Nursing: Adapting - Essay Example

Nursing: Adapting Customer’s Name Customer’s Grade Course Customer tutor’s Name 23rd May, 2011 DRABC For the case of the patient tagged as ‘Nic’ I will first of all conduct DRABC. I will first of all make sure that I do expose myself to any danger from ‘Nic’. I will also put on protective gear in order to protect me from any exposure to any contamination and infections from ‘Nic’. In order to protect ‘Nic’ from any harm I will have to make sure that the surfaces where any procedure might be done on him is well sanitized and sterilized, I will also have to recommend that he is first given a body cleansing. Patient Confidence A mentally upright patient has the right to ethical and legal courtesy and it will be my duty to determine who I will give the information about his or her medical condition (Schacknow & Samples, 2010). All the rights of friends or family come second to this (Emanuel & Librach, 2007; Fernandez, 2008). Communication with the patient is greatly influenced by both verbal and nonverbal behaviour (Beemsterboer, 2002). Attention to these techniques can increase the communication effectiveness (Lawrence, 2006). Sometimes patients like Nic cannot speak for themselves, the health worker must therefore note that the first duty is to the patient’s life and improving the patients life is a respectful way and in case this case calls for difficult judgement about matter of life and death (Finkelman, 2007). Assessment Because ‘Nic’ is conscious, has acetone smell breath and confused/unkempt it is an alarming state that he is depicting. Acetone odour of the breath is a sure sign that ‘Nic’ is in danger. Acetone in the breath usually occurs as a result of the individual’s body disposing off the excess acetone via the lungs which means that Nic’ is emitting ketoacids from his metabolism. Whenever glucose metabolism is disturbed either due to starving or an underlying disease, this problem occurs and it is usually life-threatening (Lee, 2009). I will have to check for the rising & falling of the chest and listen to the sound of his breathing. I will also check for his blood circulation by feeling the pulse rate using the oscilloscope, I will also have to have a benefit of doubt by repeating the checking of the rate after every two minutes to establish ‘Nic’ stability. I will also ensure that ‘Nic’ is placed in a stable side position and try to check for any other form of bleeding he is showing apart from the haematoma that he already has on his fore head and mange it. After managing life-threatening problems on Nic’ I will then turn him into a stable side position. I will then institute an orderly assessment on Nic’ by focusing on identification of other injuries such as fractures and burns (Weber & Kelley, 2009). Because the patient has a forehead haematoma, confusion/dishevelled and unkempt, I will have to critically look at the injury on the head and alert the EMS provider to give finding in order to strengthen the suspicion of suspected head injury (Elling & Kirsten, 2003). Because the patient is indication that he wants to pass urine repeatedly, he then definitely suffers from Polyuria which should prompt me to do facilitate diagnostic studies such as urinalysis, urine culture, creatinine clearance test or fishberg (concentration test) by collecting 24 hour urine specimen (Basavanthappa, 2003). I will also ensure that Nic get enough ventilation by providing oxygen to him (Goodman, 2008). I will maintain the airway, suction as necessary, bag valve device and oxygen, oral airway, blood glucose level mentoring (Les Hawthorne, 2010). I will also check for BLS interventions in addition I will also confirm the tidal carbon dioxide, lung sound, IVs, Cardiac Monitoring, intubulation and local protocol (Les Hawthorne, 2010). Once I will have croacked further details of symptoms to my colleagues a firmer, more confident diagnosis should be made. The basis for the diagnosis will be based on observation of my general demeanour, the sound of my voice, the reported history if any (Aldridge, 2000). Therefore information in context aids the formulation of a specific inference of what Nic is suffering from so as to formulate an appropriate management plan (Wardrope & Driscoll et al, 2008). Plan of Actions Generally Nic’s condition is unstable although he is alert but upset, lacks coordination of speech and talks irrelevant things. As a health care provider I should be able to intercept important signs and symptoms of systemic diseases that manifest from the neck up, such as diabetes via signature breath odour (Spencer & Slabaugh, 2010). For me to rule out why acetone odour is in the breath, I will have to engage the patient to be taken through Esophagogastroduodenoscopy. If the patient is diagnosed of UTI the proper antibiotic should be administered. Because the patient has fall injury is confused and has head trauma, I will try to minimise more risk of more injury and complication as a nurse by providing proper orientation about ward, proper bed rails up, giving a nurse call bell to the patient and placing the patient near the nursing station and providing special nursing to patient care if needed. If the head injury EMS results show the suspected indication of focal head