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Reflection on communication with patients
Reflection on communication with patients
Reflection on communication with patients
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Today in Sim we had a post-op patient, LH, who was experiencing some post-anesthesia confusion. In the past we have greeted out patient by their name, but the previous nurse reported that LH was a bit confused, so we made sure to introduce ourselves and then verify the patient to assess her orientation. The patient had removed both her NG suction tube and her Foley catheter, and was rather agitated. At one point she even threatened to become combative, as she wanted to go home, and didn’t want the tubes reinserted. We called the doctor to inform her that the patient had removed these, that she was agitated, and that her BP was elevated. The doctor ordered her a new NG tube, and lorazepam to help calm her for the NG tube placement. As a person,
• Previous problems you or members of your family have had with the use of anesthetics.
In health delivery system, one common goal for all providers, doctors and administrators is to provide high quality health care services at low costs. But in the United States, health care spending has increased drastically, but outcomes are not efficient. In the recent study conducted by common wealth fund shows that United States health care spending is 50 percent more when compared to 13 top nations in the world. [1] This report also shows that despite of having high health care expenditure in the United States, the health care outcomes are worse when compared to other countries whose health expenditure is low. To address these problems and improve outcomes, patient safety and satisfaction, in the field of surgery the American
I noticed that Mr. X was still on normal saline 0.9% on flow, and his report from this morning showed sodium at the higher end. Since increased sodium post operative would have an impact on his blood pressure and urine output. So, I stopped the flow and informed his doctor about the fluid and discussed if we could switch it with any other fluid. He then, said to keep it in hold, and he would decide when he comes for the round by checking at his total intake output chart and his lab values if to continue or to stop. I followed his order and explained to the patient. Since, it was day 3 (usually in the day, three patients would be mobilized on a chair) so I explained to him that he would be ambulated out of bed today to make him aware of the plan and to give him time to prepare him for the upcoming plan. As first-time mobilization could be stressful for the patient and some needs more time to get themselves ready for it. I explained him that it would be done with the doctor around. As i left the patient, I made sure to keep the nurses call bell near and told him that I would be back to check on
Chloe was anxious I knew this because during general observation Chloe had an increased heart rate. Chloe looked pale and when using touch to reassure Chloe I noticed that her pales felt sweaty to touch. Chloe also told me she felt nervous about the central catheter insertion. The doctor reassured Chloe through conversation prior to the central venous catheter insertion.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
I seized an opportunity to quietly speak with her and she explained that she had not received an adequate amount of rest the night before and the journey down had been exhausting. She also expressed concerns about being fearful about going into the operating room. I overheard a nurse earlier ask the group as a whole if anyone wanted an ativan to ease anxiety and the group consensus was no. I felt that because it was unanimous, she may have been embarrassed if it was only her that requested it. My concern for this patient was for her to remain comfortable and provide any healing initiatives that would reassure her that she was safe.
As an UConn graduate, I strive to practice UConn School of Nursing PRAXIS – professionalism, respect, accountability, excellence, integrity and service. Two weeks following the orientation on postpartum unit, I knew taking care of four mother-baby couplets overnight was not going to be an easy job at a level I trauma center, where we care for the sickest of the sick. After a thorough plan of care for each patient and tailoring it to their needs for the night, I felt more confident in my skills and time management. It wasn’t until I got a call from a 14 hour post-op c-section patient at 0455 complaining of dizziness, lightheaded, blurry vision and “feeling hot”, who an hour ago was walking to the bathroom, breastfeeding baby and eating with no complains of pain. I left my workstation behind to discover a pale, diaphoretic patient with low blood pressure. I froze. Screamed for resident down the hall. Rapid response team and more professionals were there in no time while I stood by my patient holding her hand, echoing the story to residents and attending MD I’ve told previously. After twenty minutes of stabilizing the patient and diagnosing at bedside with ultrasound and abdominal x-ray, the patient suffered internal hemorrhage from tubal ligation site. She was rushed to operating room. Speaking to her husband was even harder. I froze again. I sat on my knee, held his hand and cried with him. In
However, after my instructor left from the room, I reintroduced myself, and started a conversation, stating my objectives for the day. As I began to speak my actions while I administer vital sign, I was promptly damped by an expectedly attitude from my patient. Whenever I attempt speaking, I...
