Providing quality nursing care
Providing quality nursing care in this era of increased numbers of patients who are sicker than ever; how can we accomplish this? Assessing, Planning, Implementing, and Evaluating is the way. It still one of the best tools you can use in the pursuit of quality patient care. Essentially, it is an organized method of problem solving. In any shift, you will find yourself assessing and reassessing your patients many times. Patients and their families depend on your ability to use critical thinking to identify problems and take steps to resolve them. The nursing process can be used throughout your shift to organize your care, but assessment is always the starting point.
You start your shift with an extra patient added to your usual load due to several callouts. As you do walking rounds, you quickly assess your patients to identify any problems you need to deal with immediately. Everyone is stable at this moment so you have time to check pending orders, labs, etc. before you go back to do a more thorough assessment. Once you go back to see your patients and do those assessments, you find problems to solve in every room. Your first patient complains of increased left upper abdominal pain, at an 8 on a scale of 0-10. The patient has a diagnosis of pancreatitis, and has been having intermittent pain relieved by narcotics. The vital signs are good, with a slightly elevated blood pressure, so you medicate the patient, and retum after half an hour to evaluate the effects of the medication. Your patient feels better, with pain now 2 on a scale of 0-10, and vital signs remain stable. In the next room, your 87 year old patient was admitted with a diagnosis of GI bleeding, and had a stable night with no nausea or diarrhea, normal vital signs, and no complaints of abdominal pain. He had vague complaints of left leg pain on the previous shift, and x-rays were ordered of his left knee. These were negative, but he continues to complain of left leg pain, 8 on a scale of 0-10. This concerns you, and you decide to take the time to reassess his leg more thoroughly. You check his calf for any redness or increased heat, but don't see any difference compared to the right leg. There is a good popliteal pulse. The patient does not identify any increased pain with palpation of his calf, knee, or thigh. Finally, you move down to his foot, and remove the warm red socks he was given on admission. You are startled to note that the second and third toes on his left foot are purple and cold. When you touch them, the patient is able to identify the toes as the source of his pain. Now that you have identified the source of the pain, you can contact the physician to obtain appropriate orders and continue the process of evaluation. Your third patient, a 67 year old lady with a history of diabetes, was recently admitted with pneumonia after having symptoms of back pain, cough, and shortness of breath for two days. She has been treated with antibiotics and respiratory treatments, and has been improving. As you walk in, she complains of left sided chest pain at 6 on a scale of 0-10 for the past 10 minutes. You ask her to describe the quality of the pain, and she tells you that it is a steady, pressure-like sensation. There is no change when she takes a deep breath. It is different from her previous back pain, but still radiates to her back. You listen to her lungs; they are clear with occasional rhonchi; no change from the previous shift. Your patient denies of any previous history of cardiac problems. Her vital signs are stable, though the blood pressure is up slightly. The chest pain could be related to her pneumonia, but it worries you because it could also be cardiac. You make sure that she is getting oxygen by nasal cannula, and then place a stat call to her doctor to get orders for an EKG and cardiac enzymes. All of your patients will require reassessment after you implement your plan of action.
Critical thinking is always necessary in order to evaluate and interpret the constantly changing needs of your patients, and provide appropriate evidence-based interventions to improve their health (Wilgis & McConnell, 2008). What would be the consequences for your patients if you failed to assess and actively plan their care? Patient number one might suffer increasing pain if not medicated, or might have a severe drop in blood pressure after being medicated that is not quickly identified and treated. Patient number two has already lost circulation to two of his toes, and might suffer increasing pain and further loss of tissue sepsis could set in. Patient number three could be having an acute MI, or ventricular aneurysm, or even pulmonary embolus. It may just be related to the pneumonia, but stat testing is needed to rule out more serious and unusual problems. Nurses are the professionals who are at a patient's bedside 24 hours a day, and who can greatly improve a patient's chances for recovery by frequent assessment and effective interventions. The nursing process is one way to organize your problem solving skills practice using it on a daily basis.