injury or sub-dural haematoma I will institute the four level of management i.e. further investigation such as MRI, CT, supporting blood tests. I will ensure that I carry out a serial assessment and document the findings of the mental status using the Glasgow coma scale. The Glasgow Coma Scale utilizes fifteen points and I will check it after every two hours in order to be able to estimate and categorize the kind of expected outcome of brain injury that Nic will have gone through (Herndon, 2006). By using Glasgow Coma Scale test I will be able to determine Nic’s verbal response, motor response and eye closing & opening response so as to be able to tell the possible levels for Nic’s survival. N example of the Glasgow coma scale which I will fill is represented below. I can also use online software for the same found at . Source: Russ Rowlett and the University of North Carolina at Chapel Hill I will also conduct non-pharmacological approaches such as dietary recommendations by minimizing sugar intake of the patient and giving supplement of vitamin E, D, B6 and C. patient to get enough sleep and avoid drug and substance abuse (Varney & Roberts, 1999; Australian Medical Association, 2007). Medication is generally not necessary, however treatment is commonly based on symptoms alleviation and the major group of treatment include neuro-modulators, anticonvulsants and antidepressants (Varney & Roberts, 1999). Although it is important for me to note that the patient’s inability to answer questions correctly does not necessarily mean loss of mental competence. Part B: Nurse’s Values, Beliefs and Attitude The principles of respect for persons, autonomy, beneficence, nonmaleficence and justice are part and parcel of nursing ethics and ideal practice. A nurse is a profession who is supposed to serve individuals, families and communities (Hamric, Spross & Hanson, 2005). Respect for other persons is not only a philosophical value but also a binding principle within the nursing profession (Hamric, Spross & Hanson, 2005). Nursing as a profession should be driven by value systems (Hamric, Spross & Hanson, 2005). Value systems are enduring beliefs that guides life choices and decision in conflict resolution (Hamric, Spross & Hanson, 2005). Values are a vital feature of everyday nursing practice. Value of caring, responsibility, trust, confidentiality, honesty, justice, sanctity, empathy and respect of ones religious beliefs are very key to a quality nursing care for a patient such as ‘Nic’ who on being handed over prompts a nurse to say that ‘I’m not going near that dirty old nutter. Old people – they’re all senile and they smell’. This nurse is not sensitive to the value systems and demoralises ‘Nic’ and such an act is liable for a corrective measure against the nurse. Professional negligence occurs when there is an allegation that a standard of care was breached, causing harm, loose of dignity and non sensitivity to the patient. The overall conduct standard for the professional nurse would be what ordinary, prudent and reasonable nurse would have done in same or similar circumstances (Brent, 2001). A nurse is therefore under a legal duty to act carefully towards a patient and if she or he fails to exercise sufficient care and by so doing it has negative impact on the patient then he or she will be held liable for the tort of negligence (McHale & Tingle, 2001). In the case of the way the nurse acted on receiving ‘Nic’, this can lead to gross professional misconduct and negligence which could possibly lead to legal action being taken against her, portray a bad image to the student nurses and could also destroy the reputation of the hospital and nursing profession as a whole. If nurses can actually get sensitive about their social cultural environment then it will be a good sign for improving nursing care. When there is poor socializing among nursing care the following results; attrition, decreased productivity, and poor patient & care giver/ caregiver-caregiver relationship. The erosion of best socialising practice among nurses leads to escalating health and social problems especially among the remote Indigenous communities and this can pose a serious problem for the hospitals nurses to give health care that meets the health access and meeting the needs of the community. Nurses deal with moral challenges on daily basis regardless of the patients they come in contact with. However depending on the patient’s ailment the ethical problems created might be even greater considering that the nurse as the care giver, the family members, and the patients themselves must reach mutual and competent agreements that should guarantee the recovery of the ailing a person (Foolchand, 2005). Dealing with ethical issues effectively serves to ensure that the nurse’s competence and growth is enhanced. The moral challenges that recently confronted me served to warrant me such a need for skill enhancement and professional ethical growth. Nurses are supposed to be aware of personal values of their clients because it will help them to generate more consistent choices and behavious which can help them to be aware of their boundaries as proffesions (International Council of Nurses, 2006). Value awareness should include an understanding