Ankle Injury Nursing Reflective in Healthcare Management - Essay Example

ANKLE INJURY REFLECTION Introduction Ankle injury nursing reflective in healthcare management and assessment is a complex and proactive practice-based and learning procedure that is quite essential in nursing after a procedure. The ankle injury reflective health assessment and management process provides health professionals with opportunities to review their action capacity as they engage in continuous learning from their ankle injured patient interaction experiences. As a Trainee nurse under supervision, I was given an opportunity to reflect back to my past placement events in order to develop emotional responses that aid in my future actions when encountering a similar event. The placement experience obtained through patient assessments and management resulted into a better nursing intervention based on the pre-existing nursing knowledge for the future improvements. According to National Institute for Clinical Excellence (2004), reviews ankle joint injuries management in healthcare facility as a nursing responsibility aimed restoring the physiological function of the a ankle joint after an accident or injury has occurred. For the future practice, the nurses should reflect on the clinical experiences, concepts and understandings during the ankle injury assessment and management an adaptive response of care. Therefore, for this reflective analysis, the GIBBS model of reflection is used serving as a turning point in of ankle injury and related risks conditions assessment and management reflective analysis. GIBBS model of reflective analysis is a model of choice since it links the trainee nurses to their nursing practice, supervisors and their patients providing a systematic reflective of all the procedures and processes that were conducted in my nursing practice. For confidentiality and privacy of my nursing training experience, the name of the client, health facility, and the location has been made anonymous based on the reflective analysis for nurses’ survival in the word (Richards & Edwards, 2012). Ankle sprains are the most common sporting and UCC injuries anatomically and physiologically occurring as the tearing of bone-bone ligaments connection that stabilizes the ankle joint. My mentor reminded me that, the ankle injury causes destabilization of the hinge joint formed by fibula, tibia and the talus bones resulting in structural disarrangement, fractures and deformity of the bones and ligaments around the ankle joint. Through the department orientation I learned that, the risks factors for the ankle joint injuries in United Kingdom are associated with poor balancing, previous injury and aging process in adults (Engebretsen, 2011; Welling, 2012). Case Description It was during my clinical placement in a sporting injury department when my mentor required me to attend a 23 years old male with presenting condition of a right ankle injury complaining of ankle joint pain. I carried on the task in the presence of my mentor providing moral support as well as further clarification where I needed assistance. On HPC taking, the client described to have been playing football at 12.00 when he went playing football in the morning hours, jumped and landed awkwardly on the ground inverting his left ankle causing him to fall. The client hard a crack on his right ankle but carried on playing for 30 minutes before stopping to play. During the incidence, the client was wearing his football shoes after which he went home limping and iced his ankle for the few minutes, took Ibuprofen at 20.00 and Co-dydramol x2 at 2. 27. I was able to find out that, the reason for referral to the health facility was due to increased pain in the evening, and the ankle swelling accompanied by a female friend to the department at 045hrs. My mentor clarified that over-counter drugs are quite essential in a home setting, though they are heavily abused since the duration of Ibuprofen and Co-dydramol taking was very short for an effective mode of action and exposure to drug interactions for pain management in sports injury (Derman & Schwellnus, 2010; Rudd, R. et al., 2004). On history taking, the client had no past medical history although the client had a previous injury to the same ankle knee few years ago but had no any medical attention. The drug history and allergy was nil, lived with parents and two other brothers in family history. On the social history, the client works in a warehouse doing manual handling, drinks occasional but gave up smoking since the beginning of this year in accordance with the knee problem history taking (Macnicol & Steenbrugge, 2012). My mentor told me that patient history-taking was an essential component during the assessment and management of the patient conditions and if the client/patient history was taken minus recording, it is considered as a malpractice under the nursing codes and ethics. During the physical examination, I took my client consent to examine and assess my patient presented condition. The patient looked well and perfused but limping with left foot/ankle. The ankle joint had swellings on the lateral malleolus with no signs of cuts, scars, deformity, bruises, erythematic, and the skin was intact. I assessed the ankle for tenderness and sensation and found that, the