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Often there are situations that may result in clinical obligations while assessing any critical patient regarding decision making. I faced intensive trouble while diagnosing a patient and deciding to ask them for a discharge procedure. I had instructed a 40 years old patient to be addressed towards discharge who was suffering from an acute injury in his knee. I was ready for the fact to understand the situation and diagnose the patient with the best available evidence-based treatment during the time of admission. I had also conducted a regular follow up for the patient and then decided that the individual was recovering from the symptoms of existing acute injury. Consultation with various practitioners in the hospital was also entertained by me for approaching such a vital decision. Moreover, the doctors and other senior practitioners were also consulted for the final decision making and even the mutual consent of the patient and the patient party was also obtained for implementation of the following decision (Working Well Solutions, 2020). I had made a regular report for the patient's progress and shared it with the senior practitioners who were responsible for the diagnosis and treatment of the patient. I had also taken the help of my assistant NPs to diagnose the patient after every day's progress.
I felt a bit nervous and tense while presenting the case details before the practitioners who had been in regular touch with the patient. I also did have the attention of my young nurse practitioners while diagnosing and treating the patient. I also did experience some tough situations while addressing the patient towards movements and making him feel more relaxed and stress-free. Even I also had the feeling of a head nurse practitioner instructing their assistants to serve and provide intensive care for the patients with effective and evidence-based research. Sometimes activities such as making movements require a lot of makes efforts to stabilize the pain of the knee (Mayberry, 2013). Some major activities such as walking were also not possible for my patient. Thus I had to take him to the washroom during nights and also had the fear that the patient would suffer from a patient fall while trying to progress on his own. There was no such difficulty while communicating with or instructing the patient for asking help at any time he feels for. My patient did not have any cognitive impairment and therefore communication barrier was a factor of worry for me.
I had instructed my patient to perform regular knee exercises along with mild walking practice with the help of a pair of side crutch. I had no obstacles while instructing and communicating with the patient. This was a reason for which I had a special interest in handling the case of the patient. The patient himself was very cooperative and had good listening skills (Rolfe et al., 2001). Therefore he was able to adapt the various techniques and exercises that would ensure quick recovery from the condition of acute pain. Apart from that the experience of patient fall was experienced by me for a single time and I had instructed my patient to ring the buzzer for any emergency situation where he may be in need of physical assistance for moving to the washroom (Steele & Morley, 2017). This particular issue had made me alert regarding patient safety and thus during handovers, I always instruct the other NP to assist the patient according to the checklist that I have prepared with great diligence about the patient progress and improvements. Whenever there is a shortage of staff members in the patient wards it becomes extremely difficult for the NPs to address the patients according to the standards and priorities of NMBA. This causes serious obligations for the practitioners and nurses if at all the patient suffers any physical damage.
The particular incident shall be regarded as the case of patient recovery from acute injury. This would be helpful in dealing with patients who get admitted with acute injuries in various parts of the body including knee, chest, abdomen, stomach, etc. It offers great scope for new NPs to understand and evaluate a case on the basis of this particular case study report that I have prepared for the 40 years patient (Majid et al., 2011). Apart from that process of treatment and diagnosis that was used for mending and assessing the patient would be helpful for addressing patients in the future with similar difficulties or symptoms. Even I have also decided to address such kinds of patients with the help of electronic checklists that can be updated and redesigned with the help of efficient EHR systems.
After a full assessment of the patient, I found that the best possible treatment for the patient was mainly done on the basis of the medical diagnosis of the knee. This is done with the help of access to previous medical records available for the patient. Even I had learned that the treatment of acute injuries depends on the complexity of the pain and the level of injury suffered by the knee. After proper assessment of all these factors, I can suggest for suitable solution or treatment method (Steele & Morley, 2017). Even I can also ask for a discharge if the patient's conditions tend to improve after admission to the healthcare setting. The RICE therapy was mainly addressed by me for the well being of the patient as he was suffering from severe joint pain for making random movements through the knee disc petal.
In the future, I would like to assist patients dependent on the type of severity of their injury and also prepare electronic checklists for the patients that would be updated on a regular basis according to the patient progression. In the case of severe patients, I shall appoint an extra NP for managing and taking care of the patient along with the buzzer assistance technology (Miller, 2017). This would ensure full reliability for the patient's safety while staying at the healthcare settings. The regular evaluation shall be entertained in the form of diagnosis reports obtained and body movement improvements for the patients. Moreover, consultation with the senior practitioners during the time of decision making such as operations or discharges is very much important for clinical decision-making by an NP.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers. Journal Of The Medical Library Association : JMLA, 99(3), 229-236. https://doi.org/10.3163/1536-5050.99.3.010
Mayberry, M. (2013). Ethical decision making: a response of hospital nurses. Nursing Administration Quarterly, 10(3), 75-81. https://doi.org/10.1097/00006216-198601030-00006
Miller, E. (2017). Connecting the Quality of Evidence to Clinical Decision-Making. Pain Management Nursing, 18(3), 121-122. https://doi.org/10.1016/j.pmn.2017.04.008
Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.
Steele, D., & Morley, W. (2017). Diagnosis and management of an acute knee injury. BMJ, i6783. https://doi.org/10.1136/bmj.i6783
Working Well Solutions. (2020). Reflection - Gibbs Model and Applied Example - Working Well Solutions. Working Well Solutions. Retrieved 28 October 2020, from https://workingwellsolutions.com/reflection-gibbs-model-applied-example/.
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