Nursing Diagnosis Application to Clinical Practice - Essay Example

?Reflective Practice Introduction Reflective practice has a great role in the field of nursing as it helps nurses to make sense of the various situations in their work life. This will result in improving their performance. In the opinion of Oelofsen (2012, p. 112), reflective practice can be called the practice of making sense of the events, situations, and actions which occur in the workplace. This reflection is very necessary in the busy day to day lives of practitioners in order to improve service quality (ibid.). The first reason, according to Somerville and Keeling (2004), is that in their busy work, nurses come across various deep-seated human needs and anxieties; and as a result, such events put a lot of emotional pressure on the lives of the nurses. Secondly, according to Taylor (2006), nurses are change agents. In other words, they should have the ability to influence other people to make positive changes. In such a situation, reflective practice enables nurses to look into how their own personality and approach influenced the outcome and to make necessary changes accordingly (ibid.). One can find the theoretical basis of this reflective practice in the adult learning theory of Kolb (1984). Admittedly, Kolb’s learning model consists of four elements: concrete experience, reflective observation, abstract conceptualisation, and active experimentation. This model gave birth to Honey and Mumford’s model. This model proposes four stages. The first stage is having an experience. It is followed by reviewing the experience, concluding from the experience, and planning the next step (Peter Honey and Alan Mumford’s learning styles, n.d.). Similarly, there is the work by educationist John Dewey (1933) who proposed the concept of reflective thought; and according to the scholar, this reflective thought consists of creating a sense of the problem, using observation of the situation to fully understand the situation, reaching a conclusion, and applying the decision in practice (cited in Rodgers, 2002). The model used in this reflection is Gibb’s model of reflection (1988). This model consists of various stages ranging from description of the problem, feelings, evaluation, analysis, conclusion, and action plan. The problem I am working as a nurse in an Accident and Emergency Department on permanent night shifts. As a nurse, it is usual for me to consider my past experiences for critical reflection. The following incident and the related reflection made me realise that I should have more belief in my own abilities and decisions in order to become an effective professional. That was a normal duty day and it was nearly 1 AM when a middle-aged person came with chest pain. As it was common, I started helping the person to undress and at the same time, I started recording various observations. As I talked to him, I understood that he came because he had severe central chest pain that night, which extended from the chest to the neck and left arm. Also, I noticed that he used to feel the same chest pain on his walk to his workplace and that this pain used to subside at rest. Though he had ECGs and investigations in the past, they revealed nothing. Based on the observation, I performed one more ECG, but there was nothing and the pain had subsided. Though I could find nothing wrong, I gave particular attention to his various features and background. The person was a regular smoker, overweight, and most importantly, he had a very stressful work life. It was learnt from the chat that he was a judge. It was at that time that the intern on duty came. I communicated all my observations including the patient’s history and background to the intern. However, to my dismay, I noticed that the intern was in no mood to listen to what I said and that she was not planning to give any particular attention to the patient. So, I moved to the duty medical registrar and reported the matter. However, to my utter surprise, the registrar, too, decided that there was nothing significant in my observation as the ECG had revealed that there was nothing wrong with the patient. She was planning to discharge the patient. However, I discussed with the registrar all the aspects of the case and pointed out that high status was unlikely to turn up at a public hospital emergency department if something was not wrong. It was possible for him to go to a major hospital and have better treatment. As a result of the discussion, the registrar decided to admit the patient to a cardiology ward. However, the patient was not examined by the registrar and was left in an unmonitored bed. The decision was that the patient would be reviewed by his own cardiologist next morning. As I came for the next night’s shift, I came to know that the patient had a severe cardiac arrest as a result of acute inferior myocardial infarction. It was learnt that the patient had experienced a crescendo angina which could lead to myocardial infarction. There was a bypass surgery after three weeks. This incident opened my eyes as I found a lot of issues involved in the matter. I found serious errors from the part of various people including me, the intern and the registrar. I decided to look deep into the issue so that I could understand the areas