Management Skills in Adult Nursing - Essay Example

Introduction Management is an important aspect of effective health care delivery and one especially important element is the discharge planning of patients and their handover (Haggerty, et.al., 2003). Reflective practice is also one of the most important means by which the nursing practice can be improved and the performance of each nurse can be self-assessed and evaluated for possible improvements (Wang, et.al., 2010). This essay will reflect on a scenario which relates to a management issue of a patient who is about to be discharged. This is a scenario which was significantly relevant to me because it contained elements which I did not encounter before and which I struggled to handle. In order to improve my practice, I will reflect on this incident, and address issues of effective discharge planning, communication, and handover. The themes I will consider for this topic would follow the various questions raised by Johns’ reflective model. This model is meant to be implemented by sharing with fellow practitioners or with a mentor, which then transforms the learning to a faster pace. Johns’ model emphasizes the value of experienced knowledge as well as the power of the practitioner to access and implement information which has been secured via empirical processes (Grech, 2004). More specific themes on discharge planning, communication, and handover shall be incorporated into the text. The critical and analytical aspects of this discussion shall flow from the reflective process, with an evaluation of the specific actions based on standards of the practice (Callara, 2008). Description of incident The scenario under evaluation involves the discharge of Patient X, a 65 year old male patient who recently underwent hip hemiarthroplasty surgery. During the discharge planning process, there were several orders which I was not sure how to implement. One of the discharge orders indicated that I needed to refer the patient to the rehabilitation ward for physiotherapy and occupational therapy, and that I needed to refer the patient to a physiotherapist and an occupational therapist, and arrange future schedules for therapy. Discharge orders also indicated that I needed to recommend an appropriate health and diet plan for the patient. Health and diet plans for elderly patients, especially those who have recently suffered hip fractures must be established because these elderly patients are prone to possible re-injury (Beaupre, et.al., 2005). Beaupre, et.al., (2005) discussed that the hip fracture would likely limit the mobility or elderly patients, making them anxious to move about for fear of falling again. Sometimes, where no appropriate safety measures are put in place, falls may happen again. The goal of nurses would be to prevent any re-injuries and to ensure that the patients are equipped with the right tools to manage their condition. There were two major challenges I had to overcome carrying out the discharge orders. First issue was that before the incident, I have never communicated with the rehabilitation ward, and secondly, I was not sure what diet plan to recommend for an elderly male who has suffered a recent hip fracture. The key issues within this description I needed to pay attention to was on the issue of communication with other health professionals, as well as the diet plan for elderly patients with a recent fracture (Kripalani, et.al., 2007). These are all parts of the discharge plan which I knew was essential to my function as a nurse and which I knew I needed to be familiar with. These were also aspects of the practice which I did not have much experience or confidence in. I was afraid to make mistakes and I was not sure what the hospital protocol was in terms of patient referrals, especially as far as the rehabilitation ward and the physical/occupational therapists were concerned. My mentor however was giving me tips on how to carry out the process. She told me to review the discharge protocol of the unit, and if I had any further questions, we could ask the experienced senior nurse. In the end, I asked an experienced nurse about how to refer the patient to the rehabilitation ward. Acton (2011) discussed this as a favourable option for inexperienced nurses, consulting with older and more experienced nurses in order to implement the best possible options for their patients even with their doubts and inexperience. I was also immediately prompted to review the recommended diet plan for elderly patients, especially for those with recent fractures, and for patients with limited mobility. Reflection During the process, I believe I was trying to achieve for the patient an effective transition from the hospital care to home/community care. Coleman, et.al., (2005) discusses how this transition process has a significant implication on the coping mechanisms of patients. In the end, this transition would likely decide how well the patient’s recovery would be. I acted as I did because I had limited knowledge about the discharge orders. I knew I had to take the initiative to add to my knowledge and still effectively carry out the order. Based on my actions, the patient was referred to a physiotherapist and occupational therapist that could help him recover from his injury. I was also able to help the family and the patient in establishing a diet plan they could follow, especially in the days following the patient’s surgery. Avenell and Handoll (2004) provide support for such diet plan as this plan can improve his recovery, reduce incidents of constipation (as is common among elderly and patients with limited mobility), and improve his general health (Avenell and Handoll, 2004). My actions also benefitted me because it allowed me to learn from other more experienced nurses, to be guided by my mentor, and it helped provide guidance for future patients about to be discharged. I learned that at all times, I needed to be prepared to provide particular patients with specific information they could use during their discharge. Some patients being discharged may have had a myocardial infarction and therefore must watch their diet and take maintenance medications (Avenell and Handoll, 2004). Coleman, et.al., (2006) discusses that while the patient is admitted, it is important to already educate them about their disease or