftentimes employees that have been engrained into a routine for many years can oftentimes gain bad habits. While I recognize that the nurse practitioners were ultimately following the rules, I also recognize that they didn’t approach the situation with the greatest possible ethical responsibility or energy. In these regards, I learned that it’s necessary for individuals that desire to achieve true professionalism to constantly reassess their jobs and approach them with the greatest possible level of energy and common sense. Actions In researching the various theoretical aspects of the issue and considering potential actions that could be taken in response to my concerns I recognized that the issue was significantly more complex than I had originally envisioned. In terms of the legal aspects of the situation, the nurse practitioners were correct in indicating that it is prohibited for them to prevent the individuals from leaving their room. While the individual signs a form that indicates they need to follow their practitioners advice and can be discharged form the hospital if they fail to do so, the hospital employees have no legal power to physically restrain the individual from leaving. While a number of studies have considered the legal ramifications of such procedure, perhaps more notable for this current discussion are ethical considerations. While I have previously considered the nature of the staff nurses’ actions as unethical, Baillie (2009, p. 25) raises a number of interesting notions regarding the ethics of patient dignity. Even as it appears unethical to allow an individual that appears impaired to leave the hospital ward, Baillie argues that it is also highly important that medical practitioners respect the patient’s dignity and allow them to make their own rational decisions. In these regards, the proposed solution is advanced with the utmost concern for the patient’s dignity. Even as patient dignity must be respected, it’s also clear that significant structural changes need to be made in regards to the means of hospital professionals to restrict cognitively impaired individuals from leaving their hospital units. In terms of actions within the current system, Brown, Beck, Boles & Barrett (2010, p. 22) recognize that in large-part more emphasis needs to be placed on Advance Medical Directives. These are forms that permit hospital staff and designated caregivers increased decision-making power in terms of hospital decisions. In the cases of the patients I witnessed, they did not have Advance Medical Directives, and as such were freely permitted to make their own decisions. In these regards, I believe that it is necessary for hospitals to place an increased emphasis on medical professionals to procure Advance Medical Directives in situations where the patient is checked into the hospital with injuries or disorders that would necessitate their being cognitively impaired to the significant detriment of decision-making. As these patients were checked into the neurological ward it is apparent they would fall under this category. In terms of larger structural changes, further research is needed and regulations developed that would clearly designate situations where an individual would be impaired beyond decision-making level. In these instances, physicians would be given the power to restrict them from leaving their hospital unit until they regained competent mental capacity. As significant complications could arise from wrongly detaining individuals, it would be necessary for the medical establishment to develop clearly defined and objective categorizations wherein an individual would not be permitted to leave their hospital unit. While such regulations may represent decreased freedoms to some, it is ultimately unethical to continue to allow patients who are not cognitively enabled to make decisions to make these decisions and risk substantial injury. Works Cited Baillie, Lesley (2009) ‘Patient dignity in an acute hospital setting.’ International Journal of Nursing Studies; Jan2009, Vol. 46 Issue 1, p22-36, 15p Brown, J, Beck, A. Boles, M. Barrett, P. (2010) ‘Practical Methods to increase the use of Advance Medical Directives.’ Journal of General Internal Medicine; Jan2010, Vol. 14 Issue 1, p21-26, 6p, 5 Charts Read More