Christina Nagel
10 Kendall Street
Rochester, NH 03867
(603)781-8726
Objective:
Seeking a challenging position to enhance my nursing skills and broadening my knowledge base, while providing quality, nursing care.
Education:
University of New Hampshire- Nursing Major, cumulative GPA of 3.10, anticipated date of Graduation- May 2009
Clinical Experience:
1/07-5/07: Portsmouth Regional Hospital: Medical-Surgical Unit
8/07-12/07: Southern New Hampshire Medical Center: Medical-Surgical Unit
1/08-5/08: Lawrence General Hospital: Pediatrics, Southern New Hampshire Medical Center: Labor and Delivery
Skills and Certifications:
- Direct patient care
- Care in long term and acute settings
- Charting and documentation
- Catheter and IV care
- Extensive medical terminology
- Medication administration
- Patient education and discharge planning
- American Heart Association CPR
- LNA license in the state of New Hampshire (031798-24)
Relevant Experiences:
Nursing Care Technician- Frisbie Memorial Hospital, Rochester, NH: 7/08- Present
- Direct patient care
- Assistance with ADL’s
- Working collaboratively with all health care team members to provide quality patient care
- Documentation of I&O’s, weights, blood sugars and vital signs
- Performing 12 lead EKG’s
LNA- Sunbridge Care and Rehabilitation for Rochester, Rochester, NH: 2/07-7/08
- Performed direct patient care in a long term, Geriatric patient setting
- Bathing and personal care of residents
- Charting and documenting ADL’s and activities of residents
- Working collaboratively with all health care team members to provide quality patient care
References:
Catherine Britton: (603)332-9668
Sharon Lewis: (603)332-1310
Christy Plourde: (603)335-3955
Patricia Puccilli: (603)862-1265
Catherine Flores: (603)862-1959
Senja Olivio: (603)332-5211 ext. 8462
Tuesday, July 29, 2008
Nursing 720: Objectives for Senior Practicum
Four objectives that I would like to achieve during my clinical experience include:
1. Enriching my own nursing judgment along with my critical thinking skills.
2. Maturing from the stages of being a student nurse to the stages of becoming a new RN.
3. Create a method in which I can draw connections between the patient’s current health status or issue, and all that could be incorporated around it.
4. Advancing my comprehension on the association, collaboration and effect that diseases and medications have in relation to each other.
1. Enriching my own nursing judgment along with my critical thinking skills.
2. Maturing from the stages of being a student nurse to the stages of becoming a new RN.
3. Create a method in which I can draw connections between the patient’s current health status or issue, and all that could be incorporated around it.
4. Advancing my comprehension on the association, collaboration and effect that diseases and medications have in relation to each other.
Nursing Philosophy
I view nursing as a combination of the many aspects of health care, all intertwined to form an honorable profession. Nursing is not just caring for a client who is ill, nursing is also about providing the support that clients and families may need during a health crisis. Nursing not only enables one to care for the client, but also to care for the client's family in any way possible. A nurse should provide both the family and patient with comfort and a sense of belonging and importance. A nurse would typically care for families by offering emotional support and being as informative to the family about the given situation, as possible. In addition, a nurse is one who provides a more holistic form of health care. I believe that nurses should strive to tend to the mind and spirit, rather than placing focus on the body alone. Not only is nursing considered a profession for an individual and his or her family, nursing encompasses providing care to both communities and groups alike. Nurses do not work only in hospital settings. Nurses may also work outside of hospital walls to promote health and well-being among community members and societies.
When I think of a nurse, I think of somebody who is kind, caring, responsible and knowledgable. Nurses recognize that people are individuals, but also treat them with respect, honor and equality. The nurse is someone whom advocates for the patient in an attempt to ensure that he or she receives the best care. It is a nurse's duty to never act in a way that could harm the client. Nurses should be there to provide the care and time necessary to maintain maximum health potential, while the other team members may not have the time to spare. It is up to a nurse to realize that the life of a client or clients is in his or her hands and they need to be committed to providing the best care they can because it is the description of their profession to do so. A nurse should always feel confident about the care being given and if at all in doubt, always ask questions and ask for help from colleagues.
While this profession gives the opportunity for autonomy, a nurse is always part of a larger team that works together to help clients obtain optimal health. A nurse should always provide clients with privacy, comfort, and confidentiality, none of which will ever be taken away to break the trust between clients and nurse. It is important for clients and nurses to form a meaningful relationship in which they can communicate effectively, trust each other, and help one another.
Nurses must always actively research. Research is an important part in providing the best care possible to clients and may also provide clients with alternatives, whether they be treatments, medications, diets or specialty doctors. It is through research that we as nurses can advance our profession. In addition to researching, nurses must also stay current with health care by taking educational courses that will not only refresh what has been learned in the past, but also teach new methods or necessary information to provide optimal care to clients.
I believe that health is a state of being where one’s mind, body, and spirit are all in harmony and is experiencing no pain or discomfort and this is what all clients should experience once they have received care. I also believe that a part of health is having a healthy environment. The environment that we live in greatly effects our health, and it is important to try our best to maintain a healthy environment that way people can also maintain a healthy life.
When I think of a nurse, I think of somebody who is kind, caring, responsible and knowledgable. Nurses recognize that people are individuals, but also treat them with respect, honor and equality. The nurse is someone whom advocates for the patient in an attempt to ensure that he or she receives the best care. It is a nurse's duty to never act in a way that could harm the client. Nurses should be there to provide the care and time necessary to maintain maximum health potential, while the other team members may not have the time to spare. It is up to a nurse to realize that the life of a client or clients is in his or her hands and they need to be committed to providing the best care they can because it is the description of their profession to do so. A nurse should always feel confident about the care being given and if at all in doubt, always ask questions and ask for help from colleagues.
While this profession gives the opportunity for autonomy, a nurse is always part of a larger team that works together to help clients obtain optimal health. A nurse should always provide clients with privacy, comfort, and confidentiality, none of which will ever be taken away to break the trust between clients and nurse. It is important for clients and nurses to form a meaningful relationship in which they can communicate effectively, trust each other, and help one another.
Nurses must always actively research. Research is an important part in providing the best care possible to clients and may also provide clients with alternatives, whether they be treatments, medications, diets or specialty doctors. It is through research that we as nurses can advance our profession. In addition to researching, nurses must also stay current with health care by taking educational courses that will not only refresh what has been learned in the past, but also teach new methods or necessary information to provide optimal care to clients.
I believe that health is a state of being where one’s mind, body, and spirit are all in harmony and is experiencing no pain or discomfort and this is what all clients should experience once they have received care. I also believe that a part of health is having a healthy environment. The environment that we live in greatly effects our health, and it is important to try our best to maintain a healthy environment that way people can also maintain a healthy life.
Career Goals
After I have finished my undergraduate schooling, I would like to attend graduate school to become a Nurse Practitioner. Once I have obtained my master's degree and have become a Nurse Practitioner, I hope to begin my career in a hospital setting. I believe that working within a hospital will give me the broadest amount of experience. Further into my years as a Nurse Practitioner, and when I have started my own family, I think that I would like to work in an office setting. If I am to start my career in the hospital and then move on to a doctor's office, I believe I will be much better off because I will be well prepared for the many things I could encounter. I also will have a much more extensive knowledge base than if I had gone straight into working in the office setting. Also, in working within an office, I will have a more consistent patient base. With this more consistent patient base, I will be able to form more thorough relationships with my patients and get to know them on a more personal level.
Perhaps even further into my career as a nurse, I will teach. The reason for this is that I feel it is important to share the wealth of information that I have gained through both my education and experience in the clinical setting. I hope to use my own knowledge and experience to influence future nurses.
Perhaps even further into my career as a nurse, I will teach. The reason for this is that I feel it is important to share the wealth of information that I have gained through both my education and experience in the clinical setting. I hope to use my own knowledge and experience to influence future nurses.
Nursing 695: Independent Nursing Research Study
Introduction:
It is widely known that pain is often under-treated and under-documented in the clinical setting. It has been shown numerous times how a lack of education can influence how a nurse treats pain. Although one area that is lacking research is how factors such as religion, age, past experience with pain, degrees and educational background, units worked on and years as a nurse influence how the nurse treats pain. In a study done by Ooi Seow Yin, it was found that there is a significant association between educational level and a level of helplessness. Those with a degree were less likely to feel helpless compared to those with a diploma or advanced diploma (Yin 2007). Within the research, many articles looked into the influence of the patient’s culture and the nurse’s culture on the perception and expression of pain. It is mostly the articles on the cultural environment of the unit, and the nurses’s culture, where the gap in knowledge occurs. To better enhance the understanding of how nurses treat pain, the goal of our study is to examine a nurse’s culture based on what is lacking in the research.
Objectives:
- To determine how cultural factors such as religion, age, past experience with pain, degrees and educational background, units worked on, and years as a nurse influence how a nurse treats pain.
- To understand how a nurse’s past experience with pain can influence how she treats a patient’s pain.
- To utilize our research to educate nurses on how cultural and personal issues may influence how they treat pain in order to enhance patient satisfaction with pain management.
Setting:
A seacoast area hospice service and a medical-surgical unit with a focus on the care of oncology and end-stage disease management.
Source of Subjects: 20 RNs by convenience sampling (10 Medical -Surgical nurses and 10 Hospice nurses)
Investigator Experience:
Julianne St. Onge and Christina Nagel, both senior nursing students with 2 years of experience in the clinical setting along with prior experience working in nursing homes. Dr. Flores is a UNH faculty member with experience in qualitative research and hospice care (see attached letter).
Protocols:
After obtaining informed consent, the investigators will conduct focused interviews with participating nurses who provide end-of-life and end-stage-disease management care in the hospice and acute care settings. All responses will be kept anonymous while all names and identifiers will be removed. All interviews will be conducted in a private area such as a conference room or break room with only the interviewer and informant present. Interviews will be audio taped to ensure the accuracy of data transcription and analysis. Study participants will sign a form consenting to the recording, transcription, analysis and reporting of the data he or she provides. Study participants may request to have access to the recordings of their individual interviews. Analyzed data will be presented in an aggregated form on tables and figures that eliminates all identifiers of individual participants. All tapes and transcripts will be stored in a locked filing cabinet in Hewitt Hall. Researchers will honor requests to edit a subject from a presentation.
Consent:
Consent will be obtained using the written full form which will state that the interviewees are agreeing to take part in an audio taped interview. Both interviewer and interviewees will receive signed copies of the consent form (see attached consent form).
Data:
All subject identifiers will be removed from the interview transcripts prior to analysis. Data will be analyzed through qualitative methods such as coding, theme identification, and describing the varieties of categories within each theme using data management software. Our findings will be used to describe social and cultural factors that may influence the nurse-management of pain in end-of-life and/or end-stage-disease care. Data will be aggregated and reported in charts, graphs and anecdotal paragraphs, quotes or stories. Data will be stored in a locked filing cabinet in Hewitt Hall. Only researchers will have the ability to access the audio tapes. At the end of the study, all audio tapes will be destroyed.
Risks:
There is minimal risk to the subjects involved in this study. Researchers are taking all possible measures to ensure confidentiality of subjects.
Benefits:
Benefits include raising the subject’s awareness of how cultural and personal issues influence the management of pain at the end of life.
References
Camp, L.D., O’Sullivan, P.S. (1987). Comparison of medical, surgical and oncology patients’ descriptions of pain and nurses’ documentation of pain assessments. Journal of Advanced Nursing, 12, 593-598. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Dalton, J.A., Carlson, J., Mann, J.D., Blau, W., Bernard, S., Youngblood, R. (1998). An examination of nursing attitudes and pain management practices. Cancer Practice, 6, 115-124. Retrieved June 25, 2008, from the CINAHL database.
Fothergill-Bourbonnais, F., Wilson-Barnett, J. (1992). A comparitive study of intensive therapy unit and hospice nurses’ knowledge of pain management. Journal of Advanced Nursing, 17, 362-372. Retrieved June 24, 2008, from the CINAHL database.
Wilson, B., McSherry, W. (2006). A study of nurses’ inferences of patients’ physical pain. Journal of Clinical Nursing, 15, 459-468. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Wilson, B. (2007). Nurses’ knowledge of pain. Journal of Clinical Nursing, 16, 1012-1020. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Yin, O.S., Xia, Z., Chia, D.T.C. (2007). Nurses’ perceptions towards caring for dying patients in oncology ward and general surgical ward. Singapore Nursing Journal, 34, 16-21. Retrieved on June 25, 2008, from the CINAHL database.
Young, J.L., Horton, F.M., Davidhizar, R. (2006). Nursing attitudes and beliefs in pain assessment and management. Journal of Advanced Nursing, 53, 412-421. Retrieved June 24, 2008, from the CINAHL database.
It is widely known that pain is often under-treated and under-documented in the clinical setting. It has been shown numerous times how a lack of education can influence how a nurse treats pain. Although one area that is lacking research is how factors such as religion, age, past experience with pain, degrees and educational background, units worked on and years as a nurse influence how the nurse treats pain. In a study done by Ooi Seow Yin, it was found that there is a significant association between educational level and a level of helplessness. Those with a degree were less likely to feel helpless compared to those with a diploma or advanced diploma (Yin 2007). Within the research, many articles looked into the influence of the patient’s culture and the nurse’s culture on the perception and expression of pain. It is mostly the articles on the cultural environment of the unit, and the nurses’s culture, where the gap in knowledge occurs. To better enhance the understanding of how nurses treat pain, the goal of our study is to examine a nurse’s culture based on what is lacking in the research.
Objectives:
- To determine how cultural factors such as religion, age, past experience with pain, degrees and educational background, units worked on, and years as a nurse influence how a nurse treats pain.
- To understand how a nurse’s past experience with pain can influence how she treats a patient’s pain.
- To utilize our research to educate nurses on how cultural and personal issues may influence how they treat pain in order to enhance patient satisfaction with pain management.
Setting:
A seacoast area hospice service and a medical-surgical unit with a focus on the care of oncology and end-stage disease management.
Source of Subjects: 20 RNs by convenience sampling (10 Medical -Surgical nurses and 10 Hospice nurses)
Investigator Experience:
Julianne St. Onge and Christina Nagel, both senior nursing students with 2 years of experience in the clinical setting along with prior experience working in nursing homes. Dr. Flores is a UNH faculty member with experience in qualitative research and hospice care (see attached letter).
Protocols:
After obtaining informed consent, the investigators will conduct focused interviews with participating nurses who provide end-of-life and end-stage-disease management care in the hospice and acute care settings. All responses will be kept anonymous while all names and identifiers will be removed. All interviews will be conducted in a private area such as a conference room or break room with only the interviewer and informant present. Interviews will be audio taped to ensure the accuracy of data transcription and analysis. Study participants will sign a form consenting to the recording, transcription, analysis and reporting of the data he or she provides. Study participants may request to have access to the recordings of their individual interviews. Analyzed data will be presented in an aggregated form on tables and figures that eliminates all identifiers of individual participants. All tapes and transcripts will be stored in a locked filing cabinet in Hewitt Hall. Researchers will honor requests to edit a subject from a presentation.
Consent:
Consent will be obtained using the written full form which will state that the interviewees are agreeing to take part in an audio taped interview. Both interviewer and interviewees will receive signed copies of the consent form (see attached consent form).
Data:
All subject identifiers will be removed from the interview transcripts prior to analysis. Data will be analyzed through qualitative methods such as coding, theme identification, and describing the varieties of categories within each theme using data management software. Our findings will be used to describe social and cultural factors that may influence the nurse-management of pain in end-of-life and/or end-stage-disease care. Data will be aggregated and reported in charts, graphs and anecdotal paragraphs, quotes or stories. Data will be stored in a locked filing cabinet in Hewitt Hall. Only researchers will have the ability to access the audio tapes. At the end of the study, all audio tapes will be destroyed.
Risks:
There is minimal risk to the subjects involved in this study. Researchers are taking all possible measures to ensure confidentiality of subjects.
Benefits:
Benefits include raising the subject’s awareness of how cultural and personal issues influence the management of pain at the end of life.
References
Camp, L.D., O’Sullivan, P.S. (1987). Comparison of medical, surgical and oncology patients’ descriptions of pain and nurses’ documentation of pain assessments. Journal of Advanced Nursing, 12, 593-598. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Dalton, J.A., Carlson, J., Mann, J.D., Blau, W., Bernard, S., Youngblood, R. (1998). An examination of nursing attitudes and pain management practices. Cancer Practice, 6, 115-124. Retrieved June 25, 2008, from the CINAHL database.
Fothergill-Bourbonnais, F., Wilson-Barnett, J. (1992). A comparitive study of intensive therapy unit and hospice nurses’ knowledge of pain management. Journal of Advanced Nursing, 17, 362-372. Retrieved June 24, 2008, from the CINAHL database.
Wilson, B., McSherry, W. (2006). A study of nurses’ inferences of patients’ physical pain. Journal of Clinical Nursing, 15, 459-468. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Wilson, B. (2007). Nurses’ knowledge of pain. Journal of Clinical Nursing, 16, 1012-1020. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Yin, O.S., Xia, Z., Chia, D.T.C. (2007). Nurses’ perceptions towards caring for dying patients in oncology ward and general surgical ward. Singapore Nursing Journal, 34, 16-21. Retrieved on June 25, 2008, from the CINAHL database.
Young, J.L., Horton, F.M., Davidhizar, R. (2006). Nursing attitudes and beliefs in pain assessment and management. Journal of Advanced Nursing, 53, 412-421. Retrieved June 24, 2008, from the CINAHL database.
Nursing 622: Evidence Based Practice Paper
M.B. is an 11 year old girl who has come to the doctor’s office with her mother complaining of a sore throat, difficulty swallowing, and a fever. M.B.’s mother states that although M.B. has been complaining of difficulty swallowing, she has been trying to keep the child hydrated. This is the fourth time this year, that M.B. has made a visit to the doctor’s office for this complaint, but she has no medical history otherwise. Upon assessment, the nurse finds that M.B. has a temperature of 99.8 degrees Fahrenheit, and her throat appears red and inflamed. M.B.’s primary physician did a throat culture and a rapid strep screening to determine the source of infection and to choose the most beneficial treatment. The rapid strep screening showed that there was in fact a strep infection present. The doctor then scheduled M.B. for a tonsillectomy a week from the day she was seen. M.B. appears to be nervous about the sound of needing surgery, and looks unsure of what the procedure will involve. M.B.’s mother also appears somewhat anxious and worried. When confronted about her worried look, M.B.’s mother explained that when she was younger, she too had her tonsils removed, but she had a very bad experience both before and after the surgery.
The setting for nursing care in this case is within a doctor’s office. The nurse will play the role of both an educator and a form of support for both M.B. and her mother. While in the doctor’s office, the nurse can provide her patient and the patient’s mother with information that will hopefully decrease any anxiety and lessen the fear that may arise with experiencing a surgical procedure.
Some nursing diagnoses that can be developed by M.B.’s diagnosis of tonsilitis are: risk for deficient fluid volume related to decreased intake due to throat pain during swallowing, acute pain related to surgical excision of tonsils, and risk for injury: bleeding related to surgical incision into a highly vascular site (Potts 712). Other nursing diagnoses that can be developed from the case of M.B. based on her need for a tonsillectomy include: mild anxiety related to the need for a surgical procedure, deficient knowledge related to the routines involved in surgery, and fear related to unfamiliarity with surgery.
