Registered nurse (RN) procedures are person-centered and evidence-based with components that are preventive, curative, formative, compassionate, restorative, and palliative. In order to practice in Australia, nurses and midwives must be licensed with the Australian Nursing and Midwifery Board (NMBA) and follow the relevant requirements of the NMBA. An significant capability which effective nurses share and which is sometimes overlooked: the ability to objectively think. The definition of a problem, the pursuit of the right solution and the choosing of the most efficient approach are all aspects of the critical thinking. One of the most significant considerations in the healthcare sense is creating a successful therapeutic relationship between the nurse and the patient. This study will give a vivid knowledge on both the factors in clinical settings.
Standard 1: Description
Strong critical thinking skills can affect patient outcomes the most. Critical thinking includes understanding and evaluating the problem, arguing for a solution, implementing and, finally, assessing the results (Kong et al., 2014). The registered nurse develops practice by focusing on observations, understanding, behavior, feelings and beliefs to understand how such behaviors influence them along with it they respects all cultures and experiences, including reacting to the role of the Aboriginal and Torres Strait Islander peoples and peoples of other cultures in their family and society. They complies with legislation, rules, procedures, guidelines and other technically applicable criteria or specifications when making decisions. My patient named Janice had just amputated above her knee. Despite being on dilaudid PCA she complained about having immense pain. She described her pain as nerve pain which is burning in deep and tingling.
Feelings
I saw Janice to scream out of pain and I was helpless as PCA dosing was not working on her. I watched her pain is getting worse day by day. After discussing with the doctor he prescribed her with oral opioids along with PCA dosing. According to Peng et al, (2015), this meta-analysis examined the impact of combinations of opioid-dexmedetomidine (DEX) on postoperative patient controlled analgesia (PCA). A systematic literature review was performed to classify randomized controlled trials in adult patients, comparing opioidDEX combinations with opioid alone for intravenous PCA up to 24 hours postoperative. Seven randomized controlled trials were included. Compared with opioid alone, postoperative intravenous opioid-DEX combination PCA strategies led to lower postoperative pain intensity. The data indicate a combination of opioid-DEX is a safe and efficient treatment for intravenous postoperative PCA. I continuously asked her about the condition but no improvement was seen (Matthias et al., 2014). I felt demotivated for not being able to give her relief from pain. I was not in good state as I was unable to make her feel good and take her out of the condition.
Evaluation
As a new graduate RN I had not much of experience for which I cannot analyze the underlying reason of her pain. I communicate with all the interdisciplinary team members and discussed about the present condition of Janice and tried to use best available evidence. I described the pain as Janice told me. And while doing this, I felt that effective communication is necessary in the clinical settings to enhance the patient outcome. Tried to use ethical frameworks while making any decision about Janice (Field et al., 2014). I learnt timely documentation of assessment is required which I implied every time when I asked Janice about her condition. According to Kourkouta & Papathanasiou, (2014), good communication between nurses and patients is essential to each patient’s positive outcome in individualized nursing treatment. However, to do this, nurses must respect their patients and support them, displaying courtesy, compassion and honesty. They will therefore dedicate time to engaging with the patient with the required confidentiality, and do not forget that this contact involves people who accompany the ill person, which is why all those concerned will learn the language of contact. Good communication is also dependent not only on nurses’ physical skills but also on knowledge and experience.
Analysis
After communicating with Janice I got to know that she was having nerve pain that is accompanied with deep burning and tingling. I tried to find out the best possible intervention by researching but by then her pain was getting worse. Then I brainstormed and thought about nerve pain. Then I recalled that during my previous placement one patient was diagnosed with Diabetes along with neuropathy and he complained about the same pain. After recalling I discussed this with interdisciplinary team on medicating her with gabapentin. According to Papathanasiou et al., (2014) critical thinking is characterized as the mental process of actively and skillfully perceiving, interpreting, synthesizing and assessing the knowledge gathered through perception, experience and communication leading to a decision for action. There is regular reference in nursing education to critical thought and the relevance it has in the everyday practice of professional nursing. Nursing students should cultivate freedom of mind, honesty, perspicacity at the personal and social levels, modesty, moral strength, dignity, perseverance, self-confidence, engagement in learning and enthusiasm in order to understand and apply critical thinking. Critical thinking is an important method for healthy, efficient, and professional nursing. The nursing education programs will adopt attitudes which encourage critical thinking and activate critical reasoning skills.
Conclusion
I should have asked Janice to describe her pain earlier and analysed the underlying reason. I should have consulted with RN about the situation to get the treatment done before making the situation worse. From this case study I have concluded that critical thinking is necessary to handle any situation in the clinical settings. Critical thinking in nursing is a vital attribute required in the treatment of the patients. For a particular case, I will be able to assess conditions quickly and objectively and make the right clinical decision. It is my logical thinking skills that will drive your decision taking in situations like these.
Action plan
If this situation again arises I will consider the patients information first and through critical thinking I will take the decision and provide evidence based practice. Along with this I will provide patient-centered care to enhance the patient outcome.