affliction and the precautions they need to take in order to prevent any future health issues and to speed up their recovery. Initially, I was ill at ease and was not confident in handling the discharge process. However, as soon as I was able to gain information from my mentor and another experienced nurse, I was able to gain confidence in how to handle the process. Sheldon (2007) discussed the importance of exuding confidence in one’s practice, a confidence which the patients can also rely on and gain confident in. As soon as I was able to exude confidence, the patient then felt more confident in asking me about his diet plan and in asking me what his schedule would be with his therapists. By asking clarifications about the discharge plan, I could sense that he trusted me and what I was advising him. Influencing factors Various factors impacted on my decision-making and actions. Internal factors included my current knowledge about discharge planning. As part of my nursing academic training, we were taught about the discharge planning process, including its elements and the importance of health education for patients about to be discharged. Coleman et.al., (2004) have already discussed that the discharge planning process is part of nursing education, and these nurses are taught the theoretical bases of discharge planning. My nursing education guided me in deciding to review an appropriate diet plan for the patient. Moreover, the normal practice in the hospital also guided me in the decision-making process. As I inquired from the senior nurses, I was able to gain sufficient information on the practice of referrals to other departments and to other health professionals. Anxiety in my first time implementing a discharge plan also influenced my decision and actions. It prompted me to ask my mentor and the senior nurses about the proper protocol for referrals and to review the books on an appropriate diet plan for elderly patients who are recovering from hip replacement surgery. Forster et.al., (2003) discussed how discharge can often present its own traumatic results for the patient, especially if no effective discharge process is implemented. Since the patient and his family were also anxious about being discharged from the hospital, I knew that I had to help them in any way I can. I wanted to help them facilitate the referral process and make sure that the patient would receive immediate rehabilitation therapy in order to facilitate his recovery. This is supported by Halasyamani, et.al., (2006) who declare that immediate rehabilitation and physical therapy is crucial to hip surgery patients in order for them to immediately regain mobility and in order to prevent their muscles from being compromised. External factors which influenced my decision included the books which I was able to read on diet plans. Such books have indicated a recommended diet plan for elderly patients with recent fractures and those with limited mobility (Carpenito-Moyet, 2005). These books recommended a high-fibre, a high-calcium, and a high protein diet for these patients in order to prevent constipation, a common issue for patients with limited mobility (Tidermark, et.al., 2004). The patient’s surgery limited his mobility and placed him at risk for developing constipation and pressure ulcers. Baumgarten, et.al. (2003) discussed that this is one of the common challenges which elderly patients with hip fractures encounter. The high-fibre diet can help prevent the constipation and ensure appropriate nutrition for the patient (Baumgarten, et.al., 2003). Hospital policies also influenced me in my decision as the policies indicated that I had to communicate with the rehabilitation ward in order to refer the patient, allowing them to check for available schedules when the patient can be set for therapy sessions (John-Baptiste, et.al., 2002). The sources of knowledge which influenced my decision making and actions included my communication with the senior staff nurse. My communication with my mentor and the senior nurse helped guide me in the direction I needed to go. I also gained more confidence in my decision because I knew that it was the usual practice for the hospital (Cooper and Fishman, 2003). My previous knowledge as well as the knowledge gained from the books also influenced my decision-making and actions because these provided a theoretical foundation for these actions (White, et.al., 2010). Moreover, the books provided primary evidence which could be used to support any intervention. Alternative strategies I could have dealt better with the situation. Knowing the proper information about the patient and about his possible discharge plan is an important aspect which I should have been familiar with even before the patient was to be discharged (Kelly, 2011). In caring for a patient, he already has needs which have to be anticipated. I knew that he would be discharged eventually, so I should have reviewed the possible discharge plan, especially in relation to his needs and rehabilitation therapy. I could have discussed these plans with the patient ahead of time in order for them to be more prepared in entering rehabilitation therapy. This was discussed by Kongstveldt (2012) when the author discussed the importance of being prepared and of securing arrangements before the patient is to be discharge. Moreover, discussing the next step to their recovery ahead of time would also have eased their anxiety during discharge. I also could have read ahead of time and prepared a diet plan for the patient before the discharge. As pointed out by Bern-Klug (2010), this plan would have been discussed at length with the patient, instead of during the last minutes of their stay in the hospital. This early discussion would have encouraged questions from the patient, ensuring a thorough and detailed discussion of the appropriate nutritional supplementation. These alternative strategies would have reduced the patient’s anxiety. Atkins (2008) established that entering rehabilitation can often make patients uncomfortable, stressed, and anxious. Preparing a diet plan ahead of time would help provide a more comfortable and detailed process for the patient. The patient and the nurse can even plan the diet together, depending on the former’s appropriate preferences. Day and colleagues (2009) point out that