Based on the location and role of the nurse at the current time, the primary nursing diagnosis would be, deficient knowledge related to the surgical procedure and the routines involved. The secondary nursing diagnosis would be, mild anxiety related to the need for a surgical procedure, and third would be fear related to unfamiliarity with surgery. I would place the nursing diagnosis, risk for deficient fluid volume related to decreased intake due to throat pain during swallowing, as fourth. Although it is an issue, the mother is currently addressing the issue by keeping M.B. hydrated by enforcing her to drink plenty of fluids. The other diagnoses, acute pain related to surgical excision of tonsils, and risk for injury: bleeding related to surgical incision into a highly vascular site, are diagnoses that the PACU nurse would tend to. These nursing diagnoses are ones that cannot be dealt with in the doctor’s office, because they only become an issue once surgery has been completed.
The top three nursing diagnoses were placed as they were to give some logic to the order in which they are addressed, and how the nurse will intervene. Deficient knowledge was placed as the primary nursing diagnosis because if information is given regarding the surgical procedure and all the routines involved, then perhaps the second and third diagnoses of anxiety and fear can be lessened. If a patient has a more clear understanding on the surgery and what to expect, then it is very likely that the patient will experience less anxiety and fear towards the surgical procedure.
The one single nursing issue that will be addressed is, how to tend to a patient’s deficient knowledge regarding a surgical procedure, in order to decrease that patient’s levels of anxiety and fear. It is through this issue, that literature will be reviewed to find the best possible ways to educate adolescents on surgical procedures in hopes of decreasing anxiety and fear. The aim of the nurse is to provide enough appropriate and useful information or sources, to make the child feel more comfortable with the procedure, and at the same time, ensure that parent’s become more at ease with the procedure also.
There are many forms of information that could be found to address a patient’s knowledge deficit in order to lessen anxiety and fear. Some information that may be useful includes: how to provide education to an adolescent, a clear understanding of which developmental stage the child is at, ways in which to lessen a child’s anxiety and fear, what methods of education are most effective in teaching young adolescents, and the best method for communicating with an adolescent. Also, a nurse may want to consider what information should and should not be told to a child of a specific age group. Depending on which developmental stage the child is in, it may be appropriate to leave out certain details of a surgical procedure. The nurse will also want to find an evaluation method to determine the effectiveness of his or her interventions.
In an attempt to find information and articles regarding the issue at hand, I chose to use the MEDLINE data base through EBSCOhost and the Academic Search Premier. I am most familiar with these data bases and find them both to be very resourceful. Some key words that I used to search for my information were: tonsillectomy, child, surgery, comfort, pediatric, preparation, education and anxiety and fear. Through using these terms, I was able to come across many useful articles that addressed the exact issue that I was aiming to treat. In looking through the many articles, I chose the ones in which I was supplied with different forms of providing information to enhance comfort in young children who are about to undergo a surgical procedure. I also chose to review articles in which actual interventions were implemented to decrease pre-operative anxiety, rather than articles that reviewed other research literature. I chose to do this because I found it to be more useful in approaching my issue. In reading such articles, I am more able to conclude which forms and methods would be best in educating my patient while aiming to reduce anxiety levels of both the patient and her mother.
In an article done by Susan O’Conner-Von, titled, Preparation of adolescents for outpatient surgery: Using an internet program, researchers found that with the use of an internet program, compared to a standard hospital preparation program, levels of anxiety for both children and parents were much lower. The study compared the effectiveness of both types of preoperative, educational interventions. In looking at the end results for these interventions, researchers examined a child’s anxiety level, knowledge acquirement, pain intensity, and satisfaction with the provided method of preoperative preparation (O’Conner-Von 2008).
The internet program which offered much more satisfaction, was titled, Tonsils! who needs ‘em? Through this program, children were prepared for an upcoming tonsillectomy. Adolescents were educated on the surgical procedure in a conversational format, where another adolescent was teaching the program. The program was developmentally appropriate and provided children with both procedural and sensory information with descriptions of the normal routines that occur during surgery. Photographs were presented, as well as explanations for medical equipment and the duties of personnel present in the operating room. Once the program ended, children were given the ability to print forms on the information they learned, and in addition, advice for home care after surgery. These forms could be overlooked by the children, and given to their parents. This additional information would provide parents with crucial education on diet, pain assessment and management post-operatively, along with referral phone numbers and other useful resources (O’Conner-Von 2008).
In this study, researchers found that a standard hospital preparation program also had positive outcomes for children and parents. Although outcomes were positive, they were not quite as high as those found with the use of the internet program. A typical hospital preparation program is held once a week, in the evening and focuses on many of the same things as in the internet program. Perhaps it is through this sort of presentation that patients and parents are less satisfied because there is a greater need for more interactive type educational programs rather than lectures (O’Conner-Von 2008).
Information is presented to adolescents and their parents in a developmentally appropriate manner. Both sensory and procedural information is given, along with the routines carried about during the surgery. Photos were shown of the medical equipment used, explanations were given as to how equipment worked and what it did, as was an explanation on the duty of operating room personnel. A tour of the operating room and surgical floor was offered to patient’s and their parents in hopes of making them more familiar with the environment. Other information is also shared with parents about home care after the procedure (O’Conner-Von 2008).
Overall, it was found that any sort of preoperative education program is beneficial to both adolescent patients and their parents. Such pre-operative preparations benefit children by preventing and reducing any negative responses to surgery. It was determined that in addressing an adolescents needs pre-operatively, health care workers need to also pay particular attention to the child’s coping styles, cognitive and developmental level, and past experience with health care. As health care workers, we need to be sensitive towards the needs of an adolescent because, "with their developmental awareness, ability to process information, focus on body image, and desire for privacy and self-control, adolescent patients have unique pre-surgical preparation needs" (O’Conner-Von 2008).
In a study titled, Pre-operative intervention for the reduction of anxiety in pediatric surgery patients, researchers worked with three groups of children to determine which interventions would produce the lowest level of anxiety in children. Within two groups, children were shown either a slide show presentation or given the opportunity to role play. In the third group, children were able to experience both a slide show presentation and participate in role play (Demarest 1984).
Researchers found that the use of role play and child involvement decreased a child’s anxiety much less that children who had been given a presentation. In role play, the children were allowed to dress up in clothing appropriate for the surgery and given the opportunity to play with items such as blood pressure cuffs and stethoscopes, along with riding on a bed to the surgical floor, and wearing a mask. The children who were given a presentation in regards to surgery had no hands on experience. Overall, researchers found that children who were given the presentation and the ability to participate in role playing, had much less anxiety than those who received only the presentation, but showed similar levels of anxiety compared to the group who participated in role play only (Demarest 1984).
In another article called, Paediatric pre-operative teaching: Effects at induction and post-operatively, researchers looked at two groups of children. In one group, children were given pre-operative teaching, while the second group received an interactive teaching book. The pre-operative teaching that was provided to children and their families consisted of tours of the operating room, puppet shows, books and video tapes. While the interactive book showed some of the same things demonstrated in the pre-operative teaching, it also included images of the scrubs worn, a mask that could be removed to expose the doctor’s face, the scents used in the mask for anesthesia induction, and many other interactive methods of teaching children about their upcoming surgery. Parents too were given a book and instructed to take the book home, read it themselves, and with their children in the days prior to surgery (Margolis 1998).
Upon assessment, researchers found that children who were given the interactive teaching book had higher levels of anxiety than those who were provided with pre-operative teaching. Parents of children who received pre-operative teaching said that it had helped both themselves and their children to understand what would be occurring before, during and after the surgery. While children who received pre-operative teaching were less anxious before surgery, they tended to have an elevated stress response to the operation (Margolis 1998).
In the study done my Margolis (1998), validity of the study is at a fair level, while the study done my Demarest (1984) is poor and the study by O’Conner-Von (2008) is good. They were rated in such a way due to the date in which the study was done. With the older studies, it is much more difficult to determine if the information was valid because the interventions and surgical procedure were done so long ago. Within all three of these studies, there were similar benefits and harms. The benefits were that new ways of intervening to decrease anxiety pre-operatively were found along with the ability to lessen a child’s fear of surgery. The only harm found in all of these studies was that some children were not being benefitted by the interventions provided. Instead, these children still experienced high levels of anxiety pre-operatively and did not benefit from the studies at all. Although some of these articles may be fairly old, all three are applicable in this clinical situation. Many methods of decreasing pre-operative anxiety were provided which allows for healthcare workers to see that there are many options aside from either a pamphlet or a discussion.
In conclusion, it appears as though the nurse has many options in providing education to both M.B. and her mother to decrease their levels of anxiety regarding surgery. Through evaluation of each article, it appears as though both verbal and written information are necessary in reducing anxiety, along with interactive methods of delivering education. It appears as though, for the most part, written and verbal information is more effective for parents rather than the children. From this conclusion, it is determined that pamphlets, along with verbal instructions will be given to M.B. and her mother while M.B. will be able to take a tour of the operating room, along with the PACU, and watch a video.
The methods of preparation being given to M.B. are more hands on and allow for her to be more involved with her surgery. It is in preparing M.B. for surgery in these ways that the nurse can hope to lessen her level of anxiety and fear which will in turn also ease her mother’s anxiety. The nurse should take time to give explanations and allow time for M.B. and her mother to ask questions.
The nurse should begin by providing M.B. with the options available. Perhaps what the nurse thinks will be the most beneficial method in educating M.B., is not the best way in which M.B. retains or understands information. Aside from the nurse his or herself, the patient, patient’s parents, doctor and all other health care providers involved in the case, should take part in the attempts to decrease M.B.’s pre-operative anxiety. With interventions being implemented by the entire healthcare team, it is more likely that M.B.’s level of anxiety will be greatly reduced due to the understanding of her case by the whole team.
In evaluating the effectiveness of the interventions provided to M.B., the nurse will begin by assessing M.B. and her mother’s levels of anxiety on the day when teaching first begins. The nurse should continue to monitor M.B. up until the day of her surgery to ensure that she is making use of the resources on hand and to also assess M.B. and her mother’s levels of anxiety. Perhaps the nurse could question M.B. on some of the information provided to ensure that she is in fact becoming more knowledgeable on the subject. On the day of surgery, anxiety levels should be assessed for a final time. The nurse should expect to see a reduction in the level of anxiety and fear for both M.B. and her mother, and an increase in knowledge of the surgery.
As a nurse, it is one’s job to also be an educator. In educating patients, one is able to provide information that can be useful in making the patient aware of his or her own health and health care, while giving the patient an insight as to what exactly is going on around him or her. Especially in working with children, the nurse plays a crucial role in providing sufficient amounts of appropriate, useful information or resources, that will make the child feel more at ease before and during a procedure. At the same time, the nurse wants to ensure that a patient’s parents are also comfortable with the procedure because this in turn will enhance a child’s comfort level. No matter what role or setting the nurse is in, education plays a huge part in being a nurse. Nurses must always be knowledgeable of ways to educate patients and which methods are most useful, to ensure that the best possible interventions are being implemented to treat a diagnosis of knowledge deficit.
Resources
Demarest, D., Hooke, J., Erikson, M. (1984). Preoperative intervention for the reduction of anxiety in pediatric surgery patients. Children’s Health Care, 12, 179-183. Retrieved March 26, 2008, from the Academic Search Premier.
Margolis, J., Ginsberg, B., Dear, G., Ross, A., Goral, J., Bailey, A. (1998). Paediatric preoperative teaching: Effects at induction and postoperatively. Paediatric Anaesthesia, 8, 17-23. Retrieved March 26, 2008, from the Academic Search Premier.
O’Conner-Von, Susan. (2008). Preparation of adolescents for outpatient surgery: Using an internet program. AORN Journal, 87, 374-398. Retrieved March 19, 2008, from the MEDLINE (through EBSCOhost) database.
Potts, N., Mandleco, B. (2007). Pediatric nursing: Caring for children and their families. United States: Thomson Delmar Learning.
The setting for nursing care in this case is within a doctor’s office. The nurse will play the role of both an educator and a form of support for both M.B. and her mother. While in the doctor’s office, the nurse can provide her patient and the patient’s mother with information that will hopefully decrease any anxiety and lessen the fear that may arise with experiencing a surgical procedure.
Some nursing diagnoses that can be developed by M.B.’s diagnosis of tonsilitis are: risk for deficient fluid volume related to decreased intake due to throat pain during swallowing, acute pain related to surgical excision of tonsils, and risk for injury: bleeding related to surgical incision into a highly vascular site (Potts 712). Other nursing diagnoses that can be developed from the case of M.B. based on her need for a tonsillectomy include: mild anxiety related to the need for a surgical procedure, deficient knowledge related to the routines involved in surgery, and fear related to unfamiliarity with surgery.
Based on the location and role of the nurse at the current time, the primary nursing diagnosis would be, deficient knowledge related to the surgical procedure and the routines involved. The secondary nursing diagnosis would be, mild anxiety related to the need for a surgical procedure, and third would be fear related to unfamiliarity with surgery. I would place the nursing diagnosis, risk for deficient fluid volume related to decreased intake due to throat pain during swallowing, as fourth. Although it is an issue, the mother is currently addressing the issue by keeping M.B. hydrated by enforcing her to drink plenty of fluids. The other diagnoses, acute pain related to surgical excision of tonsils, and risk for injury: bleeding related to surgical incision into a highly vascular site, are diagnoses that the PACU nurse would tend to. These nursing diagnoses are ones that cannot be dealt with in the doctor’s office, because they only become an issue once surgery has been completed.
The top three nursing diagnoses were placed as they were to give some logic to the order in which they are addressed, and how the nurse will intervene. Deficient knowledge was placed as the primary nursing diagnosis because if information is given regarding the surgical procedure and all the routines involved, then perhaps the second and third diagnoses of anxiety and fear can be lessened. If a patient has a more clear understanding on the surgery and what to expect, then it is very likely that the patient will experience less anxiety and fear towards the surgical procedure.
The one single nursing issue that will be addressed is, how to tend to a patient’s deficient knowledge regarding a surgical procedure, in order to decrease that patient’s levels of anxiety and fear. It is through this issue, that literature will be reviewed to find the best possible ways to educate adolescents on surgical procedures in hopes of decreasing anxiety and fear. The aim of the nurse is to provide enough appropriate and useful information or sources, to make the child feel more comfortable with the procedure, and at the same time, ensure that parent’s become more at ease with the procedure also.
There are many forms of information that could be found to address a patient’s knowledge deficit in order to lessen anxiety and fear. Some information that may be useful includes: how to provide education to an adolescent, a clear understanding of which developmental stage the child is at, ways in which to lessen a child’s anxiety and fear, what methods of education are most effective in teaching young adolescents, and the best method for communicating with an adolescent. Also, a nurse may want to consider what information should and should not be told to a child of a specific age group. Depending on which developmental stage the child is in, it may be appropriate to leave out certain details of a surgical procedure. The nurse will also want to find an evaluation method to determine the effectiveness of his or her interventions.
In an attempt to find information and articles regarding the issue at hand, I chose to use the MEDLINE data base through EBSCOhost and the Academic Search Premier. I am most familiar with these data bases and find them both to be very resourceful. Some key words that I used to search for my information were: tonsillectomy, child, surgery, comfort, pediatric, preparation, education and anxiety and fear. Through using these terms, I was able to come across many useful articles that addressed the exact issue that I was aiming to treat. In looking through the many articles, I chose the ones in which I was supplied with different forms of providing information to enhance comfort in young children who are about to undergo a surgical procedure. I also chose to review articles in which actual interventions were implemented to decrease pre-operative anxiety, rather than articles that reviewed other research literature. I chose to do this because I found it to be more useful in approaching my issue. In reading such articles, I am more able to conclude which forms and methods would be best in educating my patient while aiming to reduce anxiety levels of both the patient and her mother.
In an article done by Susan O’Conner-Von, titled, Preparation of adolescents for outpatient surgery: Using an internet program, researchers found that with the use of an internet program, compared to a standard hospital preparation program, levels of anxiety for both children and parents were much lower. The study compared the effectiveness of both types of preoperative, educational interventions. In looking at the end results for these interventions, researchers examined a child’s anxiety level, knowledge acquirement, pain intensity, and satisfaction with the provided method of preoperative preparation (O’Conner-Von 2008).
The internet program which offered much more satisfaction, was titled, Tonsils! who needs ‘em? Through this program, children were prepared for an upcoming tonsillectomy. Adolescents were educated on the surgical procedure in a conversational format, where another adolescent was teaching the program. The program was developmentally appropriate and provided children with both procedural and sensory information with descriptions of the normal routines that occur during surgery. Photographs were presented, as well as explanations for medical equipment and the duties of personnel present in the operating room. Once the program ended, children were given the ability to print forms on the information they learned, and in addition, advice for home care after surgery. These forms could be overlooked by the children, and given to their parents. This additional information would provide parents with crucial education on diet, pain assessment and management post-operatively, along with referral phone numbers and other useful resources (O’Conner-Von 2008).
In this study, researchers found that a standard hospital preparation program also had positive outcomes for children and parents. Although outcomes were positive, they were not quite as high as those found with the use of the internet program. A typical hospital preparation program is held once a week, in the evening and focuses on many of the same things as in the internet program. Perhaps it is through this sort of presentation that patients and parents are less satisfied because there is a greater need for more interactive type educational programs rather than lectures (O’Conner-Von 2008).
Information is presented to adolescents and their parents in a developmentally appropriate manner. Both sensory and procedural information is given, along with the routines carried about during the surgery. Photos were shown of the medical equipment used, explanations were given as to how equipment worked and what it did, as was an explanation on the duty of operating room personnel. A tour of the operating room and surgical floor was offered to patient’s and their parents in hopes of making them more familiar with the environment. Other information is also shared with parents about home care after the procedure (O’Conner-Von 2008).
Overall, it was found that any sort of preoperative education program is beneficial to both adolescent patients and their parents. Such pre-operative preparations benefit children by preventing and reducing any negative responses to surgery. It was determined that in addressing an adolescents needs pre-operatively, health care workers need to also pay particular attention to the child’s coping styles, cognitive and developmental level, and past experience with health care. As health care workers, we need to be sensitive towards the needs of an adolescent because, "with their developmental awareness, ability to process information, focus on body image, and desire for privacy and self-control, adolescent patients have unique pre-surgical preparation needs" (O’Conner-Von 2008).
In a study titled, Pre-operative intervention for the reduction of anxiety in pediatric surgery patients, researchers worked with three groups of children to determine which interventions would produce the lowest level of anxiety in children. Within two groups, children were shown either a slide show presentation or given the opportunity to role play. In the third group, children were able to experience both a slide show presentation and participate in role play (Demarest 1984).
Researchers found that the use of role play and child involvement decreased a child’s anxiety much less that children who had been given a presentation. In role play, the children were allowed to dress up in clothing appropriate for the surgery and given the opportunity to play with items such as blood pressure cuffs and stethoscopes, along with riding on a bed to the surgical floor, and wearing a mask. The children who were given a presentation in regards to surgery had no hands on experience. Overall, researchers found that children who were given the presentation and the ability to participate in role playing, had much less anxiety than those who received only the presentation, but showed similar levels of anxiety compared to the group who participated in role play only (Demarest 1984).
