Development of Clinical Practice - Essay Example

DEVELOPMENT OF CLINICAL PRACTICE Clinical practice has developed in recent years, indicating the development of the career that is nursing. The contribution of nurses in the hospital emergency rooms has come with increased responsibility, as emergency cases continue to increase in the society (Huber et al, 2010). It is a fact that the emergency room is a vital area of any hospital, and so all the medical practitioners in an emergency room have different vital functions that they perform. I have worked as a senior nurse in a hospital’s emergency department. I have also acquired experience over a period of 12 years working as a nurse in the accidents and emergency department in addition to a one-year experience serving in the intensive care unit. During my years of service I have assisted in the treatment of many emergency cases, with the most common of them being burns. This paper shall focus on a case study of a patient, a Mr. Kroos, who was a patient at my place of work. I was the nurse in charge of Mr. Kroos’ treatment at the hospital, and this paper shall highlight the care that has been accorded to this particular patient and his family since the day they were admitted to the hospital to the date of his transfer to another hospital( ampo & Lafferty, 2011). Case Study of a Burns Patient The patient used for this case study is Mr. John Kroos, a 27-year-old German national, was brought by the hospital ambulance to the hospital following an accident in which his gas cooker had exploded, causing burns to his body. Mr, Kroos was received at the hospital’s Accidents and Emergency Department with burn wounds. He had already received first aid from the medical officer who accompanied him in the ambulance(Tshudin, 2002). On arrival at the hospital he was still in critical condition, and was placed under my care. However, the hospital does not have a specialized burns unit. In case a burns patient arrives at the hospital, he is accorded first aid treatment before being taken to the nearest hospital with a specialized unit to deal with burns. The first thing I did to give Mr Kroos the care he needed was to check for signs of any injuries he may have incurred because of inhalation, and he had minor injuries in his throat. An examination by a bronchoscope revealed that his airway had some soot (Metrohealth, 2014). He also exhibited burns on his beard, and he had massive swelling on his face, especially around his chin and his nose. In order to clear his airway, he was promptly placed on intubation (Beerthuizen, Nieuwenhuis & Haas, 2007). Since he was awake, his nose and his throat were anaesthetized with Etacaine and he was sedated as soon as the ET tube was properly positioned (Kraatz & Linneman, 2007). After further examinations, it was determined that Mr Kroos had suffered third degree burns to his face and his upper body. His clothing and his jewellery were then removed. His burns were then brushed to remove the chemicals that had attached themselves to his skin, and then washed with water (Huber et al, 2010). This was done to reduce the pain that the patient was feeling. He was then covered with dry, clean sheets and prepared for a transfer to the nearest hospital that had a specialized unit to treat burns (Ringo & Chilonga, 2013). Roles of Nurses in the Emergency Room The Nurses and Midwifery Council is the body that regulates the practice of nursing. An Emergency room nurse is a registered nurse with adequate experience. This type of a nurse specializes in the provision of specialized treatment or critical medical care to either severely ill patients or those who are critically injured. ER nurses administer medication, take blood work, clean lacerations and insert IV’s in addition to assisting the physicians within and outside of the ER. These are just a few tasks that ER nurses have. One of the regulations of the NMC is that nurses have to work with the other medical practitioners in ensuring the patient gets the best medical care (NMCode, 2008). The emergency room is usually used by paramedics, emergency medical technicians, emergency medicine physician and the emergency room nurse. An ER nurse is expected to work in coordination with all people in the ER room, and as such, nurses have specific roles. The roles that nurses play in the emergency room are varied, depending on factors such as the extent to which the patient is injured, the mechanism of the injuries the patient has, co- morbidities and the age of the patient. In a scenario such as the one described above, the role of the nurse are, as indicated by the professional guidelines of the Nurses Midwifery Council, is complementary to the duties and responsibilities of other practitioners at the Emergency room(NMC Code, 2008). To begin with, the nurse is expected to be responsible for the stabilization of the patient. This includes checking the vital signs of the patient to make sure that the patient has normal vital signs, such as the heartbeat is at a normal rate and that their blood pressure remains within the safety range (Metrohealth, 2014). In the case of Mr Kroos, he was made stable from the point of reception and the vitals were checked every other moment before his transfer. Any changes in the vital signs were immediately addressed and the appropriate medication administered. Another duty of the nurse is to examine the patient with the aim of identifying all the injuries that the patient has suffered and the extent to which the patient is injured. This is imperative, as