Decision-Making Process in Nursing - Essay Example

? Decision-Making Process in Nursing Base on Scenario: Initial Presentation and Diagnostic Phase Lecturer Health practitioners have the responsibility of taking care of the patients commencing at the time they get to the hospital until the moment they are discharged after treatment. Therefore, it is upon the nurses to make choices that pertain to the kind of care they will offer their clients to ensure they recover from the sicknesses (Royal College of Nursing, 2006, p.24). The nurses are faced with difficulties since they have to make a quick choice before the situation gets out of control (Jones, R. 2005). When making choices, nurses are obliged to take due care and ensure they discharge their duties in accordance with their professional training and expertise. This experience may have been acquired from work practice or from training (Royal College of Nursing, 2006, p.17). To attain a high degree of joint understanding between the patients, relatives and practitioners, the medical practitioners should establish а training program to ensure that all the stakeholders are made aware of the prevailing circumstances and the possible consequences of the action taken by the health care practitioners. The healthcare providers must exercise their professional ethics to ensure they act in good faith and in the interests of the patients (Royal College of Nursing, 2006, p.22). The nurses should first assess the problem and then seek for solutions to the emerging issues during the assessment process. The alternative chosen should promise the best outcome and should be as effective as possible. The medical practitioner decisions are however influenced by their expertise, the available medical facilities, and the level of acceptance of the consequences of the outcome of the decision taken, as well as willingness of the patient and the relatives to acknowledge those consequences. The nurses have a duty to assess the situation at hand and make decisions concerning the treatment that can be given to the patient. In this case, the patient who is an elderly woman and has a wound on her left limb undergoes many challenges which affect her life in many ways such as inability to move from one place to another (Royal College of Nursing, 2006, p.35). She cannot work for her daily bread since she is unable to move around. She also undergoes a lot of stress because she cannot interact with other people in the society (Jones, 2005). The first thing the nurse has to consider when examining the patient is the family background because this could give them a clue as to what may have caused the wound. Some of the problems are inherited genetically. In case the problem has ever affected one or more of the family members, the medical practitioner can get an avenue for making a conclusion regarding the patient’s condition. Also, patients’ background is likely to point out a situation in the patient’s life which may have contributed to the problem (Lewenson, and Truglio-Londrigan, 2008, p.143). These could include previous surgery wounds which may have resulted in complications for various reasons such as bone fracture during surgery or inflammations sustained during the operation process. The patient has been in this condition for a period of four weeks. Before the practitioners can make a decision regarding the patient’s condition, they should first get information from the patient because this will assist them in making the choice (Royal College of Nursing, 2006, p.26). According to the past records, this patient had similar problem three years before its recurrence, and the condition was cured by compression bandaging. The nurses can use this information to interpret the condition which may be affecting the patient. For example the venous ulcers could be treated though compression bandage unlike other types of ulcers such as those caused by depression of diabetes. The health care providers should also carry out physical assessment of the patient. They should examine the skin and the wound status to make a decision of the kind of treatment they can give to the patient (Gabka, & Bohmert, 2008, p.145). For example, this patient’s wound is not exhibiting any sign of healing and portrays signs of spreading further on the leg. The healthcare providers should clean it thoroughly and dress it properly. This particular patient lives alone but she can take care of herself as far as chores like cooking or bathing are concerned, but this has caused psychological problems due to inability to interact with other members of the society (Royal College of Nursing, 2006, p.28). The inquiry about personal history is of the essence because it will assist the healthcare givers with evidence of other conditions which could result in ulcers such as stress conditions, high blood pressure and diabetic conditions (Zuther, 2009). The fact that the lady lives