In another article called, Paediatric pre-operative teaching: Effects at induction and post-operatively, researchers looked at two groups of children. In one group, children were given pre-operative teaching, while the second group received an interactive teaching book. The pre-operative teaching that was provided to children and their families consisted of tours of the operating room, puppet shows, books and video tapes. While the interactive book showed some of the same things demonstrated in the pre-operative teaching, it also included images of the scrubs worn, a mask that could be removed to expose the doctor’s face, the scents used in the mask for anesthesia induction, and many other interactive methods of teaching children about their upcoming surgery. Parents too were given a book and instructed to take the book home, read it themselves, and with their children in the days prior to surgery (Margolis 1998).
Upon assessment, researchers found that children who were given the interactive teaching book had higher levels of anxiety than those who were provided with pre-operative teaching. Parents of children who received pre-operative teaching said that it had helped both themselves and their children to understand what would be occurring before, during and after the surgery. While children who received pre-operative teaching were less anxious before surgery, they tended to have an elevated stress response to the operation (Margolis 1998).
In the study done my Margolis (1998), validity of the study is at a fair level, while the study done my Demarest (1984) is poor and the study by O’Conner-Von (2008) is good. They were rated in such a way due to the date in which the study was done. With the older studies, it is much more difficult to determine if the information was valid because the interventions and surgical procedure were done so long ago. Within all three of these studies, there were similar benefits and harms. The benefits were that new ways of intervening to decrease anxiety pre-operatively were found along with the ability to lessen a child’s fear of surgery. The only harm found in all of these studies was that some children were not being benefitted by the interventions provided. Instead, these children still experienced high levels of anxiety pre-operatively and did not benefit from the studies at all. Although some of these articles may be fairly old, all three are applicable in this clinical situation. Many methods of decreasing pre-operative anxiety were provided which allows for healthcare workers to see that there are many options aside from either a pamphlet or a discussion.
In conclusion, it appears as though the nurse has many options in providing education to both M.B. and her mother to decrease their levels of anxiety regarding surgery. Through evaluation of each article, it appears as though both verbal and written information are necessary in reducing anxiety, along with interactive methods of delivering education. It appears as though, for the most part, written and verbal information is more effective for parents rather than the children. From this conclusion, it is determined that pamphlets, along with verbal instructions will be given to M.B. and her mother while M.B. will be able to take a tour of the operating room, along with the PACU, and watch a video.
The methods of preparation being given to M.B. are more hands on and allow for her to be more involved with her surgery. It is in preparing M.B. for surgery in these ways that the nurse can hope to lessen her level of anxiety and fear which will in turn also ease her mother’s anxiety. The nurse should take time to give explanations and allow time for M.B. and her mother to ask questions.
The nurse should begin by providing M.B. with the options available. Perhaps what the nurse thinks will be the most beneficial method in educating M.B., is not the best way in which M.B. retains or understands information. Aside from the nurse his or herself, the patient, patient’s parents, doctor and all other health care providers involved in the case, should take part in the attempts to decrease M.B.’s pre-operative anxiety. With interventions being implemented by the entire healthcare team, it is more likely that M.B.’s level of anxiety will be greatly reduced due to the understanding of her case by the whole team.
In evaluating the effectiveness of the interventions provided to M.B., the nurse will begin by assessing M.B. and her mother’s levels of anxiety on the day when teaching first begins. The nurse should continue to monitor M.B. up until the day of her surgery to ensure that she is making use of the resources on hand and to also assess M.B. and her mother’s levels of anxiety. Perhaps the nurse could question M.B. on some of the information provided to ensure that she is in fact becoming more knowledgeable on the subject. On the day of surgery, anxiety levels should be assessed for a final time. The nurse should expect to see a reduction in the level of anxiety and fear for both M.B. and her mother, and an increase in knowledge of the surgery.
As a nurse, it is one’s job to also be an educator. In educating patients, one is able to provide information that can be useful in making the patient aware of his or her own health and health care, while giving the patient an insight as to what exactly is going on around him or her. Especially in working with children, the nurse plays a crucial role in providing sufficient amounts of appropriate, useful information or resources, that will make the child feel more at ease before and during a procedure. At the same time, the nurse wants to ensure that a patient’s parents are also comfortable with the procedure because this in turn will enhance a child’s comfort level. No matter what role or setting the nurse is in, education plays a huge part in being a nurse. Nurses must always be knowledgeable of ways to educate patients and which methods are most useful, to ensure that the best possible interventions are being implemented to treat a diagnosis of knowledge deficit.
Resources
Demarest, D., Hooke, J., Erikson, M. (1984). Preoperative intervention for the reduction of anxiety in pediatric surgery patients. Children’s Health Care, 12, 179-183. Retrieved March 26, 2008, from the Academic Search Premier.
Margolis, J., Ginsberg, B., Dear, G., Ross, A., Goral, J., Bailey, A. (1998). Paediatric preoperative teaching: Effects at induction and postoperatively. Paediatric Anaesthesia, 8, 17-23. Retrieved March 26, 2008, from the Academic Search Premier.
O’Conner-Von, Susan. (2008). Preparation of adolescents for outpatient surgery: Using an internet program. AORN Journal, 87, 374-398. Retrieved March 19, 2008, from the MEDLINE (through EBSCOhost) database.
Potts, N., Mandleco, B. (2007). Pediatric nursing: Caring for children and their families. United States: Thomson Delmar Learning.
Nursing 501: Journal Learning
THE ART AND SCIENCE OF NURSING
Everything from taking a patient’s history to administering medications could be considered an art of nursing, but I see the art of nursing as more of the role that nurses play. Nurses are in the hospital for a majority of procedures and visits that patients may go through which gives nurses the opportunity to learn more about a patient and who they are. Nurses are compassionate and caring people who put all of their heart and soul into their work because they are not there for themselves, but for the patients. I see a nurse as one of the only people in the health care field who can touch a patient’s life. A nurse could easily do so by being there for patients in their time of need and making a difference by showing that they truly do care.
I see the art of nursing as something that is brought into the field by the nurse him or herself. It is not something that could be taught to one in a classroom to prepare for the hospital setting, but it is something that builds their personality and comes naturally; the want to care for somebody who is in need, show compassion, and touch someone’s life in a way that they will remember forever. On the other hand, I believe that the science of nursing is more of the use of technology. The science of nursing is the things that can be learned in the classroom and over time with experience. Not all people can learn to become a caring and compassionate person, but anyone could learn how to take a temperature or check a patient’s pulse.
The two shows that I chose to view were Pearl Harbor and Scrubs. Pearl Harbor was about the attack the Japanese made on the Americans at Pearl Harbor. Within the story of the beginning of World War two, is a love story between a dedicated nurse (Kate Beckinsale) and lieutenant (Ben Affleck) who is sent to England for war. This dedicated nurse and her colleagues are in Pearl Harbor when the attack occurs and are forced to work under intense pressure to save lives. Scrubs on the other hand was more of a comedy about the life of nurses working in the hospital. The episode I watched was called "My Overkill" from season two, and was about nurses working in the hospital who had a hard time dealing with the head doctor who often times was rude and a hard person to cooperate with. The nurses in this show find issues from their personal lives affecting their work life, such as sleeping with the head doctor’s ex-wife, and the head doctor liking one of the nurses.
In Pearl Harbor, I saw many examples of how the nurses showed the art of nursing. Mostly, I believe that the art of nursing was shown when the nurse (Kate Beckinsale) needed to stand outside the hospital and mark the forehead of patients, deciding whether or not they needed morphine, were in fatal condition, or if they needed critical care. In some ways it was up to her who was to live and who was to die. It takes a strong person to hold that type of position and although the nursing profession does call for caring and compassion, it also calls for composure and being able to think under the most intense pressure. Not just anyone can remain calm under stress and have a clear mind about what to do in certain situations.
I found no examples of art in the show Scrubs because it is more of a comedy. In the episode that I watched, the nurses barely even paid attention to the patients. Rather than making a diagnosis like they should have been doing, they were involved in their own worries. The nurses turned their workplace into more of a social, filled with gossip and rumors about either their co-workers or their own lives. The nurses and the doctors in Scrubs were very unprofessional about their jobs and did not seem to care about what did or did not get done. It definitely made the work atmosphere appear to be more stressful. Both of the shows that I chose to watch are completely opposite. While Pearl Harbor shows us exactly what it means to be a nurse, Scrubs shows us that there is no work involved and it’s all play.
I feel that science was demonstrated in both Scrubs and Pearl Harbor. In Scrubs, nurses were asked to make a diagnosis about a patient. The patient had already gone through several tests which all turned up negative, and it was the nurse’s job to find out exactly what was wrong with the patient. In Pearl Harbor, it was the nurse’s job to do such things as give Morphine, give eye exams, take blood, and give shots and stitches. Both shows showed the technicality of being a nurse and the physical labor involved. Scrubs showed a more in depth perception of the science of art while Pearl Harbor showed the typical things done by a nurse in the health care profession.
Pearl Harbor reinforced my visions of what it is like to be a nurse. The nurses helped to keep the doctors in check and help them out whenever needed. I feel that this is a nurse’s main job. In one scene, the doctor seemed unsure of himself and what was going on around him until the nurse helped him back to reality and pointed out that there was an emergency that needed to be tended to. While there may be doctors around to help in certain situations, it is always the nurses job to provide the best care possible, no matter what the case. Pearl Harbor definitely made it clear that the job of a nurse can be a hectic and overwhelming, but at the same time can have benefits. The nurse (Kate Beckinsale) actually saved the life of a lieutenant by applying pressure to his carotid artery which had been bleeding very heavily at the time. Due to the nurse’s actions of deciding to care for him rather than saying there was nothing they could do, the lieutenant was able to live another day and showed great thanks for it.
Scrubs did not match my perspective of what nursing is like at all. What I gathered from Scrubs was that more gossip is done in the hospital than actual work and caring for patients, which I know to be absolutely false. When working in a hospital, just being a nurse, it is one’s job to put one’s one life to the side while at work, and to put the patient’s needs first. It is my belief that shows like Scrubs, while they may be a huge hit, are what makes the nursing profession look like a joke. Not one person can interpret the job of a nurse until they have actually been in the position. A nurse is the one who does most of the work in the hospital while the doctors run around from patient to patient ordering tests to be done. I find it true that many nurses take their job seriously unlike the nurses in this show. Scrubs does no favors for the nursing profession except make it look like it’s completely irrelevant for running a smooth health care system.
Whether we are looking at the science or art of nursing, we are looking at nursing as a whole. They both tie in as one to form the large picture of nursing that builds a hospital into not just a place where patients receive medications and have surgeries done, but also a place of companionship and comfort. It builds a place where patients can feel safe and well cared for because they are the first priority. Neither art nor science is more important than the other. Nurses need to be well rounded with both areas by having good People skills such as good communication, being compassionate, caring, being a good listener and technical skills such as working with their hands and using different types of machines found in the hospitals.
I think it is the art of nursing that is overlooked. Although nurses are thought of as compassionate, caring, respectable people, it seems as though they are seen more as assistants to the doctors. Nurses are there to do the small work that doctors do not have time for, but that is not true. I believe that nurses are there for comfort and to make patients feel like they do matter, they will be cared for in the best possible manner, and that when they enter the hospital, they should have no worries because they are in the hands of professionals. Nurses play such a large role in the hospital setting by building a warm, serene atmosphere. With all of the chances and benefits to engage yourself both scientifically and artistically, who would not want to become a nurse, the caring hands and heart of the hospital world?
Everything from taking a patient’s history to administering medications could be considered an art of nursing, but I see the art of nursing as more of the role that nurses play. Nurses are in the hospital for a majority of procedures and visits that patients may go through which gives nurses the opportunity to learn more about a patient and who they are. Nurses are compassionate and caring people who put all of their heart and soul into their work because they are not there for themselves, but for the patients. I see a nurse as one of the only people in the health care field who can touch a patient’s life. A nurse could easily do so by being there for patients in their time of need and making a difference by showing that they truly do care.
I see the art of nursing as something that is brought into the field by the nurse him or herself. It is not something that could be taught to one in a classroom to prepare for the hospital setting, but it is something that builds their personality and comes naturally; the want to care for somebody who is in need, show compassion, and touch someone’s life in a way that they will remember forever. On the other hand, I believe that the science of nursing is more of the use of technology. The science of nursing is the things that can be learned in the classroom and over time with experience. Not all people can learn to become a caring and compassionate person, but anyone could learn how to take a temperature or check a patient’s pulse.
The two shows that I chose to view were Pearl Harbor and Scrubs. Pearl Harbor was about the attack the Japanese made on the Americans at Pearl Harbor. Within the story of the beginning of World War two, is a love story between a dedicated nurse (Kate Beckinsale) and lieutenant (Ben Affleck) who is sent to England for war. This dedicated nurse and her colleagues are in Pearl Harbor when the attack occurs and are forced to work under intense pressure to save lives. Scrubs on the other hand was more of a comedy about the life of nurses working in the hospital. The episode I watched was called "My Overkill" from season two, and was about nurses working in the hospital who had a hard time dealing with the head doctor who often times was rude and a hard person to cooperate with. The nurses in this show find issues from their personal lives affecting their work life, such as sleeping with the head doctor’s ex-wife, and the head doctor liking one of the nurses.
In Pearl Harbor, I saw many examples of how the nurses showed the art of nursing. Mostly, I believe that the art of nursing was shown when the nurse (Kate Beckinsale) needed to stand outside the hospital and mark the forehead of patients, deciding whether or not they needed morphine, were in fatal condition, or if they needed critical care. In some ways it was up to her who was to live and who was to die. It takes a strong person to hold that type of position and although the nursing profession does call for caring and compassion, it also calls for composure and being able to think under the most intense pressure. Not just anyone can remain calm under stress and have a clear mind about what to do in certain situations.
I found no examples of art in the show Scrubs because it is more of a comedy. In the episode that I watched, the nurses barely even paid attention to the patients. Rather than making a diagnosis like they should have been doing, they were involved in their own worries. The nurses turned their workplace into more of a social, filled with gossip and rumors about either their co-workers or their own lives. The nurses and the doctors in Scrubs were very unprofessional about their jobs and did not seem to care about what did or did not get done. It definitely made the work atmosphere appear to be more stressful. Both of the shows that I chose to watch are completely opposite. While Pearl Harbor shows us exactly what it means to be a nurse, Scrubs shows us that there is no work involved and it’s all play.
I feel that science was demonstrated in both Scrubs and Pearl Harbor. In Scrubs, nurses were asked to make a diagnosis about a patient. The patient had already gone through several tests which all turned up negative, and it was the nurse’s job to find out exactly what was wrong with the patient. In Pearl Harbor, it was the nurse’s job to do such things as give Morphine, give eye exams, take blood, and give shots and stitches. Both shows showed the technicality of being a nurse and the physical labor involved. Scrubs showed a more in depth perception of the science of art while Pearl Harbor showed the typical things done by a nurse in the health care profession.
Pearl Harbor reinforced my visions of what it is like to be a nurse. The nurses helped to keep the doctors in check and help them out whenever needed. I feel that this is a nurse’s main job. In one scene, the doctor seemed unsure of himself and what was going on around him until the nurse helped him back to reality and pointed out that there was an emergency that needed to be tended to. While there may be doctors around to help in certain situations, it is always the nurses job to provide the best care possible, no matter what the case. Pearl Harbor definitely made it clear that the job of a nurse can be a hectic and overwhelming, but at the same time can have benefits. The nurse (Kate Beckinsale) actually saved the life of a lieutenant by applying pressure to his carotid artery which had been bleeding very heavily at the time. Due to the nurse’s actions of deciding to care for him rather than saying there was nothing they could do, the lieutenant was able to live another day and showed great thanks for it.
Scrubs did not match my perspective of what nursing is like at all. What I gathered from Scrubs was that more gossip is done in the hospital than actual work and caring for patients, which I know to be absolutely false. When working in a hospital, just being a nurse, it is one’s job to put one’s one life to the side while at work, and to put the patient’s needs first. It is my belief that shows like Scrubs, while they may be a huge hit, are what makes the nursing profession look like a joke. Not one person can interpret the job of a nurse until they have actually been in the position. A nurse is the one who does most of the work in the hospital while the doctors run around from patient to patient ordering tests to be done. I find it true that many nurses take their job seriously unlike the nurses in this show. Scrubs does no favors for the nursing profession except make it look like it’s completely irrelevant for running a smooth health care system.
Whether we are looking at the science or art of nursing, we are looking at nursing as a whole. They both tie in as one to form the large picture of nursing that builds a hospital into not just a place where patients receive medications and have surgeries done, but also a place of companionship and comfort. It builds a place where patients can feel safe and well cared for because they are the first priority. Neither art nor science is more important than the other. Nurses need to be well rounded with both areas by having good People skills such as good communication, being compassionate, caring, being a good listener and technical skills such as working with their hands and using different types of machines found in the hospitals.
I think it is the art of nursing that is overlooked. Although nurses are thought of as compassionate, caring, respectable people, it seems as though they are seen more as assistants to the doctors. Nurses are there to do the small work that doctors do not have time for, but that is not true. I believe that nurses are there for comfort and to make patients feel like they do matter, they will be cared for in the best possible manner, and that when they enter the hospital, they should have no worries because they are in the hands of professionals. Nurses play such a large role in the hospital setting by building a warm, serene atmosphere. With all of the chances and benefits to engage yourself both scientifically and artistically, who would not want to become a nurse, the caring hands and heart of the hospital world?
Nursing 619: Patient Interview
Upon entering a patient’s room, one tends to see the patient only in the specific time frame with only the current issues at hand. Instead of seeing the patient as an individual with a personal story, he or she may be seen as another case of whatever disease it is that may be exhibited. It is difficult to put a client into context when one does not know the entire story behind the present illness. This is why it is crucial for nurses to know and clearly understand a patient’s health history along with his or her current health status. The application of the transition and trajectory theories can help nurses to place patients in a greater story to understand how the patients got where they are, the issues patients may encounter, and where they will go as far as their health status is concerned.
The trajectory theory can tell a nurse about a patient’s progression of illness and their experience with this progression. As a nurse, one would particularly care about the progression of illness and a patient’s experience with it, because it assists the nurse in developing a more specific and individualized plan of care for that patient. By looking at a patient’s trajectory, a nurse can tell where a patient is at any given time in his or her health status. By finding this particular stage in the trajectory, a nurse can determine which needs are essential for the patient at that time. The trajectory theory can also assist nurses in looking at the picture as a whole. The nurse can examine a trajectory, learn the appropriate outcomes and focus the plan of care on achieving these outcomes. It is important as a nurse to realize that any intervention performed will have an affect on the patient’s outcome making it much easier as a nurse, to fit reliable interventions with predetermined outcomes.
The trajectory theory is the idea that there is a particular course of action for any person experiencing a situation in his or her life whether it be biographically, in reference to work, or in relation to an illness (Corbin). A trajectory experienced biographically may be one encountered through a person’s life such as leaving one stage of life and entering into another. This can be found when a person goes from a lifestyle where working was a main duty to becoming retired and finding other things to do with one’s time. A trajectory in reference to work may be working one’s way from a low-end job to a much higher level job where one is given more responsibilities and tasks to become involved with. The illness trajectory is more commonly used by nurses and other health care providers. The illness trajectory can assist health care providers in determining a patient’s health progress or decline, and where he or she stands in this trajectory. With this tool, the stage of the illness can be concluded, such as the time before symptoms began, the onset of symptoms, the acute illness, stable and unstable phases, the deterioration phase and the dying phase or the alternate route of regression to patient’s pre-illness state (Shippee-Rice).
