Introduction
Mr. Smith is under the care of a registered nurse called Jane. During the assessment, the patient presented numerous illnesses, including diabetes, COPD, hypertension, and pneumonia. The nurse is responsible for attending to Mr. Smith and ensuring he is better and that his treatment has no complications. She has to address the individual’s hyperglycemia, respiratory distress, high blood pressure, and other symptoms he is presenting while also considering his medical history and environment, as indicated in Appendix 1.
Critiquing Jane’s decisions is important because it highlights the intricacies of nursing decision-making and how the professionals often go about them. It allows the evaluation of the effectiveness of Jane’s care, considering both ethical and scientific principles impacting nurses’ practices. This will shed light on these healthcare professions’ complex and complicated nature and what they have to do daily.
Body
Patient-Centered Care
As the medical field is experiencing numerous developments, more efforts have been shifted to ensuring patient-centered care. According to Kuipers, Cramm, and Nieboer (2019), PCC involves delivering care sensitive to each patient’s unique needs, preferences, and values and ensuring that the patient’s norms inform all clinical decisions. It has numerous benefits, including better outcomes, reduced readmission, and higher satisfaction. For instance, a study conducted by Nkhoma et al. (2022) on the effects of PC interventions reports that they decrease health utilization and the cost of care and enhance quality of life. It focuses on patients’ medical conditions and physical, psychological, and social aspects.
Identification and Assessment of Mr. Smith’s Health Need
The critical health need of Mr. Smith is related to respiratory distress. The distress that Mr. Smith is experiencing is attributed to Pneumonia. From the registered nurse’s case study, he has recently been diagnosed with pneumonia, which is introducing more complications. Mr. Smith presents a high heart rate at 110 bpm, a 28-bpm respiratory rate, and oxygen saturation at 88% on room air.
Moreover, he has a blood pressure of 160/90 mm Hg and a blood glucose level of 240 mg/dL, which worsens the condition. He also shows signs of anxiety and restlessness while relying on accessory muscles for breathing. which are common signs of this disease (Aslan et al., 2021). This health need presents a complex and complicated situation for Mr. Smith under Jane’s care, covering numerous biological, psychological, and social aspects.
Biological Aspect of Respiratory Distress
To assess Mr. Smith’s respiratory distress, the first step will be to consider its biological aspect. Inflammation and infection of the tissues of the lungs characterize this health need. Chebib et al. (2021) note that this discomfort often starts after developing pneumonia. When a person inhales pathogens into the alveoli, a swelling that causes the consolidation of the tiny air sacs responsible for gas exchange, fluid builds up. After contraction, their respiratory tract responds by producing mucus that obstructs the airways, hindering its function (Lim, 2022).
This explains why Mr. Smith exhibited severe shortness of breath, as it compromises an individual’s lung. This need explains the increased respiratory rate, a psychological response to addressing air deficit. Moreover, the bilateral infiltrates on the X-ray report are another biological aspect of this ailment. Chebib et al. (2021) state they represent lung areas with inflammation and infection. Lastly, the other comorbidities the patient has also contributed to the respiratory distress.
Psychological Aspect of Respiratory Distress
On the psychological aspect, respiratory distress adversely affects Mr. Smith’s life. First, according to Tai and Zhou (2023), breathing difficulties caused by pneumonia are associated with physical pain, poor treatment outcomes, prognosis, and the long duration it takes. These issues lead to negative emotions in most of them, like anxiety, irritability, and depression.
These challenges have been associated with individuals’ “non-cooperation with treatment, which affects patients’ recovery and prolongs hospitalization, increases mortality and hospitalization costs, and seriously affects” their expectations (Tai and Zhou, 2023, p. 2). In Jane’s patient’s case, his anxiety and agitation can exacerbate his respiratory distress, leading to poor quality of life, mainly due to breathing challenges and discomfort.
Effects of Disease
Respiratory distress has a social effect on Mr. Smith and other patients with pneumonia or related conditions. While social isolation is common among older adults like Mr. Smith, those with breathing difficulties experience it more severely (Fakoya, McCorry, and Donnelly., 2020). Due to the effects of the discomfort in the respiratory system, some of these individuals exclude themselves from the public or lack those who can care for them (Lim, 2022).
In this scenario, Mr. Smith lives alone and does not have social support, making him lonely and with no one to offer them emotional aid. The absence of his family hinders his medication and lifestyle recommendations adherence. This can also be a reason why he does not comply with his medications because he does not have people to encourage him to keep addressing his current state.
