Introduction
The aim of this assignment is to reflect on the management of a patient with multiple organ dysfunction syndrome (MODS). Reflective practice is associated with learning from experience, (Johns & Freshwater 1998) and viewed as an important strategy for health professionals who embrace life long learning (Department of Health 2000). Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice (Benner 1984; Johns & Freshwater 1998).
Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through direct experience. It is this that enables the practitioner to
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Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous.
Mr Cox’s sedation was stopped (Midazolam and Morphine) following the insertion of a tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many attempts he was difficult to wean from the ventilator and eventually there was reduced base entry.
Mr Cox’s abdomen became increasingly distended and his jejunostomy feed was stopped and TPN was commenced. Due to an increase in sepsis he returned to theatre for a laparostomy washout, it was discovered that his bowel loops were necrotic.
An Endoscopy following a further GI bleed confirmed an arterial bleed, and it was deemed he was still unstable for any further surgical intervention. Mr Cox continued to deteriorate with sepsis and MODS, consequently at this point, it was decided to withhold and withdraw treatment. Renal replacement therapy (RRT) was withdrawn as he was still profoundly acidotic with no improvement, and surgical intervention withheld due to instability. All other treatment was continued, but he was ‘Not for resuscitation’ in the event of cardiopulmonary arrest. Mr Cox died after 30 days in ITU.
Aesthetics
Aesthetical knowing is defined by Johns as the intuitive nature of grasping, interpreting, envisioning and responding (Johns 1995). Nurses’ aesthetic qualities are sometimes referred to as the ‘art of nursing’
The knowing addresses how nurses understand the knowledge. The doing of nursing entails the actions of nurses, bringing both knowledge and practice together (Butts and Rich, 2015). The four patterns of knowing, developed by Carper, include empirics. ethics, aesthetics, and personal knowledge. Empirical knowledge is the scientific aspect of knowing. It is based on general knowledge, and usually shared with other disciplines such sociologists and psychologists. Ethical knowledge involves morals and judgement. This is used when determining right or good acts in nursing practice, ensuring that the best decision is made and is right for the patient. Aesthetic knowledge, the art aspect of nursing, involve of the nurse’s understanding and acknowledgment of other’s living experiences. Showing empathy and respect to patients as they experience their life’s journey. Personal knowledge entails self-awareness and others, and interpersonal skills. These four patterns of knowing shows that nursing practice consist of holistic patient care, and not being solely scientific
According to Carper, one pattern described in the pattern of knowing is aesthetics. Aesthetics is essentially empathy, or having the capacity to understand what another person is experiencing (Carper, 1978). Aesthetics is purely subjective, exclusive, and open to interpretation. “Aesthetics require from the nurse to be fully engaged in the moment of the experience and interpret a client situation all at once by elucidating the meaning of the process and looking beyond the situation to focus on what might be (envisioning), so as to act according to what has been envisioned (Mantzorou & Mastrogiannis, 2011, p. 253). In essence, aesthetics is the process of nursing that involves caring for our
Carper (1978) identified four fundamental patterns of knowing which are (1) empirics, or the science of nursing; (2) personal knowledge; (3) esthetics, or the art of nursing; and (4) ethics, or the moral component of nursing. The purpose of this discussion is to explain how each pattern of knowing affects this author’s practice, and to identify the author’s preferred paradigm and provide justification for choosing this paradigm.
Plan: The patient will be admitted, kept NPO, and an appendectomy will be performed by Dr. Rogers in the morning.
My knowledge from a number of first aid courses influenced my decisions in how to care for Max, for example knowing not to move Max due to suspected injuries. Also my knowledge gained from praxis lectures and clinical practice helped to influence my decisions as I knew the importance of keeping the patient warm, clean, comfortable and advised while assessing the patient. This was demonstrated when looking after Max as the care-giver and I used appropriate hygiene practices and communication between the care giver, myself and Max to guarantee we all knew what was happening as well as what was needed.
Gustaffson and Fagerberg point out that reflective practice has relevance for clinical practice as by understanding the contents of nurses’ reflections, it is also possible to understand the advantages of reflective practice and how and when such measures should be used by the nurses for further professional development.
I believe that reflective practice is essential to carrying out clinical skills effectively. It allows the nurse to reflect on their actions and perhaps, think what they will do if a similar scenario were to occur at a future stage. I reviewed Kolb's model of reflection. This
The ability to become reflective in practice has become a necessary skill for health professionals. This is to ensure that health professionals are continuing with their daily learning and improving their practice. Reflective practice plays a big part in healthcare today and is becoming increasingly noticed.
In recent years, reflection and reflective practice have become well-known term with in the health care arena. They are words that have been debated and discussed with in the health care setting (Tony and Sue 2006). Reflective practice is essential for nurses, as nurses are responsible for providing care to the best of their ability to patients and their families (NMC, 2008). Reid (1993) states reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice. Johns (1995) notes that reflection enables practitioners to assess, understand and learn through their experience. Reflective practice, therefore, offers nurses an opportunity to review their decisions and
Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of
You were admitted and started on intravenous Esomeprazole drip for 10 hour. You were continued on intravenous fluids for 72 hours. You had negative orthostatic. You had a lying down blood pressure of 129/73 and heart rate 77. Your sitting up blood pressure was 129/69 with a heart rate of 77. Your received intravenous Zofran and Reglan on an as needed basis for nausea. Your were sent Helicobacter pylori, stool sample and gastrointestinal service to follow up. Based on the Interqual guideline criteria for abdominal pain, the clinical guidelines were not met because there was no documentation of vomiting after treatment, no abdominal imaging, no change in mental status, no sign of systemic infection. A review of your records showed that you could have been placed in observation under monitoring, had an evaluation, been tested and treated symptomatically while awaiting test results to rule out a need for surgical or other intervention that would require admission to an acute level of care. Consultation with other healthcare professionals could also have been done in observation. The consultations and repeat exams done confirmed there was no need for a surgical or diagnostic
The case I will discuss comes from the Journal of General Internal Medicine and is as follows: the patient is an 80-year-old woman who suffers from nonresectable lung cancer and has been diagnosed with lobar pneumonia. Other conditions present are: hypertension, diabetes, chronic renal insufficiency and severe degenerative joint disease. While improvement was seen with initial treatment, the patient suffered worsening hypoxemia, level of consciousness obtunded, and developed acute renal failure. Thus, the only means to prevent death was intubation with
Reflection is a process of learning from ones experience (Spalding, 1998). The objective of my experience is to show the positive effect of using therapeutic communication skills with patients. Therapeutic communication can be described as a face to face technique of
Following an adaption of Johns’ model of structured reflection (Jasper, 2003), I will discuss an event that occurred during my residential placement as a nursing student, what I have learnt and how I would act if the situation arose again. Lastly, I will discuss what I have learnt in relation to the Nursing Council of New Zealand competencies for cultural safety and communication.
Oliguric Phase: This stage is where our patient, Paul is in. Oliguria is usually present in most of the patients with worse cases of acute kidney injury. In this stage, the patient produces less urine than normal (less than 100 milliliters) and they become anuric. As the volume of urine excreted reduces, the rate at which metabolic waste products are stored is increased and this causes imbalances in electrolyte levels. This will cause hypervolemia, edema and high blood pressure. During assessment, presence of distended jugular veins is seen, which indicates fluid overload. Also, weight gain, crackles in the lungs can be heard and signs of heart failure can also be seen. White blood cells, red blood cells and casts can also be seen in the