which required improvement in my career as a nurse. Feelings I was confident to the core as I recorded the history of the patient. However, as no problem was found in the ECG and investigation, I became a little confused. The doubt rose as I noticed the stressful profession the patient was in and also the odd time the patient decided to come to the hospital. Also, there was considerable contradiction between his high status and the hospital he decided to visit. Thus, admittedly, I was in a dilemma because the investigation revealed nothing that could show that he should be admitted, but the history and background called for caution. I was fully confident when I talked to the intern about the patient, but the lack of concern exhibited by the intern again put in trouble. However, I can say that I was determined to continue advocating the patient. It was because of this reason that I went to the registrar and discussed the criteria for admission. Evidently, I would have felt guilty if I had failed to get the patient admitted. However, the lack of concern exhibited by the registrar and the intern and their decision to totally stick to technical data and symptomology made me feel totally disappointed and confused. However, admittedly, I developed a lot of confidence in my ability nursing diagnosis through this incidence. Evaluation Firstly, it is necessary to apply critical theory in nursing in order to understand the way the communication between nurse and patient should take place. Admittedly, critical theory has various applications in the nursing field. It can be used to explain health problems and vulnerability to certain health problems through external social factors (Inger, 1988). Evidently, the patient in this case was a judge. Firstly, a judge has a highly reputed profession and secondly, it is a highly stressful job. Using critical theory, it is highly possible to reach the conclusion that there was a higher possibility of cardiac arrest. Secondly, the person of such a high social status has good social connections. So, it was extreme pain that made him come to such a small hospital at such an odd hour. So, this reason alone was sufficient to take the situation seriously. Moreover, the person had chest pain in the past though investigations revealed no issues. In addition, the person was overweight and was a smoker. Admittedly, this much of information was sufficient to reach the conclusion that the person required hospitalisation and monitoring. Supporting this view, the study by Wells (1995) points out that it is possible to use the critical theory in nursing in order to make wise discharge decisions. Admittedly, if this critical theory were used effectively, the intern and the registrar would not oppose the idea of admitting the patient and ignore the history and background of the patient. Another point is the importance of nursing diagnosis. According to the North American Nursing Diagnosis Association, it can be defined as the ‘clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable’ (Carpenito, 1977, p. 4). Evidently, this nursing diagnosis has an important role in selecting appropriate nursing intervention as is evident from this case. A good nursing diagnosis requires the practitioner to be highly careful. It involves various things such as an in-depth interview, physical assessment, and critical observation of the individual, family, and community (ibid.). Admittedly, in the given case, the nursing diagnosis was done effectively and the observations were conveyed to the intern and the registrar. Though ECG revealed no problems, the patient’s context of life, role in society, profession, lifestyle, and history revealed that there was the need for caution and care. Another point to be admitted here is the functioning of a health care team and communication. As it is noted by various scholars, it is a common issue in the medical profession that nurses are often neglected in cases of decision-making (Coonan, 2011). As Nemeth points out, communication failure is one of the most common causes of healthcare accidents. Also, the scholar points out that medical care requires a lot of cognitive work because it requires proper identification of resource availability, resource allocation, prediction of future events, speculation about the best action, discussion to reach common consensus, and trade-off decisions. However, in the present case, it is seen that the registrar and the intern miserably failed to understand and acknowledge the importance of nursing diagnosis and communication. Had these people acknowledged the diagnosis I made and had they listened to what I wanted to suggest, this situation could have been avoided. Analysis From the evaluation, a number of factors become evident. First of all, one can see that in the case of this Accident and Emergency Response Unit, the management was less demographic in nature. In other words, the members had a little role in the decision-making process. If there was a democratic setting, the other members would have listened to what I had observed in nursing diagnosis. However, it was seen that the intern and the registrar wanted to ignore the important points I elaborated. The second point is that there was a degree of conflict that existed in the department. As the conflict theory