Nurses and Health Professionals: Effort Towards Promoting the Nursing Staff - Essay Example

Introduction This commentary shall provide a reflection on an encounter with an elderly schizophrenic woman admitted to the recovery ward. It shall utilize the Gibbs Reflective Cycle in its analysis, reviewing actions and critically assessing these based on evidence-based practice. Body Description of event The event involves the case of a 65 year old woman with schizophrenia who was admitted to the recovery ward. Her husband was the family member involved in her care. She was said to be suffering from haemorrhoids, however on closer inspection, she actually had an inflamed prolapsed uterus. She was not taken seriously when she expressed pain and the nurses believed her pain to be mostly psychological. They believed that since she was scheduled for surgery the coming month, she was experiencing some anxiety which manifested as pain. The nurses were opting to delay addressing her concerns because her haemorrhoids were going to be removed anyway. On assessment of patient, my adult nursing background helped me discover that she had a prolapsed uterus hanging out of her anus and it was also very painful and severely inflamed. I requested for stronger pain relievers for the patient and for the medical doctor to examine her as an emergency case. Through these actions, the patient was able to be referred for proper consult and care. Feelings I felt that I have acted in the patient’s best interest and that I made the best decision in reviewing her symptoms and evaluating her for other illnesses. I felt that in communicating better with the patient, I achieved better efficacy in understanding her physically, psychologically, and mentally. I felt that although the patient’ pain complaints may indeed be psychological, there was no harm in reviewing her complaints and evaluating whether or not such complaints may have an actual basis. I feel that by making assumptions about the patient’s condition, health professionals would not be able to uncover the exact condition of their patients. In this case, the nurses assumed that the patient’s pain complaints were psychological when in fact, it was very much real and was caused by a prolapsed uterus – one which needed immediate medical attention. This pain complaint stuck in my mind because the patient was showing signs of actual pain which I did not believe to be psychological as was expressed by the nurses. After the cause of the pain was established, I felt relieved about my decision and about personally checking the patient’s physical condition. In the process, I feel that I have done all I could to improve the outcome of the incident. Evaluation On evaluating the experience and my actions, I believe that the correct decision was made in reviewing the patient’s symptoms and its cause. The actions of the nurses were not appropriate because it caused them to miss the actual complaints of pain which the patient was feeling. Given any other situation, such pain symptoms if ignored in favour of psychological considerations, may also lead to dangerous and life-threatening situations. In some cases, pain may be a symptom of a stroke or a heart attack. When ignored, as was done in this case, less time is allocated to managing the patient’s symptoms. This is unfortunate considering the fact that early management of symptoms can best ensure early treatment and recovery. Recommending the patient to consult with the medical doctor was also a good decision, one which ensured a medical evaluation of the patient’s case. A stronger pain medication for the patient also implied an acknowledgement of the patient’s pain symptoms and reducing such pain has also become an effective means of reducing anxiety as patient was showing signs of stability in her mental state and happy mood. Analysis First and foremost, I reassessed the patient’s pain complaints. Assessing pain complaints can usually be carried out by applying the Visual Analogue Scale where the patients are asked to rate their pain complaint from 1-10, 10 being the most painful (Berger, 2007). Based on the patient’s complaint, she was in extreme pain. Secondly, the location of the pain should be established (Sieber, 2006). Establishing the location of pain would provide a starting point for the physical examination of the patient, the area from where pain is radiating would be checked for injuries, bleeding, inflammation, and other physical changes (Sieber, 2006). Thirdly, the type and the duration of the pain would be established in the physical assessment. This would help establish qualities of the pain which may provide a clue as to its cause and its effect on the patient (Turk and Melzack, 2010). Assessing pain is however a subjective process. It is difficult to verify because only the patient would be able to feel it. It is nevertheless possible to verify its manifestation by checking the patient’s facial expressions and gestures (Young, Horton, and Davidhizar, 2005). Grimacing, guarding, difficulties in moving and even breathing may all indicate signs of pain. By noting the presence of these symptoms, it may be possible to deduce that the patient is not just imagining the pain, but is actually feeling it. Referring the patient for higher pain medications is a significant intervention because the patient is in extreme pain. For older adults, the pain experience can cause much anxiety and the tolerance for pain is not as high (Mystakidou, et.al., 2006). The immediate administration of the pain medication is therefore an effective intervention. Pain medications for this patient would help in the management of her other issues – her haemorrhoids and her upcoming