considering patient preferences can ease the patient’s transition from the hospital, where he has been efficiently cared for by the health professionals, to the home/community setting, where he would have limited medical care and supervision. As the patient is given the appropriate tools he needs to safely and efficiently recover from his surgery, he would also be less anxious about his impending hospital discharge. Learning Understanding this experience based on past experience and future practice brings to mind the importance of being prepared. Sjolander, et.al., (2011) further supported the fact that preparation is the primary key to efficient health care practice and recovering for patients. I can make sense of this experience by admitting that there are aspects of my health care delivery which needs improvement. Past experience has taught me the importance of communication within the health care practice. Cornish, et.al., (2005) also established that in the discharge planning, building strong communication ties with other health professionals also helps secure efficient nursing care, prevents miscommunication, and promotes the timely delivery of health services. This makes discharge planning one of the main skills which nurses have to master Now I feel that this experience has shown me the gaps in my practice and my health care knowledge. Daniels (2004) pointed out that having the right tools to handle all scenarios in the medical practice makes for an efficient health care delivery. As it was, my knowledge and techniques were limited and I was filled with anxiety and doubt about the situation. I feel however that this experience has armed me with the proper tools to be a more efficient nurse. These tools, as discussed by Swansburg (2002) can be used in the future, not just in discharge planning, but also in implementing holistic patient care (Swansburg, 2002). This experience changed my way of knowing as it has also built aspects of my knowledge which I needed to improve on (Jacobson, 2002). It has changed my perspective of the nursing practice in terms of the reliability which each nurse has to display with each patient. The importance of having a reliable nurse was also recognized as a crucial element of efficient nursing practice. In the study by Van Walvaren, et.al., (2004), they concluded that being a reliable nurse covers various stages of the nursing care, including the patient’s admission and extending on to the patient’s discharge. The follow-up process for patients is also an essential aspect of nursing care because it helps ensure the patient’s recovery and it prevents any possible re-injury or relapse (Lowenthal, 2006). Analysis The readings and references included in this text provide support for my actions during the incident. They also emphasize the importance of communication, discharge planning, and health education for patients about to be discharged, as well as the role of the nurse in ensuring the efficient application of these processes. The readings provide support to my actions, especially in terms of consulting with a senior nurse in order to guide my decision-making on interventions which I was not adequately informed about. DeWalt, et.al., (2004) discusses that this is part of the efficient communication processes among nurses. Being able to seek advice from other more senior nurses helps graduate and transition nurses. Makaryus (2005) also emphasized that most especially in instances when the younger and less experienced nurses are not too sure about their actions and about the hospital protocols or standards of practice, the guidance of the senior nurses is an important means of ensuring the continuity as well as the efficacy of the nursing care. The ability of the nurses to communicate efficiently and openly with each other is also an important aspect of the nursing practice. It makes for a less stressful and a more supportive environment. The learning process is also two-way, with both the senior and the new younger nurses learning new and different things from each other (Makaryus, 2005). The senior nurses are able to share skills they gained through years of practice, while the younger and newer nurses can also share new and updated knowledge and skills they were able to learn in school. Communicating with the senior nurse at first was a nerve-wracking experience, however, I was more nervous about making a mistake, so I braved through my nerves and asked the senior nurse for guidance. The senior nurse was more than willing to help me, so it made the process easier for me. Communication with other health professionals is vital to health care delivery. In this case, communicating with the rehabilitation ward was essential to the patient’s care. Fox (2008) pointed out that coordinating a schedule for a patient’s physiotherapy and occupational therapy sessions necessitates communication with the rehabilitation ward. The discharge notes indicated that the patient had to be referred to the rehabilitation ward and scheduled with a physiotherapist and an occupational therapist of the patient’s choosing. Fox (2008) advises that making such schedules with other health professionals is a part of the nursing practice. Although I knew that this was a part of the nursing practice, it was still a new and unfamiliar duty to me. It was my first time to have any dealings with the rehabilitation ward as most of my dealings up to that point were with other doctors, other nurses, with dieticians, and with pharmacists. I was primarily concerned about protocol and whether or not I was following the appropriate procedures in the referral and communication process with other health professionals. Papers indicate that interprofessional communication has to be developed as an essential part of the health care practice (Cornish, et.al., 2004). Cornish, et.al., 2004) also highlights that interprofessional communication includes the act of coordinating care with other departments and health professionals, with the end goal of preventing redundancy in services, preventing errors in the medical care, and establishing the best and most efficient intervention for the patient. Conflicts in health interventions are often unveiled in interprofessional communication. The assessment of each health professional is established based on their expertise. The doctor would