alone could mean that she might be suffering from depression due to psychological problems. The nurses should not take action based on the information obtained from the patients alone. They should assess the gravity of the problem the patient is facing such as how deep the wound has sunk into the leg. They should also establish the extent to which the ulcer has extended in the leg and the growth of the granules (Lewenson, and Truglio-Londrigan, 2008, p.169). In case the wound is so serious, the nurse should severe off the most affected tissues to aid the healing of the wound. The nurses should take adequate measure to provide treatment to the wound such as ensuring it is adequately cleaned and dressed to kill germs and prevent fresh germs from gaining entry into the wound. Since the patient observation of the wound is a continuous process, the nurses should keep proper records pertaining to the way in which the patient is reacting to medication. The nurses should ensure they screen for other possible problems associated with the current patient’s conditions (Royal College of Nursing, 2006, p.29). For example, since the patient has not been moving around too much as a result of the ulcer, the nurses should examine other problems such as depression or nutrition related ailments which could most likely result in delays in the healing of the wound. In instances where the patient is experiencing pain, the nurse should prescribe some medicine that will help to ease the pain (Gabka, & Bohmert, 2008, P.154). Also, they should inquire from the patient about the intensity of the pain and in case the patient is suffering continuously this may be a sign of an inflammation and could be worsened if the drugs administered to her contain sulphur. The patient already uses Zimmer frame to support her while she walks around. This may be the reason why the patient is not reporting pain (Zuther, 2009). The nurse should encourage her to continue using the support frame so that she can avoid intense suffering. This is essential since the leg is already swollen and may become painful if the patient fails to use support. The nurses should observe the clinical signs the patient is exhibiting which will help them make a well informed choice regarding the patient’s circumstances (Royal College of Nursing, 2006, p.32). The clotting of blood in the leg could result in pain or swelling of the leg. The itching of the wound could also give the nurses an idea of the kind of problem the patient is going through and the kind of treatment the patient should be given (Gabka, & Bohmert, 2008, p.57). Examining these signs is important because the client has not been moving for some time, and the blood circulation may not have been smooth thus causing clotting of the blood. In some cases, the individual habit may result in health complications hence rendering the wound unable to heal (Royal College of Nursing, 2006, p.33). The nurses should examine the possibility of the patient’s habit and relate to the condition and determine whether it could be a contributing factor to the condition the patient is facing. For the nurses to identify the patient with this problem, they should assess the patient’s varicose veins both in standing and seated posture to observe any trace of abnormality (Goro, & Mulley, 2009, p.134). Also, the nurses should examine the hair condition at the affected region of the leg. The absence of hair follicles could be another evidence of the disease. Finally, the nurses should examine the rate of flow of blood in the veins around the wounded part of the leg to establish any abnormality which could depict the presence of this condition. The nurses make decisions based on their personal judgment and their expertise (Zuther, 2009). Sometimes when patients are transferred from other hospitals, the receiving nurse may find it hard to make a choice depending on the level of expertise of the practitioner who referred the patient to him or to her (Royal College of Nursing, 2006, p.25). In this case, the patient was referred by a general practitioner from a district hospital. The recipient judge may assume that the general practitioner in the district hospital has examined the patient both physically and clinically. They may think that the case is complicated hence requires thorough laboratory test. However, the referring practitioner may have lacked adequate facilities to detect the cause of the patients wound on her leg (Goro, & Mulley, 2009, p.234). Therefore, regardless of the qualification of the previous practitioners who examined the patient, the recipient practitioners should exercise their due concern to establish the cause of the problem without taking into consideration the complexity of the matter. Body weight of the patient should be taken to establish any weight loss in case the patient is diabetic (Gerrish and Lacey, 2010, 478). Also, the depth of the wound should be