Critique of Nursing Care
From the case study, Mr. Smith’s diagnosis indicated shortcomings in the nurse’s practice. While the registered nurse recently diagnosed her patient with pneumonia, she has delayed recognizing its severity. She should have taken immediate action after the individual exhibited a high respiratory rate and used accessory muscles to breathe. When patients feel like they are not getting enough air, they have issues related to inhaling (National Institute for Health and Care Excellence, 2019). To prevent complications, this must be prioritized for those with multiple comorbidities. Therefore, the failure to address this agency and make it an immediate primary concern was a mistake, as indicated in Appendix 1.
An appropriate prescription of drugs for patients with respiratory distress caused by pneumonia, especially those with underlying conditions, is essential. In Mr. Smith’s case, Jane administered antibiotics to help manage his state. However, the registered nurse should have done this earlier to avoid adverse outcomes like death. According to Nauclér et al. (2021), even though many patients with this ailment can be cared for from home, it is always essential to determine the severity. This implies that healthcare professionals must offer medication promptly to the patients.
When it is delayed, there is a higher chance of them recording negative results and reduced satisfaction. Moreover, during treatment, Jane should consider all comorbidities, such as COPD and diabetes. This prevents potential drug contraindications and interactions, avoiding complications (Torres et al., 2019). This implies that Mr. Smith’s nurse should have been cautious and comprehensive when diagnosing him and offering treatment.
Recommendation Based on Critique of Nursing Care
Implementing a Systematic Approach
Based on the critique of Jane’s decisions while caring for Mr. Smith, numerous recommendations could be added to the treatment plan. First, the registered nurse must implement a systematic approach for recognizing and managing severe respiratory distress. According to Schwede et al. (2020), failure to identify infections affecting a person’s breathing, such as pneumonia, increases their chances of dying.
Therefore, healthcare professionals should utilize tools like Early Warning Scores (EWS), Sequential Organ Failure Assessment (SOFA), and Glasgow Coma Scale (GCS) to spot individuals who have such diseases before they advance (National Institute for Health and Care Excellence 2019). This will help ensure that the new ailments are addressed effectively despite having other underlying conditions.
Conducting a Thorough Assessment
The second strategy that would improve Jane’s care for Mr. Smith is conducting a thorough initial assessment. The case study in Appendix 1 shows that the patient has multiple comorbidities. These include COPD, hypertension, diabetes, and recently pneumonia. These underlying conditions make identifying new conditions that can adversely affect an individual’s results challenging. Therefore, in this care plan, the registered nurse must ensure that the initial testing is comprehensive (Lim, 2022). Moreover, this will help avoid complications from drug reactions, allergies, and more.
Improving Patient Education
The third recommendation for Mr. Smith’s treatment plan is to improve patient education and engagement during the whole process. When healthcare professionals and their patients have seamless communication, they can exchange vital information that would help improve outcomes, enhance satisfaction, offer more insight, and ensure the care provided is individual-centered. This will also assist in giving sick people emotional support and create trust, which they require to adhere to medication, lifestyle change recommendations, and others (Kuipers, Cramm, and Nieboer, 2019). The nurse must offer verbal and written information to patients on their medical state, proposed cure plan, and the expected duration.
Incorporating Interdisciplinary Collaboration
Jane should incorporate enhanced interdisciplinary collaboration as she attends to Mr. Smith. According to Sillero Sillero and Buil (2021), when different healthcare professionals come together, each expert is brought to the table; they bring their specialty to the table and offer patients the quality care they need. For instance, Mr. Smith will require physicians, nurses, therapists, and social workers to help him attain positive results.
With coordination throughout the process, services will be enhanced, medical errors will be reduced, and treatments will begin faster (Sillero Sillero and Buil, 2021). This can be done through face-to-face meetings and online platforms like email, Facebook, and LinkedIn. This can also apply if the patient is in a hospital setting because of the benefits of bringing experts together within an organization.
Conclusion
This case study on a registered nurse, Jane, attending to Mr. Smith, who has multiple comorbidities, such as COPD, hypertension, diabetes, and pneumonia, critiques the choices she is making and highlights the importance of a patient-centered approach, inter-professional collaboration, comprehensive assessment, and timely recognition. The individual receiving care in this scenario has just been diagnosed with a new condition that must be addressed to ensure it does not lead to complications with underlying ailments.
For this reason, he requires a treatment plan that guarantees prompt identification, a thorough assessment of symptoms, enhanced coordination between different healthcare workers, seamless communication about his state, and more. Including this recommendation and focusing on his medical state’s social, biological, and psychological aspects in the course of care, Mr. Smith is guaranteed holistic and individual-centered services. Therefore, it is essential to consider continuous improvement and commitment to best practices in the constantly changing healthcare environment.
Reference List
Aslan, A. et al. (2021) “Acute respiratory distress syndrome in COVID-19: Possible mechanisms and therapeutic management”, Pneumonia, Volume 13, pp. 1-15. Web.