This experience happened doing my fourth surgical procedure so it was not exposure to a new or unfamiliar situation. I would attribute my abnormal behavior as a reaction to anesthesia, but unfortunately this experience has become a new normal for me post-surgery. My behavior took place after I received the pre-surgery anesthesia, and as I was entering the operating room. This was the first time that I was not fully under before being moved to the operating room. Something different happened during this procedure and upon entering the operating room, I experienced extreme anxiety/claustrophobia or most likely panic attack when I observed what appeared to me as the tiniest room ever. Psychically, I tried to get up from the bed as I desperately wanted to get out of the room and far away. I experienced a racing heart rate, my chest being squeezed tightly as if to remove all remaining air, and extreme fear as it felt like the medical personnel were restraining me while they placed the gas mask on, end of recollection. Fast forward to recovery approximately 8 hours after a normal 2-hour procedure. The procedure went as expected, it was post recovery where I encountered complications. [Post-surgery remarks explained to me by medical staff and wife] during recovery, it was as if I were
When I was just 11 years old, I fractured my ankle playing basketball at the local park. The pain was white-hot and excruciating. I was reduced to a sobbing, blubbering, mess and unrecognizable upon my arrival the doctor’s office. After the diagnosis and subsequent surgery, I was placed on crutches and barred from participating in physical activity for at least six weeks. This was paramount to torture for my 11 year-old energetic and hyper-active self. Seeing my friends run around short of breath because of their own intoxicating laughter was bittersweet at best. One evening at the local park, I was just about ready to go insane until I surveyed my immediate surroundings and noticed a couple of kids my age sitting at a wooden table a couple of feet
Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.
I remember we had a patient who was neurologically and hemodynamically unstable. He underwent craniotomy upon admission and had external ventricular drain placed to monitor his ICP. First day post op, the nurse noted elevated ICP. It has happened for 2 consecutive hours. Each time, the nurse assessed patient for possible reasons for elevated ICP such as vital signs, LOC, body alignment, elevation of HOB, checked the drainage system etc. Resident on call was notified each time but as there was no neurological
As a patient advocate I would immediately ask the RN preceptor if I could speak to them outside of the patient's room or at the nurse's station. I would start off by saying that I respect you as an RN and as my preceptor. I understand that you have always cared for patients with tube feedings this way but I wanted to let you know that stopping continuous enteral tube feedings before a patient is turned or repositioned it is no longer supported by nursing research. I would add that according to research, stopping the feedings have shown to cause patients to receive an inadequate calorie intake while being detrimental to their health (Miller, Haye, & Carey, 2015). Feedings should only be stopped for procedures that require the head of the bed (HOB) to be lowered for a prolonged period and the feedings should be resumed immediately after procedure is completed (Miller, Haye, & Carey, 2015). I would encourage the preceptor to research the new nursing evidence to ensure patient safety with present and future practices.
With a good understanding of the materials they learned and a realization of how the use of humor effected their learning experience the new nurses can then take on a role comparable to their teachers. The nurse can then look for material that may pertain to their specific healthcare setting, be responsible for creating their own comfortable environment, and remind themselves to greet each patient with a laugh-ready caring attitude. The nurse may understand the task of needing to alleviate anxiety in a patient, prone to anxiety attacks, prior to surgery, through a thorough assessment of the patients understanding of, and concerns about, the procedure. If not having a prior understanding of the patients anxiety, just initially creating an atmosphere of humor to establish relationship, relieve anxiety, release frustration, avoid painful feelings, or humor to facilitate learning. If achieved, the physiologic benefits of improved respiration and breathing, decreased muscle tension, amongst other effects show to have beneficial postoperative outcomes. This is important because post operative high anxiety, increased postoperative pain, increased analgesic requirements, and prolonged hospital stay are all correlated with preoperative anxiety (Davis-Evans,
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).