established. Urine test and blood pressure should as well be done. At the first entry into the hospital, the nurses should keep record of the patients ABPI, slough, granules and oedema and compare the readings from time to time to establish whether they are decreasing of increasing (Royal College of Nursing, 2006, p.23). A decrease in body weight could be a sign of obesity which could also be a pointer of other complications hence the need for thorough screening of the disease. The nature of the skin surrounding the wound and the wound itself will influence the choice taken by the practitioner. Due to the presence of the granules and slough, the wound of this patient requires regular cleaning and bandaging (Bluth, 1999, p.67). The presence of oedema makes the wound delicate. This will require the nurses to dress the wound carefully to prevent causing further injuries to the damaged tissues. The heath practitioners should also select carefully the type of drugs that they will administer to their clients. Some drugs have no impact at all while others may cause other complications (Royal College of Nursing, 2006, p.34). The types of drugs prescribed by the medical practitioners should be simple and should not result in other effects. Some drugs are not known to have any impact at all on the patients (Cheung, 2009, 65). For example, there is no known effect of the aspirin on the patients wound and therefore, administering such drugs to the patient may not yield any positive result. Another factor which influences the choice of the medical practitioners’ treatment processes is health facilities available for use and the knowledge of how they work (Cheung, 2009, P.25). The nurses should be able to use the equipment appropriately and make proper analysis of the results obtained. Lack of confidence and knowledge on how to use particular equipment and how to interpret the resultant readings could lead to the wrong decision regarding the patients’ problem and the care offered to them (Royal College of Nursing, 2006, p.35). Lack of experience may also result from insufficient training which limits the practitioners’ ability to make the right choice. Nurses have the mandate to make decisions regarding the kind of problem faced by their clients and the kind of treatment they should undergo (Bluth, 1999, p.57). Due to the barriers caused by lack of clear knowledge about the outcome of the decision taken, nurses should ensure that their clients are fully aware of the consequences of the decision taken. The care givers should then mix their expertise, professional ethics and the patients past records to arrive at a concrete decision (Sharon, & Elizabeth, 2008, p. 4). They should also use the available apparatus to make assessment of the patient’s conditions. Irrespective of the expected outcome or the prevailing circumstances, the healthcare providers must make a choice to help the patients recover from their conditions or alleviate pain they may be going through. In conclusion, healthcare providers are responsible for making choices regarding the patients’ prevailing conditions and the kind of treatment the patients should undergo. (Gerrish, and Lacey, 2010, 346). In order to find a concrete solution, the health providers should study the patients’ past history and establish the root cause of the problem. They should also carry out physical and medical examinations to establish the problem (Royal College of Nursing, 2006, p.36). Then, they should use their expertise and professional ethics to draw a conclusion regarding the care they should offer the patient. To achieve this, medical practitioners should exhibit confidence and professionalism in their work in order to arrive at concrete decisions. Reference List Bluth, E.I. 1999. Ultrasound: A Practical Approach to Clinical Problems. New York. Library of Congress. Pp. 111 Cheung, S.T. 2009. Crash Course: Ophthalmological Dermatology. Library of Congress. Pp. 188 Gabka, C. & Bohmert, H. 2008. Plastic and Reconstructive Surgery of the Breast. Library of Congress. Pp. 144 Gerrish, K. and Lacey, A. 2010. The Research Process in Nursing. John Wiley & Sons, Pp. 568 Goro, A.H., & Mulley, A.G. 2009. Sussman, C. & Bates-Jensen, B.M. 2007. Wound Care: A Collaborative Practice Manual. Baltimore. Healthside Publishing Service. Pp. 307 Jones, R. 2005. Oxford Textbook of Primary Medical Care. New York. Oxford University Press. Lewenson, S.B. and Truglio-Londrigan, M.2008. Decision-Making in Nursing: Thoughtful Approaches for Practice. Jones & Bartlett Publishers, Pp. 208  Royal College of Nursing, 2006. The nursing management of patients with venous leg ulcers. London. The Royal Collage of Nursing. Pp.50 Sharon, B. & Elizabeth, A.A. 2008. Wound Care Essentials: Practice Principles. Lippincott Williams & Wilkins. Pp. 11 Zuther, J.E. 2009. Lymphedema Management: The Comprehensive Guide for Practitioners. New York. Press Pvt Ltd. Read More