surgery. Her reduced anxiety would also allow for mental preparations to be made on her surgery (Mystakidou, et.al., 2006). If her pain would remain unaddressed, she would not be able to relax for her surgery and her anxiety may also lead to other symptoms, including depression, heart palpitations, and headaches; moreover, for a schizophrenic patient, other mental health concerns may also emerge. Pain management is also an important aspect of patient management. Pain management reduces anxiety and helps relieve stress (Sholtis, et.al., 2009). Discussing with the other medical doctors the temporary care plan of the prolapsed uterus is also part of the patient’s management. This plan would include pushing back the prolapsed uterus between the legs until such time that the operation would take place (Kovak and Cruikshank, 1993). The role of the nurse would be to reassure the patient that this is an effective part of the nursing care plan. Referring the patient to a medical doctor is also an effective intervention because it allowed for a medical assessment and later a medical intervention for the patient (Ettinger and Wisebrot, 2004). The medical doctor would have his own evaluation of the patient’s condition and symptoms and this evaluation would lead to a medical diagnosis for the patient’s condition. In this case, the medical doctor can confirm the prolapsed uterus diagnosis and then make the decision as to the medical intervention which would be implemented for the patient (Ettinger and Wisebrot, 2004). Referrals are a significant part of the multidisciplinary practice within the medical profession. Coordination of care would help ensure that all aspects of the patient’s care would be evaluated and addressed (Lemieux-Charles and McGuire, 2006). The various health professionals working with each other can secure a holistic care for the patient. The nurses, the medical doctor, and other health professionals evaluating, communicating, coordinating, planning, and working with each other can help ensure better patient outcomes (Lemieux-Charles and McGuire, 2006). Throughout the process of care with the patient, a therapeutic process was employed. Rapport was first established with the patient (Street, et.al., 2008). Communication was then secured by listening intently to the patient, establishing eye contact and allowing the patient to explain what she was feeling. Communication is an important element of therapeutic measures because they help establish accurate diagnosis and they help prevent medical errors as well as secure improved patient outcomes (Street, et.al., 2008). Conclusion In evaluating the above case, I believe that my decisions were favourable to the patient’s condition. My actions helped to improve the patient’s condition and helped to uncover the truth of her pain symptoms, making it possible to refer her for proper care. In evaluating what I could have done differently, I believe that I could have been more prompt and aggressive in terms of expressing to the other nurses about the patient’s actual symptoms and actual condition. Doing so would have prompted the patients to review their actions and behaviours about the patient. In the process of reviewing my actions, I was able to deduce the various skills I was able to utilize in caring for the patient, skills which included communication skills, language proficiency, and empathy. I did not allow the perceptions of other nurses to colour my judgment about the patient’s symptoms and in the process I was able to detect her prolapsed uterus. In effect, I was able to ensure her safety and well-being by making independent judgments on her condition. This process is important for nurses and other health professionals because although they are part of a team, their contributions to the patient’s well-being are singularly judged and regarded. Action plan If I were to encounter a similar situation in the future, I would not act differently. I would act as vigilantly as I have in this case, and I would continue to be vigilant in assessing the patient and in making plans on her care. I would also try to make a greater effort towards prompting the nursing staff to be more vigilant in their patient evaluation. References Berger, P. 2007, The Journey to Pain Relief: A Hands-On Guide to Breakthroughs in Pain Treatment, London: Hunter House. Brunner, L., Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. 2009, Brunner and Suddarth's textbook of medical-surgical nursing, London: Lippincott Williams & Wilkins. Ettinger, A., Weisbrot, D. 2004, The essential patient handbook: getting the health care you need-- from doctors who know, London: Demos Medical Publishing. Kovac SR & Cruikshank SH 1993, Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients, Am J Obstet Gynecol, vol. 168(6 Pt 1): pp. 1778-1783 Lemieux-Charles, L. & McGuire, W. 2006, What Do We Know about Health Care Team Effectiveness? A Review of the Literature, Med Care Res Rev, vol. 63(3), pp. 263-300 Mystakidou, K., Tsilika, E., Parpa, E., Katsouda, E., Galanos, A., & Lambros, V. 2006, Psychological Distress of Patients With Advanced Cancer: Influence and Contribution of Pain Severity and Pain Interference, Cancer Nursing, vol. 29(5), pp. 400-405 Street, R., Makoul, G., Arora, N., & Epstein, R. 2009, How does communication heal? Pathways linking clinician–patient communication to health outcomes, Patient Education and Counseling, vol. 74(3), pp. 295-301. Turk, D. & Melzack, R. 2010, Handbook of Pain Assessment, Third Edition, London: Guilford Press. Young, J., Horton, F., & Davidhizar, R. 2005, Nursing attitudes and beliefs in pain assessment and management, Issues and Innovations in nursing practice, pp. 412-419 Read More