Adult nursing scenario - Essay Example

Appendix Action Flowchart Reassure Patient Using Language and Touch as Appropriate I I V Ensure Physiological and Psychological Comfort I I V Inform and Involve Patient by Listening and Responding Empathetically I I V Deliver Medication by Correct Method and Dosage I I V Consult with Colleagues and Review Progress with Patient and Team I I V Record Actions, Conversations and Outcomes Accurately I I V Contribute to Team Discussion on The Next Steps, Ensuring Patient Has Input I I V Ensure Patient Understands and is Comfortable with All Agreed Action and Review as Required I I V Consult and Enlist Other Services CONTENTS Scenario Description - Adult Nursing Overview of Reflective Process Essay Appendix 1 Appendix 2 References and Bibliography 1. Adult Nursing Scenario: Mrs. Taylor, 68 is admitted with a history of chronic obstructive pulmonary disease (COPD). She is breathless and anxious. She has limited mobility due to a painful left hip. What are the main issues here What is the nursing contribution designed to achieve Overview of the Reflective Process: The use of reflection to enhance learning experiences has for some time been advocated by the nursing profession. Some statements as follows will confirm this: 'Reflective practice has a useful contribution to make to developing a body of knowledge that informs nursing practice.' (Wilkinson 1999). On the other hand, Newell (1994) 'cautions that reflective practice 'lacks the rigour of empirical science...' but feels it can be used in conjunction with other learning methods and knowledge areas. Using the Reflective Cycle of G. Gibbs (1988) I will reflect on the learning and developmental needs identified in the scenario described. The six 'stopping points' provide a helpful personal insight and are followed, in order, throughout this essay. Description: When Mrs. Taylor was admitted in the condition earlier described, I was working with a senior colleague, a ward sister experienced in adult nursing. The patient was in pain, greatly distressed and with some cyanosis. She had been handling her condition at home with the help of oxygen and drug therapy, so her present state indicated that some triggers must have exacerbated the condition. These could be bronchitis, pneumonia, allergy or too many cigarettes. NICE Guideline (2004) conclude ' The disease is predominantly caused by smoking and nearly all sufferers are over 35.' 2. The painful left hip was another major cause for concern. We got her settled in bed, nebuliser mask on and bed head raised, promising pain relief for the hip. Feelings: I felt a sense of urgency and the need to get medication started to alleviate the symptoms. I felt concern for her physical well-being and some frustration that it could be helped 'at once.' When I observed how sister spoke softly and reassuringly to Mrs. Taylor, touching her hand and smoothing her forehead, I felt slightly ashamed. At sister's suggestion, Mrs. Taylor breathed more slowly and her anxiety diminished. I then sat with her, asking how she was feeling, really listening carefully to her responses. 'Attending is the act of really focusing on the person who needs help. We need to make ourselves deliberately aware of what the other person is saying and of what he or she is trying to tell us.' Morrison and Burnard (1991) I thought how much more difficult this would be with a child or mentally disabled adult, recognising the need for a more psychological approach, more reassurances and a 'person-focused' nursing style. Adults like Mrs. Taylor appear more able to contribute to their own improvement, being both knowledgeable and aware. I thought that no matter which nursing domain I was involved in, I would recognise that the same requirements of reassurance, administration of medication and accurate record keeping would apply. I would also adhere to the principles of respect for any cultural or social background. If necessary, I would call on family members or interpreters or any relevant help, but seek to involve the patient directly. Thinking of these areas, I realised that some knowledge of legislation would be beneficial e.g. Children's Act, Race Relations Act, Sex Discrimination Act and the recent laws on Protection of Vulnerable Adults. I felt worried about the hip and from my reading, I knew that long term use of steroids can decrease bone density and at 68, Mrs. Taylor may have osteoporosis or a possible fracture. 'Unfortunately, the process that leads to established osteoporosis is asymptomatic and the condition usually presents only after bone fracture.' (Smith 2000) 3. Evaluation: The 'good' thing I learned was how verbal and tactile reassurances can reduce anxiety and so reduce the other symptoms. Because her psychological needs were addressed, Mrs. Taylor responded more quickly to physiological treatments. By talking and being listened to, she felt less helpless and had more power. This made me see how the patient knows best how they feel, no matter which background they stem from. Nurses would benefit from recognising this early on and that a patient can contribute positively to their treatment and recovery. The 'bad' part was my impatience and concentration on the physical aspects of the patient's condition. The pain, possible infection, potential fracture, were at the forefront of my mind. I saw them as priority rather than the whole picture, the person herself. Analysis: To make sense of it, I consider I was more involved with