The Muscular-Skeletal Examination - Essay Example

?REFLECTIVE ACCOUNT NUMBER A REFLECTION ON MUSCULAR-SKELETEL EXAMINATION The Muscular-Skeletal Examination performed by me for the first time came as an opportunity when my hospital introduced a nurse-led pre-assessment clinic. Ordinarily, hospital pre-assessment of patients is done by junior doctors, but our hospital took the assumption that this task can be effectively done by nurses, given their medical school training, as well as experience in assisting patients and doctors in hospitals. In-service training can of course be a significant contributor to nursing competence in this new medical role for nurses. My present course on Clinical Assessment Skills for Health Professionals is therefore most relevant to the pre-assessment reform which harnesses the potential capacities of nurses like me. As an experienced nurse who qualified to be in the profession in the early 1970s, I feel seasoned for this new role. Yes, there was the initial fear, but I felt that my long experience as a medical assistant to doctors serves as my great asset. Since the start, I knew I was capable of pre-assessment duties in terms of medical competence, as well as the attitudes and values needed for the task. Willing and able, I faced my first pre-assessment duty with Mr. T, a 27 year old factory glazing fitter worker who had a two-year history of pain caused by the clicking-and-giving way of his left knee. As the assigned pre-assessment nurse, I assumed the task of serving the patient referred to our Orthopaedic Out Patient Department. My main task was to gather medical data which can serve subsequent medical examination and possibly laboratory tests, as needed. As his pre-assessment nurse, I knew I can be privy to Mr. T’s medical progress and be knowledgeable of the entire medical care he was going to receive. As soon as Mr. T entered the pre-assessment clinic, I thought it was important that I win Mr. T’s confidence. And this I achieved by assuming the appropriate posture of a competent pre-assessment medical practitioner, coupled with manifestations of professional support for his case. Thus, I opened the communication line that allowed me to gather medical history data which is fundamental to the pre-assessment phase of medical treatment. Soon enough, I found out the symptoms of his ailments which he traced to the time he had an injury two years back while playing football. He said he twisted his left knee following contact with the ball, then hearing a “pop” sound and feeling sudden pain. He was not, however, prevented from getting immediately back into the game until half-time. Only during the half-time break did he feel a swelling on his left knee, although it didn’t appear serious since he still managed to pull himself up while in the bench. In following Mr. T’s case during his subsequent orthopaedic examination, I found out and recorded that Mr. T’s left knee injury was assessed as a torn Anterior Cruciate Ligament (ACL) or a meniscal tear. Swelling and bruising of the left knee were manifested within a twelve hour period. Mr. T was unable to fully bear his left body weight, thus causing him to limp. As to the immediate medical treatment he received after his injury, Mr. T conveyed to me that the athletic medical practitioner who treated him diagnosed a soft tissue injury which made it appear that his injury was not serious. He was given a one-gram Paracetamol prescription, a tablet to be taken every four-hours. In addition, he was advised to rest, and apply ice on the injured knee. Knee compression and elevation were also advised to ease pain and bring back normal knee movements. The initial x-ray results showed that Mr. T had no bone injuries and no degenerative changes to worry about. And so, he was advised physiotherapy treatment for complete rehabilitation. Over the next few week, swelling, bruising and pain subsided, and so Mr. T was able to return to work. Mr. T was also able to again play football, but over the next six months or so, his symptoms became progressively problematic. In the mornings, it took time before he could bend his left knee causing him to limp. It also became increasingly difficult for him to squat and kneel and this affected his work. During the last six months, Mr. T could no longer play football or participate in any fitness program. Despite continued physiotherapy, his symptoms persisted, and so he was referred to the Orthopaedic Department. During the pre-assessment, I was able to determine that Mr. T had no history of injury or trauma before his accident. I noticed that making this revelation gave some sense of relief in Mr. T, and I felt this was a good turn in the pre-assessment process. In my data gathering, I