ankle had a good sensation and the surrounding bones such as the calcaneum, navicular and the fibular head around the swelling had no tenderness according to Lynch (2012) ankle joint assessment guidelines. The ankle dorsi and plantar flexed actively and resisted with pain on the affected lateral malleolus though the patient could stand on the affected ankle alone for 3 seconds. I was made to understand by my mentor that the reduced ROM was a result of pain according to Garber and Gross (2010) common nursing error avoidance. A strong pedal pulse rate of 2 seconds, CRT results was evidenced while the X-ray film based on Ottawa Ankle Rules and guideline as explained by my mentor illustrated no bone injuries on the affected ankle. I diagnosed the patient with soft tissues injury and advised the patient on OTC analgesic paracetamol 1gm TDS at most 8tabs/day or Ibuprofen, bed rest, ice, and gentle exercise. Similarly, I provided the patient with tissue leaflet and advised the patient not to contact any sport until when sport free, and TCB if any problem or concern arises (Wattal & Khardori, 2014). The patient agreed and was happy with the patient and handed over to the ENP happily. Feelings At the start of the case presentation, I was confident to deal with this patient with ankle injury because I have previous cases assessed or encountered with my previous experience history as a nurse trainee. Based on this plenty experience I was pleased with my patient treatment outcome under supervision as my mentor was fully satisfied with how I carried the patient’ ankle joint injury assessment and management. I felt piteous for my patient’s ankle joint condition, as it seemed very painful and severe. Ankle injury is common UCC condition that affects the ENP or nursing practitioners’ workload evidenced by at least five patients attended by a single qualified nurse. I felt that primary nursing was a more effective procedure that could be used in the sporting injury department compared to team nursing for the management of the ankle injuries. However, due to insufficient nurses in the UCC Department makes team nursing the best alternative ankle injury management approach according to (National Collaborating Centre for Nursing and Supportive Care (Great Britain) & Royal College of Nursing (Great Britain), 2005). Evaluation It was wonderful and good that I made a complete nursing assessment, diagnosis, intervention, implementation, documentation, evaluation, and documentation and referral procedures without causing any harm or pain to my patient. I was happy with the manner in which the patient was managed without provoking any secondary pain. Understanding the anatomical and physiological ankle injuries and risks as postulated by Nyska and Mann (2012) result to result to proper identification of the right procedure and equipment used in assessment and diagnosis unstable ankle joint. Kennedy and Hodgkins (2006) claims that immediate intervention procedure for soft tissues injuries associated with the ankle injury should apply the RICER protocol as the approach of choice for an effective management of the ankle injuries. The approach aims at reducing soft tissues damages and pains for the ankle injury patients. My patient management was successful in relation to the Ottawa ankle X-ray rules and guidelines in conjunction with the RICER protocol. The patient X-ray was successfully taken as the pain was localized in the malleolar zone evidenced by bone tenderness over the lateral malleolus. Welling (2012) supports the above view and further claims that ankle joint X-ray should not be done on every patient as it has many associated health risks that may expose the tissue or cell to death when exposed to X-ray radiations in assessment of ankle fractures. However, Larsen (2002) affirms that for ankle injuries assessment and management to be successful, as a nursing trainee I had to employ consultative measure and efforts to management my client with minimum discomfort and pain. For instance, initially I had thought that my patient was for a direct ankle joint X-ray as evidenced by the cracks and pop sounds as described by my patient without considering the scientific rational as a second thought. Nevertheless, I was satisfied that my client cooperated throughout the assessment and the task was achieved through patient’s informed consent and prior explanation before the procedure. Delisa and Walsh (2014) advocates for the health practitioners and nurses to seek informed consent before any medical and nursing intervention accompanied by adequate information of which I successfully followed. The assessment under my mentor supervision was good and successful, malpractice and unethical procedures that could undermine my client confidential and privacy was not reported by my mentor. I think am confident enough and able to handle a similar condition on my own. Nevertheless, next time I should try to improve on assessment and management time according based on NMC guidelines for quality services and professional standards 2014. Comparatively, it was bad that my patient was not educated on the use of over-the-counter drugs. I was able to find that my patient had taken Co-dydramol x2 at 0227hrs within a short period of time that could have resulted in drug interactions and ineffective