NURS4002 Transitional Nursing Practice

Introduction 

Transition phase from nursing student to graduate nurse can be mixed experiences that consist of both stress and contentment. An initial six months is reflected as the critical phase for hewing nursing commitment and professional adjustment. During this phase, the students learn from the real clinical setting by applying their classroom knowledge. Further, it has been documented that evidence-based nursing practice is essential to follow  to give holistic care to the patients in today’s scenario. It is vital to follow this methodology to make eminence decisions to render nursing interventions as per the clinical need and proficiency (Fritz, & Wilson, 2018).

This case study will discuss the two clinical scenarios that take place in the clinical setting involving the unconscious patient with the history of Diabetes Mellitus type-II, hypertension, obesity, depression and leg ulcer requiring proper management to improve the patient’s clinical condition. The second case is about the anxious and behaviorally depressed patient due to her cystic fibrosis diagnosis who requires risk management and self-management techniques. It would be followed by a discussion of nursing students’ core values such as accountability, continuous learning and compassion to grow and learn.

Discussion

Clinical experience and knowledge in rendering evidence-based nursing intervention within the clinical setting

A 65 years old male with weight 110 kg and height 150 cm was admitted to the hospital with a primary complaint of loss of consciousness. During the thorough examination, his serum glucose level was 46.3mmol/L during admission his past medicinal history indicated that he was suffering from Diabetes Mellitus (DM) from the past 15 years. Further, he is suffering from hypertension, depression, leg ulcer and obesity. He was admitted in the Intensive care unit for the past 36 hours. After thorough clinical evaluation and history, he was diagnosed with Hyperglycemic Hyperosmolar state. The intensive care nursing task encompassed proper observation followed by accurate documentation. Moreover, the patient was unconscious therefore; extreme care was needed in-order render holistic interventions to patients (Mody et al., 2017).

While treating such patients, evidence-based practice is mandatory. It is vital to apply the gained knowledge from various authentic sources and classroom. As per the document, to avoid hyperglycemia or hypoglycemia, various preventive procedures are needed. Before blood glucose examination, it is critical to check for any airway obstruction and consciousness level. Glasgow comma scale was utilized for evaluation of consciousness level. In above-stated case, fasting and post-glucose levels were tested to rule out whether the patient had low or high glucose level. Blood glucose levels were needed for deciding the dose of insulin or hypoglycemic medications. After glucose level estimation, the patient was diagnosed with the hyperosmolar hyperglycemic syndrome (Pasquel & Umpierrez, 2014).

The hyperosmolar hyperglycemic syndrome is considered a complication of DM, in which high glucose can be a causative factor of high osmolality without ketoacidosis. Further, the patient can suffer from legs cramps, vision loss, dehydration, weakness and altered conscious level. Any worsening of the condition should be informed immediately to the medical officer, concern physician and nurse coordinator through the verbal and written format. Any delay in communication can shoddier the patient’s condition and can lead to permanent loss or death. The hyperosmolar condition was ideally managed through thorough clinical knowledge (Viana et al., 2014). The guidelines provided by the hospital and instructions given by the head nurse were beneficial while rendering complete care to the patient. In the present case, it was important to consider the fall risk also. After an in-depth examination, no abnormality was detected concerning circulation. He was conscious and no abnormal movement was identified. The patient was on insulin for glucose level maintenance and treated with fluid resuscitation for the hyperosmolar condition (Bunn et al., 2015).

The urine sample had sent for laboratory investigation. As per the report, creatinine and sodium levels were increased. Additionally, the potassium levels were low with high urea nitrogen level. As per the literature, electrolyte and acid-base imbalance can lead to dehydration.  A complete assessment is essential to rule out probable issues that can lead to dehydration. Nurses should observe the vital sign properly and document it on regular basis. Heart rate and blood pressure were supervised on a regular basis. The patient was motivated to drink the recommended fluid amount. Through this case evaluation, it was learned that hyperosmolar hyperglycemic is one of the DM complications that can lead to dehydration and high serum glucose level. As per the literature such situation can be associated with morbidity and mortality.  Therefore, it is vital to ensure and monitor serum glucose level and electrolyte balance in- order to render proper nursing care to a patient (Paulis et al., 2018).

Work associated issues and ability to adapt the changes

Cystic fibrosis is genetically hereditary diseases that can affect one out of 2500 people. This condition can be considered as life-limiting in nature. The current section would discuss a case of 17-year – an old adolescent girl suffering from cystic fibrosis. After complete physical and laboratory investigation, she was diagnosed with pancreatic insufficiency. The patient had been hospitalized seven  times in the past five years because of pulmonary infection. This time also she was admitted with the same chief complaint but was a little worried and depressed due to her bad health condition. The patient is good in academics and motivated to achieve high in life. In spite of her busy academic schedule, she was following her medicinal regime and daily routine to fight with her diseased condition. The patient was a little violent and aggressive due to her bad health condition (Hebden etal.,2012, Yen, Quinton,  & Borowitz, 2013).

Proper documentation and monitoring of vital sign were essential, as her condition was needed to discuss with the concerned physician and nurse coordinator. Her behaviour including violence, aggression and depression needed to discuss with the concern multidisciplinary team. Moreover, all the attempts were made to calm and relax the patient. The patient was depressed as she was not able to attend the school due to her worsening health condition. As per various literature, the patient suffering from cystic fibrosis have to be the active participant in dealing with the disease condition. Various self-management education programs had been established in order to provide complete care to the patients (Cohen-Cymberknoh, Shoseyov, & Kerem, 2011).