points out, there was a preexisting condition that made the intern ignore the diagnosis made by the nurse. In other words, the nurse wanted to have her diagnosis approved as she found it highly valuable for the welfare of the patient, but the intern found it unnecessary to listen to the same as the regulating mechanisms did not require the same. In addition, one has to observe that the intern’s attitude or personality trait, too, had a role in the issue. Moreover, the hostility from the part of the intern was rather a ‘felt conflict’. In order to overcome this problem, all the members in the healthcare team should accept the fact that effective healthcare teams require effective team members (Leggat, 2007). According to the scholar, the skills required for a team are ability to influence, analysis of data, conflict management, decision-making, leadership, listening, meeting management, monitoring and evaluation, motivation of others, negotiation, peer counseling, performance management, planning, provision of feedback, self-management, time management, verbal communication, and written communication (ibid.). In the present case, it can be seen that the team lacked many of these qualities. First of all, there was no effective analysis of data as it is evident that the data from nursing diagnosis was largely ignored. Secondly, there was no element of listening because both the intern and the registrar decided to ignore the suggestions made by the nurse. Thirdly, there was no motivation of others. When the nurse reported the concerns, the intern exhibited a totally hostile attitude. Finally there was less verbal communication as is evident from the fact that the intern and the registrar were not fully ready to acknowledge the observations made by the nurse. Conclusion From the reflection, it becomes evident that I need to improve the confidence in my own nursing diagnosis and my own experience in diagnostic reasoning. Admittedly, the information I collected from the nurse was sufficient to reach the decision that the patient required admission and proper treatment. Moreover, it is necessary for the whole department to accept patients as a whole person, not just the symptom. Totally depending on symptomology and ignoring the history and background of the patient can have a negative impact on the quality of the care provided. Thirdly, nursing diagnosis has a very vital role in deciding the appropriate nursing intervention. So, it becomes evident that the observation I made was accurate and vital for taking appropriate decisions. The whole team should accept this. Moreover, the whole department has to go a long way to function effectively as a team. As is seen, the team lacks proper communication and listening, and there is no participative decision-making. Action plan This incident gave me a lot of confidence in my own ‘gut feeling’ which I developed over my years of nursing experience. In addition, it developed my confidence in the accuracy and importance of nursing diagnosis in medical intervention. This will make me function more effectively and confidently while making nursing diagnosis in future. Secondly, it will help both me and my department in identifying the role of all members in a team and the need to communicate with and listen to all while making decisions. References Adult learning theory. Skillsforcare. [Online] Available at: http://www.skillsforcare.org.uk/socialwork/l_and_m_framework/Adultlearningtheory.aspx [Accessed 26 Jan 2013]. Carpenito, L. J., 1977. Nursing diagnosis application to clinical practice. Philadelphia: Lippincott. Coonan, B., 2011. Why healthcare team communication is a matter of life and death. Tripple Pundit. [Online] Available at: http://www.triplepundit.com/2011/12/when-internal-communication-matter-life-death/ [Accessed 26 Jan 2013]. Inger, H. M., 1998. Critical theory: a foundation for the development of nursing theories, Research and Theory for Nursing Practice, 2 (3), p. 225. Leggat, S. G., 2007. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health. [Online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800844/ [Accessed 26 Jan 2013]. Nemeth, C. P., n.d. The context for improving healthcare team communication. [Online] Available at: http://www.ctlab.org/documents/Chapter%201%20-%20Improving%20Healthcare%20Team%20Communication.pdf [Accessed 26 Jan 2013]. Oelofsen, N., 2012. Developing reflective practice: a guide for health and social care students and practitioners. Banbury: Lantern Publishing. Peter Honey & Alan Mumford’s learning styles, n.d. [Online] Available at: http://www.warwickshire.gov.uk/corporate/manguid3.nsf/0/1cf33af4b893438c802570040050089b/$FILE/Learning%20Styles.pdf [Accessed 26 Jan 2013]. Rodgers, C., 2002. Defining reflection: another look at John Dewey and reflective thinking. Teachers’ College Record Volume, 104 (4), pp. 842-866. Somerville, M. and Keeling, J., 2004. A practical approach to promote reflective practice within nursing. Nursing Times, 100 (12), p. 42. Taylor, B., 2006. Reflective practice: a guide for nurses and midwives. Maidenhead: Open University Press. Wells, D. L., 1995. The importance of critical theory to nursing: a description using research concerning discharge decision-making. Canadian Journal of Nursing Research, 27 (2), pp. 45-58. Read More