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Impactives role of nursing intuition
Impactives role of nursing intuition
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I believe that nursing intuition is a valid aspect of the nursing profession. I also believe that the coincidence of occurrence increases with experience. Sometimes, something does not feel right or look right, and the nurse is unable to positively identify what is causing the issue. The situation just feels questionable.
I was working in the emergency room(ER) as triage nurse, and when I went to the waiting room to call for a 22-year old female, who signed in for cough, something did not look like a 22-year old who signed in because of a cough. Her toddler was sitting beside her, trying to talk to her, but she was not paying much attention to him. Granted, some people choose to not respond to small children at times, because of the million
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I escorted her to a room, and helped her change into a gown. I understand that a 22-year old is capable of changing her own clothes, but I wanted to spend more time with her for further investigation. Auscultation of the lungs revealed bilateral clear and equal breath sounds, and heart tones were audible and regular. No peripheral edema was noted upon examination of her lower extremities, and she denied a history of similar symptoms or any medical issues in the past. Again, my nursing experience was challenged. Everything looked great, except this feeling remained that something was wrong. ER was busy that day, so I put in on order for a chest x-ray, and then told the doctor why she wanted to be seen. I told him that I ordered an x-ray, but something was not right about her skin color, not jaundiced, swallow, or cyanotic just not right, and I asked for basic lab work. The doctor felt lab work was not needed at that time, and I did not push the issue. I just thought to myself, “maybe he is right, and I have worked too many days in a row”. When the patient returned from the x-ray department, I met her at the room. I asked how
A critical analysis of the four fundamental patterns of knowing in nursing is essential for nurses to be able to grasp the complicated nature of the nursing practice. Barbara Carper (1978) lists the four patterns of knowing as: empirics, esthetics, personal knowledge, and ethics or moral knowledge (p.14). The science of nursing is called empirics and the connection of art to nursing is referred to as esthetics (Carper, 1978, p.14). These patterns are four very complex areas of nursing that every nurse must consider in order to be as successful as possible in providing care. In this evaluation the author will discuss how these concepts affect present learning and practice.
Nurse A seemed confident and calm while nurse B appeared tired. With the first patients, I noticed that both nurses were asking for first and last name and confirmed the information with the picture in the computer and the medication cup. After a few minutes, I turned my attention to nurse B because I noticed she did not ask a particular patient for his name. Instead, she relied on the name provided by a patient care technician. When she was about to give the medication to the patient, nurse A noticed that the patient on the computer screen was not the patient on the counter. She immediately told nurse B “ That is not Mr… girl ” and nurse B responded while laughing “ He looks exactly like …, I need to get some coffee ASAP”. The patient immediately realized what happened and told nurse B his name. After that, nurse B reached for the right cup and administered the medication to the patient. Even though a medication error was not committed and no harm was inflicted to the patient, by violating important QSEN competencies this incident could have caused a negative patient outcome.
I oriented EMT Soper on 7/10/16. EMT Soper was on time and prepared for shift. EMT Soper showed a lot of initiative and ask many questions in the beginning of the shift, when there was downtime. EMT Soper and I went over some of his EMT Field Evaluation forms. We went over where the equipment is stored and how to apply equipment. I did not want to complete any more field evaluation forms until I saw EMT Soper work as a care giver. EMT Soper had 2 calls both utilizing ALS, one that was recalled enroute to the hospital due to proximity. EMT Soper was hesitant on the first call, but was easily corrected. He obtained accurate vitals during both calls. EMT Soper ask appropriate questions at times, but still needs to work and build on his patient
There are different types of knowledge and different ways of knowing. Four fundamental concepts of knowing in nursing highlighted by Caper (1978) are empirical, personal, ethical and aesthetic. He divided knowledge into two forms which are tacit and explicit. Tacit is insights and based on experience and not easily visible and expressible, difficult to share and communicate with others which is highly personal. Empirical sources of knowledge depend upon an individual’s manner of observing and responding to events in the outside world (Higgs et al, 2004). Whereas explicit is formal and based on rationality and easily can be expressed, shared, communicate which are highly universal principles. Rationalism comes from within the individual and depends upon theoretical reasoning rather than on data from the real world (Higgs et al, 2004).
For example, if a nurse instructs me how to insert an intravenous line, but this differs from what was taught in school, does this mean her method is wrong and/or harming the patient (ethical knowing)? Are there new guidelines from the manufacturer (empiric and unknowing)? Did she still adhere to the basic aseptic technique taught in nursing school (empiric knowing)? Is this a problem that other nurses have when being precepted by different nurses- the varying techniques that created my confusion, and who and how is it decided what is the correct method (personal and sociopolitical knowing)? This form of knowing allows me to have a truly open mind about the situation and how it affects my patient, essentially rejecting and sometimes even questioning what I think I already know. Some knowledge is easier to clarify and place into practice, such as empiric knowledge, while other knowledge is much harder to attain, especially when it comes to ethical or sociopolitical
A confused man presents into the Emergency Department in a dishevelled and unkempt state, the nurse assigned to this patient recognises the following; the man is in his mid-sixties, confused and disorientate, anxious, has an acetone breath odour, also at examination locates a haematoma on the right side of his forehead while the patient also states repeatedly that he wants to pass urine. As acknowledged previously the nurse responded in an inappropriate manner therefore making a significant impact on the care of this patient for the upcoming shift, the nurse presented signs of neglect thus actions need to be taken to keep the patient safe with the best suitable care possible.
