Question #1
This week was quite hectic and busy and the only way to face the tight schedule of events was being organized and setting priorities. I was dealing with five complicated patients, and it became very hard to take breaks. The psychiatric unit is pretty unique in terms of dealing with patients. Patients in this unit have unique needs that require a multi-dimensional and holistic approach (Shea, 1998). Within the weekly, schedule, I was supposed to attend to five different patients, and this implies that finding breaks were a tall order. However, as my preceptor decided; I was going to take entitled breaks in the upcoming shifts.
One of the challenging but fascinating experiences during the week was to prepare and present all the five patients in the Team rounds which encompass presentations to the doctors, pharmacists, social workers and patient care coordinators. Prior to the presentation, I was supposed to conduct a mental analysis of the five patients as a way of grasping any form of information that they would like to be addressed in the Team rounds .However, before we could present our patient cases, another nurse had done it on our behalf and to my preceptor’s disappointment, we missed a chance to raise some of the concerns we believed were pertinent to the patients’ well-being (College of Registered Psychiatric Nurses of BC, 2012).
In the past three weeks, I was working with patients with depression currently undergoing ECT treatments. Although draining since it involved getting the ECT paperwork ready and went through the ECT checklist, it was equally an interesting experience.
It was encouraging to have two discharges during the week and according to the doctor’s directive, I had to administer an intramuscular injection to the patients before discharge. It was fascinating to see how the two patients were different though were both diagnosed with schizophrenia and had no problems with oral medications. As I was administering injection to one of the patients, he seemed comfortable with the ordeal, though the other patient was rather naive as he was uncomfortable to show his skin. It had to take my assertive voice to assure him that I will take care of everything. This occasion exposed how patients are diversified and as such nurses should be culturally-competent to deal with such diversities.
Although everything was seemingly intriguing, I was scared of patients who had a history of sexual assault especially during the night shifts.
Admittedly, the experience came in handy as it availed a chance for me to utilize different nursing principles and ethical standards. One of the principles that stood out very useful is the principle of asepsis. Within my schedule, I was supposed to administer injection and prevention of pathogens at the site of injection is very important. On the other hand, asepsis encompasses striving to provide the most antiseptic conditions, devoid of pathogens. As such, was concerned about the hygiene of the patients and equipment. Moisture provides a fertile ground for microbial growth and hence pathogenic infections (Paul & Elder, 2009). I was thus concerned about keeping the equipment and environment dry. People with psychiatric disorders are prone to physical injury and as such, I ensured that the infrastructure within the psychiatric unit was safe. The events provided different learning opportunities. For instance, I understood the need to foster healthy external and internal patient environments to foster healing especially for patients with psychiatric conditions. This class of patients is unique in terms of needs and is hugely affected by external stimuli. Therefore, there was the need to fine-tune the social environment as a way of fostering healing. Moreover, the experience exemplified the need for cultural competence. The human race is diverse in terms of beliefs and cultural values and as such, being tolerant to different patient situations is very important.
The CRPNBC Professional Standards for Psychiatric Nursing Practice and Code of Ethics lay emphasis on proper record keeping and documentation in clinical practice. Convincingly, dealing with patients who were under ECT treatment provided a unique learning opportunity of the proper use of clinical documents. The CRPNBC Professional Standards also emphasize on the need for accountability in clinical practice. Being a psychiatric nurse implies that the nurse is the patient’s advocate and as such should be ready to be held accountable for all their actions.
Question #3
As a continuing learner in practice monitoring own progress, maintaining a feedback process and the ability to make assessment decisions based on the available feedback are key to ensuring a positive learning experience as well as providing quality care. This week, I was on 12-hour night shifts, and the situation around the workplace was hectic. Usually, in such situations, it is very hard to maintain and manage both care delivery and assessing one’s progress. However, I squeezed every bit of time to remain organized. I ensured that on every other day, I had a prior planning of my daily activities. However, without a doubt the challenge of working in a healthcare setting is the dynamic nature of issues that you have to deal with. As such, it requires a continuous negotiation and consultative process and thus, I have never been afraid or doubtful to engage my colleagues or my preceptor on such issues (Shea, 1998). Whether it is a clinical procedure, a medication or a change in care process, I have maintained my integrity to remain open about issue in order to protect the safety of the patient as well as expand my knowledge and skill (Paul & Elder, 2009).
My preceptor was very supportive over the week. However, I had to do my part to ensure that whatever responsibilities were placed on me. I was able to accomplish them on time. Thus, taking into consideration the role of my preceptor, I had to implement all the nurse’s suggestions as presented as well as squeezing in the doctor’s suggestions as the care process for each patient demanded. This was also accompanied by the crucial documentation that accompanies all assessments I was supposed to perform for very patient. These would form the basis of my preceptor’s report and the doctor’s decision about the care process and the patient’s status. We, usually, had ‘debrief sessions’ with my receptor where I got to inquire about my progress and where my preceptor through I would improve.
