This is the case of a patient who had a coronary artery bypass surgery two days back and still he is not waking up well and is not conscious. The nurse is examining him through neurological assessment and learns that it might be about thiocyanate toxicity levels. She talks to the physician but she refuses it so she involves the decision from different department and her results found out that it was this toxicity due to the medication of BP that the patients were not conscious. This essay aims to identify and gives a strategy for the challenge experienced by the nurse followed by the application of the same strategy by the student nurse in case she came across a similar incident.
As per the short story of RN, this is the story of an RN Brenda who is caring for the patient who has had coronary artery bypass surgery. She was caring for this patient but he was not waking up. It was after the neurological assessment that she learnt that the reason for his not waking up might be higher thiocyanate levels that may be due to the medication that is being used to control his BP that is nitroprusside. When she tried to convey this is to the physician, he refused to accept it saying that the renal function is fine. The biggest challenge that the nurse faced in this case was to challenge the view of the physician. She still felt that something is not fine and as per her responsibility for the patient- centred care she used her education and experience to challenge the physician's view.
She contacted Tucson Poison Control and deduced that it was a toxicity that was leading to the patient's loss of consciousness. This was the biggest challenge for her because she is a nurse and challenging a doctor's view can put her in the danger. She was so firm for her patient and with her responsibilities that she preferred to use her experience and education to save the patient’s life (Holland, Tiffany, Tilton & Kleve, 2017). The strategy to address this challenge used by her was a growth mindset. The grown mindset refers to the mindset of people that go beyond the fixed mindset where the individual applies their skills and hard work to get better results. The strategy of growth mindset worked here because the nurse used her education, experience, decision making and critical thinking skills to make the patient conscious.
The literature suggests that nitroprusside, the agent used to control BP has a direct impact on increasing thiocyanate levels to a level of toxicity. The prolonged infusion of sodium nitroprusside leads to the increased infusion rate of thiocyanate levels that leads to thiocyanate toxicity. This strategy helped her in achieving patient-centred care because every patient is different and it is the nurses' responsibility to carry out patient-centred care (Jarrar et al., 2019). The mindset theory holds implicit assumptions about the origin of the capability like intelligence and talents.
It states that talent and intelligence have a profound impact on the way health care professionals view their mistakes. The health care professionals with a fixed mindset (like the physician in this case) have a belief that ability is endowed and status thus, lack of ability is indicated by mistake (Bernecker & Job, 2019). The health care professionals with a growth mindset believe that the ability is acquired through effort and learning from the experience thus a mistake is an opportunity of learning (Klien et al., 2017). The nurse used a strategy of growth mindset to facilitate person-centred care.
If during the clinical placement, the student nurse experiences the similar situation where their knowledge states that the decision made by the physician of not going for further tests despite the patient being in the unconscious state then the student nurse must take some action using the appropriate strategy. The scope of practice of the student nurse is very limited and they are not allowed to work without the supervision of RN. The student nurse ca always apply the strategy of a growth mindset when faced a situation similar to this for their RN, doctor or a surgeon (Cutumisu et al., 2018). When the case is about challenging the view of the surgeon or a doctor then the student nurse can suggest their opinion to the RN so that RN can talk to them about this or take some action within their scope of practice.
There are several changes and challenges within the health care system thus continuous learning is very important for the nurses. The implicit theories of intelligence that are both the fixed mindset and growth mindset are applied when dealing with a challenge (Holzken, 2016). The student nurse can use the strategy of growth mindset to using right interventions to influence the mindset of RN (if they have fixed mindset) so that the way the RN perceives this situation can be changed. The student nurse must use this strategy only when she believes that their intelligence is malleable and has the potential to change and develop. The student nurse does not have much experience and they only have the experience of education but not the experience of practical work so they can apply this strategy to influence the RN.
This incremental theory has more confidence in the hard work of the believers and their effort. Even if the physician, doctor or RN have a fixed mindset, the student nurse can inspire them with their education, critical thinking skills, decision-making skills so that they start to believe into growth mindset concept (Grace, 2018). The literature also suggests that the nurses with a. growth mindset work harder as they know that their effort is very important for the benefit of their patients. The student nurse must be intelligent enough to recognize that in a similar situation, the view of the physician does not correspond with the patient-centred care and it needs to be changed (Khuan & Juni, 2017). The student nurse with a growth mindset will not immediately respond defensive but will trust RN on their credibility.
The student nurse will get positive feedback as a similar thing happened with the nurse within the story. The people with a growth mindset are more willing to learn and put in efforts like the student nurse can use evidence-based literature if they experience any similar situation and they can talk to RN about the same. In this story, the nurse called Tucson Poison Control to get a piece of advice on ordering a thiocyanate level. Similarly, the student nurse must only practice within their scope of practice and must seek advice on their view when they wish to challenge the view of the physician or a surgeon (Kelly et al., 2016).
This will help them to carry out patient-centred care for the patient like the one mentioned in the story. The patient's unresponsive state even after the second day of surgery is a matter of concern but the physician was only relying on the normal functioning of the kidney. If the student nurse faces a similar situation, she must first use evidence-based literature to get her facts right and then she should use the view of RN for challenging the physician or the surgeon's view (Godshall, 2019). There is no harm in challenging the view of seniors who have a fixed mindset because patient-centred care is of paramount importance for the nurses.
This learning achieved through this unit assessment is on the theory of mindset and its importance in carrying out person-centred care. The biggest learning achieved is that sometimes it is necessary to challenge the view of the physician or a surgeon if the nurse is not feeling fine due to her experience and education. It is very important to change the mindset of people having a fixed mindset and also the people with a growth mindset can influence others (Graebe, 2019). The learning of patient-centred care and the delivery of safe care practices are important has also been achieved from this unit assessment.
The nurses must only practice within their scope of practice but there is no harm in contacting interdisciplinary team members if there is a necessity or when the nurse does not feel that patient-centred care is being taken. The nursing leadership is very important and the nurses must always look for the methods of safe and high quality of patient care (Boamah et al., 2018). The health care environments may be challenging for the future of nurses but the nurses should have a growth mindset so that they can bring about this change.
The conclusion drawn is that the growth mindset strategy is one of the most effective strategies that can be used to address the challenge of challenging the view of the physician or a surgeon. The nurses must always present their point of view and should thrive for the delivery of safe and high quality of patient care. They must use their education and experience in the practice so that patient-centred care can be achieved. The student nurses who have a growth mindset can also address similar situations by having a conversation with RN using their critical thinking and decision making skills.
Bernecker, K., & Job, V. (2019). Mindset Theory. In Social Psychology in Action (pp. 179-191). Switzerland: Springer, Cham.
Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180-189.
Cutumisu, M., Brown, M. R., Fray, C., & Schmölzer, G. M. (2018). Growth mindset moderates the effect of the neonatal resuscitation program on performance in a computer-based game training simulation. Frontiers in Pediatrics, 6, 195.
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Holland, A. E., Tiffany, J., Tilton, K., & Kleve, M. (2017). Influence of a patient-centered care coordination clinical module on student learning: A multimethod study. Journal of Nursing Education, 56(1), 6-11.
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Khuan, L., & Juni, M. H. (2017). Nurses' Opinions of Patient Involvement in Relation to Patient-centered Care During Bedside Handovers. Asian Nursing Research, 11(3), 216-222.
Klein, J., Delany, C., Fischer, M. D., Smallwood, D., & Trumble, S. (2017). A growth mindset approach to preparing trainees for medical error. BMJ Quality & Safety, 26(9), 771-774.
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