Nursing Critical Analysis

Critical Analysis of a Personal Experience in Nursing
Susan Main
66819440
Faculty of Nursing
University of Manitoba

November 17, 2010
NURS 3430
Ruth Dean
Nurses must think critically when making decisions in their daily practice to provide effective care in our health care environment. Critical thinking begins by asking questions about any situation. In this paper I will describe my most memorable experience in nursing and then I will conduct a critical thinking analysis using the “IDEALS” framework from Facione (2010). The “IDEALS” framework is devised of six questions for effective critical thinking and problem-solving. These include identifying the problem, defining the context, enumerate choices, analyzing, reasoning, and
then self-correcting ourself. These questions will be used to examine my personal experience in a critical manner. Personal Experience My most memorable experience in nursing happened while I was working in dialysis at the Health Sciences Center. We had a patient who was born almost completely deaf, however if you shouted in his ears sometimes he would hear you. He was approximately 40 years old. Last year, he also went blind; fortunately, he had learned to communicate through speech and American Sign Language (ASL). This patient would arrive for his dialysis treatment with an interpreter, who would tell us of any concerns. The interpreter would then leave the patient alone for 4 hours. On this particular day the patient was crying when I walked into his room to get a report from his primary nurse. I was there to provide coffee relief for this nurse so I asked him, “Why is the patient crying?” I thought the patient perhaps was in pain. The nurse did not know why he was crying and said, “The patient did not want to be here today and wanted to leave”. The nurse and I walked out of the room and we agreed that I would try to find out what was wrong, for I knew some ASL. I went back into his room, placed my hand in his, and spelled my name using ASL. He smiled, and then shook my hand; therefore, I continued to spell words in an effort to communicate with him. He verbalized to me that he was depressed and wanted to die. He stated that he wanted to kill himself, and for the last two weeks he had been holding a kitchen knife to his throat. He also considered other ways of dying, such as discontinuing his dialysis treatments, and expressed his desire to go home. He was feeling this way because his best friend stopped calling him and he did not know why.
I had some concerns for this patient’s safety so I asked him if he was taking medication for depression. He stated he was. I inquired if he was seeing a psychiatrist for his condition. He replied,” I have not seen him in a while”. We discussed whether he should make an appointment with his doctor soon. I asked him if one of our dialysis doctors could talk to him about what was going on because I was worried for his safety. The patient needed to know that since he wanted to harm himself I had to document this in his chart and let the doctor know. He nodded his head up and down. I also informed the patient that someone would be contacting an interpreter so the doctor could communicate with him. I spoke to the charge nurse of this situation as well as the primary nurse when he came back from his coffee break. I then documented our conversation in his chart. The patient ended up getting admitted to the hospital for his safety. I can only imagine what would have happened if I was unable to communicate with him. Since critical thinking begins by asking questions about any situation. I will now take this experience and conduct a critical analysis using the “IDEALS” framework from
Facione (2010). Six Questions used for Effective Thinking and Problem Solving Identify the problem The problem we encountered was that this patient was contemplating suicide, either by cutting his throat or by discontinuing dialysis treatments. I feel that the primary nurse involved was not concerned enough to take the initiative to find out what was wrong with his patient. To me, lack of communication between the nurse and the patient was also a problem. Define the context The context or environment of this situation was the hospital. He had to go there for his dialysis treatments and was done with travelling to the hospital 3 times a week. This patient was lonely, depressed, tearful and was feeling dejected which made this situation worse. I feel that I was also part of this environment that positively affected the outcome. Enumerate choices The options that I had were to inform the charge nurse and primary nurse or ignore the problem altogether. I needed to let the patient know that I was going to inform his nurse, and that his doctor would be notified. I chose to document this situation in the patient’s chart instead of verbally reporting this information to his nurse and let him deal with everything including documentation. Analyze options This patient needed help in his time of crisis. The doctor needed to find out if this patient was taking his medication for depression, and if the dosage was enough? Was this patient capable of harming himself? He needed an assessment from the medical staff. The charge nurse could call the Psychiatric Liaison Nurse from the emergency department, who can do a mental health assessment. This patient needed to be taken out of a situation that could possibly lead to his harm and we were obligated to admit him to the hospital which was a safer environment.
The primary nurse could call his parents and inform them of what was going on. Perhaps the parents could find out why his friend was no longer calling him. His friend may be ill and in the hospital, or out of town on vacation. I hope the primary nurse did not think I was interfering but merely trying to help. List reasons explicitly I was curious about why he was crying and curious why his primary nurse was not. If I did not know ASL how would we find out what was wrong with the patient? He obviously did not tell his interpreter that morning why he was crying. If this patient was not admitted to the hospital he may have gone home and cut his throat thinking no one cared whether he lived or died. I am glad that curiosity is part of my personality. Self-correct I think I made the right decision in trying to find out what was bothering that patient. I wish I could have got more involved and followed through with the outcome but he was not my patient. Upon reflection I could have called the interpreter immediately when realizing there was a problem. Sometimes this
patient does not open up and reveal his feelings to everyone. I felt that I needed to gather as much information from this patient as I could before a plan of action could be determined. I would not have done anything different. Conclusion This experience confirms to me, that critical thinking is vital in caring for patients. If I had not taken the time to learn ASL, or used my critical thinking skills, this patient might have been successful in committing suicide. Critical thinking can help a nurse advocate for their patients and make better informed choices about their care. The “IDEALS” framework is a useful tool that I can use for effective critical thinking and problem-solving in my daily nursing practice.