These tasks were tough to manage while also monitoring patient status. During these shifts, it was always important to engage colleagues in consultative talks. As such, conversations were a common feature during the night shifts. I could add some knowledge and on one aspects of care or another. However, I was very careful that I do not compromise the time to attend to patients and other activities as suggested by the preceptors (Paul & Elder, 2009). These meetings however facilitated cohesiveness with colleague which I considered crucial in healthcare setting where compassion and psychological pressure could easily take a toll on the nurse especially when patient demands overwhelm the nurse.
Organizational culture is always considered a crucial aspect of the care process within any institution. However, developing an organizational culture is a gradual process. Similarly, one of its key elements is the ability to retaining the long serving staff and modeling the staff maneuvers to suit the organizational culture (Paul & Elder, 2009). One of the challenges I experienced during the shifts was the ever changing staffs and especially the casual and part-time nurses. This is because, on one side lies the disconnection between the institution and the casual and part-time workers. They feel that their role is confined to deliver within the specified settings and responsibilities rather than being incorporated in the organizational culture. This disconnection gradually develops to impact even the permanent staff. In fact, this disconnection as I realized tends to develop communication problems and at times impacting on the care process.
While dealing with a borderline personality disorder patient on one of my shifts, I was surprised by the demanding nature of the patient. I was scheduled to give her Ativan 2 mg at 2000 hours but after reviewing her other medications I realized that she is supposed to have loxapine 25mg at 2200hours and Ativan 1mg and zopiclone 7.5mg. Upon this review I decided to withdraw the Ativan which was supposed to help her manage her anxiety. However, she was not comfortable with this and she retorted harshly that “maybe we should not work together”. This statement did not go well with me as I thought the patient was taking it personal and undermining my skill and experience. I informed my preceptor of the events later during the debriefing. The preceptor advised me that I should take less time dealing with BPD patients as they tend to demand a lot of attention and one must be able to differentiate between attention seeking and care needs of a patient (Shea, 1998). These statements from my preceptor reaffirmed my decisions to stick to my decisions no matter what the patient though of the decision since I would ultimately be accountable for any outcomes related to their health (College of Registered Psychiatric Nurses of BC, 2012).
One of my key goals this week is to develop a more confident approach to the care process and to incorporate the patient family in the care process. One of the most important aspects of care is to have a network that helps the patient live through the emotional, physical and psychological pain they endure. As such, the family offers unique support that if harnesses would prove good to the outcome. This I seek to accomplish through attending to calls from patient’s family with patient consent and thus build a relationship that can help improve patient outcomes (College of Registered Psychiatric Nurses of BC, 2012). My second goal is to develop a relationship with the psychiatrists and the pharmacist so that I can gain a significant level of experience on medications and how to deal with psychological cases.
Question #5
PNUR is a conceptual framework that in its core focuses on four central aspects in the administering treatment and subsequently the healing process. The framework, typically takes in four aspects; person, health, nursing and environment. The interaction between there four factors influences the patient outcome. The framework describes the patient as an individual in a deprived state of health. On the other hand, health is defined as wellbeing. The environment represents the external factors such as social aspects that influence the patient outcome (College of Registered Psychiatric Nurses of BC, 2012). The nurse is the patient’s benefactor and has a role in fine-tuning all these conditions to ensure positive patient outcomes.
Neuman Systems Model views the human body as an open system with successive lines of defense. The outermost level is the flexible line of defense which protects the normal line of defense from external stimuli. When the flexible line of resistance is subdued by external stimuli, it activates the lines of resistance. Therefore, stressors and how the client deals with the stress determine how he/she is affected by the dynamical movements of the defense lines. Positive results occur when the body is naturally able to subdue the stress and expand the flexible line of defense to protect the internal structure.
Similarly, our patient scenario may apply this framework. The apparent mental and heath state of the patient is as a result of diminished response to stress. The forty-four-year-old system is unable to stretch the flexible line of defense to subdue the external stress. Stress can occur from either a personal or interpersonal perspective. In this scenario, psychological stress is emanating from both perspectives. He is overwhelmed by his apparent decrease in self-worth and is quite guilty that his wife is providing everything. Therefore, as a therapeutic approach, it is important to focus on expanding the line of resistance and subsequently the flexible line of defense. This should be focused towards restoring a sense of worth to the patient and putting restraints to unhealthy behaviors such as beige eating.
References
Paul, R., & Elder, L. (2009). The miniature guide to critical thinking (5th ed.). Dillon Beach, CA: The Foundation for Critical Thinking
Shea, S. C. (1998). Psychiatric Interviewing: the Art of Understanding A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Philadelphia: Saunders-Elsevier.