I wasn’t quite sure what to believe. I knew I wanted to assess the patient and speak with him first before jumping to conclusions. My preceptor and I went to go let the patient know we were going to be his nurses for the day. Once we entered and started doing our assessment on the patient, he seemed like he was fine. When I asked him to rate his pain on a scale of 1-10, he stated it was 10. I asked him where he was experiencing the pain, he stated it was where the incision site was (upper chest) and all over his body. He demanded the best pain medications we have immediately. Other than what he subjectively told us, he seemed okay. His vitals were normal, his blood work came back with nothing alarming and a urine culture was negative. He was a previous drug abuser in the past from the past medical report. I started to think he just wanted pain medication just to abuse them again. I do admit after assessing the patient, I did in fact jumped to conclusions. Was I starting to be biased towards my
It is important for nurses to have the ability to analyze information, using inferences, drawing conclusions, and evaluate your decision and action. During my medical surgical rotation, I was assigned to a female elder patient who
The next time I walked into a Neonatal Intensive Care Unit was as a fourth year medical student. This time not as a spectator, but as a medical professional expec...
I seized an opportunity to quietly speak with her and she explained that she had not received an adequate amount of rest the night before and the journey down had been exhausting. She also expressed concerns about being fearful about going into the operating room. I overheard a nurse earlier ask the group as a whole if anyone wanted an ativan to ease anxiety and the group consensus was no. I felt that because it was unanimous, she may have been embarrassed if it was only her that requested it. My concern for this patient was for her to remain comfortable and provide any healing initiatives that would reassure her that she was safe.
As a result, she breached the standard 6 which states that “registered nurse should provide a safe, appropriate and responsive quality nursing practice” (NMBA, 2016). In line with this standard, nurses should use applicable procedures to identify and act efficiently to potential and actual risk such as unexpected changing patient’s condition (NMBA, 2016). Through early identification and response by the nurse, this will ensure that the patient’s condition is recognised and appropriate action is provided and escalated (Australian Commission on Safety and Quality in Health Care, 2011). Moreover, the nurse did not immediately escalate the patient’s deteriorating condition to the members of the health care team. Therefore, she also disregards the standard 4.3 stating that nurses should have work with the interdisciplinary health care team and to collaborate, communicate and discuss the patient’s status (NMBA,2016). The purpose of collaborating and communicating with the team is to provide a comprehensive plan of care for the patient and to facilitate early treatments needed by the patient (Cropley,
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
The provision states, “Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self -determination. Self -determination, also known as autonomy, is the philosophical basis for informed consent in health care. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgement; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process (nursingworld.org)”. Ms. Rogers cannot even get to this point because of the resident refusal to treat her. There could many things going on with her. She could have pancreatitis, gallbladder issues or many other diagnosis related to her abdominal pain. She won’t know until a physician does a full workup on her. She obviously wants to be seen or else she wouldn’t have come to the ER. She knows something is not right is she is staggering in the hospital. She has rights as a patient to be seen by a physician. I think is the resident doesn’t want to evaluate her then the ER nurse needs report that person and go find another physician to do the job. I would also talk to the house supervisor about the situation so it could be reported to administration. Doctors go into medicine to help all people, not to pick and choose who they want to
Examples of different cases to demonstrate the concept of the intuition are described by Roger et al (2014). The model case describes an example of the concept in which all defining attributes of the concept are displayed. A related case is then identified where it illustrates some form of the concept, but not all defining attributes are present. Lastly, the contrary case is present which defines what the concept is not, due to none of the defining attributes being present. The model case describes a nurse whose assessment included all of the defining attributes. In the related case the nurse based knowledge from a holistic assessment and synthesized previous experiences and observation, however, did not have immediate knowledge, rather based her clinical decisions from a factual standpoint. In the contrary case presentation the nurse, who was a new graduate, used no defining attributes of intuition and based care strictly on knowledge from a textbook and his
The nurse insisted on calling her sister to be there for her when she wakes up. 10-15 mins later, paramedics and firefighters arrive at the scene and acted on trying to get her to respond, while I am getting the wheel chair in case she wakes up so she can just hop on and go home. As time go by she started showing signs of coming back to being conscious & out of nowhere she started busting out crying all over us & started thanking us. After she got done being emotional from the incident that took place, we put her in the wheel chair & we took her to the car & prayed she’ll go to a doctor to get checked out. Her mom was so thankful that we assisted helping her daughter with her medical problem while everyone just stepped over her and went to class. Just hearing her mom say that we made her day by helping her daughter made me realize that we are helping one each another may show how of a caring person you are. One person told me that “strike back against the selfishness and greed of our modern world, and help out a fellow human being today. Not next month,