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Nursing Practice: Developing Practical Nursing Skill

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Nursing Practice: Developing Practical Nursing Skill

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Nursing Practice: Developing Practical Nursing Skill

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Question:
Discuss about the Nursing Practice for Developing Practical Nursing Skill.
 
Answer:
Introduction:

What: I arrived on the ward at around 8.00 a.m. and I usually start my day with assisting the patients with their morning session daily activities. While assisting in daily activities, one of the patients, I came across was Mr. A.  He was admitted to the hospital for the management of the neuropathic pain. I was asking Mr. A about his toilet use and whether he needs assistance. He became angry on me and started shouting at me and my colleague. He was wishing to meet his son. He was arguing that, hospital people are keeping him away from his son. However we know that his son died 2 years ago in a train accident.  It has been well established that people with dementia has good memory of the past (Jacques & Jackson 2000). Even though in the current situation it is not a reality, they feel or realize past facts and demand for past fact. Even though it was uneasy situation for me, I kept cool and tried to convince him and made him realize that his wish is not reality now. I was fortunate that situation got resolved and Mr. A became calm and he was ready to take assistance for toilet use.        
So What: I had mixed feelings in that incidence and I was confused about my words. Whether I said anything wrong to him. I felt awkward at that time and was upset with myself. Because, I was feeling, I disturbed a stable patient and due to me only, he became agitated. I also felt that other patients in the ward got disturbed due to this incidence and other patients thought I did something wrong with Mr.A. At the same I became sad because, I forced Mr. A to memories his expired son. Even though, I was afraid in that condition, I kept myself calm and handled situation to make him calm. Ethics and professional practice in nursing mentioned about not to unrestrained patient (Roberts and Dyer, 2004).
 
Now my feeling is very satisfied and I feel happy that I did good job to handle the situation. I also got the confidence that I can handle such situations in the future also. My feelings are completely different from the feelings at the time of incidence. At the time of incidence, I was afraid and confused, but now I am confident and satisfied. Overall effect of my action was positive. I understand that Mr. A has dementia problem so that I can take care of him in that direction. Also, Mr. A went to toilet and completed his routine daily activities. This is important in nursing practice to complete patients’ daily activities in smooth and comfortable manner (Baillie, 2005). This helps in making patient stable. Positive outcome of the incidence is that, I followed ethical and professional practices in the adverse conditions. This is very important in nursing practice to follow these practices in adverse conditions (Grace, 2013). Negative impact of this incidence on me is that I got abused from the patient, for whom I was taking so much care for his well-being. For me this situation was very good learning and it gave me opportunity to evaluate my behavior in difficult situations. I realized that these practices, I can’t learn from classrooms or textbooks. Experience and handling real time case like Mr. A case can teach to handle such situations. I realized that my effective communication, holistic approach for patient care and positive attitude towards patient’s condition, helped me to handle this incident to produce positive outcome form this incident (Thresyamma, 2005). Even tough, I was handling this condition independently for the first time, I learned and grasped skills and aptitude to handle such situations from my mentor.  I observed him handling such situations in couple of instances. Few people may have different feeling as compared to me in that situation. I handled that situation in more democratic way. I understood his state of mind and took him in confidence and made him calm. However, few people may have different view and approach on this situation. They might handle this condition in more autocratic manner and giving only orders to complete the daily activities. This type of approach might have led to negative consequence and Mr. A might got more irritated and that might be trouble for all the people in the ward. In handling this situation other nurse and ward boy helped me.  They helped me in assisting him physically to take to the toilet and two other senior members in the ward to calm down him. I felt troubled in facing Mr. A next time because, he may not like my assistance because he had bad experience with me. However, due to his dementia, he forgot that incidence and that gave me moral boost to provide nursing practice to him. It is evident that patients having dementia can have such behavior in few instances. In such instances, these patients become more agitated and emotionally disturbed. In reality, these patients don’t wish to harm or hurt anybody physically, emotionally and psychotically (Adams and Gardiner, 2005). However, this occurs due to lack of control on themselves. Being a nurse, I know this fact and knowledge of this fact helped me take quick decisions about Mr. A and this make sense to respond to his aggressive reactive reaction.            
Now what: I learned that effective communication with the dementia patients is very important because these patients forget very easily and they are unaware of actual reality. If I would not have done anything for Mr. A, he might have got more irritated and his daily activities might have got disturbed and this might led to more psychological and biological problems in Mr. A. I could have prevented this incidence from happening. It is evident that patients are more cooperative and understands more, if they are provided with person centered care. In this person centered care there is good reputation between patient and nurses (Colomer and de Vries, 2016). It is well established that communication with dementia patient is very difficult task for nurse. However, person centered care would help to have good communication among them and it helps to avoid such aggressive behavior of the patient. Next time, I will focus on person centered care in such patients.  
This incident also helped me to identify gaps in my mental and psychological knowledge and definitely I will look into it and bridge this gap by acquiring more knowledge and experience (Jensen and Inker, 2015). So that, I can handle such situations more effectively. For improving this knowledge I should discuss with my seniors about their experiences. After getting positive outcome in this case, I got more confidence and moral boost in my nursing practice. As a result, in future I will take more challenges in clinical setting and handle these cases effectively by implementing my knowledge, skills, techniques and experience. 
 
References:
Adams, T., and Gardiner, P. (2005). Communication and interaction within dementia care triads
Developing a theory for relationship-centred care. Dementia, 4(2), pp. 185-205. 
Baillie, L. (2005) Developing Practical Nursing Skills .London: Hodder Arnold. 
Colomer, J. and  de Vries, J. (2016). Person-centred dementia care: a reality check in two nursing homes in Ireland. Dementia, 15(5), pp. 1158-1170. 
Grace, P.J.  (2013). Nursing Ethics and Professional Responsibility in Advanced Practice. (2nd ed.). Jones & Bartlett Learning. 
Jensen, C.J. and Inker, J. (2015). Strengthening the Dementia Care Triad Identifying Knowledge Gaps and Linking to Resources. American Journal of Alzheimer’s Disease and Other Dementias, 30(3), pp. 268-275. 
Jacques, A and Jackson, G (2000) Understanding Dementia. London: Churchill Livingstone 
Roberts, T. G., & Dyer, J. E. (2004). Student teacher perceptions of the characteristics of effective cooperating teachers: A delphi study. Proceedings of the 2004 Southern Agricultural Education Research Conference, pp. 180-192. 
Thresyamma, C.P.  (2005). Fundamentals of Nursing.  Procedure Manual for General Nursing and Midwifery Course. Jaypee Brothers Medical Publishers Pvt Ltd.

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