Advanced Nursing Practice Situation

Scenario: Today is a busy day at the community health center since yesterday was a holiday. I am seeing walk-ins, and my three examination rooms are full. I hope I will be able to see more than 20 patients today—the expectation of ‘management’—and will be rewarded with a productivity bonus. My next patient is John, a 42-y.o. man I have known for several years. He is accompanied as usual by his wife Mary. Today, John is complaining of lower extremity swelling and pain in most of his joints. He is worried about losing his job as a truck driver, because he is having difficulty climbing in and out of his truck. He is afraid that he may have lupus, because all of his siblings and his mom have this disorder. He also requests a refill on his antidepressant, which doesn’t seem to be working as well as it did a month ago. While reviewing his chart, I notice that John has gained weight—he now weighs over 300 lbs. In reviewing his medications, I see that the antidepressant he is taking may be contributing to his weight gain. John’s physical examination is unremarkable. His heart rate is regular without murmur or irregularity, and his lung sounds are without wheezes or crackle. Since John is a large man, all of his joints areas are large, but they are all symmetrical, with good range of motion and only mild palpation tenderness in his wrists. His ankles are large but without erythema or other skin discoloration or disruption, and his pedal pulses are strong and equal bilaterally.

I ponder how to manage this visit. Do I take the time to investigate John’s depression more thoroughly, wondering about his 11 y.o. daughter, who at his last visit was on chemotherapy for a neuroblastoma? Should we discuss the pros and cons of different antidepressants? Should we discuss the possibility of a gastric bypass again, even though I know the thought of anesthesia terrifies him? Do we again discuss the importance of a healthy diet and increased exercise, giving consideration to his joint pain? I am torn between what I feel this patient deserves and the call of the clock. Would it be unreasonable to order the necessary lab tests to investigate the possibility of lupus, hypothyroidism, or some other disorder and postpone these time-consuming discussions until his next visit?If I am expedient with this visit, the other patients waiting also will be grateful. Maintaining a caring practice in an economically driven discipline requires skill and grounding in those values that are essential for quality patient care. In the context of the caring theory and analysis of the Advanced Practice Nursing Situation above, let’s discuss this situation using “multiple ways of knowing.”

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Questions for this week’s Postings:

In your posting this week please provide a word metaphor that might express the meaning of this situation as described above?
Remember this is your opportunity to tap into the aesthetics of knowing that is seeing the beauty and uniqueness in this situation so think about it a bit before responding.
Make it your own word and not just what someone else said.
Please explain why you chose this word and if you have experienced this type of situation before and what did feel about that situation?

 

Sample Answer

 

On the situation presented for this week the best metaphor, I could use to describe the situation is “collective fighting” against the pressing life situation. In the situation presented the health facility is flooded with patients having different health issues. As a health practitioner, I expect to attend to more than 20 patients as per the expectations of the management. The patient at hand, John aged 42 years old accompanied by his wife Mary, has been experiencing lower extremity swelling with increasing joint pains. John is worried about losing his job as truck drivers due to the difficulties of climbing out of the truck. He is also worried about having lupus, a situation that seems prevalent in their family.

However, as a health practitioner, it is my duty to ensure the situation is under control irrespective of the pressure and worries the patients might be undergoing. By using the metaphor “collective fighting”, Mr. John will have a feeling that I am part of his current situation of health. Besides, this will revive his fighting spirit and lower the possibilities of giving up in life. However, considering the stringent ethical standards demanded in the field of medicine, I would explain to John all his situations candidly and give a rationale for a positive living (Houser, 2016). Secondly, it would be pretty in order to administer laboratory tests to establish the health issues with certainty.

Further, since lupus seems to be prevalent in John’s family, it will be necessary for him to undergo lab tests to help live and maintain a healthy living. In summary, since medicine practice is an ethical discipline, there is need to show exceptional skills and quality service delivery by maintaining unbiased clarification of life situation based on the test results (Sherwood, & McNeill, 2017). Next, by applying the triage principle, I will be able to deal with the patients based on their conditions. I chose the metaphor “collective fighting” to create an image of struggling without quitting. Additionally, this phrase gives a sense of solving the problem as a team, which gives them a sense of belonging and even pressing harder in the fight for their lives.

 

References

Houser, J. (2016). Nursing research: Reading, using and creating evidence. Jones & Bartlett Learning.

Sherwood, G., & McNeill, J. (2017). Reflective practice: providing safe quality patient-centered pain management. Pain management, 7(3), 197-205.

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