Advancing Transition In Nursing Practice

Describe about the Advancing Transition In Nursing Practice.

Nurses play a critical role in providing care to a patient with chronic health conditions. During their nursing practice, they come across variety of complex cases requiring immediate clinical attention. To promote professional accountability in nursing, it is necessary for nurses to deliver care with the knowledge of clinical reasoning and critical thinking. Nurses who have effective clinical reasoning skills influences patients’ health outcome in a positive way. This essay is a narration of my personal nursing practice improvement episode, and it shows how I use clinical reasoning cycle in my nursing practice to treat patients.

My personal practice improvement episode is centered around a 49-year-old divorcee patient named Peter Ron Alexander who came to our clinical ward with complaints of anxiousness, depression, agitation and inability to cope with living alone. Further investigations revealed that he was suffering from major depressive disorder. He was married and had three children. I found psychiatric history in his family as his father was also suffered from melancholic depression in the past. I was entrusted with the responsibility of caring the patient post four days of acute care. Before dealing with the patient, it was necessary for me to review the complete health description and diagnostic of patient. After going through patient report, I found that it was his second admission for depression and anxiety. It also revealed that he had suicidal thoughts of jumping off a cliff while jogging in the area near the cliff. Concerned with this suicidal thought of killing himself, his parents and brother admitted him to the acute unit of our hospital and he is now scheduled mentally ill.

Clinical reasoning is a process by which nurses collects information about patients, process the information, develops understanding of patient’s problem, plan appropriate interventions, evaluate the outcome and then reflect and learn from the process. Proper clinical reasoning skill is the key to planning intervention for patients and also learning from it (Moon 2013). When nurses have poor clinical reasoning skills, they fail to detect the patient chronic condition, and this leads to adverse outcomes. Adverse patient outcomes in nursing practice occur because of failure to diagnose patients accurately, inability to develop appropriate nursing intervention and poor management of complications in the patient. These issues further highlighted the importance of promoting clinical reasoning skills in a patient to promote management of deteriorating patient’s conditions (Bulman and Schutz 2013).

While applying the patient's episode to my clinical reasoning cycle, I began with collecting cues about patient's condition. It was my initial days of my nursing career, so I wanted to make sure that performed my duties to the best of my ability and did not miss any critical information about patients. During my first interaction with the patient, I tried to start some conversation with patients and get some useful health information. I came to know that although he was not a smoker, he took drugs and alcohol in the past. He was still emotionally depressed, and I found him to be in the worse mood in the morning. His appetite had also decreased, and I had to force him to eat. Whenever I was talking with him, I found him to be a little agitated and his psychomotor ability also slows down. But one serious thing that I noted after enquiring about his life was that he was entirely withdrawing from society, feels no enjoyment in life, and he feels he is a burden to his family. This thought might be the trigger for his intent of suicide at times (Duffy et al. 2015). I realized that he suffers from major depression and planning out effective nursing intervention will be vital to improving his condition.

Apart from the patient’s family history of disease and psychological knowledge, first I went about in assessing patients vital signs. He had sitting BP of 138/86 and standing BP of 133/84 which suggested that he does not have hyper tension, but he is in the phase of pre-hypertension which means likely to develop high blood pressure (Lo et al. 2013). His other vital signs were normal. In order to assess his risk of fall, fall risk assessment and waterloo pressure injury risk assessment was done. The score suggested the overall risk of fall was low. If it had been high, I would have to provide extra support to him in the form of a good mattress, bed side rail, etc. to prevent falls (Rosario et al. 2014). His mental status examination revealed visible shaking of both hands. I found him wringing his hand and fidgeting while sitting. Although he made good eye contact, I noticed his speech to be abnormal. He was not able to complete his sentences and was losing words in between speech. His family members stated his intention of suicidal thought, but he denies any such thoughts. I found him to be preoccupied with unrealistic thoughts.

After recalling and reviewing detailed patient condition, I interpreted that the patient has acute depression, and he is on the verge of acute mental illness. Major depressive disorder is characterized by a continued period of low mood, pain without knowing the cause, low self-esteem, lack of interest in enjoyable things and tendency to drift away from social life. Patients are at risk of the condition due to family history of the condition, sudden change in life, loss of family members, due to medications, health problems, and substance abuse (Snyder 2013). Depression often goes unrecognized by patients or family members. My current patient suffered from severe depression which is evident from his lack of sleep, psychomotor agitation, depressed mood and recurrent thoughts of death and suicidal plans. I had the responsibility of conducting my professional practice according to National Competency Standard for Registered Nurse (O'Connell et al. 2014).