was also able to draw out data or information which can be of positive value to his subsequent clinical treatment, such as information on his family, occupation, and social habits. In particular, I and Mr. T found the self-revelation that he was a non-smoker most encouraging. After the interview and data gathering, I applied the medical requirements in pre-assessment, including examining his respiration, blood pressure, and pain score. I also made a review of his body system, experience of discomfort, skin color, and physical looks which appeared well nourished. I made certain that I immediately conveyed to Mr. T the good pre-assessment findings I gathered. Among the positive messages I relayed to him was an assurance that after treatment and rehabilitation, he will most likely be able to resume work, even play football. However, I noticed that owing most possibly to his present condition, he took my affirmations only with a faint smile. Using the Driscoll Model of Structured Reflection, I now take a Reflection-on-Action analysis of the pre-assessment experience which I had for the first time. Different from Reflection-in-Action which is done while undergoing a task/process, Reflection-on-Action is retrospective and recalls a task/process already done (Davis, “Learning Matters”). On the Driscoll question WHAT, the pre-assessment task was a challenge for the nursing staff. The duty previously given to junior doctors was now given to us nurses, namely gather the medical data needed for subsequent medical treatment and rehabilitation. We were tasked to prove that pre-assessment work can be done satisfactorily by nurses even without junior doctors. As to HOW DID I DO, I reviewed my submitted comprehensive report, and saw no information gaps. The Orthopaedic medical team can use such reports for eventual diagnosis, laboratory tests, and treatment. From the patient’s viewpoint, I felt I achieved a balance by assuming a professional role and providing adequate affirmation on Mr. T’s condition, thus giving him confidence in the subsequent medical processes he would undertake. Along a biomedical perspective, I was also thorough and complete, confining myself to necessary medical information on Mr. T. After that first time experience, I now observe that my submitted written report serves as a commendable evidence of the task I performed. As to WHAT DO I DO NOW, I feel I can build up on experience and perform my pre-assessment tasks with efficiency and competence. Along an exploratory note, I see the need to develop a pre-assessment form, something like a template, which can serve as a guide to nurse assessors. Through this template, all information which need to be gathered will not be missed out. The form shall also serve as a structured guide on standard medical data gathering for pre-assessment work. Looking back on the overall task, I perceive the danger that in pre-assessment, the assessor may fall into the trap of performing the task mechanically, worst even treat the patient as a subject for data gathering, not a human subject with inherent fears, anxieties, and confusion on his ailments. I therefore see the importance of empathy as a basic and essential element in medical pre-assessment, especially since subjects are patients, etymologically meaning “those who suffer.” Inherent in physical pain, is emotional pain causing a total psychical disorientation of a person, which can inhibit cure and recovery. From the point of view of reflective medical practice, I experienced structured reflection to be helpful in developing higher standards of practice. Other than pre-assessment written reports, a personal professional journal concretizes reflection and a nurses’ commitment to lifelong learning. Reflection is thinking. Scientist Pierre Teilhard de Chardin saw a gradual evolution of the mind with homonisation as ”the process by which the original proto-human stock became (and is still becoming) more truly human” (Chardin, 13). And when we reflect, we are “thinking attentively of the same thing several times over” (Dimnet, 148). When Newton was asked how he discovered the law of gravitation, Newton answered, “By thinking about it all the time” (149). There really is no fundamental difference between discovery through reflection and invention. Thinking by way of structured pondering opens immense possibilities even for a modern-day nursing professional. References Chardin, Pierre Teilhard , The Phenomenon of Man (London: Fontana Books, 1969) 13. Print. Davis, Nicolas. Learning Skills for Nursing Students. Web. 27 May 2011. http://www.learning matters.co.uk/sampleChapters/pdfs/9781844453764_10.pdf Dimnet, Ernest. The Art of Thinking (Greenwich, Conn.: Fawcett Premier Book) 148. Print. Read More