Chebib, N. et al. (2021) ‘Pneumonia prevention in the elderly patients: the other sides,’ Aging clinical and experimental research, Volume 33, pp. 1091-1100. Web.
Kuipers, S. J., Cramm, J. M. and Nieboer, A. P. (2019) ‘The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting’, BMC health services research, 19(13), pp. 1-9. Web.
Lim, W. S. (2022) ‘Pneumonia—overview,’ Encyclopedia of Respiratory Medicine, p. 185–197. Web.
National Institute for Health and Care Excellence (2019) ‘Pneumonia (community-acquired): antimicrobial prescribing’. Web.
Nauclér, P. et al. (2021) ‘Impact of time to antibiotic therapy on clinical outcome in patients with bacterial infections in the emergency department: implications for antimicrobial stewardship,’ Clinical Microbiology and Infection, 27(2), pp. 175-181. Web.
Nkhoma, K. B. et al., 2022. A systematic review of impact of person-centered interventions for serious physical illness in terms of outcomes and costs. BMJ Open, 12(7), p. e054386. Web.
Schwede, M. et al. (2020) ‘Clinician recognition of the acute respiratory distress syndrome: Risk factors for under-recognition and trends over time,’ Critical care medicine, 48(6), pp. 830-837. Web.
Sillero Sillero, A. and Buil, N. (2021) ‘Enhancing interprofessional collaboration in perioperative setting from the qualitative perspectives of physicians and nurses’, International Journal of Environmental Research and Public Health, 18(10), p. 10775. Web.
Tai, X. and Zhou, X. (2023) ‘Analysis of risk factors for negative emotions in patients with severe pneumonia and their impact on prognosis’, Journal of Thoracic Disease, 15(5), p. 2680. Web.
Torres, A. et al. (2019) ‘Challenges in severe community-acquired pneumonia: a point-of-view review’, Intensive care medicine, Volume 45, pp. 159-171. Web.
Appendices
Appendix 1: Case Study: Managing Complex Patient Situation
Introduction
In this case study, we will explore the complex and critical decisions made by a registered nurse, Jane, working in a busy urban hospital. Jane’s patient, Mr. Smith, is a 68-year-old male admitted to the medical-surgical unit with multiple comorbidities, including diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). Mr. Smith was recently diagnosed with pneumonia and is experiencing severe shortness of breath, elevated blood glucose levels, and increased blood pressure.
Background Information
Mr. Smith has a history of non-compliance with his diabetes management and has been a long-time smoker. He lives alone and is socially isolated, which may contribute to his non-adherence to medication and lifestyle recommendations. Additionally, Mr. Smith’s family is not actively involved in his care.
Clinical Data
- Mr. Smith’s vital signs are as follows:
- Heart rate: 110 bpm
- Blood pressure: 160/90 mm Hg
- Respiratory rate: 28 bpm
- Oxygen saturation: 88% on room air
- Blood glucose level: 240 mg/dL
- Mr. Smith appears anxious, agitated, and is using accessory muscles to breathe.
- Chest X-ray reveals bilateral infiltrates consistent with pneumonia.
- Lab results show an elevated white blood cell count and C-reactive protein levels.
Scenario
Jane, the nurse responsible for Mr. Smith’s care, is faced with a series of critical decisions:
- Assessment and Prioritization: Jane must prioritize her assessments and interventions. Should she focus on managing Mr. Smith’s respiratory distress, hyperglycaemia, or hypertension first?
- Medication Management: Given Mr. Smith’s complex medical history, what medications should Jane administer? Should she address his elevated blood glucose with insulin? Should she administer antibiotics for pneumonia, considering possible drug interactions and contraindications?
- Patient Education and Engagement: How can Jane effectively communicate with Mr. Smith to gain his cooperation in managing his conditions? How can she address his non-compliance and smoking history?
- Collaboration: Jane needs to collaborate with the interdisciplinary healthcare team, including the physician, respiratory therapist, and social worker. How can she ensure effective communication and coordination of care for Mr. Smith?
- Ethical Dilemmas: Are there any ethical dilemmas in this case, such as respecting Mr. Smith’s autonomy in decision-making versus ensuring his well-being?
Conclusion
This case study highlights the multifaceted nature of nursing decision-making in a real-world healthcare setting. Jane’s decisions will impact Mr. Smith’s health outcomes, making it imperative for her to consider evidence-based practices, effective communication, collaboration, and ethical principles in her decision-making process. In your assignment, you can further explore these decision points, discussing the scientific and ethical principles that guide nursing decisions and analyzing the potential outcomes of different choices. This case study provides a rich context for examining the complexities of nursing decision-making.