mode of action as claimed by Derman & Schwellnus (2010) for pain management in sports medicine. My client was not advised on self-centered ankle injury management, risk factors and causes of the ankle joint injuries to prevent future reoccurrence and effective rehabilitation of the injured ankle. Analysis Lynch (2012) and ( Larsen, 2002) describes ankle joint injury assessment and management as a systematic procedure that requires bed rest in an elevated position accompanied by ice packs administration after every 2hrs for 20 minutes plus bandage compression to prevent swelling and bleeding. I used problem-based nursing diagnostic approach to identify my patient’ assessment needs and triaged my patient’s condition as a sporting injury. I considered the use of full body host sling if the presenting condition worsens for the transfer of the patient to the X-ray and wheelchair for movements. The RICER protocol used was effective in alleviating my patient ankle pain as well as relaxing muscle contraction as evidenced by positive self-concept and self-control secondary according to ( (Asper & Rosser, 2013). For this reason, I was satisfied that I had adopted the right assessment and management technique and procedures in the nursing care and physical assessment of my patient as a trainee nurse. I strongly believe that my goals were SMART as my mentor was always available to guide and support my progress throughout the procedure. My mentor’s support increased my competence and accountability according to Harrison (2014) hypothesis of program replacement and accountability. On reflection, I realized that if my assessment and nursing management plan were not SMART enough accompanied by appropriate assessment tool, my patient could have been exposed to further injury and complications. Duckworth (2010) supports my view stating that ankle injuries are exposed to musculoskeletal, and tissue injury complication if poorly handled during medical and nursing interventions of the patient. Nevertheless, Browner (2015) claims that unsafe handling of musculoskeletal and tissue injury intervention during nursing practice is considered as malpractice and form of abuse of the patient’s treatment rights. Conclusion My patient was effectively and comfortably transferred to the ENP without stimulating further pain, which was the initial objective of the assessment and management of my patient. On reflection, I considered nothing significant to be changed or done differently from the kind of assessment and management techniques applied to my patient. Therefore, encountering with ankle injury patient was factual and real because my mentor was present throughout the assessment providing technical supportive guidance according to the NICE Guidelines (Garber & Gross, 2010). Nevertheless, I need to reevaluate and reflect on similar clinical condition so that I can have an opportunity to develop and improve my assessment analysis and management skills of the ankle injury. The new challenge or chance to be encountered will enable me independently carry out a complete nursing diagnosis and intervention of an ankle injury without any guidance or assistance. Similarly, it is imperative for me to provide health education to my future patients on the importance of over-the-counter drugs in alleviating pain, risks factors, causes and self-centered rehabilitation management associated with the drugs. This measure will help in preventing any reoccurrence and advance effect that ankle injury patients are likely to encounter according to (Van Dijk, 2012) evidence-based clinical guidelines on over-the-counter drugs. Action Plan In future ankle injury case management or situation, I will work to ensure that all the patients referred to the health sporting injury department are attended and referred without stimulating or causing any form of injury to the ankle injury condition. However, it is quite essential for me to reflect on similar case situation or event to so that I can develop independent assessment analysis and management of the ankle injury patients. This kind of action would able to sharpen my future annual placement training as a nurse for the assessment and management for the ankle injury patients (National Institute for Clinical Excellence, 2004). For this reason, the action that I will take will facilitate a better nursing practice training in the future that will contribute to my ankle injury nursing skills developing and modeling me as an independent expert-nursing practitioner after qualification and graduation. Similarly, for any future nursing clinical situation as well as the resurface of similar condition, I will ensure ankle injury health education, assessment and management is strictly followed for an efficient ankle injury healing (Nice, 2012). References Asper, M., Rosser, M., Mooney, G. P., & Jasper, M. (2013). Professional development, reflection, and decision-making in nursing and health care. Chichester, West Sussex, Wiley-Blackwell. Brooker, C., & Waugh, A. (2013). Foundations of nursing practice: fundamentals of holistic care. Browner, B. D., Jupiter, J. B., Krettek, C., & Anderson, P. (2015). Skeletal trauma: basic science, management, and reconstruction. Delisa, J. A., Gans, B. M., & Walsh, N. E. (2014). 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