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Medical-surgical nursing is a field of nursing that is highly dynamic. Professionals such as myself in this field have to always innovate in the workplace and quickly adapt to changing conditions within the environment. Because my profession involves dealing with patients with chest pains, bariatrics, Congestive Heart Failure(CHF), and pneumonia, the status of patients is always fluctuating, and one has to use critical thinking to come up with a solution. Critical thinking in medical-surgical nursing is part of everyday life. A medical-surgical nurse should have the capacity to use the information one has acquired to objectively analyze and evaluate a situation and come up with an informed judgment (Ignatavicius & Workman, 2006). This paper will examine critical thinking in a particular incident in my workplace.
A woman had to spend an additional five days at my workplace owing to lack of critical thinking by a medical-surgical nurse. The woman had just given birth through cesarean. After successfully giving birth, she remained in intensive care as the doctors monitored her progress. After a few days of substantial improvement in her health, she started complaining of stomach pains along with chest pains. As a person who had just undergone an operation, the nurse in charge issued her with some strong painkillers which worked to reduce the chest pains. Later that day, the woman was discharged from the hospital. Later that day she was readmitted with severe chest and stomach pains. She underwent a CT scan. The scan revealed that she had a gaseous abdomen band. However, the doctor recommended another CT scan and the scan showed a perforated hollow viscus which had caused severe pneumonia. As it turns out the medical-surgical nurse in charge had failed to report the stomach and chest pains to the doctor because the patient exhibited signs that are typical of patients who have just undergone a cesarean. The strong painkillers had made the situation worse because they had worked to remove the pains hence the patient was unaware of her condition. As the hospital administration later revealed, the patient had contracted pneumonia before giving birth.
The medical-surgical nurse in charge was one with a lot of experience. She had been in charge of several similar cases, and the signs and symptoms convinced the nurse that the patient was suffering from post-surgical effects. The nurse took the background information into consideration because the patient had undergone an operation. However, she did not consider the environment because it was a cold season and the patient had been exposed to some elements of weather. There was no adequate consideration of alternative causes such as a mistake in the cesarean process or a secondary disease such as pneumonia. The situation needed someone who is flexible, one who can consider alternatives to help the patient. But flexibility alone is only applicable if one is fully engaged. As for the nurse, she was probably too disengaged to notice the chest pains complaints by the patient and just took note of the stomach pains complaints. The decisions made were based on usual practice. But in this particular incident, there was a need to seek out the truth even if it went contrary to general practice. The patient was a pregnant lady who the doctors closely monitored before the operation. It was the usual practice that a dominant disease such as severe pneumonia would have gone unnoticed by the doctors before she entered the operating room. However, on this occasion that was not the case and the nurse needed to deviate from her usual procedure.
The signs were there, but they resembled other post-operation symptoms. Low-grade fever, shortness of breath and tiredness were all present in the patient(Marco et al., 2005). The same signs are also present in most patients who have undergone an operation. In such cases, it would make sense to get a second opinion, but this did not happen. Not only did the nurse fail to get a second opinion from the doctor, but she also was unable to seek the second opinion from us as her colleagues. The second opinion is an integral part of critical thinking (Paul & Elder, 2006). After administering the painkillers to the patient, the nurse could have checked in on the patient to see her progress. The nurse failed to do so hence gave up too quickly. Because the nurse did not forward her patient's complaints, nobody was standing back to reflect on what was going on. The hospital should have assigned more than one nurse or have nurses attend to this patient in shifts hence indicating lack of critical thinking on the hospital's administration part.
There is no evidence of the nurse breaking the situation down. The schedule later revealed that the nurse had taken an extra shift which could have impaired her judgment because of fatigue. There is, therefore, no way to tell if the nurse upheld the standards. The similarities in the signs suffered by the patient were carefully distinguished, but the differences were not recognized. For example, persistent dry cough is not typical of a patient that underwent a cesarean, and it should have stood out as a red flag. Had the nurse garnered all possible information, she would have noticed some deviation from the common post-surgical symptoms.
There was adequate evidence to support the conclusion drawn by the nurse. For any nurse in such a situation, the post-surgical pain would have been the first conclusion before critically analyzing the situation. However, there was evidence that the pneumonia was predictable, as for the gaseous abdomen band, there was no evidence. Overall knowledge was not properly utilized to objectively analyze and evaluate the situation to come up with an informed decision. It is clear the nurse was fatigued, and the hospital needs to change their schedule to prevent such incidents.
Ignatavicius, D. D., & Workman, M. L. (2006). Medical-surgical nursing: Critical thinking for collaborative care. Elsevier Saunders.
Marco, A. P., Greenwald, M. K., & Higgins, M. S. (2005). A preliminary study of 24-hour post-cesarean patient-controlled analgesia: postoperative pain reports and morphine requests/utilization are greater in abstaining smokers than non-smokers. Medical science monitor, 11(6), 255.
Paul, R., & Elder, L. (2006). The miniature guide to critical thinking: Concepts & tools. Dillon Beach, CA: Foundation for Critical Thinking.
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