practice as opposed to skills. Thanks to the guidance and example of my senior colleague, I learned to step back and take stock, to deal with 'first things first'. My urgent desire to help with medication etc. could have had detrimental affects on Mrs. Taylor, frightening her even. I saw how quickly caring for her psychological needs brought results. She gave me information on her condition, her feelings and lifestyle. I stayed with her and was able to reach empathy simply by listening. She told how she had hit her hip on a table a few days earlier, but waited till the home help came today. The GP was called and had her admitted. With no family and few visitors, and a fierce independence, Mrs. Taylor could do with help. It was just by spending a little time and listening properly that I gathered so much and now think this action was as valuable in helping her as was the medication. When she was drowsy and relaxed, I wrote up my records, including all she had told me and assured her I would keep coming to see her. I shared the information with sister and my colleagues. When asked what I would do next, I thought we should involve the orthopaedic team, take more bloods etc. Again, I was homing in on the physiological issues. Thinking again, I suggested we enlist the help of social services and others who could improve Mrs. Taylor's life outside hospital. ' The term shared care applies when: The responsibility for care of the patient is shared 4. between individuals or teams which are part of separate organizations.' (Pritchard & Pritchard 1994). Conclusion: The most important thing I could have done was to have 'seen' Mrs. Taylor as a person first, rather than a set of serious symptoms needing urgent treatment. Instead of rushing for the clinical and medical supports, I should have taken things more slowly and observed my senior colleague, and asked for her advice. As it was, I was fortunate to be able to establish a rapport with Mrs. Taylor, which allowed me to deliver better nursing care to her as a real person. The patient involvement is always to be sought, and I should have seen that. As well as this, I should have been more ready to consult with others in the team, not thinking it was all down to me to do it. Had I done so earlier, I would have been more useful and less panicked by the situation. Thinking time and seeking advice is what I need to be aware of in future. Action Plan: By this reflection, I have learned that to apply 'caring' in a more communication-based, person-focused way is better for the patient in the long run. In future, that will be my approach, recognising that the whole point is putting the patient first, and not the symptoms. I will be more 'holistic' in my thinking and consult more readily with others. In particular, I will always, where possible, involve the patient in such consultations; after all they know best how they feel. This is the person's right, to contribute and have input to their own welfare. By recognising and applying these principles, in any domain of nursing, I hope to become a skilled and caring professional. According to Morrison and Burnard (1991), 'Why should nurses care This question can be addressed in several ways, but there are three important aspects that underpin the nurse's need to care for other people. These are the contractual aspect, the ethical aspect and the spiritual aspect of caring for others who are ill.' Knowing more about these and applying them will also contribute to my development as a nurse. Reference List and Bibliography AGCAS website - http://www.prospectsac.uk./links/occupationspage(s) Adult Nurse, Learning Disability Nurse, Mental Health Nurse and Paediatric Nurse. Retrieved 26 March 2006 Chambers, R. et al, 2001. Cardiovascular Disease Matters in Primary Care Radcliffe Medical Press Ltd. UK Dougherty, L. and Lister, S. 2004. The Royal Marsden Hospital of Clinical Nursing Procedures 6th Edn. Blackwell Science. Oxford. Gibbs, G., 1988. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford Further Education Unit, Oxford. Morrison, P., and Burnard, P., 1991 and 1997. Caring and Communicating. The Interpersonal Relationship in Nursing. Palgrave. Basingstoke and New York. National Institute for Clinical Excellence website - http://nice.org.uk/pdf/2004_010_launch.pdf Nice Guideline to Improve Care of Patients with Chronic Obstructive Pulmonary Disease 2004 Retrieved 26 March 2006. Newell, R., 1994. Reflection; art, science and pseudo-science. Editorial - Nurse Education Today, 14.2. Osteoporosis Foundation website - Position Statement- Recommendations for Enhancing the Care of Patients with Fragility Fractures. Retrieved from http://osteofound.org/health_professionals/pdf/aaos_position_statement.pdf. 26 March 2006 Patient UK website - Chronic Obstructive Pulmonary Disease. Retrieved from http://www.patient.co.uk/showdoc/23068705/ 26 March 2006. Pritchard, P. and Pritchard, J. 1994. Teamwork for Primary and Shared Care: A Practical Workbook. 2nd Edn. Oxford Medical Publications. Oxford. Smith, R. 2000. Disorders of the Skeleton. Chapter 19 Oxford Textbook of Medicine, Oxford University Press Walsh, M., 2000. Nursing Frontiers - Accountability and the Boundaries of Care. Butterworth Heinemann Oxford. Wilkinson, J. 1999. Definition of Reflective Practice. Hinchliffe, S. Ed. Directory of Nursing 17th Edn. Churchill Livingstone. Edinburgh. Woodham, A., and Dr. Peters, D. 1997 Encyclopedia of Complementary Medicine. Dorling Kindersley. London. Read More