Self-management helps the patient and their family to adjust, choose and monitor the treatment requirement. In the current situation, necessary assistance was needed to shift the patient from the intensive care unit to daycare centre. The registered nurse needs to perform risk evaluation to analyze, identify and manage the depression and anxious behaviour of the patient. It is vital to discuss disease-specific information to the patient in order to provide professional and medical advice. As per the hospital norms, an educational intervention was provided to the patient and family. Educational interventions aid equip patient and her family with knowledge, skill and confidence to take liability for a decision related to her treatment plan and managing illness demand in a flexible way. Communication with the patient aids the patient to overcome with the depression, violence and anxiety (Filigno etal., 2012).

The patient was also suffering from frequent cough episodes and breathing difficulty. For the above-stated issue, chest physiotherapy and bronchodilators were given to the patient. The patient was motivated to adhere to the diet modification and medicine regime as compliance is required. The verbal cognitive therapy was provided to her in order to help the patient to monitor her symptoms and behaviour. Communication with the patient helps the patient to stick to the medicine regime and diet modification. Moreover, aggressive and comprehensive therapies were prescribed to the patient. The management plan was for the patient including physical therapy, antibiotics, balanced diet, chest physiotherapy, postural drainage and exercise. The management plan was thoroughly discussed with the patient prior to hospital discharge. Further, the discussion had been made with the patient regarding cross infection, as it is documented that cross-infection is very much common in cystic fibrosis patients. Therefore, proper segregation was provided to the patient. After daycare, the patient was shifted to separate inpatient segregation care (Rhee, McQuillan, & Belyea, 2012).

As per the researchers, the patients have to go through the transition phase. The shift from child to adulthood can bring new developmental experiences and challenges. The patient and her parents were worried about the switch to adult health care. The patient’s mother was depressed too as compared to her father. The communication session had held with the parents and patient to discuss the transition phase. After evaluation of the case, it can be acknowledged that critical thinking and proper decision-making are utmost in nursing practice. Further, proper communication and cognitive support can help the patient to overcome their anxiety and fear (Fegran etal., 2014).

Conclusion 

It can be concluded that the transition phase from nursing student to graduate nurse can be both stressful and easeful. The nursing students need to apply his or her knowledge into the clinical setting in order to render proper and complete care to the patient. As per the above-discussed case, it is essential to evaluate every case thoroughly. Further, proper documentation and communication with nurse coordinator and concern physician are vital steps to follow. Evidence-based learning always helps the student to learn more and practice effectively.  

References

Bunn, D., Jimoh, F., Wilsher, S.H. & Hooper, L., 2015. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review. Journal of the American Medical Directors Association, 16(2), pp.101-113.

Cohen-Cymberknoh, M., Shoseyov, D., & Kerem, E. (2011). Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. American journal of respiratory and critical care medicine, 183(11), 1463-1471.

Fegran, L., Hall, E. O., Uhrenfeldt, L., Aagaard, H., & Ludvigsen, M. S. (2014). Adolescents’ and young adults’ transition experiences when transferring from paediatric to adult care: a qualitative metasynthesis. International Journal of Nursing Studies, 51(1), 123-135.

Filigno, S. S., Brannon, E. E., Chamberlin, L. A., Sullivan, S. M., Barnett, K. A., & Powers, S. W. (2012). Qualitative analysis of parent experiences with achieving cystic fibrosis nutrition recommendations. Journal of Cystic Fibrosis, 11(2), 125-130.

Fritz, R.L. & Wilson, M., 2018. Evidence-Based Practice in Nursing. In The Intersection (pp. 1-17).

Hebden, L., Cook, A., van der Ploeg, H. P., & Allman-Farinelli, M. (2012). Development of smartphone applications for nutrition and physical activity behavior change. JMIR research protocols, 1(2).

Mody, L., Greene, M.T., Meddings, J., Krein, S.L., McNamara, S.E., Trautner, B.W., Ratz, D., Stone, N.D., Min, L., Schweon, S.J. & Rolle, A.J., 2017. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA internal medicine, 177(8), pp.1154-1162.

Pasquel, F.J. & Umpierrez, G.E., 2014. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care, 37(11), pp.3124-3131.

Paulis, S.J., Everink, I.H., Halfens, R.J., Lohrmann, C. &  Schols, J.M., 2018. Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. Journal of the American Medical Directors Association.

Rhee, H., McQuillan, B. E., & Belyea, M. J. (2012). Evaluation of a peer-led asthma self-management program and benefits of the program for adolescent peer leaders. Respiratory care, 57(12), 2082-2089.

Viana, M. V., Moraes, R. B., Fabbrin, A. R., Santos, M. F., & Gerchman, F. (2014). Assessment and treatment of hyperglycemia in critically ill patients. Revista Brasileira de terapia intensiva, 26(1), 71-76.

Yen, E. H., Quinton, H., & Borowitz, D. (2013). Better nutritional status in early childhood is associated with improved clinical outcomes and survival in patients with cystic fibrosis. The Journal of pediatrics, 162(3), 530-535.