Reflection On Knowledge-Based Practice

The interactions and decisions made when caring for Mr. Smith were largely guided by the CRNBC Professional Standards, especially Standard 3: Knowledge-Based Practice (CRNBC, 2012). When collecting data on my patient I used variety of sources before using the data to guide my diagnostic process and interventions (CRNBC, 2012). This includes, the physical assessment of the patient, looking up the patient’s history and communicating with the patient (CRNBC, 2012). For example, the appearance of Mr. Smith’s legs looked healthy with strong bilateral push and pull strength but when looking at Mr. Smith his legs looked unproportioned to the rest of his body. Upon communication with him I discovered that he had been bedfast for most of his hospital stay and had lost much of the muscle mass in his legs. This helped reinforce the idea of using multiple sources of information to assess a patient because everyone is different, normal for some may not be for others and the best
person to help in your assessment is the patient themselves. The goals and interventions I set for Mr. Smith were patient-centered priorities as I incorporated his priorities into the plan of care (CRNBC, 2012). For example, on the first day, Mr. Smith’s goals were clear, he wanted to be strong enough to be discharged but was reluctant to ambulate with me as he felt pain in his right shoulder when it was moved and stated that he would ambulate with the physiotherapist when they came around. I offered him additional analgesics and suggested we go later when the pain subsided while in the meantime performing active range of motion exercises in bed. After providing him with an alternative option, I informed Mr. Smith on the importance of physical activity in preventing further weakening of his legs. As a result, Mr. Smith went for a short five-minute walk with me and performed a few sets of leg exercises. Lastly, with the help of another nurse I improved my knowledge-based practice in regards to diabetic patients.
My previous knowledge had led me to believe that insulin should be given to patients in the situation where they are hyperglycemic. On my first day with Mr. Smith his glucose level was 16.2 mmol/L at 1200, I noticed that the medication administration record indicated that insulin could only be given 15 minutes before meal. Understanding that the onset of the insulin was 15 minutes I was still curious as to why we were not supposed to give the insulin any earlier to fix the high levels of glucose. I shared my thoughts with my nurse and learned that if insulin was given too early and the patient was not able to consume any carbohydrates, they could potentially go into hypoglycemic shock (CRNBC, 2012). Relating this to the theory that I had learned previously about how hypoglycemia was more dangerous than hyperglycemia I can take this information and better my nursing practice for the
future.