The transition theory is based on the idea that when one encounters a change in life or something different, one may make an alteration in his or her current lifestyle to progress to a higher or newer state of being (Meleis). The ability to realize that a change is occurring is important for nurses and all health care providers alike. Knowing that there is an upcoming change or being able to recognize signs of an already occurring change, allows the nurse to find ways in assisting the patient in making his or her transition to the next phase of their life or trajectory (Selder). With assistance and support, patients may feel more at ease during their transition and may also have better outcomes.
Both the transition theory and the trajectory theory have a strong relationship with one another. The trajectory theory is a path that consists of different stages. When a patient is at one stage and moving into another, a transition is required. This is so, because the patient is reaching a different phase from the one he or she was currently in. For example, a patient may go from a stable phase in which the patient may think that his or her health may be improving, but instead, the patient enters into a phase of deterioration. The transition made here may be the patient coming to terms with the fact that the disease has not completely finished its course and that he or she may remain ill longer or may need to stay in the hospital longer than had been planned, keeping the patient from getting back to his or her normal routine in life.
The interview with my patient went very smoothly despite my fear of having a difficult time accomplishing what needed to be done. Once I was finished assisting my patient with her morning care, I requested her permission to ask some questions about her health and the factors surrounding it, and she agreed to answer any questions I had, to the best of her ability. Before starting this interview, I had written down a few questions to ask, thinking that it would be the best way to start conversations which may lead to other questions. I had taken a chair to the patient’s bedside and sat down so that I was at eye level with her. It was then that I began to ask my questions. Some questions that I had asked included; what is your perception of your health status at this moment, how has your health been in the past, what do you feel will be the outcome of your illness, and how do you cope with your illness or keep yourself healthy. These questions led to further questions such as; where do you live, where does your family live, what kinds of activities do you enjoy, when did you first start to notice you were ill, what brought you into the hospital and many more while trying to stay focused on patient’s health. The interaction progressed very nicely and continued as more of a conversation between the two of us rather than a question and answer interview.
The patient I had interviewed was very open about her illness. Although her diagnosis may have appeared simple at first, because it was Pneumonia, she had a lot to share with me about her illness and her life. The patient had shared that she felt miserable and not like herself, she had previously been fairly healthy and without any issues besides a minor case of Pneumonia which she had the previous month, but was treated for. She has four children and lives in a nursing home. She told me that while at the nursing home, she was independent and was able to do many things on her own, but since she became diagnosed with Pneumonia, she has felt very weak and unable to be as active as she may have been in the past.
When looking at my patient in terms of her trajectory, I found her to be in the acute phase. In the acute phase, the patient is hospitalized with an acute illness. This phase follows the trajectory onset, when signs and symptoms first begin to appear (Shippee-Rice). Typically, in an elderly patient, Pneumonia is diagnosed when signs and symptoms such as general deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia and tachypnea are present. Chest x-rays are obtained to differentiate a diagnosis of Pneumonia from chronic heart failure which may cause similar signs and symptoms. Treatment is provided by means of adequate hydration, supplemental oxygen therapy, assistance with deep breathing and coughing, frequent position changes and early ambulation (Smeltzer). These treatment options may provide the patient with the strength to reach a more stable phase and return to his or her pre-illness state where as they may also provide no benefit to the patient and he or she may begin to deteriorate and possibly die. This branch between deterioration or becoming well again may be seen as the stable or unstable phase of a patient’s illness trajectory where as the complete decline to death or incline to a pre-illness state may be seen as the final stages of the trajectory.
A major transition that the patient will have to make is relying on health care workers, and others to assist her in completing her activities of daily living or at least providing more assistance than she otherwise would have required. This is something that the patient has not needed to allow in the past because she has been fairly independent. This is a transition that the patient will need to make in order to allow herself to be taken care of because she is too weak and unable to do so appropriately. The patient stated that she does not experience many ups and downs with her illness although she has not been diagnosed with Pneumonia for long. One up for her may have been being treated for her first diagnosis of Pneumonia and being free from the illness, although a down would have been contracting the illness again only a month later which had brought her into the hospital at this time. The patient is Catholic and believes that praying each day and having her family who supports her, has made being ill easier to handle because she is not alone. The patient states that very few things bother her, she is very easy-going and does not experience many stressors or things that make her illness more difficult to deal with. She keeps her head up in any situation and always looks at the positive aspect of any issue she is up against. The patient does expect that her condition will be treated and she will return to her pre-illness state rather than the condition worsening. She is very optimistic and follows doctors and nurses orders closely to better improve her current health status and outcomes.
Three variables that are affecting this patient’s trajectory are adherence to treatment regimen, family support, and her attitude and belief system, all of which have a positive affect on her trajectory. These three factors also affect a patient’s transition within his or her trajectory. Adherence to treatment regimen is important with any condition. The more likely a patient is to adhere to his or her treatment, the better chances a patient has of a positive outcome, leading the patient to a more positive path on his or her illness trajectory. Family support is also important because it gives the patient motivation to stick with the treatment being prescribed by doctors and nurses, and it also lets the patient know that there is somebody there who cares for him or her. Without any support from her family, this patient may have given up on following her treatments or may not have cared about her health or treatments at all. A positive attitude is great to have in any situation. When people have a negative attitude, they may become depressed because they see no good side to the situation which may lead to incoherence to treatment and worsening of a condition. An optimistic attitude gives the patient high hopes and a more positive outlook on his or her trajectory, seeing only that a good outcome will arise from the situation rather than a poor one. Having a belief system may also apply the same benefits to an illness trajectory as does a family and a strong support system. Having a certain belief can give one faith in both his or herself, and the outcome of the trajectory of the disease.
With a better view on the patient’s trajectory and transitions, nursing care can be much improved. When looking at where a patient is and where a patient may be going, a nurse can focus his or her care on that specific time period as well as preparing for what may be ahead. As a nurse, it is important to focus on the future of a client’s condition, but most importantly, his or her present health status because the interventions that are provided now will be the ones which affect the future outcomes. It is also important for the nurse to look at the past stages of the patient’s illness trajectory in order to understand how the patient got where he or she is. This way, the nurse can assist the patient in changing the things that may have caused his or her illness to begin with. The transitions patients are making is also important for a nurse to pay attention to. If a specific transition is being made by the patient, or needs to be made in order to enhance his or her health, it is the nurse’s job to find the best way to make this possible. It is the responsibility of the nurse to assist the patient in identifying and altering the poor health habits that a patient may have in a way that will be most successful for the patient.
This patient’s trajectory was similar to that found in theory. The illness trajectory for this patient had a pre-trajectory phase, a trajectory onset phase, an acute phase, and so far, also a stable or unstable phase (Shippee-Rice). Also, as stated in Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, the elderly population with Pneumonia may be more difficult to treat and in turn resulting in a higher mortality rate. It is here that I also see my patient following the assumed trajectory of Pneumonia. Because this patient had been 84 years old and had already been diagnosed with Pneumonia but contracted it again, I found it to be more likely that she would have many more complications. Seeing this patient case and knowing the risks of Pneumonia within the elderly population has shown a consistency with the expected trajectory.
These models and theories are very useful in practice. Nurses are more likely to see the patients as a whole and not just as a case when he or she looks at the patient’s trajectory and entire story. Many times, a nurse may go into a patient’s room only to examine the current situation on hand rather than considering many of the underlying variables that have a large impact on the patient’s current and future health status. All nurses should be examining their patients by using the trajectory and transition theories in order to best provide care for their patients.
References
Corbin, J. R.N. (1998). The corbin and strauss chronic illness trajectory model: an update. Scholarly Inquiry for Nursing, 12, 33-41.
Meleis, A., Schumacher, K. (1994). Transitions: a central concept in nursing. IMAGE: Journal of Nursing Scholarship, 26, 119-127.
Selder, F. Life transition theory: the resolution of uncertainty. Nursing and Health Care, 10, 437-451.
Shippee-Rice, R. Ph.D., R.N. (2007). Clinical Decision Making 1: Transition and Trajectory. Unpublished presentation.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., Cheever, K.H. (2008). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. Philedelphia: Lippincott, Williams & Wilkins, a Wolter Kluwer Business (11th ed., Vol. 2).
The trajectory theory can tell a nurse about a patient’s progression of illness and their experience with this progression. As a nurse, one would particularly care about the progression of illness and a patient’s experience with it, because it assists the nurse in developing a more specific and individualized plan of care for that patient. By looking at a patient’s trajectory, a nurse can tell where a patient is at any given time in his or her health status. By finding this particular stage in the trajectory, a nurse can determine which needs are essential for the patient at that time. The trajectory theory can also assist nurses in looking at the picture as a whole. The nurse can examine a trajectory, learn the appropriate outcomes and focus the plan of care on achieving these outcomes. It is important as a nurse to realize that any intervention performed will have an affect on the patient’s outcome making it much easier as a nurse, to fit reliable interventions with predetermined outcomes.
The trajectory theory is the idea that there is a particular course of action for any person experiencing a situation in his or her life whether it be biographically, in reference to work, or in relation to an illness (Corbin). A trajectory experienced biographically may be one encountered through a person’s life such as leaving one stage of life and entering into another. This can be found when a person goes from a lifestyle where working was a main duty to becoming retired and finding other things to do with one’s time. A trajectory in reference to work may be working one’s way from a low-end job to a much higher level job where one is given more responsibilities and tasks to become involved with. The illness trajectory is more commonly used by nurses and other health care providers. The illness trajectory can assist health care providers in determining a patient’s health progress or decline, and where he or she stands in this trajectory. With this tool, the stage of the illness can be concluded, such as the time before symptoms began, the onset of symptoms, the acute illness, stable and unstable phases, the deterioration phase and the dying phase or the alternate route of regression to patient’s pre-illness state (Shippee-Rice).
The transition theory is based on the idea that when one encounters a change in life or something different, one may make an alteration in his or her current lifestyle to progress to a higher or newer state of being (Meleis). The ability to realize that a change is occurring is important for nurses and all health care providers alike. Knowing that there is an upcoming change or being able to recognize signs of an already occurring change, allows the nurse to find ways in assisting the patient in making his or her transition to the next phase of their life or trajectory (Selder). With assistance and support, patients may feel more at ease during their transition and may also have better outcomes.
Both the transition theory and the trajectory theory have a strong relationship with one another. The trajectory theory is a path that consists of different stages. When a patient is at one stage and moving into another, a transition is required. This is so, because the patient is reaching a different phase from the one he or she was currently in. For example, a patient may go from a stable phase in which the patient may think that his or her health may be improving, but instead, the patient enters into a phase of deterioration. The transition made here may be the patient coming to terms with the fact that the disease has not completely finished its course and that he or she may remain ill longer or may need to stay in the hospital longer than had been planned, keeping the patient from getting back to his or her normal routine in life.
The interview with my patient went very smoothly despite my fear of having a difficult time accomplishing what needed to be done. Once I was finished assisting my patient with her morning care, I requested her permission to ask some questions about her health and the factors surrounding it, and she agreed to answer any questions I had, to the best of her ability. Before starting this interview, I had written down a few questions to ask, thinking that it would be the best way to start conversations which may lead to other questions. I had taken a chair to the patient’s bedside and sat down so that I was at eye level with her. It was then that I began to ask my questions. Some questions that I had asked included; what is your perception of your health status at this moment, how has your health been in the past, what do you feel will be the outcome of your illness, and how do you cope with your illness or keep yourself healthy. These questions led to further questions such as; where do you live, where does your family live, what kinds of activities do you enjoy, when did you first start to notice you were ill, what brought you into the hospital and many more while trying to stay focused on patient’s health. The interaction progressed very nicely and continued as more of a conversation between the two of us rather than a question and answer interview.
The patient I had interviewed was very open about her illness. Although her diagnosis may have appeared simple at first, because it was Pneumonia, she had a lot to share with me about her illness and her life. The patient had shared that she felt miserable and not like herself, she had previously been fairly healthy and without any issues besides a minor case of Pneumonia which she had the previous month, but was treated for. She has four children and lives in a nursing home. She told me that while at the nursing home, she was independent and was able to do many things on her own, but since she became diagnosed with Pneumonia, she has felt very weak and unable to be as active as she may have been in the past.
When looking at my patient in terms of her trajectory, I found her to be in the acute phase. In the acute phase, the patient is hospitalized with an acute illness. This phase follows the trajectory onset, when signs and symptoms first begin to appear (Shippee-Rice). Typically, in an elderly patient, Pneumonia is diagnosed when signs and symptoms such as general deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia and tachypnea are present. Chest x-rays are obtained to differentiate a diagnosis of Pneumonia from chronic heart failure which may cause similar signs and symptoms. Treatment is provided by means of adequate hydration, supplemental oxygen therapy, assistance with deep breathing and coughing, frequent position changes and early ambulation (Smeltzer). These treatment options may provide the patient with the strength to reach a more stable phase and return to his or her pre-illness state where as they may also provide no benefit to the patient and he or she may begin to deteriorate and possibly die. This branch between deterioration or becoming well again may be seen as the stable or unstable phase of a patient’s illness trajectory where as the complete decline to death or incline to a pre-illness state may be seen as the final stages of the trajectory.
A major transition that the patient will have to make is relying on health care workers, and others to assist her in completing her activities of daily living or at least providing more assistance than she otherwise would have required. This is something that the patient has not needed to allow in the past because she has been fairly independent. This is a transition that the patient will need to make in order to allow herself to be taken care of because she is too weak and unable to do so appropriately. The patient stated that she does not experience many ups and downs with her illness although she has not been diagnosed with Pneumonia for long. One up for her may have been being treated for her first diagnosis of Pneumonia and being free from the illness, although a down would have been contracting the illness again only a month later which had brought her into the hospital at this time. The patient is Catholic and believes that praying each day and having her family who supports her, has made being ill easier to handle because she is not alone. The patient states that very few things bother her, she is very easy-going and does not experience many stressors or things that make her illness more difficult to deal with. She keeps her head up in any situation and always looks at the positive aspect of any issue she is up against. The patient does expect that her condition will be treated and she will return to her pre-illness state rather than the condition worsening. She is very optimistic and follows doctors and nurses orders closely to better improve her current health status and outcomes.
Three variables that are affecting this patient’s trajectory are adherence to treatment regimen, family support, and her attitude and belief system, all of which have a positive affect on her trajectory. These three factors also affect a patient’s transition within his or her trajectory. Adherence to treatment regimen is important with any condition. The more likely a patient is to adhere to his or her treatment, the better chances a patient has of a positive outcome, leading the patient to a more positive path on his or her illness trajectory. Family support is also important because it gives the patient motivation to stick with the treatment being prescribed by doctors and nurses, and it also lets the patient know that there is somebody there who cares for him or her. Without any support from her family, this patient may have given up on following her treatments or may not have cared about her health or treatments at all. A positive attitude is great to have in any situation. When people have a negative attitude, they may become depressed because they see no good side to the situation which may lead to incoherence to treatment and worsening of a condition. An optimistic attitude gives the patient high hopes and a more positive outlook on his or her trajectory, seeing only that a good outcome will arise from the situation rather than a poor one. Having a belief system may also apply the same benefits to an illness trajectory as does a family and a strong support system. Having a certain belief can give one faith in both his or herself, and the outcome of the trajectory of the disease.
With a better view on the patient’s trajectory and transitions, nursing care can be much improved. When looking at where a patient is and where a patient may be going, a nurse can focus his or her care on that specific time period as well as preparing for what may be ahead. As a nurse, it is important to focus on the future of a client’s condition, but most importantly, his or her present health status because the interventions that are provided now will be the ones which affect the future outcomes. It is also important for the nurse to look at the past stages of the patient’s illness trajectory in order to understand how the patient got where he or she is. This way, the nurse can assist the patient in changing the things that may have caused his or her illness to begin with. The transitions patients are making is also important for a nurse to pay attention to. If a specific transition is being made by the patient, or needs to be made in order to enhance his or her health, it is the nurse’s job to find the best way to make this possible. It is the responsibility of the nurse to assist the patient in identifying and altering the poor health habits that a patient may have in a way that will be most successful for the patient.
This patient’s trajectory was similar to that found in theory. The illness trajectory for this patient had a pre-trajectory phase, a trajectory onset phase, an acute phase, and so far, also a stable or unstable phase (Shippee-Rice). Also, as stated in Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, the elderly population with Pneumonia may be more difficult to treat and in turn resulting in a higher mortality rate. It is here that I also see my patient following the assumed trajectory of Pneumonia. Because this patient had been 84 years old and had already been diagnosed with Pneumonia but contracted it again, I found it to be more likely that she would have many more complications. Seeing this patient case and knowing the risks of Pneumonia within the elderly population has shown a consistency with the expected trajectory.
These models and theories are very useful in practice. Nurses are more likely to see the patients as a whole and not just as a case when he or she looks at the patient’s trajectory and entire story. Many times, a nurse may go into a patient’s room only to examine the current situation on hand rather than considering many of the underlying variables that have a large impact on the patient’s current and future health status. All nurses should be examining their patients by using the trajectory and transition theories in order to best provide care for their patients.
References
Corbin, J. R.N. (1998). The corbin and strauss chronic illness trajectory model: an update. Scholarly Inquiry for Nursing, 12, 33-41.
Meleis, A., Schumacher, K. (1994). Transitions: a central concept in nursing. IMAGE: Journal of Nursing Scholarship, 26, 119-127.
Selder, F. Life transition theory: the resolution of uncertainty. Nursing and Health Care, 10, 437-451.
Shippee-Rice, R. Ph.D., R.N. (2007). Clinical Decision Making 1: Transition and Trajectory. Unpublished presentation.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., Cheever, K.H. (2008). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing. Philedelphia: Lippincott, Williams & Wilkins, a Wolter Kluwer Business (11th ed., Vol. 2).
Nursing 619: Teaching Plan
Patient education is very important and is one of the many tasks that nurses incorporate into patient care. Patient education allows the nurse to explain why a certain intervention is done or what a medication may do for the patient, how and when it should be taken and possible side effects. These are just a few of the things covered by patient education. By teaching a patient about his or her care, the nurse also promotes self care which can allow the patient to be more independent rather than relying on others to assist him or her. The goal of patient education is to change or sustain behaviors that will help in maintaining or improving his or her health status (Rankin). In order for this goal to be achieved, it is crucial for the nurse to look at the given health status from the patient’s view (Leddy 2006). If not seen from the patient’s perspective, one may teach the patient in a way in which the patient is expected to obey recommendations or the education may be more focused on the needs of the facility rather than the patient (Rankin).
An 80 year old, white, widowed female is admitted to the hospital with a chief complaint of a cough, shortness of breath and increased sputum production. After a thorough examination, the patient was hospitalized for a medical diagnosis of Pneumonia. The patient’s past medical history consisted of COPD, a history of smoking, Non-Hodgkin’s Lymphoma, a complete heart block with the placement of a pacemaker, gastric outlet obstruction, hypertension and anemia. Some nursing diagnoses for this patient involving her health history include activity intolerance related to dyspnea and shortness of breath, ineffective airway clearance related to a diagnosis of COPD, risk of aspiration related to general weakness, risk for falls related to weakness, fatigue related to generalized weakness and excessive tiredness, nutrition imbalance: less than body requirements related to poor oral intake, impaired swallowing related to generalized weakness, nausea related to discomfort and many others (Newfield 2007).
This patient had reached an education level of eighth grade, her religion is Catholicism, she is retired and lives in a nearby nursing home where her family visits her frequently. The patient states that there is no family history of any illness and that her family is very healthy. Her family consists of her two sons, who are 58 and 54 and two daughters who are of ages 55 and 52, her husband has passed away. This woman had a very active past social life but upon falling ill with Pneumonia, her ability to complete even her activities of daily living without any assistance, is almost impossible. She use to go for walks with friends and take the time to participate in activities offered at the nursing home in which she lives.
