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Unit 41: Standards and Domains for Professional Practice, ST Patrick's College London

STANDARD 1: Analysis of Nursing practice

Lap sleeve gastrectomy is a laparoscopic procedure which helps in removing approximately 75% of the stomach which leads to narrowing down of gastric tube or sleeve. No modification in intestine is done during this type of surgery. The event discusses regarding deteriorated condition of Mr. ‘X’, who is a middle-aged man post his lap sleeve gastrectomy day 2. A redon drain tube was inserted in his body after his surgery so as to drain material in the form of pus and blood through suction. Since, it is a flexible tube made up of plastic and silicone, it is pierced with numerous holes one part of its wall. It can easily remove unwanted material from the body which could have been produced during surgery (Kohno and et.al., 2013).

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The issue faced by Mr. X was that redon tube was not able to drain appropriately and hence, was changed on day 2. After change, a huge amount of blood was coming out of that tube leaving the patient in unbearable pain. It requires proper actions to be taken by nurse so that the pain and impact on patient’s body can be reduced to minimum. However, the issue that was faced by nurse is that patient was a non-Caucasian man and had a bit of language barrier as well. Hence, it was getting difficult for nurse to ascertain the feeling of Mr. X.

In case of language barrier, it is important for the staff to take actions considering cultural sensitivity in mind. Providing effective and sensitive nursing care requires empathy, commitment and flexibility. There are certain nursing interventions that can be followed by them in case of Mr. X. Some of them are listed as below:

Each patient carries a unique outlook. However, the case become more sensitive if he / she belongs to entirely different culture with diverse language as well. Hence, it becomes important to treat and educate before making any type of assumption regarding Mr. X.

Finding a translator when a patient struggles in speaking a particular language can also help in sorting out the issue. It will help in developing a better understanding of the condition of Mr. X.

Due to extensive loss of blood, it becomes important for the nurse to address patient’s signs and symptoms as well as try to understand condition withhelp of his posture and body movement (Hur and Roh, 2013). Any type of redness, tenderness and increased ooze could be a sign of infection. The healthcare professional must be informed regarding condition for better treatment practices.

The nurse must document drainage in every hour so as to attain its consistency and amount. In case of heavy flow of material from body, it becomes important to perform blood culture to ascertain that if there is any infection in the body or not (Jeon and et.al., 2016).

Due to presence of culture barrier, it is difficult to assess the level of pain that Mr. X is facing. In such cases, understanding through irregular movement in the body and try connecting with the patient through listening, asking questions, seeking it to understand and following through it with bit of understanding gathered by the nurse.

Increasing clinic diversity among clinicians can help in dealing with issue where nurses can meet requirements of patients without facing any type of problem that can create problems for the patient (Doenges, Moorhouse and Murr, 2014).

Having cultural differences in patients due to barrier in language, it becomes difficult for the nurse to understand that what they are feeling. In such scenario, translator can help in building understanding. Moreover, appropriate knowledge of patient’s laboratory reports can help the nurse in dealing with issue. Further, adoption of effective pain management techniques can also help in finding appropriate solution for Mr. X.

STANDARD 2: Engaging in therapeutic and professional relationships

A therapeutic relationship in between nurse and patient can be defined as the helping relation which is totally based on respect and mutual trust. A nurse must be able to nurture the relationship with hope and faith with being sensitive to other’s feelings. This type of care relationship helps in bringing patients close to the nurse and they are able to share their, physical, emotional and spiritual needs. One of the important aspects that is related to therapeutic relationship is that there must be effective verbal and nonverbal communication in between patient and nurse. It enables providing care in format where patient becomes an equal part of achieving wellness at the end.

Trust, intimacy and respect are the other factors that are related to therapeutic relationship. With the same, nurse gets power to act in the best interest of patient and take alldecisions based on it (Allen, 2016). All verdicts taken by nurse for patient’s health have high dependence on cultural, psychological, spiritual and physical requirements of patient. The key component of therapeutic relationship is trust. It is critical to be maintained in a professional relationship. It will help patient to understand knowledge and attitude carried out by the nurse during treatment. Another aspect is directly linked to respect and professional intimacy between the two. It is important that the nurse respects dignity of client. The nurse must not be judgemental and professional during overall care tenure. Empathy is also important to be kept by the nurse. Hence, he / she must be able to extend understanding with maintenance of adequate emotional distance as well (Seo and et.al., 2012). It helps the nurse in performing his / her duties without compromising with objective of professionalism. Another vital aspect that is directly linked to power hold by the nurse is working under a specific position. They have the right to make decision for patients on behalf of their clients in such a manner that it can promote wellness. The power must be used by nurse only for good of patient and no undue advantage must be taken out of it.

The warmth,friendliness, genuine interest andempathy facilitates to support. It helps in developing interpersonal relationships between the patient and nurses. It improves the overall satisfaction levelof the patient that has been received. Adherence to quality, decreased level of anxiety, decreased health care cost and improved quality of life is directly initiated by the nurse in the therapeutic relationship with the patients. research states that there are various terms used to describe this type of relationship, such as, purposeful relationship, helping relationship, nurse-client relationship or therapeutic alliances. In a patient centred care, a level of relationship is kept at the centre (Hong and Lee, 2014). It plays a vital role in eliciting patient’s true wish and also help in concerning to both their needs and emotional concerns. It is a constructiveclinician – patient experience and achieve the output in case of requirement of acute care setting as well. There are certain methods that can be adopted by the nurse so as to initiate effective care and therapeutic relation with the patient are:

The nurses must introduce themselves and use patient’s name while talking to him. It helps in developing personal relationship. It helps in development of trust and respect between each other.

The patient must feel privacy when nurse is providing care to the patient. It must be ensured that basic needs and requirements of the patient are met in case of reliving ongoing pain or any kind of discomfort (Xiu-fang, 2012).

Nurse must effectively listen to the patient and restating the interpretation he / she has made out of the patient’s statements. It helps in keeping a connection to the patient. The nurse must reflect his / her real side while communicating with the patient. Not restating too much in the conversation is perceived that one is not listening appropriately to what has been said.

Smiling, nodding and maintaining eye contact are few ways based on which it can be ascertained that the two are engaged in the communication. The voice must be calm, slow and polite.

It is also important for the nurse to maintain a professional boundary while communicating with the patient. In one culture it may be appropriate to touchand hug. However, it may not be appropriate in the other one (Hong and Lee, 2014).

Therapeutic relationship can help in achieving harmony in mind, body and spirit and ensure that the nurse will be able to incorporate good caring behaviour towards the patient. It can be a win-win situation in which patient and nurse can share growth experience to each other.

Adopting the same in case of Mr. X, it can be stated that adoption of therapeutic relationship when the patient is already in a bad condition can help in dealing with the issue in the most effective manner. Giving emotional support to the patient can help ingetting effective treatment and responding to it.

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