Contemporary Nursing Practice 1 

Comparison

Primary assessment Similarities: The use of DRABCD for primary assessment. Differences: The expert comments highlighted the significance of DRABCD and persuaded the clinical assessment of the patient in a sequential manner. Which was not done in the assignment submitted by me. The factor “exposure” was not included. Possible explanations for differences &/or omissions: Even when both the approaches used DRABCD for the assessment of the patient, the expert approach followed a sequence-based analysis where as I followed the patient response to analysis approach. I documented the primary assessment with observation, patient response, followed by the analysis of the information collected. Exposure was omitted as patient was already under clinical observation and hospitable environment.

Focussed Assessment

Similarities: Identification of common priority problems (Respiratory, cardiovascular, and Gastrointestinal)

Differences: Muscoskeletal system was not prioritised, Gastrointestinal system was given a higher priority.

Possible explanations for differences &/or omissions: The musco-skeletal system was omitted as the patient is already on bedrest and was able to move in in presence of supervision in front of the physiotherapist. The gastrointestinal system has been given priority as it can be associated with her pain, diet, and even urinary and renal problems.

Nursing Problems, Planning, and Implementaion

Similarities: Identification of common nursing problems (Actual: Pain, UTI; Potential: Anxiety and household management and nutritional deficiencies), justified evaluation and interventions used in the document. Differences: Prioritisation of risks like VTA, falls, pressure injuries, hypoxemia. Possible explanations for differences &/or omissions: The nursing problems identified could belong to a diverse range. UTI has been prioritised as the patient has a history of recurring UTI and it has also resulted in events like incontinence. Further, it was also the likely reason for her fall where the patient was rushing for bathroom and fell down. Person-centred care plan has been included for complete care of the patient.

Reflection on Learning

Consolidated:

It was a learning experience to have received the expert perspective on how to identify and prioritise the patient problems for effective management of the condition. This practice helped me accumulate knowledge about critical thinking and analysis and work on the high priority areas in the clinical scenarios. This experience also consolidated the development of descriptive and analytical approaches that are crucial in nursing practice. Since the experts had multiple health problems identified, they articulated and prioritised with reason helping me understand the significance of critical analysis and prioritisation to ensure patient beneficence.

My knowledge about the application of suitable intervention and evaluation of the outcomes has also been consolidated through this assessment. Challenged: Even though I had tried my best to understand and underpin the priority health problems and was happy that I had several overlaps with the opinions of the experts, my analysis about prioritisation of the health problems was challenged. For instance, I had considered gastrointestinal problems a high priority that could have been assessed after the respiratory stabilisation in the patient.

It was also a challenge to prioritise and filter suitable interventions as the patient is suffering from multiple clinical anomalies and also possess a history of numerous health conditions. Main take-home idea: The main take-home idea that I gathered by the completion of this assessment is the importance of prioritisation in planning and conducting the nursing assessment. I have realised that in a clinical setting, patients are likely to present with multiple health conditions that can impact the primary health problem in focus. Therefore, it is important to identify the major health problems, perform the suitable assessment, apply the required intervention, and evaluate the results effectively to ensure beneficence of the patient that can be of significant importance in my future practice.

Impact on Practice

The key knowledge that was gained through this assessment was about how to effectively prioritise the nursing problems in a clinical setting and apply the interventions appropriately with adequate analysis and evaluation. Prioritising in nursing is of essential importance as it helps the nurses to take timely actions and ensure the well being of the patient (Suhonen et al., 2018). This assessment provides a scope for the development of critical skills essential for a healthcare practitioner. Critical reasoning is one of the core domains that must be possessed by the nurses as it helps in the determination of the primary and secondary problems of the patients and to articulate and apply the suitable nursing intervention for the same (Middleton et al., 2019).

An essential strategy that I will use to prioritise and comply with the patient's needs is to critically evaluate the condition and use tools like Maslow’s hierarchy so ensure the application of suitable intervention and a timely approach for the highest quality care (Ward, 2016). This approach will help me plan and evaluate the nursing needs of the patient by breaking them into classes that can be addressed based on their immediate needs (Dahlke et al., 2019). Therefore, this will assist me in developing as an effective nurse practitioner in the future and also help me work more critically and analytically in my due course. With learning and knowledge about how to prioritise patient problems, I will be able to provide care and support to the patients ensuring their beneficence.

References for iSAP Comparative Report

Dahlke, S. A., Hunter, K. F., & Negrin, K. (2019). Nursing practice with hospitalised older people: Safety and harm. International Journal of Older People Nursing, 14(1), 12220.

Middleton, S., Charnock, A., Forster, S., & Blakey, J. (2019). Factors affecting individual task prioritisation in a workplace setting. Future Healthcare Journal, 6(1), 114.

Suhonen, R., Stolt, M., Habermann, M., Hjaltadottir, I., Vryonides, S., Tonnessen, S., ... & Scott, P. A. (2018). Ethical elements in priority setting in nursing care: A scoping review. International Journal of Nursing Studies, 88, 25-42.

Ward, T. D. (2016). Think Like a Nurse: A Critical Thinking Initiative. ABNF Journal, 27(3).

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