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One of the central tenets of Benner’s work is the idea that care forms the central aspect of nursing, that it allows a nurse to better connect to a patient, to better administer care, and to better see possible problems and situations before they arise (Alligood, 2002, 157). Though I agree to a certain extent with the primacy of care to any practical nursing environment, I believe that care can only be of actual use to a nurse if he or she has the advantage of experience to guide them in how to best support their patients.
Much of my recent practice has been as a primary triage nurse for an (unfortunately) over-crowded emergency room. This emergency department has fifty-three adult patient beds and it is up to me to decide how they are best used in most situations, only changing significantly when patients develop new symptoms or problems become apparent after the triage process has already begun. In a recent experience I had fifty-two beds filled with extremely high priority patients, something of a nightmare, and nearly simultaneously had six patients presenting the extremely distressing symptom of chest pains, all describing them in nearly identical ways.
I obviously had only one bed to give until other beds cleared from patients being released or transferred, and had to make one of the most difficult decisions I ever had to make as a triage nurse. I realize in retrospect that I naturally applied many of Benner’s theories of Person, Environment, Health and Nursing to the situation at hand without necessarily realizing it at the time. Obviously, in a triage situation, two of the aspects of this theory most directly applied to what I was doing in practice – Health and Nursing.
In a triage setting two things are important: identifying the patient most in need of care (or in extreme triage situations, the person to whom care will be most useful) and as a nurse finding the best and most efficient way to identify the best and most effective methods of allowing them to receive that care. So I had to identify which of these people was the most unwell, and how I could best act to make them better, whilst simultaneously trying to get the other five the care they needed as fast as humanly possible.
My education certainly played a significant role in my decision. In nursing school, I learned how to differentiate between a wide variety of chest pains, to use specialized language (such as throbbing, stabbing, dull, sharp and so on) to help weed out the possible causes of a wide variety of pains, and thus by knowing their causes apply the best care to the group of six as possible, which in this case meant getting the most serious case a bed as soon as possible. Likewise, I had an academic knowledge of how to use pain scales to help identify patients based on their level of pain from one to ten, with one being nearly nothing and ten being the worst level of pain possible.
Using this academic knowledge I was able to quickly dismiss two of the cases as most likely being caused by acid reflux (burning pain high in the esophagus with relatively moderate pain scale) and patients who were, though taking a good precaution by seeking medical care, probably not in need of emergency services in an urgent fashion. Following this, however, the situation became much more difficult. Two of the people I
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