Description
RN practice is focused on participating in effective therapeutic and professional relationships with intent. The RN creates, manages and ends partnerships in a way that differentiates professional and personal partnership boundaries. Communicates effectively, and recognizes the dignity, community, traditions, opinions and rights of a individual. The RN guides and leads people to tools to improve health-related decisions and advocates on behalf of persons in a way that values the dignity and legal power of the patient. The RN uses delegation, oversight, coordination, consultation and referrals in mutual partnerships to achieve positive health results. In the clinical settings a patient named Lauren. She was from different back ground and I was working with my supervisor. I did not interact adequately with the patient because she was defensive and began to recognize the disease phase of the patient instead of going into their previous medical background. She became arrogant and my supervisor handled her by making her comfortable. She listened to her cautiously despite of her speech problem. She used verbal and nonverbal contact to gain confidence from patients. The patient expressed trust in her slowly, and cooperated with her.
Feelings
I felt bad for refusing to cooperate with her. I felt a bit disheartened that I didn’t take the time to get to know her and make her more confident, so she could share her feelings. When watching my supervisor, I noticed my contact with people was missing. If I had outstanding communication skills, such as active listening, verbal and non-verbal contact, then I’d win her trust. According to Benbenishty & Hannink, 2015), non-verbal communication helps build confidence which describes as a conviction that the patient’s welfare will be taken care of , an attitude bound up with time and space in which one depends on another with faith. Communication psychologists frequently rely on a 55/38/7 formula: 55% body language, 38% voice tone and 7% real words. Therefore the health professional as a listener must commit to the act of listening intentionally. I believe that the practice of active communication is an integral part of therapeutic and professional relationship.
Evaluation
I assume that an important element in nursing is the therapeutic and professional relations. Therapeutic contact should care for the mental and physical needs of the individual. I learned a lot about coping with a patient in a difficult situation. It wasn’t a pleasant feeling because I don’t believe stuff like that can happen in practice. Nevertheless, in terms of learning experiences, it was nice because it taught me that being attentive to a patient who feels distressed is of utmost importance. This went well as I recognized the importance of being patient, of having the time to listen to a patient. That will, after all, have indirect impacts on the person’s well-being and on the influence of how they feel.
Analysis
Health care practitioners who invest in therapeutic and professional relationships need to develop a set of communication skills to effectively facilitate this process. According to Foronda, MacWilliams & McArthur, (2016), the association between miscommunication and bad patient experiences is well known. An integrative analysis was undertaken to clarify the existing state of awareness pertaining to interprofessional contact. Evidence has shown educational systems using structured methods and simulation are successful in developing interprofessional communication skills. Recommendations provide preparation outside behavioral strategies to tackle wider patient safety frameworks, valuing diversity, team research and cultural awareness
Conclusion
The way someone frames the problem is one consideration in the scenario that helped me see subtle factors influencing therapeutic and professional relationship. As I have learnt teamwork and the capacity to draw on experience greatly impacts the ability to provide the best possible quality of care. Time and commitment is therefore important to the patients, because they can never be taken away. It has to be recognized that our values affect the actions of our patients and we acknowledge that our client has different values and convictions that help us understand why they believe and behave as they do.
On reflection, I saw how easily contact on a nurse could win a patient’s trust and confidence. I will take the experience with me throughout my nursing career, knowing the importance of good communication and getting the ability to think back on an event and break it down to learn what happened.
Conclusion
As applied to both the situation, the key components of the therapeutic relationship were explored with respect to the evidence base in order to establish a positive reflective episode reflecting a description of incidents, feeling, evaluation, analysis and conclusion. Critical thinking is one of the most essential components which makes a nurse successful. As a nurse, where there is such a scenario that there are several solutions or procedures and the job is to decide the remedy which will provide the patient with the best possible outcome then critical thinking comes into play. In brief, this paper addressed the nurse’s personal observations in the sense of an episode of analytical work in order to understand in reality the importance and values of the therapeutic relationship. The reflection process will create an effective response plan and, in this situation, it is believed that patients should be treated in a more compassionate way, ensuring that they have an empathic and respectful approach to treatment while preserving nursing boundaries.
References
Benbenishty, J. S., & Hannink, J. R. (2015). Non-verbal communication to restore patient–provider trust. Intensive care medicine, 41(7), 1359-1360. DOI 10.1007/s00134-015-3710-8
Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Science, 9(1), 172. https://doi.org/10.1186/s13012-014-0172-2
Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse education in practice, 19, 36-40. https://dx.doi.org/10.1016/j.nepr.2016.04.005
Kong, L. N., Qin, B., Zhou, Y. Q., Mou, S. Y., & Gao, H. M. (2014). The effectiveness of problem-based learning on development of nursing students’ critical thinking: A systematic review and meta-analysis. International journal of nursing studies, 51(3), 458-469
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65 doi: 10.5455/msm.2014.26.65-67
Matthias, M. S., Krebs, E. E., Bergman, A. A., Coffing, J. M., & Bair, M. J. (2014). Communicating about opioids for chronic pain: A qualitative study of patient attributions and the influence of the patient–physician relationship. European journal of pain, 18(6), 835-843. https://doi.org/10.1002/j.1532-2149.2013.00426.x
Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: the development of an essential skill for nursing students. Acta Informatica Medica, 22(4), 283.
Peng, K., Liu, H. Y., Wu, S. R., Cheng, H., & Ji, F. H. (2015). Effects of combining dexmedetomidine and opioids for postoperative intravenous patient-controlled analgesia. The Clinical journal of pain, 31(12), 1097-1104. DOI: 10.1097/AJP.0000000000000219
Siles-González, J., & Solano-Ruiz, C. (2016). Self-assessment, reflection on practice and critical thinking in nursing students. Nurse education today, 45, 132-137 https://dx.doi.org/10.1016/j.ijnurstu.2013.06.009
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