Clinical Audit Essay

My first encounter with a Certified Registered Nurse Anesthesia (CRNA) was during my undergraduate nursing OB/GYN rotation. I was impressed with the CRNA when she placed the epidural to the patient in labor. I remembered patient had difficulty staying still due to the contraction, but the CRNA took her time to explain the procedure while comforting the distressed patient. Once the epidural was in placed and the medication started working, I could tell the relief the patient experienced. I realized then that a CRNA goes beyond the delivery of anesthesia, pain management and monitoring of patients. Thus, obtaining this degree will prepare me to ease the patient’s mind through education, pain management, monitoring, experience and compassion.

There are many concepts in nursing theory that need further clarification. A concept analysis can provide a thorough explanation of a term in nursing theory that will help healthcare professionals better communicate. The Walker and Avant approach to perform a concept analysis was specifically formulated with nurses in mind (McEwen & Wills, 2014). Walker and Avant proposed a concept analysis be used to further understand the meaning of a term or concept in anticipation that those using the term would have the same understanding (McEwen & Wills, 2014). When a term or concept is in question or needs further questioning in any field of nursing, a concept analysis is indicated (McEwen & Wills, 2014). Walker and Avant’s concept analysis is comprised of eight steps; select a concept, determine the aim of the concept, list all possible uses of concept, defining attributes, model case, alterative case (borderline, related, contrary, invented, and illegitimate), list antecedents and consequences, and lastly list empirical referents (McEwen & Wills, 2014). The defining attributes are deemed most beneficial in obtaining comprehension due to the fact that these attributes show which show up in regularity when relating to the concept (Linda & Judith, 2011). Using the Walker and Avant concept analysis model a formal concept analysis will be performed on the term “pain”. Middle range nursing theory gave the example of pain as one of many concepts used in nursing (McEwen & Wills, 2014).

The Academy of Pediatrics and the American Pain Society believe that pain in children is experienced with interrelated factors such as sensory, emotional, cognitive and behavioral, combined with environmental, sociocultural and contextual elements (Stanley & Pollard, 2013). The authors find that pediatric pain often goes under treated. Pain management engages the entire nursing process, placing the nurse’s role as central to its

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Public health nursing is an important aspect of nursing field, which contributes tremendously to the safety and health of our society. Public health nurses work hard to assure our communities are healthy and are able to attain needed support to be self-sufficient. However, it seems their hard work goes unnoticed by vast majority of our society. This of course, is my opinion, but I would say that if I were to survey various communities, most people would say that “Nurses just work in the hospital”. I could be very wrong.

Before any quality improvement plan (QIP) can be developed, the overall aim of the project must be determined to ensure the QIP stays on track. This includes deciding what is going to be measured, what the current baseline is, what the target will be and a timeline for accomplishing the goal (Health Quality Ontario, n.d.). Thus, the aim for this QIP is to reduce the rate of worsened pain in the VC from the current value of 20.2% of residents with worsened pain by 1% by the next quarter by educating nurses on the correct way to assess and document pain in the electronic system.

Nursing assessment is a substantial way of gathering physiological, psychological, spiritual, and emotional condition of the patient. It creates a whole picture of an individual and assist the health care providers to formulate a diagnosis. Assessing the comfort of the patient is equally important as taking the blood pressure or temperature. Pain is the fifth (5th) vital sign that is subjective in nature when performing an assessment of a patient. Various studies were conducted in finding the most appropriate evidence-based nursing practice in assessing and managing the pain of a cognitively impaired patient, whether it is acute or chronic or the underlying cause is cancer or post-operative incision. As emphasized by Song, Eaton, Gordon, Hoyle, and Doorenbos (2015), it is vital to ensure that “pain management is based on the best evidence” (p. 456). Perhaps knowing the causes of inability to assess and manage the pain in a cognitively impaired patient would give a clearer understanding of the practice.

In the physical realm of patient-centered care pain, comfort, sleep, and rest are important aspects of the fourth dimension of patient-centered care. Patient-centered care is the complete focus of the medical team on providing respectful care to meet patient needs, preferences and values guide decisions on each individual patient care. To understand the subjective view of the patient, these four aspects are at the forefront of their needs within the hospital setting to provide the best patient outcome. Nurses provide good patient-centered care by actively partnering with patients to determine care priorities and plans to tailor their level of involvement, according to their preferences, and being flexible by changing the care plan as the situation changes including providing smooth transitions between care goals. By doing this, nurses can assist patients with all pain by providing comfort and assuring the patient that there will be no deficiency of their quality of sleep.

The first step of this model is to create a sense of urgency and to get the nurses motivated to change (Kotter, 1995). By explaining that data from the last quarter demonstrated an increase in rates of worsening pain, will communicate the “why now” of the QIP to the nurses. Additional education about the responsibility and accountability nurses have in accurately assessing, managing and documenting pain will assist in

The study sought to improve patient care in three areas. The first area was improving pain assessment documentation by introducing a standardized pediatric assessment. The second area was decreasing the time the patient received pain medication. The last area was evaluating the effect of the nursing intervention in reducing the pediatric patient’s pain at discharge via a pain scale. This study was conducted at a 35 bed level 2 emergency department in the United States. A total of 1200 EMRs were collected from pediatric patients ranging from 3 months to 6 years in age (Ramira et al., 2016, p. 43). Half of the cases were review before the

In the context of the caring relationship, nurses perform a primary role in the assessment and management of pain and other

Nursing is the holistic helping of persons with their self-care activities in relation to their health. I agree Vargina Henderson in her definition of nursing and nurses role, According to Henderson, 1966 “Nursing is primarily assisting the individual in the performance of those activities contributing to health and its recovery, or to a peaceful death”. Varginia Handerson, 1964 stated that “the nurse must get inside the skin of each her patient in order to know what he needs”. from this statement I conclude that nurses play an important role in promoting patient quality of care. Nurses play an important role to promote pain management practices for patients, a critical component of the nurse’s role in pain management is pain assessment, medications administration, organizing and delivering patient care activities, advocating for patient rights, educating patients and contact with physicians regarding changes in patient conditions; these nursing functions are critical in the management of pain. So, we can’t imagine nursing discipline without nursing

Nurses are at the bedside 24/7, she pointed out, and integrative therapies can allow for better symptom management. "At hospitals and health care centers across the country, aromatherapy and acupressure, for example, are being used to better nausea. Mind-body interventions are being used to help patients relax," she said. "And hospitals now are being highly incentivized to use non-pharmaceutical approaches for pain

Clinical practice guidelines (CPG) are used to guide the healthcare providers for specific clinical decision making. Researchers had proven that by using CPG it helps in reducing inappropriate variations in healthcare practice. In healthcare service the use of CPG had shown improvement in promoting the delivery of high quality care. CPG had been long develop and evaluated in the medicine field however, in nursing profession, nurses had shown a great interest in developing and using CPG as a means to facilitate evidence based nursing practices. Hospitals that had adopted CPG had shown a great reduction on inappropriate variations in clinical practice and prometed high quality care with evidence based health

The purpose of a clinical audit is to improve the quality of care in the NHS (Healthcare Quality Improvement Partnership, 2011). To assist practitioners in changing practice to match the rapidly evolving evidence base guidelines are issued by organisations such as NICE (Fineout-Overholt & Melnyk, 2011). However there is often a gap between recommended practice and current practice which leads to lower quality care (Courtney &