The learning needs for this patient include education on the importance of positioning to prevent bed sores, coughing and deep breathing activities, and the importance of ambulating to prevent constipation. I know that these are the main learning needs because of the patient’s diagnosis of Pneumonia and current health status. To prevent complications, I have chosen many of these learning needs and have also chosen some of them based on Coughing and deep breathing along with oxygen therapy and the use of an incentive spirometer are always important in a patient with a diagnosis of Pneumonia to prevent atelectasis (Smeltzer 2008). Ambulation is important to prevent constipation which may lead to further problems such as bowel obstruction and compaction. Positioning is then a major preventative measure for ensuring that a patient does not develop bed sores. Positioning allows for a patient to be turned off of areas where pressure is exerted on the body to prevent tissue breakdown which can result from excessive pressure on a particular region. I would prioritize these learning needs as the education of coughing and deep breathing first, the importance of positioning as second, and the importance of ambulation as third. I would choose to place them in this order because it is in the patient’s best interest to be concerned with her respiratory system and her current respiratory illness in order to prevent any further complications. I also chose to place them in this order because being short of breath and experiencing dyspnea was a major concern for the patient herself therefore I found it important to focus on these issues first. Since Pneumonia was the primary diagnosis for this patient, it seemed most important that we treat the effects of this illness on the patient first. The patient also had a bed sore on her coccyx and I placed that as second because it was an additional issue with this patient that needed to be handled. I then placed ambulation as third simply because it did not rank superior to the other learning needs, and the patient was also receiving a laxative to ease bowel movements. The primary nurse for this patient identified the learning needs coughing and deep breathing and positioning while I identified the need of ambulation to prevent constipation and also to promote better circulation.
To be effective in this particular teaching situation, it would be necessary for the teacher to know information about the topics being taught to the patient. In order to educate a patient on coughing and deep breathing, one would need to know how to cough and deep breath, ways in which to splint a patient’s stomach in case of abdominal pain or surgery, the duration in which deep breathing and coughing should be done, the anatomy and physiology of the respiratory system and oxygenation. To educate a patient on positioning, one would need to know ways to position, which areas on the body are considered to be more at risk for bed sores or are known as bony prominences, when positioning should be done, how to maintain a patient in a specific position, and also the importance of frequent position changes to promote supportive treatment for Pneumonia (Smeltzer 2008). When educating a patient about ambulation to prevent constipation, it is important for the educator to know the anatomy and physiology of the gastrointestinal system, ways to assist a patient with ambulation, how to transfer a patient, different ambulatory devices that can be used to assist a patient with ambulation, the duration in which a patient should ambulate and how many times, and the patient’s limits to ensure that the patient will not be harmed in any way.
Some assessments that should be done prior to educating a patient in order to develop an effective teaching plan include the readiness to learn, the type of learner the patient is, the stage of change the patient is at, an impairments or barriers that may inhibit learning. Readiness to learn is very important when it comes to determining when patient teaching should be done. If a patient is not ready to learn then it is not the appropriate time to educate him or her on the issue because they will not be receptive. To assess whether or not a patient is ready to learn the nurse can examine if a patient is experiencing anxiety, how open the patient is about the information that would be provided, assessing where the patient is, and the attitude the patient exhibits when approached about new issues or teaching topics (Leddy 2006). Knowing what type of learner the patient is, is crucial in determining how to best present the learning needs to the patient in order to effectively teach the learner. It is good to know whether a patient is a verbal learner, a visual learner, or some other form of learner that way material can be presented in a way that will allow the patient to understand. The stage of change can have a very strong impact on patient learning. If a patient is at a point in the illness trajectory when he or she feels very ill, the patient is not likely to be receptive to education. It is best to provide education when a patient is feeling relatively healthy so that he or she is more attentive to the education rather than how he or she may be feeling (Leddy 2006). Any impairments a patient may have can strongly inhibit his or her learning. If a patient is deaf or blind, it is important to provide the correct tools to enhance learning. When a nurse is unknowing of such factors, he or she may educate the patient on a particular issue and may believe that the patient was listening and understanding when in fact, the patient was confused with the education because the impairment kept him or her from properly learning the information being provided. Barriers may also create an issue with patient education. A typical barrier may include a difference in languages. If a patient speaks a language other than the one that the nurse speaks, then it is up to the nurse to find a way to teach the patient so that he or she understands. The nurse may find a translator who speaks both the nurse and the patient’s language or may find teaching material that is in the patient’s language. A barrier such as this may lead to miscommunication between the patient and care giver which may lead to complications with the patient’s health because he or she did not properly understand the teachings of the nurse.
The 80 year old woman showed a strong readiness to learn shown by the initiative she took to ask questions about things she did not understand, and she also showed a very positive attitude towards her health and her care. It turned out that this patient was more of a verbal learner and learned best through explanations and asking questions about the things she needed clarification with. She was at a stage of change in her illness where she was having a good day and was very attentive to her care givers showing that it would be an appropriate time to provide education. The only impairment that this patient had was the fact that she wore reading glasses, but since she was not much of a visual learner, this didn’t seem to cause an issue. There were no barriers because the patient spoke English.
The one outcome that the patient found to be very important to achieve was that she had no difficulty breathing and experienced no shortness of breath. I believe that with one teaching session on the importance of coughing and deep breathing, the outcome that the patient is looking to achieve could very well be met. I do believe though, that the outcome would only last for so long and that the patient would need reinforcement to continue with the strategies she was taught to enhance her breathing and prevent further complications. Once teaching has ended and the patient has continued to follow through with the education she received about coughing and deep breathing for a short time, the motivation to continue with such exercises may diminish. This is why it is important for teaching to be reinforced and even taught over again if necessary. I think that the patient reaching her outcomes would be short lived and would only continue if the patient were to follow through with the skills she has learned.
Some behavioral objectives for achieving the patient’s desired outcome include assuming a sitting position, taking a deep breath by using slow breathing techniques, and exhaling slowly. Once the patient knows how to breathe deeply, she will inhale deeply and slowly, exhale slowly, take a short breath and let out a cough from deep in the lungs (Smeltzer 2007). The patient will perform deep breathing every 15 minutes with a short rest after each group of five deep breathes. Coughing should be performed by the patient two or three times after each deep breathe and deep breathing should be performed every two hours while the patient is awake (Smeltzer 2007). The patient will be able to demonstrate the ability to cough and deep breathe to the educator and the patient will know whether she is doing the procedure correctly based on how well the patient feels her breathing is after participating in these techniques. If the patient feels that her breathing is no longer difficult and she does not experience any shortness of breath, then the patient has achieved the outcome she had wished to accomplish. These objectives are behavioral meaning that if the patient initiates the correct behaviors, then her respiratory status is very likely to improve and she will no longer experience the shortness of breath or dyspnea she had before, nor will she develop any complications.
To educate the patient on the importance of coughing and deep breathing and how it is done, I did a demonstration for her. Since my patient was a verbal learner I found it best to explain things to her with words. I also found it important to do a demonstration so that I could physically show her what was being expected as an outcome from the teaching session. I also found this to be a good way to clarify anything that may have been unclear or caused confusion with her because of my choice of words and her understanding or interpretation. The teaching strategy that I had used is based on the behaviorist model of teaching or learning in that a behavior is being changed or added into a patient’s lifestyle to enhance her health (Leddy 2006).
To evaluate whether or not the outcome was achieved, I would monitor the patients respiratory rate, note any use of accessory muscles, assess lung sounds, watch for any dyspnea or shortness of breath during activity, and monitor the patient’s oxygen saturation levels. I would evaluate the quality of my teaching by paying particular attention to the terms I used while teaching, I would note anything I may have said that was confusing or hard to understand I would also determine the quality of my teaching when asking for a return demonstration by the patient. If the patient is unable to explain what I had taught her and is unable to demonstrate the procedures correctly, then I would know that I was unclear in my teaching and that I may need to change the way I explain something. If the outcomes had not been met, and coughing and deep breathing did not turn out to be an effective learning or teaching experience, I would move onto teaching the patient about the incentive spirometer. I could also continue to monitor the patient’s use of coughing and deep breathing and reinforce teaching each time it was necessary for the patient to complete such tasks.
The objectives for this patient were met. The patient was able to meet performance objectives as a result of the learning experience and teaching session. Once the patient had been taught more about coughing and deep breathing, she was able to complete them both on her own and when necessary. She also began to feel much better about her breathing when she engaged in the techniques and no longer found herself to be experiencing as much difficulty breathing or shortness of breath. As I approached and carried out this assignment of teaching a patient about coughing and deep breathing, I thought about the best ways to teach the patient the technique and what would be the most helpful if I were in her situation. I thought about the many ways in which she could be taught about coughing and deep breathing, the ways in which I would know she understood what she was being taught, whether or not I should go into detail about the anatomy of the respiratory system and how these techniques would help the patient and many more things. I looked for information on how to perform coughing and deep breathing, when to perform, for how long and teaching techniques for this particular process. I did not encounter any problems because the facility I was in had plenty of information about coughing and deep breathing that assisted me in my teaching strategies nor did I have any problems with my patient and teaching her. Some concerns I did have though were that my teaching would not be effective or that I wouldn’t know how to explain the procedure correctly or I would be wrong about something and give the patient the wrong information.
Although I had some concerns about teaching this patient, I do feel as though my teaching was successful. The outcomes that had been previously made were met and the patient was able to continue the process of coughing and deep breathing on her own when necessary. Next time, to improve my approach or success with teaching such an intervention, it would be best to spend more time with the patient finding out what he or she wants to know more about and how I can best address those issues that may arise. I think that this will allow me the chance to interact more with the patient about what he or she wants rather than what the healthcare facility or health care givers believe may be best for this patient at his or her current health stage. Overall though, I have learned much more about the importance of patient education and how it can make the difference between health and illness.
References
Leddy, S., Hood, L. (2006). Leddy and pepper’s conceptual bases of professional nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, sixth edition.
Newfield, S., Hinz, M., Tilley, D., Sridaromont, K., Maramba, P. (2006). Cox’s clinical applications of nursing diagnosis: adult, child, women’s, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Company, fifth edition.
Rankin, S., Stallings, K., London, F. Patient education in health and illness. Lippincott Williams & Wilkins, a Wolters Kluwer Company.
Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. (2008). Brunner and suddarth’s textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, eleventh edition: volume 1.
An 80 year old, white, widowed female is admitted to the hospital with a chief complaint of a cough, shortness of breath and increased sputum production. After a thorough examination, the patient was hospitalized for a medical diagnosis of Pneumonia. The patient’s past medical history consisted of COPD, a history of smoking, Non-Hodgkin’s Lymphoma, a complete heart block with the placement of a pacemaker, gastric outlet obstruction, hypertension and anemia. Some nursing diagnoses for this patient involving her health history include activity intolerance related to dyspnea and shortness of breath, ineffective airway clearance related to a diagnosis of COPD, risk of aspiration related to general weakness, risk for falls related to weakness, fatigue related to generalized weakness and excessive tiredness, nutrition imbalance: less than body requirements related to poor oral intake, impaired swallowing related to generalized weakness, nausea related to discomfort and many others (Newfield 2007).
This patient had reached an education level of eighth grade, her religion is Catholicism, she is retired and lives in a nearby nursing home where her family visits her frequently. The patient states that there is no family history of any illness and that her family is very healthy. Her family consists of her two sons, who are 58 and 54 and two daughters who are of ages 55 and 52, her husband has passed away. This woman had a very active past social life but upon falling ill with Pneumonia, her ability to complete even her activities of daily living without any assistance, is almost impossible. She use to go for walks with friends and take the time to participate in activities offered at the nursing home in which she lives.
The learning needs for this patient include education on the importance of positioning to prevent bed sores, coughing and deep breathing activities, and the importance of ambulating to prevent constipation. I know that these are the main learning needs because of the patient’s diagnosis of Pneumonia and current health status. To prevent complications, I have chosen many of these learning needs and have also chosen some of them based on Coughing and deep breathing along with oxygen therapy and the use of an incentive spirometer are always important in a patient with a diagnosis of Pneumonia to prevent atelectasis (Smeltzer 2008). Ambulation is important to prevent constipation which may lead to further problems such as bowel obstruction and compaction. Positioning is then a major preventative measure for ensuring that a patient does not develop bed sores. Positioning allows for a patient to be turned off of areas where pressure is exerted on the body to prevent tissue breakdown which can result from excessive pressure on a particular region. I would prioritize these learning needs as the education of coughing and deep breathing first, the importance of positioning as second, and the importance of ambulation as third. I would choose to place them in this order because it is in the patient’s best interest to be concerned with her respiratory system and her current respiratory illness in order to prevent any further complications. I also chose to place them in this order because being short of breath and experiencing dyspnea was a major concern for the patient herself therefore I found it important to focus on these issues first. Since Pneumonia was the primary diagnosis for this patient, it seemed most important that we treat the effects of this illness on the patient first. The patient also had a bed sore on her coccyx and I placed that as second because it was an additional issue with this patient that needed to be handled. I then placed ambulation as third simply because it did not rank superior to the other learning needs, and the patient was also receiving a laxative to ease bowel movements. The primary nurse for this patient identified the learning needs coughing and deep breathing and positioning while I identified the need of ambulation to prevent constipation and also to promote better circulation.
To be effective in this particular teaching situation, it would be necessary for the teacher to know information about the topics being taught to the patient. In order to educate a patient on coughing and deep breathing, one would need to know how to cough and deep breath, ways in which to splint a patient’s stomach in case of abdominal pain or surgery, the duration in which deep breathing and coughing should be done, the anatomy and physiology of the respiratory system and oxygenation. To educate a patient on positioning, one would need to know ways to position, which areas on the body are considered to be more at risk for bed sores or are known as bony prominences, when positioning should be done, how to maintain a patient in a specific position, and also the importance of frequent position changes to promote supportive treatment for Pneumonia (Smeltzer 2008). When educating a patient about ambulation to prevent constipation, it is important for the educator to know the anatomy and physiology of the gastrointestinal system, ways to assist a patient with ambulation, how to transfer a patient, different ambulatory devices that can be used to assist a patient with ambulation, the duration in which a patient should ambulate and how many times, and the patient’s limits to ensure that the patient will not be harmed in any way.
Some assessments that should be done prior to educating a patient in order to develop an effective teaching plan include the readiness to learn, the type of learner the patient is, the stage of change the patient is at, an impairments or barriers that may inhibit learning. Readiness to learn is very important when it comes to determining when patient teaching should be done. If a patient is not ready to learn then it is not the appropriate time to educate him or her on the issue because they will not be receptive. To assess whether or not a patient is ready to learn the nurse can examine if a patient is experiencing anxiety, how open the patient is about the information that would be provided, assessing where the patient is, and the attitude the patient exhibits when approached about new issues or teaching topics (Leddy 2006). Knowing what type of learner the patient is, is crucial in determining how to best present the learning needs to the patient in order to effectively teach the learner. It is good to know whether a patient is a verbal learner, a visual learner, or some other form of learner that way material can be presented in a way that will allow the patient to understand. The stage of change can have a very strong impact on patient learning. If a patient is at a point in the illness trajectory when he or she feels very ill, the patient is not likely to be receptive to education. It is best to provide education when a patient is feeling relatively healthy so that he or she is more attentive to the education rather than how he or she may be feeling (Leddy 2006). Any impairments a patient may have can strongly inhibit his or her learning. If a patient is deaf or blind, it is important to provide the correct tools to enhance learning. When a nurse is unknowing of such factors, he or she may educate the patient on a particular issue and may believe that the patient was listening and understanding when in fact, the patient was confused with the education because the impairment kept him or her from properly learning the information being provided. Barriers may also create an issue with patient education. A typical barrier may include a difference in languages. If a patient speaks a language other than the one that the nurse speaks, then it is up to the nurse to find a way to teach the patient so that he or she understands. The nurse may find a translator who speaks both the nurse and the patient’s language or may find teaching material that is in the patient’s language. A barrier such as this may lead to miscommunication between the patient and care giver which may lead to complications with the patient’s health because he or she did not properly understand the teachings of the nurse.
The 80 year old woman showed a strong readiness to learn shown by the initiative she took to ask questions about things she did not understand, and she also showed a very positive attitude towards her health and her care. It turned out that this patient was more of a verbal learner and learned best through explanations and asking questions about the things she needed clarification with. She was at a stage of change in her illness where she was having a good day and was very attentive to her care givers showing that it would be an appropriate time to provide education. The only impairment that this patient had was the fact that she wore reading glasses, but since she was not much of a visual learner, this didn’t seem to cause an issue. There were no barriers because the patient spoke English.
The one outcome that the patient found to be very important to achieve was that she had no difficulty breathing and experienced no shortness of breath. I believe that with one teaching session on the importance of coughing and deep breathing, the outcome that the patient is looking to achieve could very well be met. I do believe though, that the outcome would only last for so long and that the patient would need reinforcement to continue with the strategies she was taught to enhance her breathing and prevent further complications. Once teaching has ended and the patient has continued to follow through with the education she received about coughing and deep breathing for a short time, the motivation to continue with such exercises may diminish. This is why it is important for teaching to be reinforced and even taught over again if necessary. I think that the patient reaching her outcomes would be short lived and would only continue if the patient were to follow through with the skills she has learned.
Some behavioral objectives for achieving the patient’s desired outcome include assuming a sitting position, taking a deep breath by using slow breathing techniques, and exhaling slowly. Once the patient knows how to breathe deeply, she will inhale deeply and slowly, exhale slowly, take a short breath and let out a cough from deep in the lungs (Smeltzer 2007). The patient will perform deep breathing every 15 minutes with a short rest after each group of five deep breathes. Coughing should be performed by the patient two or three times after each deep breathe and deep breathing should be performed every two hours while the patient is awake (Smeltzer 2007). The patient will be able to demonstrate the ability to cough and deep breathe to the educator and the patient will know whether she is doing the procedure correctly based on how well the patient feels her breathing is after participating in these techniques. If the patient feels that her breathing is no longer difficult and she does not experience any shortness of breath, then the patient has achieved the outcome she had wished to accomplish. These objectives are behavioral meaning that if the patient initiates the correct behaviors, then her respiratory status is very likely to improve and she will no longer experience the shortness of breath or dyspnea she had before, nor will she develop any complications.
To educate the patient on the importance of coughing and deep breathing and how it is done, I did a demonstration for her. Since my patient was a verbal learner I found it best to explain things to her with words. I also found it important to do a demonstration so that I could physically show her what was being expected as an outcome from the teaching session. I also found this to be a good way to clarify anything that may have been unclear or caused confusion with her because of my choice of words and her understanding or interpretation. The teaching strategy that I had used is based on the behaviorist model of teaching or learning in that a behavior is being changed or added into a patient’s lifestyle to enhance her health (Leddy 2006).
To evaluate whether or not the outcome was achieved, I would monitor the patients respiratory rate, note any use of accessory muscles, assess lung sounds, watch for any dyspnea or shortness of breath during activity, and monitor the patient’s oxygen saturation levels. I would evaluate the quality of my teaching by paying particular attention to the terms I used while teaching, I would note anything I may have said that was confusing or hard to understand I would also determine the quality of my teaching when asking for a return demonstration by the patient. If the patient is unable to explain what I had taught her and is unable to demonstrate the procedures correctly, then I would know that I was unclear in my teaching and that I may need to change the way I explain something. If the outcomes had not been met, and coughing and deep breathing did not turn out to be an effective learning or teaching experience, I would move onto teaching the patient about the incentive spirometer. I could also continue to monitor the patient’s use of coughing and deep breathing and reinforce teaching each time it was necessary for the patient to complete such tasks.
