Reflection: Assessment and Nursing Intervention on the Transition
[Institution Title]
Introduction
Transitioning from the Post-Anaesthesia Care Unit (PACU) to a regular medicine ward is not a breezy task especially among nurses who are initiating the transfer and the nurse receiving the patient. There are pressing concerns that must be considered. This is especially necessary since keeping the patients to stay longer at the PACU have resulted to congestion, patient and family dissatisfaction due to limited visiting hours and surgical delays (Thomas & De Leon-Ayson, 2008). Given these concerns and the vulnerability of the patients’ condition, nurses participating in the transition of patients from PACU to the ward are confronted with a complicated but manageable responsibility. In this case, this paper would evaluate the scenario that involves the dialogue between the nurses and patient as far as assessment and nursing intervention are concerned. Towards the end, I will provide recommendations on how the scenario can better be improved to suit the needs of the patient.
Receiving a Patient to the Ward from the PACU
The transition of a patient from the PACU to the medicine ward was presented through a video presentation entitled “Receiving a Patient to the Ward from the PACU” (Australian Catholic University, 2014). In the video, it showed two nurses discussing the post-operation orders enumerated for the patient that was transferred to the ward from the PACU. The patient came in with a PCA, (i.e. patient-controlled analgesia) and an abdominal wound. The nurse who was initiating the transfer conveyed the medical history of the patient to the receiving nurse. This includes identifying the reason for the hospital admission and why the patient was admitted to the PACU. During the discussion, the transfer nurse also presented to the receiving nurse the reason that caused the patient to stay at the PACU longer than anticipated. The assessment of the patient included identification of the patient’s medical diagnosis and findings. The transferring nurse also informed the receiving nurse about the patient being on PCA and how the patient is fully knowledgeable on how the PCA works and how it is navigated. The patient was also assessed for signs of mobility and pain. The patient was asked to raise her arm to confirm that patient was conscious, cognizant and was not limited in terms of motion.
Given the extent of the discussion and the degree of assessment performed, I have concluded that the procedure has been adequately prioritized. I made this analysis in reference to the performed assessment because it was able to satisfy the important aspects of the patient’s condition. These include, but is not limited, to the level of consciousness, oxygen, respiration, and temperature, CVS, urine output, pain, nausea & vomiting and drains & dressing (Fraser Health Authority Regional , 2010, p.1-3). I noticed that during the transfer and the assessment, the patient was listening the whole time. This is good considering that the patient can also raise questions, confirm or disagree with any of the information that are being relied to the receiving nurse.
Effectiveness of Communication: Nurse-nurse and nurse-patient
Communication is an integral aspect of the nursing profession. This allows for the quick recovery of the patient through therapeutic communication. In the case of a scene from the video clip, I noticed that there was seemingly the inadequacy on the part of the nurses on their knowledge relating to the appropriate and properly accorded communication process used in the healthcare industry. Communication in nursing is considered among the most crucial nursing intervention (Colloca & Finniss, 2012). As mentioned earlier, feedback is just as important as the five other components of communication. Feedback extend opportunity to the sender of the message to know whether the receiver properly and correctly receives the message (Mellin-Olsen, Staender, Whitaker, & Smith, 2010). In the same manner that also feedback enable to clarify any unclear information. Thus, communication is an important tool for check and balance. However, in the case of the receiving nurse, there was a failure on her side to verbalize indications that she understood the process of the transfer. In addition, she did not ask any relevant questions that might help her and the other nurses in the ward to address the needs of the patient. However, the receiving nurse has been several times throughout the video to be nodding, almost as a sign of confirmation or validation. However, the nod does not exactly confirm anything without the proper verbal confirmation. On the part of the transferring nurse, I firmly believe that she exhibited adequate knowledge and skills in communication. This was evident at how she carefully identifies each part of the post-operative orders to the receiving nurse. In addition, the transferring nurse also sought the validation and confirmation from the patient on some of the information that she discloses during the transfer. This includes the patient’s knowledge and understanding of how to use the PCA as well as the patient’s ability to raise her hand.
There are quite a number of barriers to effective communication. These often include cultural and physiologic barriers. Cultural barrier relates to language. Although this issue was not shown in the video, I noticed that the nurses use terminologies that might not be within the level of the patient’s comprehension which could largely qualify to the same issue. The culture in the hospital using medical and clinical terminologies is not the same culture as with a non-medical professional. The transferring nurse conferred the results of the diagnosis about the patient’s condition. However, a large portion of the discussion I believe has been too technical. This particularly relates to medication and dosage and clinical findings which might not be within the level of understanding of the patient. The patient should be able to understand the nature and the details of her condition to help her see the relevance of the interventions being initiated.
In terms of physiologic barriers, this is in reference to the patient who will be receiving health education that is a part of the nursing intervention (Colloca & Finniss, 2012). In this case, there is the importance to assess whether the patient is experiencing pain. I noticed that the patient was not showing any signs of discomfort that makes the intervention favourable under this condition. Pain can compromise the effective and efficient transfer of information. If that happens, it will compromise the intention of the health education. Pain diverts and distorts concentration that could hamper the effective and efficient transfer of important details and health teachings. Hence, I emphasized earlier that the patient needs to be cognizant during the assessment and the level of pain to which the patient was at was considered a necessary aspect of the assessment and intervention process. On the part of the patient in the video, it showed that she was cognizant and alert. There was also no indication of pain that could hamper the effective transfer of information.
Discussion of Post-Operation Orders
Part of the post-op order was to monitor the patient’s vital signs and level of pain. The transferring nurse informed the perceiving nurse that she needs to check the patient for any signs of infection following the procedure that she has been in. The post-op order also included monitoring the patient for management of her PCA and ensure that the patient is following the instructions. The nurse is also instructed to monitor the patient for signs of lethargy, nausea and vomiting. Part of the post-op order also included medication and treatment which had been adequately explained by the nurse during the transfer. There was also the order referring to the patient’s wound which requires draining and dressing. Since patient has an abdominal wound, it is also normal that the patient experiences pain. This means that the nurse should also be able to manage and control the patient’s pain by offering distraction techniques, drug administration and pain management. Overall, my personal analysis suggest that all of the physician’s order for post-op had been properly discusses and explained to both the receiving nurse and the patient.
Recommendations for Improvement
References
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