Nursing Reflective Practice

Reflective Practice Portfolio
Q1: Recall a situation in your clinical experiences in which an ethical decision was being made. If you have not been involved in this process yet, ask your preceptor to share an experience with you. Be sure only to discuss the situation as a case scenario without use of names of persons involved. Which ethical decision-making principles came into play? What impact did the ANA and/or ICN codes of ethics have on the decision that was made?
Answer
A 48 year old African-American patient has just been involved in a fatal accident and has been admitted and held in the recovery room. After conducting several scans, we realize that his chance of survival is minimal. I am approached by the evening supervisor who requests
me to permit a visitor who has just arrived. The visitor claims that he is the patient’s brother and wants to say goodbye. I allow the visitor to see the patient. However, the supervisor hurriedly came back and said that he has made a terrible mistake. As a matter of fact, the supervisor tells me that the patient’s family has just arrived and is angry that we have allowed the patient’s significant other to see the patient. I talked to the visitor who admits that he is the patient’s significant other and not the brother as he had initially claimed. He pleads with us to allow him to stay because he is convinced that he has a legal right to be considered family. This scenario put me in a dilemma. Hence, I am compelled to decide whether to ask the patient’s significant other to leave or stay. Individuals who should be involved in the decision-making process include the significant other, the patient’s family, and the nurse.
I have three options in this case. The first option is to ask the significant other to leave. However, there are consequences of asking the patient’s partner to leave. In particularly, the patient’s significant other will feel mishandled and not treated with dignity and respect. As a nurse, I would feel that I have not adhered to American Nurses Association Code of Ethics for Nurses, such as treating people with dignity and compassion (Marquis & Huston, 2014). The second option entails asking the patient’s partner to stay. There are consequences associated with this option as well. First, permitting the patient’s significant other to stay will go against the family’s wishes and they may become aggravated. The patient’s family plays an important role in the patient’s care and as such, I would not wish to exclude the family in the treatment process. Thus, the patient too will not be happy. In fact he might want his lover to stay and this may actually speed up his recovery.
The last option is to ask both the patient’s partner and the patient’s family to leave and deny both sides the chance to say goodbye to their patient. Because there is conflict between the two parties, allowing them to stay will put the health and safety of the patient at risk. However, there are consequences associated with this option too. Both the patient’s significant other and the patient’s family will feel that they have not been treated with dignity and respect. The patient may expect both of them to stay and asking them to leave will not be in the best interest of the patient. The principle of nonmaleficence contends that healthcare professionals should do all they can to avoid causing harm to others. In this case, asking the patient’s significant other and family to leave will cause harm to each of them. Moreover, according to the principle of justice, healthcare professionals are expected to treat every individual equally, regardless of their gender, ethnic and racial backgrounds.
I will permit both the patient’s family and significant other to stay. Respectively, I will allocate different visitation time for both the patient’s significant other and the patient’s family. Because there is a conflict between the patient’s family and significant other, I will not permit them to stay in the same room at the same time. Also, as the nurse in charge, I will request the patient’s significant other to respect the family. Equally, I will request the patient’s family to respect the rights of the patient’s significant other and the relationship she shares with the patient as two mutually consenting adults.
Q2: Investigate the current health policy priorities for your state’s nurses association. Then, address the following: Discuss the benefits that could come to you, your community, healthcare consumers in the district, and other members of the nursing profession if proposed priorities were supported. Develop a plan of action to educate your state senators and representatives about these priorities. (Include a copy of the email or letter you would send.)
Answer
The current health policy priorities for Georgia Nursing Association (GNA) include addressing the primary care and nursing shortage and ensuring workforce safety (GNA, 2015). Georgia is increasingly experiencing a considerable shortage of primary care providers. The demand for registered nurses is high in the state. The Georgia Nursing Association intends to support tax credits to advanced practice registered nurse who precept.
There are several benefits associated with increasing the number of primary care providers and improving workforce safety in the state. Some of these advantages include improving the quality of care, patient outcomes, as well as, prevent illness and death. To educate the Georgia senators and representatives regarding the importance of increasing the number of primary care providers and ensuring workforce safety, I will send them emails detailing the need to adopt these priorities or meet with them personally. The following is a copy of the email.
Dear Senators/ Representatives,
The findings of recent studies by Georgia and the Kaiser Foundation have demonstrated that Georgia is experiencing an increasing shortage of primary care providers. Additionally, there are many risks associated with primary care providers involved in the delivery of quality patient care such as lateral violence against healthcare workers and the risk of exposure to infectious disease. Consequently, there is need for primary care providers in Georgia to access sufficient personal protective equipments.
I urge you to support initiatives that will address the increasing shortage of primary care providers and ensuring workforce safety. For instance, you may consider legislation that extends tax credits to advanced practice registered nurses who precept.
Thanks in Advance,
Donnell
Q3: Compare and contrast the nursing care delivery model used on the unit within which you are working with one of the other nursing care delivery models described in your readings.
o Reflect on why you think the unit chose the model it uses. What are the advantages and disadvantages of the model chosen by the unit?
Answer
The nursing care delivery model used in my unit is the primary nursing model. This model places much emphasis on providing wellness services and primary care to vulnerable or underserved populations. Furthermore, the model recognizes that nurse practitioners have the opportunity and the skills to reframe how primary care is delivered. Integration, coordination management of chronic conditions and diseases, wellness, and primary care are the pillars to a reinvented healthcare system that tries to improve patient outcomes while at the same time reducing costs.
The primary nursing model is different from health homes model (team nursing model) described in my readings. Under the team nursing model, health teams coordinate the patient’s care across providers and settings. The team provides health services to eligible individuals suffering from chronic conditions. The team may encompass physician assistants, doctors of chiropractic, mental and behavioral health providers, social workers, dieticians, nutritionists, pharmacists, nurses, as well as, medical
specialists. My unit chose the primary nursing model with an aim of addressing the increasing health needs of vulnerable or underserved populations.
Q4: Describe quality improvement activities occurring within your assigned nursing department.
Include the following in your description. What prompted the quality improvement initiative? Which of the Institute of Medicine Primary Goals is addressed through this project? Describe the expected outcome and how it will be measured.
Answer
To improve quality, the nursing department where I work is adopting wearable smart devices with an aim of minimizing costs and enhancing patient’s care, such as patient monitoring. The adopted wearable smart devices encompass fitness bands and flexible patches. The fitness bands will assist patients to adjust to sleep patterns and activity while flexible patches enable them to easily detect hydration levels, heart rate and body temperature.
The Institute of Medicine Primary Goals addressed through this project includes efficiency and effectiveness. The expected outcomes of adopting wearable smart devices include improved patient monitoring and patient outcomes. These outcomes will be measured by conducting patient satisfactory surveys with an objective of determining whether the wearable smart devices have assisted them in monitoring their health. The findings of this survey will provide evidence as to whether or not wearable smart devices have in fact been successful in improving patient
outcomes.