Discuss the managing patient deterioration or patients with pain in the ED. An example of an incident that required leadership/management skills.
As a registered nurse, the management and the provision of the care and safety to the patient in every situation is the foremost duty of my profession. During the practice, a nurse has to face several cases where patients are suffering from various ailments. There was one case during my nursing practice involving a lady who was a 70-year-old suffering from intense abdominal pain and was immediately admitted to the emergency department. The management of the elderly patients is sometimes very difficult due to certain barriers faced during the assessment and the treatment and this case also included the same problem. As pain is the subjective experience and there is no objective means or tests to measure the quality and intensity of the pain. Hence, an effective communication is very important for the management of the acute and chronic pain in the patient (Herr et al., 2011). However, as the patient in this case was elder and was also positive for dementia, there was a barrier in the communication, which hindered the assessment of the pain in detail. At that time there was the requirement of the patience and interpersonal skills to encourage the patient to discuss her pain in detail. Moreover, with the help of the training that I had received during my nursing practice, I also kept on observing the behavioral expressions of the patient in determining the intensity of the pain. With the knowledge of the past medical history of the patient and under assistance of the physician, the low dose of the analgesic trial was given to the patient according to the available information regarding the pain for its management (Czarnecki et al., 2011).
Description- As the patient was a geriatric patient and had dementia symptoms; I was having issues while communicating with her and it was decreasing the effectiveness of the pain management service
Feelings- I felt bad for the patient by looking at her situation and felt bad for the fact that I was not capable of improving her situation. However, I always tried to communicate with her and tried to establish a positive relationship with her. I observed her past medical history and current status and tried to implement the effective pain assessment tools for analyzing her pain severity
Evaluation- While evaluating my role for handling this patient, I have analyzed that I have tried to achieve the nursing competency standard; I always repeated facts to combat with her forgetfulness. In this context, I have explored the experiences from nursing training and handled the patient by observing her behavioral expression to assess the intensity of the pain.
Conclusion- In conclusion, it can be said that I have tried to assist the patient by evaluating her issue, in spite of the barrier in communication due to her status of dementia and severe pain. Through the help of my management and nursing skills, I tried to establish a care plan for resolving the situation.
Action- Finally, I tried to rely on her previous medical history and with the help of a physician started to administer low dose pain medication trial and followed up her improvement throughout 15 successive days.
Being a registered nurse, it is important to ensure patient’s safety and provision of the best quality of work to the patients. For providing the best care service, from my perspectives, the nurse should have the best management and leadership qualities. It is because, being a registered nurse, they have enough responsibilities to manage critical situations in the health care environment. In addition to the patient care services, the registered nurse has to manage many internal issues which might arise in the contemporary health framework within team mates and other health care workers. In this context, the registered nurse has the highest priority to assess the incident and implement the most suitable intervention through her acquired skills and capabilities to resolve those issues, thereby helping the organization to improve the overall quality of service provided (Barr & Dowding, 2012).
In this context, one incident I have faced an incidence which required the essential management/leadership skills of a nurse leader and I explored the leadership skills for resolving the current issue in that context through the implementation of effective nursing strategies suitable for that situation. I will explain the situation through a reflective framework, the Gibb’s Reflective cycle. Gibb’s reflective cycle included the five consecutive steps, including description, feelings, evaluation, conclusion and action (Bouch, 2012).
Description- During the period of my nursing practice, I have faced a conflict where one of my team mate undertaken a wrong step in the health care settings. She forgot to administer a particular medication to a patient. After addressing her fault, she did not attempted to rectify her fault, in spite of thinking about resolving the situation; she did not inform anyone about the issue. I was not aware of the issue at all. The patient was at a severe condition and missing one dose of his medication could be life threatening. The day after this incidence, she told me about the incident she have done.
Feelings- After listening the incident from her, I was initially shocked, thinking about the consequences. I felt shocked thinking about the possible consequences for both the patients and the nursing staff. The patient might have negative consequences due to the missing dose of his essential medication. On the other hand, if the negative consequences happened to the patient, the patient family could sue the nursing staff; her nursing license could be cancelled. Thus, I felt sad for both of them, however, I could not support the nursing staff, as she did not tell anyone about her mistake and did not attempted to recover the situation. Therefore, it could be characterized as an offensive activity.
Evaluation- From the situation, I have evaluated that the nurse did not met the nursing competency standards as well as the ethical considerations in the nursing competency framework. I have also analyzed that the patient’s situation can deteriorate further, if the missing dose is not compensated by an alternative approach, because the patient was in severe condition. I have analyzed the fact that I should convince the nursing staff to inform the situation to the entire health care team and then we could help her to resolve the situation. In this way we can make the situation better.
Conclusion- In conclusion, I can say that the nurse did not meet the nursing standards along with the ethical codes which have been set for the nursing practices. In addition, the nurse did not inform the higher authority to resolve this issue. At this situation, with my problem solving skill, I tried to convince her to talks with the entire health care team to resolve the issue.
Action- Finally, I have convinced the nurse to talk with the health care team. With a positive attitude, I helped to arrange a meeting with the team and there she talked with the patient’s physician. At this stage, I requested the physician to talk with the patient party and her apologies to the entire team and patient party. Finally, based on the patient’s assessment, the physician successfully applied alternative medication to the patient. Through effective communication and management skills, the situation was resolved.
Reference List
Barr, J. & Dowding, L. (2012). Leadership in health care. Los Angeles: SAGE.
Bouch, J. (2012). Reflective writing. Advances In Psychiatric Treatment, 18(3), 161-161. https://dx.doi.org/10.1192/apt.18.3.161
Czarnecki, M., Turner, H., Collins, P., Doellman, D., Wrona, S., & Reynolds, J. (2011). Procedural Pain Management: A Position Statement with Clinical Practice Recommendations. Pain Management Nursing, 12(2), 95-111. https://dx.doi.org/10.1016/j.pmn.2011.02.003
Herr, K., Coyne, P., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations. Pain Management Nursing, 12(4), 230-250. https://dx.doi.org/10.1016/j.pmn.2011.10.002
Bibliography
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Wald, H., Borkan, J., Taylor, J., Anthony, D., & Reis, S. (2012). Fostering and Evaluating Reflective Capacity in Medical Education: Developing the REFLECT Rubric for Assessing Reflective Writing. Academic Medicine, 87(1), 41-50. https://dx.doi.org/10.1097/acm.0b013e31823b55fa
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