the nurse would know the most appropriate method of administering treatment for the patient. In the case of Mr Kroos, the extent of the injuries suffered was determined after he was stabilized. By identifying the injuries that a patient has suffered, the patient gets to receive treatment for all injuries suffered. Lack of such examination increases the chances of the patient not receiving complete treatment, leading to extended treatment beyond the duration that the treatment would have taken. Further, it would increase the chances of other complications arising, because in cases such as burns, the unidentified injuries would not be treated, meaning they may not heal as they ought to. Another responsibility of nurses in the emergency room is to make arrangements for the transfer of a patient to another hospital in case the hospital does not have the capacity to handle the case of that patient or in case the hospital does not have the necessary requirements to undertake the treatment of such a patient. This is done to ensure the patient gets the best medical care during the period that he requires medication. These were the prevailing circumstances in this case, as the hospital in which i work lacks adequate facilities to treat burns patients. In that regard, I had to arrange for the transfer of Mr Kroos from my hospital to the nearest hospital with the capacity to effectively treat burns. The nurse in charge of taking care of the patient is also prevailed upon to inform the family of the patient of the situation of the patient. This would be important, as the family would be able to offer important information such as whether the patient has any conditions or allergies that would guide in the administration of medication. Getting information on the needs of the patient would ensure that the kid of medication offered to the patient did not work to harm them, rather to help them ease their pain and get a quick recovery (Beerthuizen, Nieuwenhuis & Haas, 2007). Further, the family of the patient would also need to be counselled in order to be helped in dealing with the events that have taken place. In many cases, the patient and their family undergo some level of trauma after the occurrence of such an accident. The nurse would help them get the necessary help such as counselling services to that effect. The nurse is also expected to discuss the needs of the patient with the other medical care providers at the hospital (Ringo & Chilonga, 2013). This discussion is expected to give the other caregivers adequate information on the status of the patient and the kind of medication that was administered. This is important in avoiding cases where the patient receives the wrong medication in the course of treatment, or even a scenario where the patient is given either an overdose of medication or a dose below the quantity required. Further, it would help in the correct classification of the patient for correct determination of the kind of treatment that they should be accorded (Kratz & Linneman, 2007). In addition to that, the sharing of information on the needs of a patient among medical practitioners is important in making sure that the next practitioner who shall take charge of the patient after the shift of the current nurse is over will accurately administer treatment and medication. Issues concerning care for the Patient and their Family Every hospital has a trauma alert policy. The main aim of having a trauma alert policy in a hospital is to have in place rapid provision of coordinated and efficient care for the patient that has been severely injured and their families. This alert would usually be activated the moment the pre- hospital staff have issued a notification to the hospital staff that a patient was injured and had suffered trauma, hence they needed to be treated at the hospital’s Trauma centre. The Emergency Department Physician that will be on duty at the time would then assemble the team that would help deal with the trauma (Feliciano, Mattox & Moore, 2008). Adequate and relevant preparations would then be put in place to ensure the patient gets the services that would help them deal with the trauma without delay. Many times, nurses are involved in trauma management. In offering help to traumatized victims of an accident, it is imperative that certain factors be considered in order to apply accurate treatment to the patient (Carter, 2012). First is the age of the patient that has suffered trauma. This will help in determine the matters such as the language that will be used during the treatment process, as subtle language is used in the case of children. Further, it will help in determining the kind of treatment that will be accorded to the patient. In some cases, some patients may require actual medication in the form of pills to help them deal with their traumatic experiences. Another factor to be considered is the degree of injuries that the patient has suffered. This would help in determining the main reason for the trauma. Information on the extent of injury suffered would be important in the understanding of the reason for trauma, and how the trauma team would handle the patient in the face of such trauma. The right approach would then be applied in helping the patients deal with the trauma. Of importance too is the number of victims that were involved in the accident. Most traumatized accident victims are more disturbed by the number of people who suffered direct damage during the occurrence of the accident (Campo & Lafferty, 2011). Research has established