Nursing Crisis Management - Case Study Example

Crisis Management October 9, Crisis Management Introduction One of the roles of a nurse is to manage a crisis when a patient is admitted in a deplorable state. In the case of a crisis the nurse or the doctor in charge has to make a quick action on the way to handle the crisis which may be the line between the life of the patient and losing him or her. The nature of the patient’s symptoms determines the way one will handle the situation and the way to help the patient who may be affected physically and also emotionally (Jankowski, Sampliner, Kerr, & Fong, 2009). The nurse should always try to give hope to the patient no matter how critical the situation is Sometimes the case is not so clear and so it is upon the doctor and the nurses in charge to decide how well to manage the crisis as they try to establish the best way to handle the situation. This paper will address the way to handle a crisis referring to a common case where the creation of an intestinal stoma is important to divert the intestinal contents and act as a way of managing the symptoms that the patient is having. The patient in reference has a past medical history of hypertension and so it is tricky on how to make her understand the nature of the case that the doctors are handling. Informing her that she may need a surgery should be done in a well-informed manner to avoid running into more complications which are tougher to manage. Her new symptoms makes it important to create a stoma in order to divert the enteric contents and make it possible to surgically manage the gastroenterologic symptoms (Clear Passage Physical Therapy, n.d). Developing a Crisis Management Plan Once the patient was admitted the first thing we did as it’s the routine is to assess her condition and inquire on her past medical history. That is important in establishing the best way to handle her and avoid complicating the case even more. Emma is 54 years old and she works in a retail shop. We establish that she has a past medical history of hypertension. She is both socially and physically capable and independent which is important to establish whether she may be having fears on the way she will be making a living if she is subjected to a treatment or a management plan that will affect her physically. The symptoms she is having which include nausea and vomiting leads to the conclusion that this is an emergency case and so she has to be admitted to an acute surgical unit through the acute and emergency department due to abdominal obstruction. Other symptoms which are used to come up with the decision include the fresh rectal bleeding with associated altered bowel habit which she had been having for a week. To confirm the case that she could be having an abdominal obstruction, it is important to view the condition and the orientation of her intestines. This is done be performing X-rays and computed tomography scans (Jankowski et. al. 2009). The two are important to confirm cases of abdominal obstruction before resolving to do a surgery on the patient. The surgeons conclude that the best way to manage her case is by carrying out an abdominal explorative surgery on the patient. To perform any surgery it is required to give the patient all the required information which include the complications that may arise from the procedure (Shelba, 2009). This pre-operative information helps the patient to ask any questions that they may be having and put the nurse or surgeon in a position to advise them accordingly. It is also important to do a psychoanalysis therapy to establish how ready the patient is and whether they will be able to handle the operation. In this particular case, Emma questions the surgeons on the application of an alternative management plan that would not involve the introduction of a stoma on her as she felt that this would greatly hamper her day to day activities. Remember she is an independent woman and so she is wary that if anything goes wrong she may be forced to rely on other people to get a living or for any support that she may need. She is advised that the chances of her getting a stoma were low and that the information she was being given was compulsory for any patient who was admitted in the hospital having abdominal obstruction. She assents to having the surgery and in the procedure the surgeons find it important to form a stoma to divert the intestinal contents. She however recovers well and though her treatment starts in an intensive treatment unit, she is later transferred into the surgical unit as she responds positively to the treatment. The aim of any management plan is to help the patient recover and regain his or her lost health. To accomplish this on our patient we had to pool together the knowledge on managing abdominal obstruction and assessing her psychological status guide her accordingly before doing the surgery which was meant to address the crisis. Effects of Stoma Formation on this Individual According to the questions that arise that arise from the patient she is psychologically not prepared to have a stoma formed on her. Though forming stomas is quite common, there are many factors that need to be considered before it is done. These main one is psychological effect on the patient. A stoma is resulted to as a crisis management plan when all other methods cannot work or when the doctors feel that it will be the best to make the patient recover (Ludmir, 1989). Emma expressed her concerns when the surgeon was giving her the pre-operative information and psychoanalysis therapy on the possibility of a stoma formation to manage her condition. She feels that the stoma formation will greatly affect her daily life and she is not sure she will be able to care for herself. This shows her state psychologically and the surgeon is fast to reassure her that not all patients who undergo such a surgery end up having stomas formed to clear their intestinal contents. She reluctantly assents to the surgery. After the surgery she is assisted to recuperate by a stoma specialist who is meant to give her the information she may need pertaining the stoma and reassure her that she will still be able to recover and live a good life. Initially she had lived a self-reliant life where she is a retail shop manager. Having a stoma will affect her social life and she may not be able to interact with people in the manner she was used to. Other complications such as fistula that may arise also impact greatly on the self-esteem of the patient and she must be fearing (Fraser Health, n.d). The biological complications that can come with stoma formation include improper site selection which can lead to the stoma being in an unpleasant location or an area affecting other body processes (David & Beck, 2008). It has been seen in certain cases where stoma formation has led to more serious complications such as fistula and peristomal infection if the surgeon was not so keen while performing it. Others include vascular compromise which can