The objectives for this patient were met. The patient was able to meet performance objectives as a result of the learning experience and teaching session. Once the patient had been taught more about coughing and deep breathing, she was able to complete them both on her own and when necessary. She also began to feel much better about her breathing when she engaged in the techniques and no longer found herself to be experiencing as much difficulty breathing or shortness of breath. As I approached and carried out this assignment of teaching a patient about coughing and deep breathing, I thought about the best ways to teach the patient the technique and what would be the most helpful if I were in her situation. I thought about the many ways in which she could be taught about coughing and deep breathing, the ways in which I would know she understood what she was being taught, whether or not I should go into detail about the anatomy of the respiratory system and how these techniques would help the patient and many more things. I looked for information on how to perform coughing and deep breathing, when to perform, for how long and teaching techniques for this particular process. I did not encounter any problems because the facility I was in had plenty of information about coughing and deep breathing that assisted me in my teaching strategies nor did I have any problems with my patient and teaching her. Some concerns I did have though were that my teaching would not be effective or that I wouldn’t know how to explain the procedure correctly or I would be wrong about something and give the patient the wrong information.
Although I had some concerns about teaching this patient, I do feel as though my teaching was successful. The outcomes that had been previously made were met and the patient was able to continue the process of coughing and deep breathing on her own when necessary. Next time, to improve my approach or success with teaching such an intervention, it would be best to spend more time with the patient finding out what he or she wants to know more about and how I can best address those issues that may arise. I think that this will allow me the chance to interact more with the patient about what he or she wants rather than what the healthcare facility or health care givers believe may be best for this patient at his or her current health stage. Overall though, I have learned much more about the importance of patient education and how it can make the difference between health and illness.
References
Leddy, S., Hood, L. (2006). Leddy and pepper’s conceptual bases of professional nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, sixth edition.
Newfield, S., Hinz, M., Tilley, D., Sridaromont, K., Maramba, P. (2006). Cox’s clinical applications of nursing diagnosis: adult, child, women’s, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Company, fifth edition.
Rankin, S., Stallings, K., London, F. Patient education in health and illness. Lippincott Williams & Wilkins, a Wolters Kluwer Company.
Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. (2008). Brunner and suddarth’s textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, eleventh edition: volume 1.
Nursing 619: The Role of Family in the Critically Ill
Family plays a very significant role in the life of a critically ill patient. Being critically ill can bring about many emotions that may have never been experienced by either the patient or his or her family. It is not easy for any patient, especially one with a serious illness, to spend an extended amount of time in a hospital but with family by a patient’s side, perhaps the patient’s length of stay will shorten and his or her quality of life will greatly improve. It is for these reasons that it is important for the healthcare team to allow the family plenty of time to spend with the patient, educate the family on a patient’s care, and to not only address the needs of the patient, but to attend to the needs of the family also.
In the book, Bed Number Ten by Sue Baier, Sue, a woman who is diagnosed with Guillan-Barre explains what it is like to be an immobile patient in the ICU. Along with the painstaking exposure that Sue had in the hospital, she also illustrated for the reader the role of her husband, daughters and mother during the time she spent in the hospital. Given her situation and the many issues she was faced with although already difficult to handle, Sue would have had even more difficulty if it had not been for the ongoing support from her family.
The issue of the role of family in the critically ill patient is very important in professional practice when delivering care to patients, it is very likely to see family along with the patient. In the United States, healthcare personnel works in a culture in which family is a central role in any person’s life. Families are built upon caring relationships and when anything happens with one member, the others cope by relying on each other and being there to support the other family members. It is crucial for healthcare workers to include the family and coach them in caring and providing treatment for the patient. The patient in the hospital although he or she is the one in need of medical attention, the patient is not the only one who is in need of assistance. It is crucial for the family to recognized and seen as present rather than being pushed aside and having the patient be the only priority for the healthcare team.
A family is a durable source of security and stability for any person, especially for a patient who is critically ill (Beckmann Murray 1997). Family is an important part in any person’s life and will always serve as a form of comfort and support for its members. Some tasks of a family include, creating a sense of family loyalty, providing social togetherness, providing relationships within the family that foster security, support, encouragement, motivation, morale and creativity, and helping its members to cope with crises (Beckmann Murray 1997). Sue’s family did exactly these things for her. While in the ICU, Sue’s family would visit as often and as long as was allowed to help Sue through the unyielding days she spent at the hospital. With the support and visitations of Sue’s family, she found it much easier to cope with the long hours of the day and the terrible experiences she had to endure (Baier 1995).
A family system is endlessly adaptive yet is strongly influenced by the surrounding environment (Beckmann Murray 1997). Adapting to new situations is a major function of the family especially helping in its growth and development throughout life as its members change and also develop. These adaptive mechanisms can be seen as a family’s way of coping with stressors. Each mechanism demonstrates a way in which the family maintains an internal balance to further assist the family in dealing with external stressors or crises (Beckmann Murray 1997).
For example, one adaptive mechanism that Sue Baier’s family acts upon is the additional roles played out by different members of the family. When a family member is ill, other family members must adapt by striving to be flexible in his or her roles (Beckmann Murray 1997). In Bed Number Ten, Sue says "Promptly at eleven-thirty, Bill returned. He looked so tired. How could he not be tired? So much to do." (Baier 1995). Because Sue had been stuck at the hospital due to her paralyzing illness, she was unable to complete her normal tasks and because this was so, her husband needed to get them completed for her. To cope with Sue’s illness, but to keep his family balanced, it was necessary for Bill to take on additional tasks each day.
One way in which a family will cope other then relying on the other members and striving to be flexible in roles, families learn to cope by seeking out information (Beckmann Murray 1997). When a loved one is in the hospital, families like to understand what is going on. It is critical to keep the family informed of their loved one’s health status and keep them updated on all the information necessary for them to know. Because the ICU can be so fast paced at times though, it is sometimes difficult to relay information to family members (Kjerulf 2005). It is important that families are given the chance to ask questions and it is just as important that they receive the answers. Families want to be able to participate in patient care, have the diagnosis and prognosis clarified and they also want to have equipment explained to them so that they too can better understand the experience that their loved one is going through (Fox-Wasylyshyn 2005).
Not only can family play a large role when other family members are away for extended periods of time, but family can also greatly assist the patient while in the hospital. In the ICU, family can serve as a tool for the patient, facilitating better communication and increasing the patient’s ability to do things (Engstrom 2007). This was very true for Sue Baier. When at her worst stage of her illness, Sue was unable to move any part of her body with the exception of her eyes. It was through her eyes that Sue spoke with her husband and at times her healthcare providers who would take the time. Many patients may describe the inability to talk people as frightening and scary, but the family becomes interpreters in communication between the patient and others because they can mostly understand what the patient is trying to say or what he or she means (Engstrom 2007).
"‘Did you sleep well last night?’ How do I answer him? Frantically I flutter my eyelids. ‘No, Sue, one blink for yes or move your mouth for no.’ Oh, Bill, always by the rules. But the rules have changed. Again I blinked repeatedly. He studied me for a moment, and again I blinked my eyes several times. Then he understood. ‘You can’t move your mouth can you? Is that what you were trying to tell me?’ One firm, elaborate closing and opening of the lids. Yes. ‘Well, then, how about one blink meaning yes and two for no?’ (Baier 37)."
Although the family has a better chance of understanding what a patient wants, it is also true that the family may not understand exactly what the patient wants at times. This may put extra stress on the patient and make him or her feel like giving up (Engstrom 2007).
Having family by a patient’s side while staying in the hospital can drastically reduce the amount of anxiety a patient encounters. The onset of an illness can cause unpredictability due to the unfamiliar world around a patient, but with family around, a patient can feel safer and more at ease (Engstrom 2007). Having family nearby can give a patient a familiar face when the staff is never the same, failing to provide a constant or familiar face. In the study, "Receiving power through confirmation: the meaning of close relatives for people who have been critically ill", researchers found that patients felt happier when family was near, but when family had gone home, patients described feelings of loneliness and fear while also feeling as though he or she was trapped in bed. Researchers also found that much like Sue, while family members were gone, patients would count down the time until they would return (Engstrom 2007). "My tears washed away the image of him leaving. When I blinked them away, he was gone. Only the clock was still there. Seven forty-two. Three hours and forty-eight minutes until Bill would return." (Baier 22).
Having family members around while a patient is in the hospital can supply the patient with consistence in an environment that is otherwise inconsistent. With family by a patient’s bedside, he or she has a familiar face which can make a patient feel more comfortable, safer and less alone. It is significant for patients to be able to experience the company of a familiar face most importantly because a patient’s healthcare providers may always be changing due to rotations of the hospital personnel. The repetitive changing of nurses especially has a negative effect on a patient’s quality of life (Kjerulf 2005). If a patient were to have a more consistent nursing staff, both the nurse and the patient could become more comfortable in working with one another and patient outcomes could be improved in a much shorter period of time.
When family is not around, patients exhibit much more anxiety than when family is present. The study, "Receiving power through confirmation: the meaning of close relatives for people who have been critically ill", researchers found that patients felt as though they were losing control and could die when family was not present (Engstrom 2007). In Bed Number Ten, Sue says "I was totally at the mercy of people I did not know and with whom I could not communicate. People who didn’t even seem to care" (Baier 32). It is important as a healthcare provider to make a patient feel as comfortable as possible and never feel as though they are surrounded by strangers and scared of what could happen to them. As healthcare providers, we should be accommodating to patient’s needs and supplying to him or her a safe environment where the patient can feel as though healthcare providers are competent and will provide the best care possible.
In encountering a life changing event such as becoming critically ill, a patient will feel like he or she has lost all control due to such a disruption, but with family nearby, patients are given a reason to continue with his or her struggles. Family is vital to an ill patient. Family gives a patient motivation and a reason to continue to fight through the endeavors he or she may come into contact with. The support of a family can demonstrate to a patient exactly what his or her existence means to the other members of the family then in turn giving the patient the will to live when he or she may feel as though all is lost and giving up is the only option (Engstrom 2007). This constant reminder of how much a family cares for a patient is very important in giving the patient the power to want to become healthy again. Family may give the patient courage to feel as though he or she can continue on and make it through this difficult time (Day 2006). Patients feel that because family demonstrated that they cared so much, patients did not want to fail them by giving up since family was the most important people in the patient’s lives during their time of illness. Patients came to realize that the family still expected something from them and that they needed to fight their illness to fulfill the family’s expectations (Engstrom 2007).
Both patient and family needs should be attended to when setting up a plan of care. Families feel as though healthcare personnel can assist best in their coping by allowing them to be included in the patient’s care and by addressing the family’s needs also (Fox-Wasylyshyn 2005). By addressing a family’s needs, healthcare teams can promote knowledge and assist the family in dealing with the crisis at hand. Patient recovery may also be promoted when the healthcare team comes together with the family to understand the issues at hand (Fox-Wasylyshyn 2005). A stress-free environment is best for a patient who is critically ill and a lot of stress can be diminished if both the family and healthcare team are on the same level and understand what is going on with the patient and his or her care.
Allowing the family to be present while a patient is in the ICU is very important and can promote family education and decrease anxiety (Day 2006). Having family near when a patient is critically ill can greatly increase a patient’s quality of life (Engstrom 2007). If healthcare providers were to actually keep the patient’s health as their top priority, then things may go more smoothly in the ICU, but without cooperation and collaboration between the family and healthcare providers, situations may become more difficult to handle. It is important for healthcare personnel to recognize the positive influence that a family’s presence can have on a patient’s state of health. Rather than forcing families out of the room and allotting a certain amount of time for visitation, healthcare workers should be encouraging the presence of family.
"The minutes passed so quickly, and too soon Bill was telling me it was time to go. They had rules, he explained. Only three visits a day-and only fifteen minutes at a time. As weak as I was, I clung desperately to his hand and begged him not to leave. ‘It’s the rule, Sue. Besides, they say that any longer a visit would only tire you.’ The rule, the ultimate answer." (Baier 22).
In the article, Family perceptions of end-of-life care in an urban ICU, families said that unit visiting hours were too limited and did not allow for families to spend enough time with their loved ones, and that if visitation policies were to be more flexible, then access between the family and patients could be greatly maximized (Kjerulf 2005).
In allowing a patient’s family to spend more time in the ICU, healthcare providers may begin to learn more about who the patient is as a person. In order to fully understand how to care for a critically ill person, one needs to be able to recognize and consider the human experience of illness (Engstrom 2007). Any healthcare provider can begin to understand the human experience of a given situation as long as that healthcare provider sees the patient as another person rather than just somebody who is sick and needs medical attention. A family makes up a very large portion of who somebody is and one can learn a lot about a patient by spending time with his or her family. By having the knowledge about a patient’s experience, one can greatly improve the quality of care being provided (Engstrom 2007).
It is important for healthcare workers to begin to consistently be involving the patient’s family in care. In doing so, healthcare workers will need to stop seeing a patient as just an individual who can be separated from his or her family and instead, families should be treated along with the patient (Day 2006). Healthcare workers need to stop looking at just the patient as the recipient of treatment and begin to see the family as also in need of and receiving care. In many cases, a critical care team may only focus decision making and care planning on the individual rather than collaborating with the patient’s family and encouraging the involvement in a the patient’s care.
The article, "Family involvement in critical care: shortcomings of a utilitarian justification" states that:
"To subscribe to the idea that the critical care team alone can provide a cure while treating the patient as a radical individual is a dangerous mistake that denies the curative influence of the family and the importance of the patient’s involvement in family relationships." (Day 225).
This quote alone is very powerful and sends out a strong message. It is absurd for a healthcare team to believe that they have all the power in the world to cure a patient of a critical illness without any consideration to family and the therapeutic power it may have on a patient’s health status. Healthcare teams need to begin to see that there is indeed a lot of things that they can do to improve a patient’s health, but they also need to consider the smaller, simpler things that a patient will also benefit from.
After having done the research for the role of family in the critically ill patient, I have learned exactly how strong the position of family is. I now feel as though I will look differently at family gathering in a patient’s room. Before there had been times when I would see the family with the patient and think to myself that there must be other things going on in the family’s lives that should be preventing them from spending so much time in the hospital. Now though, I understand more clearly that family is a strong bond that is difficult to break because of the many emotions and relationships that have evolved over time. There is no reason for family to not be seen as important when providing care to a patient. In fact, family is one of the most critical factors in improving a patient’s health.
Family is significant in improving a patient’s health status. Family is the best thing that a patient can have around during this difficult time because family is always a source of support and stability, encouragement and motivation (Beckmann Murray 1997). Patients in a study stated that after having shared the experience of being critically ill with their families, they felt as though their relationships were confirmed, relationships had grown stronger and they felt as though they cared more for each other (Engstrom 2007). Not only are these family relationships important in critically ill patients, but relationships between families and healthcare teams need to be developed for optimal outcomes (Kjerulf 2005).
Both the patient and his or her family should be cared for during the time of hospitalization because they are in reality a single unit. A family unit cannot be torn apart or seperated and have each member be treated individually because the relationships in the family are so concrete. This is why a patient’s family should be allowed to stay at the bedside to provide support and to be involved in patient care. Healthcare providers need to allow families time to spend with patients along with allowing them to be involved in a patient’s care by educating the family and including them. A family supplies a therapeutic regime which can greatly improve a patient’s health. Because the presence of family can improve a patient’s outcomes, it is important to keep the family in mind as a method of treatment and whatever is good for the patient should be seriously considered and applied when possible.
References
Baier, Sue. (1995). Bed Number Ten. New York: CRC Press.
Beckmann Murray, R., Proctor Zentner, J. (1997). Health Assessment and Promotion Strategies: Through the Life Span. United States of America: Appleton & Lange, A Simon & Schuster Company.
Day, Lisa. (2006). Family Involvement in Critical Care: Shortcomings of a Utililitarian Justification. American Journal of Critical Care, 15(2), 223-225.
Engstrom, A., Soderberg, S. (2007). Receiving Power Through Confirmation: The Meaning of Close Relatives for People Who Have Been Critically Ill. Journal of Advanced Nursing, 59(6), 569-576.
Fox-Wasylyshyn, S., Williamson, K. (2005). Family Perceptions of Nurses’ Roles Towards Family Members of Critically Ill Patients: A Descriptive Study. Heart and Lung, 34(5), 335-344. Kjerulf, M. et al. (2005). Family Perceptions of End-of-Life Care in an Urban ICU. Canadian Association of Critical Care Nurses, 16(3), 22-25.
In the book, Bed Number Ten by Sue Baier, Sue, a woman who is diagnosed with Guillan-Barre explains what it is like to be an immobile patient in the ICU. Along with the painstaking exposure that Sue had in the hospital, she also illustrated for the reader the role of her husband, daughters and mother during the time she spent in the hospital. Given her situation and the many issues she was faced with although already difficult to handle, Sue would have had even more difficulty if it had not been for the ongoing support from her family.
The issue of the role of family in the critically ill patient is very important in professional practice when delivering care to patients, it is very likely to see family along with the patient. In the United States, healthcare personnel works in a culture in which family is a central role in any person’s life. Families are built upon caring relationships and when anything happens with one member, the others cope by relying on each other and being there to support the other family members. It is crucial for healthcare workers to include the family and coach them in caring and providing treatment for the patient. The patient in the hospital although he or she is the one in need of medical attention, the patient is not the only one who is in need of assistance. It is crucial for the family to recognized and seen as present rather than being pushed aside and having the patient be the only priority for the healthcare team.
A family is a durable source of security and stability for any person, especially for a patient who is critically ill (Beckmann Murray 1997). Family is an important part in any person’s life and will always serve as a form of comfort and support for its members. Some tasks of a family include, creating a sense of family loyalty, providing social togetherness, providing relationships within the family that foster security, support, encouragement, motivation, morale and creativity, and helping its members to cope with crises (Beckmann Murray 1997). Sue’s family did exactly these things for her. While in the ICU, Sue’s family would visit as often and as long as was allowed to help Sue through the unyielding days she spent at the hospital. With the support and visitations of Sue’s family, she found it much easier to cope with the long hours of the day and the terrible experiences she had to endure (Baier 1995).
A family system is endlessly adaptive yet is strongly influenced by the surrounding environment (Beckmann Murray 1997). Adapting to new situations is a major function of the family especially helping in its growth and development throughout life as its members change and also develop. These adaptive mechanisms can be seen as a family’s way of coping with stressors. Each mechanism demonstrates a way in which the family maintains an internal balance to further assist the family in dealing with external stressors or crises (Beckmann Murray 1997).
For example, one adaptive mechanism that Sue Baier’s family acts upon is the additional roles played out by different members of the family. When a family member is ill, other family members must adapt by striving to be flexible in his or her roles (Beckmann Murray 1997). In Bed Number Ten, Sue says "Promptly at eleven-thirty, Bill returned. He looked so tired. How could he not be tired? So much to do." (Baier 1995). Because Sue had been stuck at the hospital due to her paralyzing illness, she was unable to complete her normal tasks and because this was so, her husband needed to get them completed for her. To cope with Sue’s illness, but to keep his family balanced, it was necessary for Bill to take on additional tasks each day.