that the more the number of victims of an accident the more intense the trauma is likely to be to the victims. This is because the witnessing of the suffering of other people and their pain affects the patient directly (Cook, 2008). The families of the affected would also need to be given counselling services, especially in the event of permanent injuries inflicted on the `patient (Scherer & Battistella, 2004). The families may have trouble accepting the fact that a member of their family has undergone either pain or injuries, which have had adverse effects on the patient(Feliciano, Mattox & Moore, 2008). In this effect, it would be prudent to help members of the patient’s family to access counselling services in order to help them come to terms with the injuries either physical or psychological that have been suffered by the patient. It would also be important to help the family of the patient to understand the role that they play in the life of the patient, and how they can use such role to help the patient to take control of the situation that they may find themselves in after healing from an accident (Friedman, 2002). How my knowledge has influence the care that the patient received. As a professional nurse, the provisions of the Nurses and Midwifery Council had to guide the nature of my actions in the treatment of a patient (NMC Code, 2008). It is important to note that the moment a patient is brought to a hospital they are received by the nurses on duty at the hospital at the time of arrival. My knowledge on initial care of burn patients was important in making sure that Mr Kroos got the best treatment at the hospital despite the fact that the hospital does not have a burns unit. In this regard, Mr Kroos underwent processing from admission to further basic treatment, such that he was stable by the time he was transferred to the other hospital.. In addition to that, my knowledge on the procedures to be undertaken in the treatment of a burn victim was essential in the offering of intensive care to the patient as required. The treatment that was accorded to Mr Kroos on arrival of the hospital was important in the determination of the treatment that he was going to receive afterwards at the hospital to which he was transferred. The knowledge that I possess in assessment of the patient’s injuries and his overall situation also helped in providing guidance in the kind of treatment that Mr Kroos would receive in the latter stages (Carter, 2012). It is important to note that the determination of the status of the patient is an essential part of nursing services provided at hospitals. This gives direction as to the methods of treatment to be issued to a patient aside from helping in making the decision on the prescriptions to be made for the patient(Kratz & Linneman, 2007). In the event that a mistake is done in the determination of the extent of the injuries suffered by a patient, the entire process of treatment has high chances of being compromised. With this knowledge in mind, I made many enquiries into the injuries that the patient had gotten from the burns. This helped a lot in the understanding of the situation, as it was, which was important to me and to the other medical practitioners at the hospital, as we knew how offer basic treatment to a burns patient. My knowledge in the administration of medicine and the prescription of the same came in handy in the case of Mr Kroos. On arrival at the hospital, I came to the deduction that the patient had some injuries in the throat because of inhaling smoke. I had to administer sedatives and intubation to the patient. Further, I undertook the administration of anaesthesia to the throat of the patient in order to reduce the pain of the patient, which helped in making the patient stable enough before his transfer. There are many cases where nurses have given the wrong medication to the patient; either entirely the wrong medication or the wrong doses of medication (Garber, Gross & Slonim, 2010). This usually has negative effects, as the treatment administered does not help in treating the ailment of the patient. In fact, it could contribute to making the patient’s situation worse. I avoided such malpractice by giving the right medication to the patient, which helped reduce the pain of the patient. As a nurse with experience in emergency room procedures, I understand the importance of therapy both to the patient and to the family of the patient (Cook, 2008). Mr Kroos had third degree burns to his face. This could have the effect of making the burns patient face difficulty in living his life normally. The importance of therapy to the patient is that it helps them realize that they have to accept the scars caused by an accident (Amstadter & Vernon, 2008). I used my skills in therapy to offer counselling to the patient. Further, I counselled the patient’s family to help them come to the realization that the patient depended on them for mental strength, and that they had to offer the support that the patient needed in order to deal with the trauma caused by the accident (Amstadter & Vernon, 2008). References Amstadter, A. B., & Vernon, L. L. (2008). Emotional Reactions During and After Trauma: A Comparison of Types of Trauma. Journal of Maltreatment, Aggression & Trauma, 16(4), 391-408. Assessment Considerations for the Burn Patient. (n.d.). - The MetroHealth System. Retrieved May 6, 2014, from http://www.metrohealth.org/?id=1563&sid=1 Beerthuizen, G., Nieuwenhuis, M., & Haas, K. D. 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