How the issues? My safety concerns with this

How
often have you had a patient in a hospital tell you that they feel scared and
uncertain of the medical treatment that they are receiving?  Hospitals can be very overwhelming to a
patient, but when the nurse incorporates patient centered care(PCC) and family
centered care(FCC) within the plan of care for her patient, she will help
diminish these feelings.  Additionally,
it is important for a nurse to, demonstrate behaviors that exhibit confidence
and skill in her nursing performance, while enforcing the quality standards of
the institution that she is employed by.

            The purpose of this paper is to explain
how PCC and FCC can contribute the healing process of a patient by diminishing
their fears and anxieties.  Lastly, I
will discuss six questions in relationship to case study one that I was given
along with this assignment.

            Masters(2017) quotes the definition
of (PCC) from the Institute of Medicine(IOM) as “providing care that is
respectful of and responsive to individual patient preferences, needs and
values and ensuring that patient values guide all clinical decisions.”  My interpretation of this statement, is that
the medical staff and the hospital institution should respect and implement the
wishes of the patient as long as it falls within the safety guidelines of care
to the patient and the facility. 
Masters(2017) further states that the definition of FCC is an “extension
of PCC, by including the family or friends of the patient into the care
plan.”  The goal for the nurse and the
medical team caring for this patient, should be to incorporate all aspects of
care and individuals that are relevant to improving the patient’s health and wellbeing.

Case Study Questions

1.    
What safety issues can you identify for this
patient and what nursing skills did you use to determine the issues?  My safety
concerns with this patient pertains to the 33 years that he has had diabetes.  According the American Diabetes Association, “diabetes
can cause several complications, including heart disease.”  This patient is only 43 years of age and is
about to have quadruple bypass surgery. 
My 26 years of nursing alerts me that this man’s diabetes has not been
managed very well and this has lead to his coronary artery disease.          

 

2.    
What interventions can you consider to provide
high quality and safe patient care?  Before I institute any interventions, I would
like to know more information about his health history, and if he has ever had diabetic
teaching, and if so how long ago was it? 
Another important question to ask him, is if he has ever had a low blood
sugar below 60?  I sensed a lot of fear from
this patient pertaining to his blood sugar being out of control if he were put
on an insulin drip.  Additionally, are
his compounded feeling’s of not being able to communicate because of his unconsciousness.  Once my data has been obtained, I would
provide him with easily understandable and accurate teaching, with my goal
being to obtain his trust in my nursing skills.

 

3.    
What is the meaning and significance of this
experience of illness to the patient?  I interpreted many feelings from this
patient.  These include; that he is
afraid of dying, and of being a cardiac cripple like his father.  I detected feelings of his financial
obligation with his surgery and hospitalization.  Lastly, it appears that he is concerned of
his capability of being intimate with his fiancée, and of possibly loosing his
job if he is off of work for to long.

 

4.    
How would I include the patient as a collaborator
in their care?  I believe that this patient needs to feel
secure in the staff and hospital that he is in for his surgery.  I would attempt to establish this trust in
him by being consistent with my plan of care. 
I would explain to him what nursing care I’m providing at the time and
what it’s purpose is.  This would include
medications, imaging, surgical preparations.  I believe that he would acknowledge that I
will be as concise and attentive postoperatively as I have been preoperatively.

 

5.    
When patient safety and patient wishes conflict,
how do nurses decide what approach to take?  This is a fine line
to walk.  As nurse’s we always want to do
everything to make our patients as comfortable as possible, but in the case of
letting him regulate his blood sugars with his insulin pump is a dangerous
situation.  I would incorporate my teaching
with him and his mother if he agreed per HIPPA guidelines to explain the
rationale of how much safer he would be with an insulin drip instead of his
insulin pump.

 

6.    
If this patient was my brother or father, how
would I intercede to influence the staff in respecting his requests?  I would
explain to the staff that this patient has many fears and concerns, and I
believe that he does not trust medical professionals very much.  When goals are set, they need to be
implemented on a timely schedule.  Consistency of care and explanation of
any medical action is very important to develop a trusting nurse-patient
relationship.  What does it mean to a patient to have an advocate?  “It means that a nurse will protect the
rights of her patients in their decision making.”