Gastroenterology Nursing

In the health care facility

I have been working within the gastroenterological unit. The department is concerned with the gut health in which doctors engage in investigation, diagnosis, and treatment of related conditions. The main duty of the qualified gastroenterologists is to conduct endoscopy for both upper and lower gastrointestinal conditions. Normally, a patient admitted in gastroenterology wards requires special nursing care because of their digestive system is so delicate. As such, I applied the ideas from the classroom along with the skills acquired along the line practice to administer the best care possible. Following the experience with various patients, it is now easy to link theory to practice and appreciate the course (Fusaroli et al. 2012, p. 1064). For purposes of discussion, a case involving a 40 year old patient will be considered. The female patient was admitted in gastroenterology ward suffering from Liver Cirrhosis. Basically, the patient is selected because her condition is a long term condition which requires extensive care and management. At the same time, the patient’s initial condition was such that she complained of pain, was weak such that she could not walk on her own. Such a condition provides the best scenario for exercising professional nursing duties while monitoring progress (Guevara et al. 2010, p. 1137). Therefore, this paper will explore the care stages for the patient including assessment, compassionate, safe, and effective care.

Ethical and Professional Roles

In the care of patients, it is important that the nurse observes ethical and professional code of conduct for practice. The standards are set to ensure comfortable relationship between nurse and patient as well as family members. Within the gastroenterology ward, the two upfront code of ethics include giving respect and maintaining confidentiality. The scope of respect involves patients, friends and families participating in treatment process. By definition, respect can mean to esteem another person in such way that you recognize and consider their uniqueness and essence in every decision making step. In critical care practice, respect becomes one of the foundational principle which determines the excellence of the entire duty (Aitamaa et al. 2010, p. 470). Nursing requires that respect be accorded to individuals because they are human and not for the sake of respective titles, position, or race. In this regard, a respectful nursing practice entails appreciating patient choices, welcoming patient participation in decision making, ensuring effective communication, and not judging the patients. When caring for a patient, nurses are not expected to withhold any information from the family of the patient himself regarding their condition and response to medication. Additionally, the nurse should give whole attendance and not fragment care services based on personal judgments. Although ethical code call for respect, nurses may sometimes violate the principle knowingly or unknowingly. Nonetheless, it is an obligation for every professional registered nurse to exercise respect for all patients (Iacobucci et al. 2013, p. 486). Within the gastroenterology ward, the patients were expected to be treated with respect such that they are informed of their condition and their say factored in during the care period.

On the other hand, the principle of maintaining confidentiality states that a nurse should ensure privacy of every information disclosed to them by the patients and families. With confidentiality in place, a trusting relationship between nurses and patients as well as families and fellow nurses can be established. Information must be kept confidential unless it fall below the set limit of confidentiality. In certain cases, a family member may disclose something that the patient is not aware of (Rosenkoetter & Milstead, 2010, p. 137). Such circumstances may provoke an attempt of violation when the nurse tells the patient in fulfilling the principle of respect whereby information should not be kept from the patient. Therefore, it is possible to say that the principles do not function exclusively but can sometimes be violated depending on the situation at hand. However, nurses must make every effort to ensure that ethical and professional code is adhered to in the line of practice since every nurse is responsible for his/her action. Consequently, the secret information about the admitted woman remains private with the nurse throughout her stay and afterwards (Zahedi et al. 2013, p. 1).

Physical and Psychological Impact of the LTC

The long term condition (LTC) under consideration is Liver Cirrhosis. Medically, the condition leads to both physical and psychological impairments depending on the duration and severity of the attack. The impacts may both exist at the same time or the psychological effects may follow the physical either instantly or progressively. In the case of our patient, the liver disease might have been caused and worsened by alcohol intake since she was reported to have a medical history of ETOH. The physical impacts of Cirrhosis noticed in the patient includes loss of weight leading to weakness in the entire body, very dry skin usually characterized by itchy sensation (Tsochatzis et al. 2014, p. 1749). Due to the body weakness, the patient could not walk on her own and so she was supported from one place to another. At the same time, she had a swollen abdomen due to the accumulation of fluids, a condition known as ascites. Moreover, the patient lost appetite and complained of pain and fatigue. Normally, Cirrhosis affects the body such that a yellow discoloration appears in the eyes and skin surface due to concentration of metabolic toxins in the bloodstream. Additionally, the condition made the palms to become ready and the blood vessels sticking out on the skin. The physical symptoms points to the fact that the patient’s liver was extensively damaged (Zhou et al. 2014, p. 7312).

Severe liver damage leads to psychological disorders when the toxins in the blood build up in the brain. As a result, brain function declines, a condition referred to as hepatic encephalopathy. The admitted patient with Liver Cirrhosis showed signs of mental activity retardation such as poor concentration, difficulty in thinking, and forgetfulness. Also, she exhibited hepatic encephalopathy symptoms including poor judgment, confusion, anxiety, and drowsiness. Due to brain impairment, the patient had lost hand movements for writing and expressed confusion in speech (Felipo, 2013, p. 851). Generally, the 40 year old behaved more like a small child since she was assisted in doing most of the things including speech therapy. However, the hepatic encephalopathy had not reached a critical stage of a coma and was manageable. Nevertheless, quick treatment and care was necessary to mitigate the effects of the symptoms which are known to be so deadly. The onset of hepatic encephalopathy made the patient dependent on support and poor reasoning such that it was difficult to engage her in decision making (Johnson et al. 2010, p. 200). As such, the family was requested to be available for purposes of consultation. The presence of both physical and psychological impacts on the same patient initiated advanced nursing care practice.