An important component of my nursing practice is implementing accurate nursing intervention following the complete assessment of patient condition. This reflection will help in identifying where I lag behind and could not implement safe nursing practices. In the case of dealing with this patient, I decided to consult other members of my health care team so that I did not commit any errors. In the first week of admission, the patient was prescribed Mirtazapine, Escitalopram, Quetiapine, and Imovane. Mirtazapine and Quetiapine are used to treat a mental condition like depression and bipolar disorder (Begert and Bradley 2015). As the patient had trouble in sleeping, sedative-hypnotics medications like imovane will give good sleep to the patient (Hollister 2014). My plan for treating the patient was to relieve him from his symptoms of depression and mood swings. I helped him to identify his strength and goals to recover from depression. The most difficult part was getting the patient verbally express his feelings. Due to his moods swings and agitation, I initially felt a lot of difficulties. But interacting with him was important to change his mind. I had to be very patient, calm and supportive while he was showing anger. I tried to appraise him when he would accomplish certain activities to raise his spirits. I instilled in him the thought that life is worth living, and it should not be wasted by suicidal thoughts. One should always live and enjoy life to the fullest and fight with challenges in life. I think this interactive worked for my patient.

Electroconvulsive therapy is mainly given to patients with depression. During this therapy, electrical current is sent through patient’s brain to induce a seizure. This session was also planned for my patient (Nordenskjöld 2013). The other stepwise nursing intervention for the patient was making the patient go to the gym and performs yoga, giving her psychosocial intervention like cognitive-behavioral therapy and interpersonal therapy (Segal 2012). I had to treat the patient for five weeks. Despite interpersonal therapy, for the first two weeks, I found little change in his mental status. This made me feel that may be I was competent enough, and I was not able to provide proper treatment. But my senior health care member revealed that immediate change does not take place, the patient usually take 2-3 weeks to become more confident and lively in life. I also had to make sure that patient adheres to medication. Some patient may need to continue longer with pharmacotherapy.

After all the necessary intervention, in the third week, the patient mood was average, but his suicidal thought had completely vanished. This gave me a sense of encouragement that at least the patient is showing some improvement though very slowly. The antidepressant medication was working for the patient but not initially the sedative medications did not work for him. Despite taking Imovane and Quetiapine drugs, he had a problem with sleeping. I could not identify why this happened. On consultation with physician and psychiatrist, they explained to me that patients with severe depression are not able to sleep properly. Lack of sleep is the trigger for other problems as a person does not feel active then. This made me realize why his mood did not improve in the first two weeks. It also because the medication did not improve his sleep. This form of complexities in patients helps develop critical reflection skills. It also helped me to realize my mistakes in nursing practice and knowing the rationale behind any complications (Thompson and Pascal 2012).

After six weeks of nursing intervention and treatment of the patient for depression, the outcome was that his mood became normal, and his family also noticed a significant change in his behavior. He no longer had to go through ECT therapy. When the patient was responding to ECT therapy, the session was suspended, and lithium and nortriptyline were started on the patient. This was given to reduce relapse of symptoms, and it would also lead to the longer relapse-free period for the patient (Atiku et al. 2015). This was also a new finding for me as I assumed treatment normally stops with the successive response of the patient to ECT therapy. At the time of discharge, he was sleeping well up to 10 hours, had good appétite and no intention for suicide. He was also positive towards had a future life which was evident from his new job offer from other companies. I strictly advised the patient to adhere to his medications (amitriptyline, lithium SR, and olanzapine) prescribed.

Through this experience with a patient, I got to know a lot about patients with depression. The use of critical reflection cycle was a useful exercise for me to develop my scope of practice as well as learn from it. Caring for the patient with depression was both challenging as well as awarding for me. I needed to develop my skills to be of benefit to the patient, and the most difficult part was an initiating conversation with such patients. I also feel that listening is the most important thing to identify their problem as well as make the patient feel valued. I felt task was accomplished when I saw the patient living the hospital with lively spirits, confidence and returning to normal life

Reference

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