One way in which a family will cope other then relying on the other members and striving to be flexible in roles, families learn to cope by seeking out information (Beckmann Murray 1997). When a loved one is in the hospital, families like to understand what is going on. It is critical to keep the family informed of their loved one’s health status and keep them updated on all the information necessary for them to know. Because the ICU can be so fast paced at times though, it is sometimes difficult to relay information to family members (Kjerulf 2005). It is important that families are given the chance to ask questions and it is just as important that they receive the answers. Families want to be able to participate in patient care, have the diagnosis and prognosis clarified and they also want to have equipment explained to them so that they too can better understand the experience that their loved one is going through (Fox-Wasylyshyn 2005).
Not only can family play a large role when other family members are away for extended periods of time, but family can also greatly assist the patient while in the hospital. In the ICU, family can serve as a tool for the patient, facilitating better communication and increasing the patient’s ability to do things (Engstrom 2007). This was very true for Sue Baier. When at her worst stage of her illness, Sue was unable to move any part of her body with the exception of her eyes. It was through her eyes that Sue spoke with her husband and at times her healthcare providers who would take the time. Many patients may describe the inability to talk people as frightening and scary, but the family becomes interpreters in communication between the patient and others because they can mostly understand what the patient is trying to say or what he or she means (Engstrom 2007).
"‘Did you sleep well last night?’ How do I answer him? Frantically I flutter my eyelids. ‘No, Sue, one blink for yes or move your mouth for no.’ Oh, Bill, always by the rules. But the rules have changed. Again I blinked repeatedly. He studied me for a moment, and again I blinked my eyes several times. Then he understood. ‘You can’t move your mouth can you? Is that what you were trying to tell me?’ One firm, elaborate closing and opening of the lids. Yes. ‘Well, then, how about one blink meaning yes and two for no?’ (Baier 37)."
Although the family has a better chance of understanding what a patient wants, it is also true that the family may not understand exactly what the patient wants at times. This may put extra stress on the patient and make him or her feel like giving up (Engstrom 2007).
Having family by a patient’s side while staying in the hospital can drastically reduce the amount of anxiety a patient encounters. The onset of an illness can cause unpredictability due to the unfamiliar world around a patient, but with family around, a patient can feel safer and more at ease (Engstrom 2007). Having family nearby can give a patient a familiar face when the staff is never the same, failing to provide a constant or familiar face. In the study, "Receiving power through confirmation: the meaning of close relatives for people who have been critically ill", researchers found that patients felt happier when family was near, but when family had gone home, patients described feelings of loneliness and fear while also feeling as though he or she was trapped in bed. Researchers also found that much like Sue, while family members were gone, patients would count down the time until they would return (Engstrom 2007). "My tears washed away the image of him leaving. When I blinked them away, he was gone. Only the clock was still there. Seven forty-two. Three hours and forty-eight minutes until Bill would return." (Baier 22).
Having family members around while a patient is in the hospital can supply the patient with consistence in an environment that is otherwise inconsistent. With family by a patient’s bedside, he or she has a familiar face which can make a patient feel more comfortable, safer and less alone. It is significant for patients to be able to experience the company of a familiar face most importantly because a patient’s healthcare providers may always be changing due to rotations of the hospital personnel. The repetitive changing of nurses especially has a negative effect on a patient’s quality of life (Kjerulf 2005). If a patient were to have a more consistent nursing staff, both the nurse and the patient could become more comfortable in working with one another and patient outcomes could be improved in a much shorter period of time.
When family is not around, patients exhibit much more anxiety than when family is present. The study, "Receiving power through confirmation: the meaning of close relatives for people who have been critically ill", researchers found that patients felt as though they were losing control and could die when family was not present (Engstrom 2007). In Bed Number Ten, Sue says "I was totally at the mercy of people I did not know and with whom I could not communicate. People who didn’t even seem to care" (Baier 32). It is important as a healthcare provider to make a patient feel as comfortable as possible and never feel as though they are surrounded by strangers and scared of what could happen to them. As healthcare providers, we should be accommodating to patient’s needs and supplying to him or her a safe environment where the patient can feel as though healthcare providers are competent and will provide the best care possible.
In encountering a life changing event such as becoming critically ill, a patient will feel like he or she has lost all control due to such a disruption, but with family nearby, patients are given a reason to continue with his or her struggles. Family is vital to an ill patient. Family gives a patient motivation and a reason to continue to fight through the endeavors he or she may come into contact with. The support of a family can demonstrate to a patient exactly what his or her existence means to the other members of the family then in turn giving the patient the will to live when he or she may feel as though all is lost and giving up is the only option (Engstrom 2007). This constant reminder of how much a family cares for a patient is very important in giving the patient the power to want to become healthy again. Family may give the patient courage to feel as though he or she can continue on and make it through this difficult time (Day 2006). Patients feel that because family demonstrated that they cared so much, patients did not want to fail them by giving up since family was the most important people in the patient’s lives during their time of illness. Patients came to realize that the family still expected something from them and that they needed to fight their illness to fulfill the family’s expectations (Engstrom 2007).
Both patient and family needs should be attended to when setting up a plan of care. Families feel as though healthcare personnel can assist best in their coping by allowing them to be included in the patient’s care and by addressing the family’s needs also (Fox-Wasylyshyn 2005). By addressing a family’s needs, healthcare teams can promote knowledge and assist the family in dealing with the crisis at hand. Patient recovery may also be promoted when the healthcare team comes together with the family to understand the issues at hand (Fox-Wasylyshyn 2005). A stress-free environment is best for a patient who is critically ill and a lot of stress can be diminished if both the family and healthcare team are on the same level and understand what is going on with the patient and his or her care.
Allowing the family to be present while a patient is in the ICU is very important and can promote family education and decrease anxiety (Day 2006). Having family near when a patient is critically ill can greatly increase a patient’s quality of life (Engstrom 2007). If healthcare providers were to actually keep the patient’s health as their top priority, then things may go more smoothly in the ICU, but without cooperation and collaboration between the family and healthcare providers, situations may become more difficult to handle. It is important for healthcare personnel to recognize the positive influence that a family’s presence can have on a patient’s state of health. Rather than forcing families out of the room and allotting a certain amount of time for visitation, healthcare workers should be encouraging the presence of family.
"The minutes passed so quickly, and too soon Bill was telling me it was time to go. They had rules, he explained. Only three visits a day-and only fifteen minutes at a time. As weak as I was, I clung desperately to his hand and begged him not to leave. ‘It’s the rule, Sue. Besides, they say that any longer a visit would only tire you.’ The rule, the ultimate answer." (Baier 22).
In the article, Family perceptions of end-of-life care in an urban ICU, families said that unit visiting hours were too limited and did not allow for families to spend enough time with their loved ones, and that if visitation policies were to be more flexible, then access between the family and patients could be greatly maximized (Kjerulf 2005).
In allowing a patient’s family to spend more time in the ICU, healthcare providers may begin to learn more about who the patient is as a person. In order to fully understand how to care for a critically ill person, one needs to be able to recognize and consider the human experience of illness (Engstrom 2007). Any healthcare provider can begin to understand the human experience of a given situation as long as that healthcare provider sees the patient as another person rather than just somebody who is sick and needs medical attention. A family makes up a very large portion of who somebody is and one can learn a lot about a patient by spending time with his or her family. By having the knowledge about a patient’s experience, one can greatly improve the quality of care being provided (Engstrom 2007).
It is important for healthcare workers to begin to consistently be involving the patient’s family in care. In doing so, healthcare workers will need to stop seeing a patient as just an individual who can be separated from his or her family and instead, families should be treated along with the patient (Day 2006). Healthcare workers need to stop looking at just the patient as the recipient of treatment and begin to see the family as also in need of and receiving care. In many cases, a critical care team may only focus decision making and care planning on the individual rather than collaborating with the patient’s family and encouraging the involvement in a the patient’s care.
The article, "Family involvement in critical care: shortcomings of a utilitarian justification" states that:
"To subscribe to the idea that the critical care team alone can provide a cure while treating the patient as a radical individual is a dangerous mistake that denies the curative influence of the family and the importance of the patient’s involvement in family relationships." (Day 225).
This quote alone is very powerful and sends out a strong message. It is absurd for a healthcare team to believe that they have all the power in the world to cure a patient of a critical illness without any consideration to family and the therapeutic power it may have on a patient’s health status. Healthcare teams need to begin to see that there is indeed a lot of things that they can do to improve a patient’s health, but they also need to consider the smaller, simpler things that a patient will also benefit from.
After having done the research for the role of family in the critically ill patient, I have learned exactly how strong the position of family is. I now feel as though I will look differently at family gathering in a patient’s room. Before there had been times when I would see the family with the patient and think to myself that there must be other things going on in the family’s lives that should be preventing them from spending so much time in the hospital. Now though, I understand more clearly that family is a strong bond that is difficult to break because of the many emotions and relationships that have evolved over time. There is no reason for family to not be seen as important when providing care to a patient. In fact, family is one of the most critical factors in improving a patient’s health.
Family is significant in improving a patient’s health status. Family is the best thing that a patient can have around during this difficult time because family is always a source of support and stability, encouragement and motivation (Beckmann Murray 1997). Patients in a study stated that after having shared the experience of being critically ill with their families, they felt as though their relationships were confirmed, relationships had grown stronger and they felt as though they cared more for each other (Engstrom 2007). Not only are these family relationships important in critically ill patients, but relationships between families and healthcare teams need to be developed for optimal outcomes (Kjerulf 2005).
Both the patient and his or her family should be cared for during the time of hospitalization because they are in reality a single unit. A family unit cannot be torn apart or seperated and have each member be treated individually because the relationships in the family are so concrete. This is why a patient’s family should be allowed to stay at the bedside to provide support and to be involved in patient care. Healthcare providers need to allow families time to spend with patients along with allowing them to be involved in a patient’s care by educating the family and including them. A family supplies a therapeutic regime which can greatly improve a patient’s health. Because the presence of family can improve a patient’s outcomes, it is important to keep the family in mind as a method of treatment and whatever is good for the patient should be seriously considered and applied when possible.
References
Baier, Sue. (1995). Bed Number Ten. New York: CRC Press.
Beckmann Murray, R., Proctor Zentner, J. (1997). Health Assessment and Promotion Strategies: Through the Life Span. United States of America: Appleton & Lange, A Simon & Schuster Company.
Day, Lisa. (2006). Family Involvement in Critical Care: Shortcomings of a Utililitarian Justification. American Journal of Critical Care, 15(2), 223-225.
Engstrom, A., Soderberg, S. (2007). Receiving Power Through Confirmation: The Meaning of Close Relatives for People Who Have Been Critically Ill. Journal of Advanced Nursing, 59(6), 569-576.
Fox-Wasylyshyn, S., Williamson, K. (2005). Family Perceptions of Nurses’ Roles Towards Family Members of Critically Ill Patients: A Descriptive Study. Heart and Lung, 34(5), 335-344. Kjerulf, M. et al. (2005). Family Perceptions of End-of-Life Care in an Urban ICU. Canadian Association of Critical Care Nurses, 16(3), 22-25.
Nursing 620C: Pediatric Care Plan
Patient History
D. G. is an eleven month old girl who was admitted with right lower lobe Pneumonia with a secondary diagnosis of dehydration. She has a past medical history of suspected Neurofibromatosis due to the multiple café au lait spots covering her body. Her mother complained of a fever for nearly three days reaching temperatures around 103 degrees. Other complaints include: a cough, bilateral eye discharge, a runny nose, decreased appetite, and vomiting. She has been placed on Rocefin to kill what might be causing her Pneumonia, and also Lactinex to enhance her normal flora which is being killed by the Rocefin. She had an IV infusing D 5 ¼ normal saline running at 45 ml/hr. Her mother stayed with her while in the hospital.
Upon assessment, D.G.’s vitals consisted of a temperature of 98.1 degrees, a pulse of 130, a respiratory rate of 26, and a blood pressure of 100/75. Her weight was documented at 17 pounds and 13.4 ounces which was about 7 ounces more than she had weighed the previous day. She appeared to be resting comfortably in her mothers arms, and when placed in the crib, also appeared to be resting comfortably.
She appeared very pale for her ethnicity and looked like she had not been feeling well. She had a radial and pedal pulse along with color, sensation and movement bilaterally. Capillary refill time was measured as less than three seconds, and had no edema. She was awake and alert, and only became agitated upon being assessed, but was easily consoled by her mother. Her Oxygen saturation was documented at 100% on room air. Although she did not experience any dyspnea or labored respirations, upon assessing her lung sounds, Rhonchi was heard scattered throughout. She had scant, clear sputum or secretions assessed upon bulb suctioning and was on no respiratory treatments.
Her appetite was poor, although she had been drinking some Pedialyte and Good Start formula. D.G. experienced no nausea or vomiting, but did experience two episodes of diarrhea. She had bowel sounds present in all four quadrants, and her abdomen was soft and non-distended. D.G. was voiding clear, yellow, quantity sufficient urine. She had full range of motion with no casts and was being held by her mother through most of the shift. Skin was warm, dry and intact aside from the café au lait spots on her body.
Nursing Diagnoses
The following nursing diagnoses have been developed for D.G. in relation to her current health status:
1. Risk for impaired gas exchange related to exudates accumulation and increased mucous production
2. High risk for fluid volume deficit related to fluid loss through hyperthermia or hyperpnea (or both)
3. Ineffective airway clearance related to inflammation
4. Ineffective breathing pattern related to an inflammatory infection in the lower airway
5. Acute pain related to infiltration of IV
6. Risk for infection related to inadequate primary defenses
7. Altered nutrition: less than body requirements related to increased metabolic needs
8. Knowledge deficit or parents related to unfamiliarity of the disease process, complications, measures to control it and prevent its transmission
Impaired Gas Exchange
Assessment
Through assessment, the following information was gathered in relation to the diagnosis:
Subjective Information:
-D.G.’s mother states that she looks and feels much better than the previous day
-Mother states that D.G. has not been coughing as much
-D.G.’s mother says that she has been sleeping better and is more relaxed
Objective Information:
-The patient does not look as though she is having difficulty breathing
-Lung sounds have Rhonchi scattered throughout
-There is no use of accessory muscles in breathing
-Oxygen saturation is measured at 100% on room air
-Respiratory rate is 26 which is within normal limits for D.G.’s age
-D.G. has scant amounts of clear sputum and/or secretions
-D.G. hardly needs to be suctioned
-D.G. appears tired and lacking in energy
Goals
Short Term Goal:
The short term goal for D.G.’s diagnosis of impaired gas exchange is that she will have an Oxygen saturation greater than 90% and will be able to maintain oral intake by around 11:00 AM on April 4th.
Long Term Goal:
The long term goal for D.G. in relation to her diagnosis is that D.G. will have an improved gas exchange evidenced by the ease of respirations, improved skin color, and decreased restlessness by around 6:00 PM on April 4th.
Nursing Interventions:
1. Intervention: Assess respiratory status
Rationale: Indicates if treatment is effective or if condition is worsening (Speer 24)
Outcome: The child will have no abnormal results in a respiratory assessment
2. Intervention: Auscultate breath sounds every 2-4 hours
Rationale: Decreased or adventitious breath sounds signal potential airway obstruction that could further aggravate hypoxia and necessitate prompt intervention (Swearingen 124)
Outcome: Breath sounds will be evident and without any adventitious sounds
3. Intervention: Observe for and promptly report signs of respiratory distress
Rationale: These signs of respiratory distress including restlessness, anxiety, changes in mental status, shortness of breath, tachypnea and the use of accessory muscles represent the need for medical intervention (Swearingen 124)
Outcome: The child will show no signs of respiratory distress
4. Intervention: Monitor and document vital signs every 2-4 hours
Rationale: A rising temperature or changes in vital signs may signal the presense of worsening inflammation response in the lungs (Swearingen 124)
Outcome: Vital signs will be monitored every 2-4 hours and will remain within the normal limits
5. Intervention: Monitor oximetry readings and report an Oxygen saturation of 90% or less
Rationale: An Oxygen saturation of 90% or less is a significant sign of an oxygenation problem that can indicate the need for Oxygen therapy (Swearingen 125)
Outcome: The child's Oxygen saturation will remain at about 95%
6. Intervention: Encourage oral intake of fluids
Rationale: Fluids generally liquify secretions (Speer 25)
Outcome: Patient will be taking oral fluids every 1-2 hours
7. Intervention: Administer antibiotics as prescribed
Rationale: Decreases the inflammation response in the lungs to promote healing and decrease the risk of mortality (Swearingen 124)
Outcome: Antibiotics will be administered as prescribed
8. Intervention: Provide frequent rest periods
Rationale: Rest is necessary to conserve energy to fight infection (Speer 25)
Outcome: Patient will rest frequently throughout the day
9. Intervention: Suction as needed
Rationale: Maintains airway patency (Speer 24)
Outcome: Patient will be suctioned as appropriate
10. Intervention: Ensure the availability of emergency equipment
Rationale: Basic emergency preparedness (Newfield 348)
Outcome: Emergency equipment will be available at the bed side in the event of an emergency
11. Intervention: Provide for parental or caregiver input in planning and implementing care as far as comfort measures, daily hygiene and feeding are concerned
Rationale: Parental involvement provides emotional security for children and allows parents or caregivers to practice care techniques in a supportive environment (Newfield 348)
Outcome: Caregivers will take part in child's care by assisting in hygiene, feeding and comfort
12. Intervention: Allow for the parents or caregivers to verbalize concerns about the child's health status and changes while encouraging them to ask questions
Rationale: Decreases anxiety and provides a teaching opportunity (Newfield 348)
Outcome: Caregivers will ask questions and voice any concerns or misunderstanding about the child's condition
Outcome
Through implementing the nursing interventions above, D.G. was both cooperative and responsive. D.G.’s mother stayed involved in her care throughout every procedure and was very attentive to her needs. After having implemented these interventions, D.G.’s lung sounds had rhonchi scattered throughout, but without any signs of dyspnea. All vital signs remained within normal parameters and Oxygen saturation was documented at 100% on room air. D.G. was placed in her crib to nap a few times during the day, but was otherwise held by her mother. D.G. was also able to maintain an oral intake that was not as high as the nurses would have liked to have seen, but was in fact taking oral fluids. D.G.’s mother states that’s he is looking and feeling much better than she had the past few days in the hospital.
Evaluation
The short term goal for D.G. was met well before 11:00AM on April 4th. Her Oxygen saturation remained at 100% throughout the day and she was able to maintain her oral intake. It appears that the nursing interventions implemented greatly increased D.G.’s ability to keep her intake in her system, and also allowed her a better respiratory status than she may have previously had.
The long term goal for D.G., evaluation was set for around 6:00PM on April 4th. The client has made some progress towards this goal evidenced by her having no difficulty breathing, and being able to relax rather than being restless. Perhaps if fluids were pushed more often, her color would improve, and she would not appear to be so pale, and there would be less rhonchi heard scattered throughout her lungs because the secretions would become more liquefied.