Activity of Living and Assessment

In view of the physical and psychological impacts identified in the patient, it is clear that she cannot manage certain activities of daily living of which nurse assessment and assistance is required. Since the patient has weak body and cannot walk on her own, it is obvious that she cannot accomplished functional mobility. As such, she cannot get from the bed to a chair of go anywhere without support. Therefore, the forty year old lies or sits in one particular position until she is transferred to a new place. In order to select an appropriate occupational therapy for the patient, the nurse must first perform a mobility assessment (Bajaj et al. 2011, p. 1646). Primarily, the purpose of the assessment procedure is to provide the necessary details for the selection of the best safe patient handling and mobility (SPHM) technology. The right choice of SPHM makes it safer to transfer patients during hospitalization. In the case of our patient, the registered nurse carried out the assessment in four stages. The first step is the assessment of siting balance and trunk strength. To get the results, the patient was placed in a semi-inclined position and told to sit upright. Additionally, she was request to reach out for the nurse’s hand as well as to rotate in the sitting position (Cook et al. 2014, p. 396). The outcome was shaky movement of body parts and instability but was able to rotate and grab the nurse’s hand.

The second assessment stage is for examining the strength of lower extremities as well as the stability. The procedure involved having the patient at the edge of the bed with the feet on the floor position. She was then asked to straighten one knee and point toes with the ankle bent. The process is repeated with the other leg as well. Fortunately, the patient was able to perform the required moves and so confirmed strength in the lower extremities. Meanwhile, the third assessment stage is for testing the strength of the lower extremities to stand. At this stage, the patient is required to stand from the bed using with the help of an assistive device (Schell et al. 2013, p. 10). A patient is declared strong enough to stand if she is able to hold on for a given number of counts by the nurse. The case patient was able to rise from bed and stand for the entire period of five counts. The final step involves an assessment of gait and standing balance. Here, the patient is required to walk around the bedside. During the process, the nurse evaluated stability and balance on motion. For this last test, the patient in question could not manage to walk on her own. Therefore, she was confirmed to be at mobility level 3 for patients who can stand with support but unable to go about independently (Brown & Flood, 2013, p. 1170).

Effective Care

The case patient has been confirm to be immobile from one location to another and so depend entirely on the nurse for movement. Therefore, there was need for safe patient handling procedure so as to make movement convenient and to protect the nurse from injury. Meaning, the selected occupational therapy care must be safe, effective and compassionate. In this regard, the most appropriate care for transferring patients within the ward setting is the combination of patient lift and slings. The lifts are either electrically powered or hydraulic operated. The assistive device help the nurse to move the patient from the chair to the bed easily and with limited body mobility (Sharps & Romig, 2013, p. 381). Normally, patient lifts exists in different types and for different purposes. For instance, the stand-up lift is used for moving the patient from a sitting to standing position, whereas bathtub lift is useful for transferring the patient from the bed to the bathtub for a bath. By the use of patient lift, the case patient could be moved efficiently from the bed to a chair as well as transferring her across other beds for medical attention. Moreover, the electrically powered lift ensured smooth motions suitable for a patient experiencing body pains (Spidare et al. 2012, p. 272). As a result, the woman received compassionate care for her condition.

The safety part of the care was met by the presence of sling attached to the lift. Generally, four types of slings were applicable in the patient’s case namely, U-sling, full body sling, bathing and toileting sling, and stand up slings. Since the patient assessed has pain and body weakness, it was proper to assigned stand up sling to be used alongside stand up lift. As such, she was able to rise to a sitting position efficiently and safely without risk of falling from the bed. Regarding using the restroom and bathing, the toileting sling was used together with the bathtub lift (Spidare et al. 2012b, p. 250). The process ensured that she stayed in good hygiene as was the care nurse. On the other hand, full body sling was appropriate for providing maximum body support when transferring the patient from the bed to a seat or from bed to stretcher. Finally, the u-sling supported the woman when she was seated so that she might not topple over. Definitely, the combination of patient lift and sling provided the best care as the assistive device for functional mobility. Just by the operation of the lifts controls, the nurse was able to get the woman in motion to the desired position and location as guided by sling type (Biersteker et al. 2011, p. 921). Consequently, the care was safe, compassionate, and effective for the patient, nurse, and other ward users.

Lessons Learnt and Conclusion

Basically, there is more to understand when it comes to the practical field. Several patients were admitted to the health facility with various conditions requiring special attention in each case. The first thing that came to mind are the ethical and professional code for nursing which gave the basic guideline of relating with patients, fellow nurses, and personal commitment to service delivery. The session allowed to appreciate how the ethical principle relate and where to apply each for the best result. The second concept noticed was the practical manifestation of the theoretical concepts of nursing. For instance, I served as a novice who was under supervision and enquired in almost each step. Meanwhile, the practicing registered nurses were spread across the subsequent Benner’s levels according to years of experience (Weidman, 2013, p. 102). Actually, I have come to realize that theory in course work is more of an ideal case of events. However, the picture painted in the nursing practical field is an interplay of many factors. For instance, the course work points out that a nurse has the responsibility to care for the patient and monitor progress, but that one depends on whether the patient is willing to corporate and the availability of appropriate tools (Anderson et al. 2012, p. 205). In conclusion, nursing theory is the general guideline to practice which forms the foundation and reference point for professional service suitable for patients.

References

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