of the complex interplay between culture and decision making. When a client culture seems to contradict the known western medical practice, health care providers may resort to coercion or paternalistic measures to influence patient’s choices to be more consistent with the provider’s values. Nurses must therefore understand the kind of assumption they might make based on their own cultural values and biases and how these assumptions might impact on the way they recommend on a patients treatment. Cultural and Religious beliefs are also not to be forgotten when handling patients. Spiritual or cultural claims grounded in an identifiable and established community are more defensible that those that are merely idiosyncratic to the person making the claim. It is vital for nurses to respond with respectful dialogue, support and compassion. Patient’s demands for treatment must be considered in relation to other claims that also have ethical weight. The integrity of the nurse, legal considerations, economic realities and issues of distributive justice must be considered when instituting the treatment demands of the patient. Ethical dilemma and situations of moral distress are often first recognised by the intense emotional reaction they elicit. Emotions are present in all clinical settings, but when personal or professional values are questioned or trespassed, and then the instinctive response is to react with anger or frustrations. Although this is a helpful gauge to awaken awareness that something is going somewhere ethically, too often the individual becomes entangled in the emotions and is unable to move towards an awareness of the consequences for others. It is frequently at this point that the different parties become polarised and embedded in a particular view point. There are various strategies that can be used to control & solve ethical conflicts and acts of negligence in the nursing fraternity. One way of eradicating unruly behaviour and lack of respect for patient’s values is by teaching the concepts and skills of values clarification as part of the disciplinary interventions (Hardingham, 2004). This process will enable the health professional handling patients from all walks of life to articulate the professional values that influence their behaviour to recognise and respect the values of other team members, patients and families (Hardingham, 2004). Careful assessment of a patient’s value enhances the treatment decision making and clarifies the motivations underlying the individuals expressed wishes and treatment preferences for the health care system (Hardingham, 2004). Moral discussions and deliberation can take the form of a debate that degenerates into an assault. One party disputes it, the original party defends and the second party attacks. Breaking these cycles of destructive interactions is central to arriving at solutions that are resourceful. Resolutions are most effective when the parties in dispute create the solution. However in situations where the solution is not easily achieved, it is best to solicit for help from a member of the ethics committee or another professional colleague not involved in the case. Conclusion Communication with the patient is greatly influenced by both verbal and nonverbal behaviour. Attention to these techniques can increase the communication effectiveness between the patient and the health care provider which in the long run enhances the quality of care that a patient receives from the health care system. References Aldridge, D. (2000). Spirituality, healing, and medicine: return to silence. Jessica Kingsley Publishers. Australian Medical Association, (2007). Medical practice, Issue 55; Issues 57-64. 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Medical technology assessment directory: a pilot reference to organizations, assessments, and information resources. National Academies. Hamric, A. et al. (2005). Advanced practice nursing: an integrative approach. USA: Elsevier Health Sciences. Hardingham, L.B. (2004). Integrity and moral residue: Nurses as participants in a moral community. Nursing Philosophy, 5, 127-134. Herndon, R. (2006). Handbook of neurological rating scales. USA: Demos Medical Publishing. International Council of Nurses (2006). The ICN code of ethics for nurses. Geneva, Switzerland: author. Lawrence, P. (2006). Essentials of general surgery. Lippincott Williams & Wilkins. Lee, S. (2009). Breath: causes, diagnosis and treatment of oral malodour. San Bernardino, CA: Culminare, Inc. Les Hawthorne, A. (2010). Patient Assessment Practice Scenarios. Jones & Bartlett learning. McHale, J. and Tingle, J. (2001). Law and nursing. Elsevier Health Sciences. Schacknow, P & Samples, J. (2010). The Glaucoma Book: A Practical, Evidence-Based Approach to Patient Care. USA: Springer. Spencer, S.L., Slabaugh, M.R. (2010). Organic and Biochemistry for Today. USA: Brooks/Cole Pub Co. Varney, N and Roberts, R. (1999). The evaluation and treatment of mild traumatic brain injury. Taylor & Francis. Wardrope, J and Driscoll, P. et al. (2008). Community Emergency Medicine. Elsevier Health Sciences. Weber, J. and Kelley, J. (2009). Health Assessment in Nursing. Lippincott Williams & Wilkins. Read More

 

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