cause other related complications to the patient. Surgical revision where the patient may be required to undergo another surgery is also common though corrective measures are used to avoid it (Husain & Cataldo, 2008). Weakened muscles which may result from the operation leads to impairment of the patient’s physical movement and this can result to her spending much more time in hospital. The operation is also costly especially when the patient is supposed to eat a specified diet so as to help in her recovery. Emma may be worrying that after the whole process she may not be in a position to cater for her financial needs rendering her to be an invalid in the society. She is also supposed to be on analgesics to relieve pain which also complicates the case and offers her more psychological discomfort. Due to the complications and effects arising from the stoma formation, it is therefore important to put her under the care of a specialist who will handle her as she recovers and also guide her on how to live once she is out of hospital. It is tough for new patients to adapt to the new life once a stoma has been formed on their body as a way of managing their condition. One of the major problems is adapting to the new life. In our case, Emma is a retail manager in a shop so she is used to dealing with customers on a daily basis. After the operation she may be forced to stay at home as she will need some time to recover. She is also anxious on whether she will be able to lead her independent life as she was used to. When the surgeon is giving her the pre-operative information needed before the operation, she expresses her fear on the same. She seems reluctant to cope with the crisis and although she is put under the care of a specialised personnel she may need more time to fully recover. It is important to make her understand the importance of the operation as well as giving her emotional support so that it enhances her recovery and adapting to the new life. This calls for a joint effort between the hospital personnel and her relatives. It is therefore important to brief them on her condition before she is discharged to deal with her in the right way. The patient’s is fearing that her self-image will be greatly affected if she undergoes the stoma formation as a way of addressing her problem. She is therefore appealing with the surgeon to know whether that is the only way to handle the problem. This is the kind of fear that patients have when it involves such kind of cases that can affect their lives once the operation is complete. The members of the nursing team have an important responsibility in reconciling the person with her relatives and reassure her that she will be able to live a normal life amid the fears (Hayanga, Bass-Wilkins & Bulkley, 2005). Management of the Patient and Crisis As discussed earlier in the discussion, the way the nurses manage a crisis marks the difference between the patient’s recovery or deterioration (Hudson, 2010). In this specific case, the patient comes complaining of nausea and vomiting. She is immediately admitted to an acute surgical unit. Determining the cause of the problem is important in any given case (Nikki, 2012). In this case, the nurses are able to identify that the patient is suffering from. Since she is reported to be having fresh rectal bleeding and vomiting which are characteristic of abdominal obstruction which are symptoms of abdominal obstruction (Shah, Subedi, & Maharjan, 2009. The doctors could also use rectal-sigmoid stents to manage the same (Lamah, Mathur, Blake, & Swift, 1998) The medical investigations carried on her show the need to form a stoma to function in emptying her intestinal contents. A naso-gastric tube was inserted to drain her stomach contents and prevent more food materials moving down to the intestines. This is important if the patient is to undergo a surgery especially on her abdomen (Helyer & Alexandra, 2008. An abdominal explorative surgery is to be done on her. The patient needs to be given the important information and psychological readiness before the operation is done (American Dietetic Association, 2009). The surgeon give her all the preoperative information given before conducting the surgery and forming the stoma. After the surgery, she is retained in the intensive treatment unit to receive treatment before she is transferred to the acute surgical unit. Open surgery stoma formation was preferred to laparoscopic one due to the complications of the latter (Talal & Maher, 2006). This is done to enable a close observation of her condition and monitor the way she was fairing as she recovered. Her recovery was further monitored by the stoma care specialist nurse who assisted in supporting her following the surgery. The nurses therefore manage to manage the crisis in a good way and ensure that the patient is recuperating in a good manner. Total Parenteral Nutrition TPN is often used in cases where it is not advised for the patient to take food orally or the patient is too week to feed. It involves the use of a needle or a catheter that is injected into the vein and the TPN allowed to drip for about 11 hours. The Total Parenteral Nutrition often includes a combination of body requirements such as energy giving nutrients, proteins and electrolytes which are essential in the recovering of the patient (Wilmore, Groff, Dudrick, & Bishop, 1969). Since Emma is suffering from bowel obstruction, it is not advisable to allow her continue eating as food will cause her more distress. After the surgery and stoma formation she is equally weak and to facilitate her recuperation it is advisable that TPN be administered. TPN has the advantage of reaching the blood stream fast and so in case of drug administration, it can be incorporated in the mixture (David & Thomas, 2013). The patient also recovers fast since the medical personnel is in a position to select what is fit for her. On the other hand, free fluids to light diet includes clear liquids that are given to a patient before a surgical operation or a test is done. They help maintain adequate hydration as well as providing the electrolytes needed in the body during the operation. Conclusion This is an example of a crisis management and the importance of addressing a case in an informed way in the hospital. Nurses encounter many cases where they are supposed to handle patients who need special attention due to the sensitivity of the treatment that they are supposed to receive (Tzeng & Yin, 2006). Bowel obstruction cam also signify colonic stenting (Whelton, & Bhowmick, 2013). This therefore calls for specifity in handling such cases. An example is our case where the stoma formation has many known side effects which can make the patient not to lead a normal life after it is formed. This calls for a psychological therapy to prepare the patient psychologically before the operation (Registered Nurses Association of Ontario, 2006; Debra, Hanna, & Romana, 2007). 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