A case study: A patient s Advocacy

Transcription

1 A case study: A patient s Advocacy An insight of renal nurse s inpatient experience in Emergency Department (ED) promoting a person-centred care (PCC)

2 Presentation's contents 1: Renal nurse s inpatient event in ED 2: Reflection using (GIBBS) Cycle on rendered care 3: Contemporary clinical practice s & adverse impacts 4: PCC approach in caring for end stage kidney disease (ESKD) population 5: Take home key message: PCC & nursing advocacy

3 Reflection using (GIBBS) Cycle

4 Renal nurse s inpatient event 1: 46 year old woman, living with family 2: Admitted twice to ED with acute pain 3: Headache, black outs, nausea & projectile vomiting 4: Got operated & received speedy recovery

5 Reflection using (GIBBS) Cycle: On first physician care Description: Patient was kept in vulnerable position Feelings: Young & active person / sudden illness / severe clinical presentations Evaluation: Missed clinical judgement in making clinical diagnosis

6 Reflection using (GIBBS) Cycle: On first physician care Conclusion: Discharge home without treating the root cause Action: Negligence Near miss event or an adverse event

7 Critical thinking on near miss event s outcome Near miss or adverse event impacts: Poor patient s outcome: Stroke / Brain death Disability / Death Impacting client's family Impacting to their community

8 Reflection using (GIBBS) Cycle: Second doctor s care decisions Description: Patient autonomy is respected PCC by listening to the client Feelings: Physician comprehended client s situation / strived to make right clinical judgement Evaluation: Right clinical assumption was made

9 Reflection using (GIBBS) Cycle: Second doctor s care decisions Conclusion: Transfer to right health care facility to treat root cause Action: Promoting PCC Life saving event Positive client outcome Pleasant inpatient experience

10 Contemporary clinical practice and impacts 1: Early discharge 2: The culture of professional practice in ED 3: A pre-set clinical guidelines and organisational policies 4: Increased number of patient admissions 5: Shortage of heath care professionals

11 Learnt insight principles from our case study & renal care application: Importance of Application of PCC approach Application of nursing advocacy role Application of GIBBS reflective critical thinking cycle In preventing near miss & adverse events

12 Case study s insight PCC application for ESKD population Available to Walk an extra mile with our clients Listening to their present problems Supporting them with information to resolve Involving them in chronic disease management Empowering them to live with improved quality of life

13 Shared decision making Case study s insight PCC application (ESKD people) Informed decision making Conservative renal care approach Collaborative chronic care approach Home dialysis decision making Refusal to dialysis treatment

14 Renal Nursing advocacy & Near miss or adverse events Renal nurses can prevent near miss or adverse events: 1: By being great resource 2: By updating clinical knowledge & skills 3: By involving right interdisciplinary team member 4: By identifying abnormal variants AEAP

15 Take home key message: PCC & client s positive outcome PCC: Reflective clinical practice / Clients positive outcome Nurses-patient therapeutic relationship role / Education Importance of nursing advocacy / vulnerable clients Empowerment of clients / choosing their treatment

16 This case study s client is not anybody else & is about myself

17 Reference Alfaro-LeFevre, R. (2013). Critical Thinking, Clinical Reasoning, and Clinical Judgement: a Practical Approach (5th ed.). USA: Saunders: Elsevier Inc. Australian Commission on Safety and Quality Care. (2008). Australian Charter of Healthcare Rights. Australia: Australian Commission on Safety and Quality Care. Browne, G., Cashin, A., & Graham, I. (2012). The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do! Journal of Psychiatric & Mental Health Nursing, 19(9), doi: /j x Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development of a therapeutic relationship. British Journal of Community Nursing, 19(10), doi: /bjcn

18 Reference Fact Sheet. Subdural haematomas. Retrieved , from Better health Channel omas/$file/subdural_haematomas.pdf Murray, M. A., Bissonnette, J., Kryworuchko, J., Gifford, W., & Calverley, S. (2013). Whose choice is it? Shared decision making in nephrology care. Seminars In Dialysis, 26(2), doi: /sdi Mollicone, D., Pulliam, J., & Lacson, E., Jr. (2013). The culture of education in a large dialysis organization: informing patient-centred decision making on treatment options for renal replacement therapy. Seminars In Dialysis, 26(2), doi: /sdi Victorian Auditor-General s Report. (2008). Managing acute patient flows. 2015, from Managing-Acute-Patient-Flows.pdf

19 Thank You & Questions