usually establish a diagnosis and treatment for the patient; the nurse would deliver bedside care, administer medications, carry out doctor’s orders, and monitor the patient’s vital signs; and pharmacists dispense medications and discuss adverse effects and interactions of patient medications (Oondasan and Reeves, 2005). Other health professionals have various functions as well. In the case of this patient, the physiotherapist has the duty to assist the patient in recovering his mobility and muscle functions. The occupational therapist has the duty of re-establishing functionality for the patient, and teaching him how to adjust and make functional adaptations based on his limited mobility (Wright and Sugarman, 2009). The referral was not very difficult, because the therapists were more than happy to receive the patient. They reviewed the patient’s history with me, including the current doctor’s orders as well as the patient’s needs and limitations. Based on my readings on healthy diet plans for elderly patients, I was able to discover that I need some improvements in my practice on such aspect of nursing care. Although I had the working knowledge on the appropriate diet plans for elderly and for patients with recent hip surgeries, I was not thoroughly confident in such knowledge. Webb (2011) recommends the use of primary evidence in the practice. Using the books in the hospital helped provide me with immediate knowledge that was essential to the establishment of an effective diet plan. There were information in the books which I was not aware of and reviewing such data allowed me to understand the condition of the patient and his diet needs (Levin and Feldman, 2006). Patient education was an important aspect in the patient’s care, especially in terms of adding to the patient’s knowledge about their disease and about the life changes they need to make. Patient education is supported by the NMC competencies as it declares that nurses “must support and promote the health, well-being, rights, and dignity of people, groups, communities, and populations”. Synthesis The critical reflection above indicates important aspects of my nursing practice and my future development. I was able to understand that I needed to improve my skills (planning, referral, and communication) in relation to the discharge of patients; in other words, I do not have yet the necessary expertise in effectively discharging patients. I need more experience in carrying out these procedures, especially experience based on different diseases and needs of patients. This was also emphasised by Alano (2002) when he concluded that experience is still the best teacher and building on such experience can eventually improve the delivery of health services (Alano, 2002). The reflection does indicate however, that I do have the basic knowledge in discharge planning, and that I can adequately carry out the procedure, however, there are specific details and aspects of the planning which I need to be familiar with. Feedback from the senior nurse I consulted indicated that I was respectful, polite, and eager to learn about the nursing practice. She also said that with more experience, I would be able to gain better instincts in nursing. I wish to raise the fact that maintaining interprofessional communication can help the health professionals gain significant progress in efficient patient care. Beaupre, et.al., (2005) discusses that interprofessional care can help the health professionals collaborate with each other and eventually secure a stronger and more effective delivery of health services. Where the nurses and the rehabilitation therapists, as well as the patient’s attending physician, work with each other, they can establish a recovery plan for the patient, one which can help him regain his functions, his mobility, as well as his muscle strength. In the communication process, there is also a need to open channels of communication among the different professions, to improve skills like: speaking clearly, politely, and respectfully to each other. In other words rapport needs to be built among the different health professionals. There are things which I would do differently in the future. Primarily, I would be more engaged in the preparation of the discharge plan for specific patients. Moreover, I would not wait for a patient’s last day in the hospital before I review his possible discharge plan. Foust (2007) supports the early preparation of interventions. The immediate discharge of patients is also important in preventing any further stress to the patient. Early discharge also frees hospital beds for other patients and helps in the continuity of patient care. Such early preparation allows the patients time to understand the lessons that are being imparted to them. I would include the family in the discharge plan, especially since they would usually be tasked with caring for the patient at home. Including the family and other caregivers in the health education secures the continuity of care, as discussed by Tomura (2011). The discussion with the family would include medication intake, patient exercises, and schedules of follow-up check-up and rehabilitation therapies (Walker, et.al., 2007). Conclusion I would definitely however ask the senior nurse again for guidance on hospital protocol on referral as well as any other information she can share about the nursing practice. I would also review my knowledge and refresh the information I know using books or journals. Books are primary sources of information which can be utilised to support interventions and more importantly, these, along with journal articles, help support information which can be applied for evidence-based practice. These books and journals can supplement my current knowledge and are also valuable sources of data which can then be applied in the clinical setting. Such data, along with the clinical and practical experience of nurses can help support a more holistic as well as an evidence-based practice. There are still improvements which I need to implement in my practice, however, I am confident that I am in the right path. By gaining more experience, I am sure that I can also make the best decisions with the patients, for the nursing practice, and for the health care system in general. 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