Fluid Volume Deficit
Assessment
Through assessment, the following information was gathered in relation to the diagnosis:
Subjective Information:
-D.G.’s mother states that she is taking more oral fluids than she previously was
-Mother states that D.G. still is not drinking as much as she should be
-Mother states that many times, when she tries to give D.G. her bottle to get her to drink, she -pushes it away and refuses
-Mother states that she looks and feels better than she previously had
Objective Information:
-D.G. looks pale for her ethnicity and looks as though she does not feel well
-Her mucous membranes are moist
-D.G. has good skin turgor
-D.G. has gained weight
-Capillary refill time for D.G. was determined to be less than 3 seconds
-D.G. had two episodes of diarrhea
-D.G. is able to maintain oral intake
-D.G.’s intake and output are nearly balanced
-D.G.’s eyes do not look as though they are sunken in, and her fontanel does not feel sunken
Goals
Short Term Goal:
The short term goal for D.G. in relation to her diagnosis for fluid volume deficit is that she will have good skin turgor, moist mucous membranes and a capillary refill time within 3 to 5 seconds by the time her noon assessment is completed on April 4th.
Long Term Goal:
The long term goal for D.G. is that she will maintain a stable weight and her intake and output will be nearly balanced and within at least 200ml of each other by the end of the day shift which is around 3:00PM on April 4th.
Nursing Interventions:
1. Intervention: Monitor I & O's
Rationale: A decrease in urine output indicates dehydration (Speer 25)
Outcome: I & O's will remain closely balanced
2. Intervention: Assess for an increased respiratory rate and fever every 1-2 hours
Rationale: This is essential in detecting fluid loss, which can increase with an increased respiratory rate and temperature (Speer 25)
Outcome: Respiratory rate and temperature will remain within normal parameters
3. Intervention: Assess for signs of dehydration including poor skin turgor, dry mucous membranes, and sunken fontanels and eyes
Rationale: This intervention detects the need to adjust fluid intake (Speer 25)
Outcome: Patient will demonstrate good skin turgor, moist mucous membranes and no sunken fontanel or eyes
4. Intervention: Encourage fluid intake to a minimum appropriate for the child's age (about 700-1,000 ml/kg in 24 hours)
Rationale: Prompt replacement and maintenance of appropriate fluids prevents further circulatory or systemic problems (Swearingen 163)
Outcome: Patient will be able to drink the appropriate amount of fluids for her age
5. Intervention: Weigh the patient daily at the same time with the same clothing but without a diaper, and on the same scale
Rationale: Weight serves as a major indicator of whether or not treatment is effective (Swearingen 164)
Outcome: The patient's weight will not fluctuate, but will remain at a healthy level
6. Intervention: Maintain IV therapy
Rationale: Ensures adequate hydration status (Newfield 127)
Outcome: IV therapy will be continued and administered as prescribed
7. Intervention: Report any urine output less than 0.5 ml/kg/hr
Rationale: Less than this amount indicates fluid volume deficit (Newfield 126)
Outcome: Patient will have a urine output greater than 0.5 ml/kg/hr
Outcome
Through implementing the nursing interventions above, D.G. was once again, both cooperative and responsive. Her intake and output were closely monitored while fluids were strongly encouraged. D.G. still refused any oral fluids and pushed away her bottle when her mother attempted to get her to drink some more. D.G.’s respiratory rate remained within normal parameters, she demonstrated good skin turgor, a capillary refill time of less than three seconds, moist mucous membranes, a pale skin color for her ethnicity and had no sunken fontanel or eyes. Upon being weighed, it was determined that D.G. was actually gaining back some weight. Her urine output remained within normal parameters and was nearly balanced with her intake.
Evaluation
The short term goal for D.G. was met by noon assessment on April 4th. D.G. demonstrated good skin turgor, moist mucous membranes and a capillary refill time of less than three seconds. If fluids had been encouraged more often, perhaps these goals could have been met much earlier, or during previous days.
The long term goal for D.G. had an evaluation time set for 3:00PM on April 4th. D.G. had made significant progress towards this goal. On her I&O sheet, it was shown that her intake closely matched what her output was, making them nearly balanced. This is always a good sign when assessing a patient’s intake and output.
Overall Evaluation
Overall, it appears as though the nursing interventions that were implemented, were effective in enhancing D.G.’s health status. Before having intervened, D.G. had nursing diagnoses of impaired gas exchange and fluid volume deficit. In acting upon these diagnoses and treating them with specific interventions, D.G. made a significant improvement in becoming a healthier individual like she previously had been. D.G. was able to maintain a better fluid balance which was important in treating her fluid volume deficit, and with the help of the fluids, was able to maintain a somewhat clearer airway than she had. Although her lung sounds did not completely clear, tending to these two nursing diagnoses definitely gave her an advantage in being able to rid her body of Pneumonia. Each intervention implemented had an exact reason behind it, which allowed for a more clear understanding as to why certain tasks or procedures would be performed.
Conclusion
In conclusion, a thorough nursing care plan can meet the needs of any patient, no matter what age, diagnosis or other factors are in place. In developing this care plan, one can clearly organize how to approach caring for a patient with a specific diagnosis. In doing so, the nurse can see which diagnoses rank over others, demonstrating which ones should be treated first, while also giving specific interventions used to approach meeting the goals of the diagnosis. In this specific case, it is clear that the actions of the nurses can greatly influence a child’s health status. In intervening to D.G.’s needs, nurses are able to improve her health status to allow her to return home where she can be better cared for by her mother alone.
References
Jaffe, M. (1998). Pediatric nursing care plans. Colorado: Skidmore-Roth Publishing Inc.
Newfield, S. (2007). Cox’s clinical application of nursing diagnosis: Adult, child, women’s, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Company.
Potts, N., Mandleco, B. (2007). Pediatric nursing: Caring for children and their families. United States: Thomson Delmar Learning.
Speer, K. (1994). Pediatric care planning. Springhouse Publishing Company.
Swearingen. (2008). All-in-one care planning resource: Medical-surgical, pediatric, maternity, & psychiatric nursing care plans. United States of America: Mosby Elsevier.
D. G. is an eleven month old girl who was admitted with right lower lobe Pneumonia with a secondary diagnosis of dehydration. She has a past medical history of suspected Neurofibromatosis due to the multiple café au lait spots covering her body. Her mother complained of a fever for nearly three days reaching temperatures around 103 degrees. Other complaints include: a cough, bilateral eye discharge, a runny nose, decreased appetite, and vomiting. She has been placed on Rocefin to kill what might be causing her Pneumonia, and also Lactinex to enhance her normal flora which is being killed by the Rocefin. She had an IV infusing D 5 ¼ normal saline running at 45 ml/hr. Her mother stayed with her while in the hospital.
Upon assessment, D.G.’s vitals consisted of a temperature of 98.1 degrees, a pulse of 130, a respiratory rate of 26, and a blood pressure of 100/75. Her weight was documented at 17 pounds and 13.4 ounces which was about 7 ounces more than she had weighed the previous day. She appeared to be resting comfortably in her mothers arms, and when placed in the crib, also appeared to be resting comfortably.
She appeared very pale for her ethnicity and looked like she had not been feeling well. She had a radial and pedal pulse along with color, sensation and movement bilaterally. Capillary refill time was measured as less than three seconds, and had no edema. She was awake and alert, and only became agitated upon being assessed, but was easily consoled by her mother. Her Oxygen saturation was documented at 100% on room air. Although she did not experience any dyspnea or labored respirations, upon assessing her lung sounds, Rhonchi was heard scattered throughout. She had scant, clear sputum or secretions assessed upon bulb suctioning and was on no respiratory treatments.
Her appetite was poor, although she had been drinking some Pedialyte and Good Start formula. D.G. experienced no nausea or vomiting, but did experience two episodes of diarrhea. She had bowel sounds present in all four quadrants, and her abdomen was soft and non-distended. D.G. was voiding clear, yellow, quantity sufficient urine. She had full range of motion with no casts and was being held by her mother through most of the shift. Skin was warm, dry and intact aside from the café au lait spots on her body.
Nursing Diagnoses
The following nursing diagnoses have been developed for D.G. in relation to her current health status:
1. Risk for impaired gas exchange related to exudates accumulation and increased mucous production
2. High risk for fluid volume deficit related to fluid loss through hyperthermia or hyperpnea (or both)
3. Ineffective airway clearance related to inflammation
4. Ineffective breathing pattern related to an inflammatory infection in the lower airway
5. Acute pain related to infiltration of IV
6. Risk for infection related to inadequate primary defenses
7. Altered nutrition: less than body requirements related to increased metabolic needs
8. Knowledge deficit or parents related to unfamiliarity of the disease process, complications, measures to control it and prevent its transmission
Impaired Gas Exchange
Assessment
Through assessment, the following information was gathered in relation to the diagnosis:
Subjective Information:
-D.G.’s mother states that she looks and feels much better than the previous day
-Mother states that D.G. has not been coughing as much
-D.G.’s mother says that she has been sleeping better and is more relaxed
Objective Information:
-The patient does not look as though she is having difficulty breathing
-Lung sounds have Rhonchi scattered throughout
-There is no use of accessory muscles in breathing
-Oxygen saturation is measured at 100% on room air
-Respiratory rate is 26 which is within normal limits for D.G.’s age
-D.G. has scant amounts of clear sputum and/or secretions
-D.G. hardly needs to be suctioned
-D.G. appears tired and lacking in energy
Goals
Short Term Goal:
The short term goal for D.G.’s diagnosis of impaired gas exchange is that she will have an Oxygen saturation greater than 90% and will be able to maintain oral intake by around 11:00 AM on April 4th.
Long Term Goal:
The long term goal for D.G. in relation to her diagnosis is that D.G. will have an improved gas exchange evidenced by the ease of respirations, improved skin color, and decreased restlessness by around 6:00 PM on April 4th.
Nursing Interventions:
1. Intervention: Assess respiratory status
Rationale: Indicates if treatment is effective or if condition is worsening (Speer 24)
Outcome: The child will have no abnormal results in a respiratory assessment
2. Intervention: Auscultate breath sounds every 2-4 hours
Rationale: Decreased or adventitious breath sounds signal potential airway obstruction that could further aggravate hypoxia and necessitate prompt intervention (Swearingen 124)
Outcome: Breath sounds will be evident and without any adventitious sounds
3. Intervention: Observe for and promptly report signs of respiratory distress
Rationale: These signs of respiratory distress including restlessness, anxiety, changes in mental status, shortness of breath, tachypnea and the use of accessory muscles represent the need for medical intervention (Swearingen 124)
Outcome: The child will show no signs of respiratory distress
4. Intervention: Monitor and document vital signs every 2-4 hours
Rationale: A rising temperature or changes in vital signs may signal the presense of worsening inflammation response in the lungs (Swearingen 124)
Outcome: Vital signs will be monitored every 2-4 hours and will remain within the normal limits
5. Intervention: Monitor oximetry readings and report an Oxygen saturation of 90% or less
Rationale: An Oxygen saturation of 90% or less is a significant sign of an oxygenation problem that can indicate the need for Oxygen therapy (Swearingen 125)
Outcome: The child's Oxygen saturation will remain at about 95%
6. Intervention: Encourage oral intake of fluids
Rationale: Fluids generally liquify secretions (Speer 25)
Outcome: Patient will be taking oral fluids every 1-2 hours
7. Intervention: Administer antibiotics as prescribed
Rationale: Decreases the inflammation response in the lungs to promote healing and decrease the risk of mortality (Swearingen 124)
Outcome: Antibiotics will be administered as prescribed
8. Intervention: Provide frequent rest periods
Rationale: Rest is necessary to conserve energy to fight infection (Speer 25)
Outcome: Patient will rest frequently throughout the day
9. Intervention: Suction as needed
Rationale: Maintains airway patency (Speer 24)
Outcome: Patient will be suctioned as appropriate
10. Intervention: Ensure the availability of emergency equipment
Rationale: Basic emergency preparedness (Newfield 348)
Outcome: Emergency equipment will be available at the bed side in the event of an emergency
11. Intervention: Provide for parental or caregiver input in planning and implementing care as far as comfort measures, daily hygiene and feeding are concerned
Rationale: Parental involvement provides emotional security for children and allows parents or caregivers to practice care techniques in a supportive environment (Newfield 348)
Outcome: Caregivers will take part in child's care by assisting in hygiene, feeding and comfort
12. Intervention: Allow for the parents or caregivers to verbalize concerns about the child's health status and changes while encouraging them to ask questions
Rationale: Decreases anxiety and provides a teaching opportunity (Newfield 348)
Outcome: Caregivers will ask questions and voice any concerns or misunderstanding about the child's condition
Outcome
Through implementing the nursing interventions above, D.G. was both cooperative and responsive. D.G.’s mother stayed involved in her care throughout every procedure and was very attentive to her needs. After having implemented these interventions, D.G.’s lung sounds had rhonchi scattered throughout, but without any signs of dyspnea. All vital signs remained within normal parameters and Oxygen saturation was documented at 100% on room air. D.G. was placed in her crib to nap a few times during the day, but was otherwise held by her mother. D.G. was also able to maintain an oral intake that was not as high as the nurses would have liked to have seen, but was in fact taking oral fluids. D.G.’s mother states that’s he is looking and feeling much better than she had the past few days in the hospital.
Evaluation
The short term goal for D.G. was met well before 11:00AM on April 4th. Her Oxygen saturation remained at 100% throughout the day and she was able to maintain her oral intake. It appears that the nursing interventions implemented greatly increased D.G.’s ability to keep her intake in her system, and also allowed her a better respiratory status than she may have previously had.
The long term goal for D.G., evaluation was set for around 6:00PM on April 4th. The client has made some progress towards this goal evidenced by her having no difficulty breathing, and being able to relax rather than being restless. Perhaps if fluids were pushed more often, her color would improve, and she would not appear to be so pale, and there would be less rhonchi heard scattered throughout her lungs because the secretions would become more liquefied.
Fluid Volume Deficit
Assessment
Through assessment, the following information was gathered in relation to the diagnosis:
Subjective Information:
-D.G.’s mother states that she is taking more oral fluids than she previously was
-Mother states that D.G. still is not drinking as much as she should be
-Mother states that many times, when she tries to give D.G. her bottle to get her to drink, she -pushes it away and refuses
-Mother states that she looks and feels better than she previously had
Objective Information:
-D.G. looks pale for her ethnicity and looks as though she does not feel well
-Her mucous membranes are moist
-D.G. has good skin turgor
-D.G. has gained weight
-Capillary refill time for D.G. was determined to be less than 3 seconds
-D.G. had two episodes of diarrhea
-D.G. is able to maintain oral intake
-D.G.’s intake and output are nearly balanced
-D.G.’s eyes do not look as though they are sunken in, and her fontanel does not feel sunken
Goals
Short Term Goal:
The short term goal for D.G. in relation to her diagnosis for fluid volume deficit is that she will have good skin turgor, moist mucous membranes and a capillary refill time within 3 to 5 seconds by the time her noon assessment is completed on April 4th.
Long Term Goal:
The long term goal for D.G. is that she will maintain a stable weight and her intake and output will be nearly balanced and within at least 200ml of each other by the end of the day shift which is around 3:00PM on April 4th.
Nursing Interventions:
1. Intervention: Monitor I & O's
Rationale: A decrease in urine output indicates dehydration (Speer 25)
Outcome: I & O's will remain closely balanced
2. Intervention: Assess for an increased respiratory rate and fever every 1-2 hours
Rationale: This is essential in detecting fluid loss, which can increase with an increased respiratory rate and temperature (Speer 25)
Outcome: Respiratory rate and temperature will remain within normal parameters
3. Intervention: Assess for signs of dehydration including poor skin turgor, dry mucous membranes, and sunken fontanels and eyes
Rationale: This intervention detects the need to adjust fluid intake (Speer 25)
Outcome: Patient will demonstrate good skin turgor, moist mucous membranes and no sunken fontanel or eyes
4. Intervention: Encourage fluid intake to a minimum appropriate for the child's age (about 700-1,000 ml/kg in 24 hours)
Rationale: Prompt replacement and maintenance of appropriate fluids prevents further circulatory or systemic problems (Swearingen 163)
Outcome: Patient will be able to drink the appropriate amount of fluids for her age
5. Intervention: Weigh the patient daily at the same time with the same clothing but without a diaper, and on the same scale
Rationale: Weight serves as a major indicator of whether or not treatment is effective (Swearingen 164)
Outcome: The patient's weight will not fluctuate, but will remain at a healthy level
6. Intervention: Maintain IV therapy
Rationale: Ensures adequate hydration status (Newfield 127)
Outcome: IV therapy will be continued and administered as prescribed
7. Intervention: Report any urine output less than 0.5 ml/kg/hr
Rationale: Less than this amount indicates fluid volume deficit (Newfield 126)
Outcome: Patient will have a urine output greater than 0.5 ml/kg/hr
Outcome
Through implementing the nursing interventions above, D.G. was once again, both cooperative and responsive. Her intake and output were closely monitored while fluids were strongly encouraged. D.G. still refused any oral fluids and pushed away her bottle when her mother attempted to get her to drink some more. D.G.’s respiratory rate remained within normal parameters, she demonstrated good skin turgor, a capillary refill time of less than three seconds, moist mucous membranes, a pale skin color for her ethnicity and had no sunken fontanel or eyes. Upon being weighed, it was determined that D.G. was actually gaining back some weight. Her urine output remained within normal parameters and was nearly balanced with her intake.
Evaluation
The short term goal for D.G. was met by noon assessment on April 4th. D.G. demonstrated good skin turgor, moist mucous membranes and a capillary refill time of less than three seconds. If fluids had been encouraged more often, perhaps these goals could have been met much earlier, or during previous days.
The long term goal for D.G. had an evaluation time set for 3:00PM on April 4th. D.G. had made significant progress towards this goal. On her I&O sheet, it was shown that her intake closely matched what her output was, making them nearly balanced. This is always a good sign when assessing a patient’s intake and output.
Overall Evaluation
Overall, it appears as though the nursing interventions that were implemented, were effective in enhancing D.G.’s health status. Before having intervened, D.G. had nursing diagnoses of impaired gas exchange and fluid volume deficit. In acting upon these diagnoses and treating them with specific interventions, D.G. made a significant improvement in becoming a healthier individual like she previously had been. D.G. was able to maintain a better fluid balance which was important in treating her fluid volume deficit, and with the help of the fluids, was able to maintain a somewhat clearer airway than she had. Although her lung sounds did not completely clear, tending to these two nursing diagnoses definitely gave her an advantage in being able to rid her body of Pneumonia. Each intervention implemented had an exact reason behind it, which allowed for a more clear understanding as to why certain tasks or procedures would be performed.
Conclusion
In conclusion, a thorough nursing care plan can meet the needs of any patient, no matter what age, diagnosis or other factors are in place. In developing this care plan, one can clearly organize how to approach caring for a patient with a specific diagnosis. In doing so, the nurse can see which diagnoses rank over others, demonstrating which ones should be treated first, while also giving specific interventions used to approach meeting the goals of the diagnosis. In this specific case, it is clear that the actions of the nurses can greatly influence a child’s health status. In intervening to D.G.’s needs, nurses are able to improve her health status to allow her to return home where she can be better cared for by her mother alone.
References
Jaffe, M. (1998). Pediatric nursing care plans. Colorado: Skidmore-Roth Publishing Inc.
Newfield, S. (2007). Cox’s clinical application of nursing diagnosis: Adult, child, women’s, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Company.
Potts, N., Mandleco, B. (2007). Pediatric nursing: Caring for children and their families. United States: Thomson Delmar Learning.
Speer, K. (1994). Pediatric care planning. Springhouse Publishing Company.
Swearingen. (2008). All-in-one care planning resource: Medical-surgical, pediatric, maternity, & psychiatric nursing care plans. United States of America: Mosby Elsevier.
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