FACILITATED SENSEMAKING
When a loved one is admitted to an ICU especially in critical health status, patient family members usually experienced anxiety, fear, depression, uncertainty and nervousness, traumatic experiences (post-traumatic stress). This needed support among the healthcare members especially nurses who assume the role of patient advocate. Family need to have a better understanding of the situation and what they should do to promote the feeling of comfort, security, serenity and to adapt to their new role as caregiver, thus preventing adverse psychological outcomes.
Most ICU patients cannot make a decision for their own medical treatment, in such way family may be required to make a difficult decision on behalf of the patient,
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Sensemaking is an iterative process that should be addressed as patient condition changes, providing an understanding of situation and surroundings.
Laurette et al., (2007) conducted a randomised controlled trial in France to investigate adverse psychological outcomes in family members in ICU and showed significant reduction of adverse outcomes using written information and a structured method of case conferencing. The family members are given an opportunity to enquire questions, express worries, and confront painful emotions with the help of caring, compassionate professionals.
Davidson (2010) recommends set of nursing interventions in facilitated sensemaking to helping families make sense of the situation and give meaning to the caregiver such as:
1.) Establishing rapport, to know the patient family members and describing the cues in the environment, evaluating family understanding of why the patient is brought in
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Often family members of patient needs are being neglected or unintentionally overlooked especial simple needs. The opportunity given to family members to be involved in bedside care lessen their feeling of helplessness. Addressing family needs help them through the process thus minimise adverse psychological outcomes. Further testing of facilitated sense making is warranted to recognise if the set interventions are effective. Perhaps it will be in advantage having a post-ICU clinic run by nurses like in the United Kingdom to assist family needs in addressing long-lasting anxiety, depression and symptoms of
Sometimes when patients come into the hospital it can be difficult at times for them when they are feeling bad in knowing exactly what is going on. There are cases where it’s
Kindness and thankfulness are appreciated, but you have to be careful with eye contact and touching of the patient. With male patients touching with a handshake is important, but with women you should wait for them to extend their hand first. Eye contact varies with the patient. Some see prolonged eye contact as a sign of being impolite. Most importantly lengthy indirect discussion of a condition is not preferred, but the method of direct action oriented approach is
Nursing practice requires both critical thinking and clinical reasoning. Critical thinking is the process of deliberate higher level thinking to define a patient’s problem, examine the evidence-based practice in caring for the patient’s, and make options in the delivery of optimal care. Critical thinking involves the demarcation of statements of fact, judgment, and opinion. The progression of critical thinking requires the nurse to think imaginatively, use reflection, and engage in logical thinking (Alfaro-LeFevre, 2013). Critical thinking is a vital skill needed for the recognition of patient’s problems and the execution of interventions to endorse effectual care outcomes (Bittencourt & Crossetti, 2012).
“Concept clarification is an important step in developing useful and useable knowledge in nursing science.” (Tofthagen, 2010). Within the home health field of nursing one of the major and most significant concepts is team work. Simply stated, concept analysis incorporates a method or approach by which concepts that are of interest to a discipline are examined in order to clarify their characteristics or attributes” (Cronin, 2010). Within a home health care team there are Registered Nurses, Physical Therapists, Home Health Aides, Medical Social Workers, Managed Care Coordinators, and Clinical Managers.
My Intent to Be a Nurse Practitioner Coming from a third world country where there aren’t many opportunities for work and funding for education, proceding to nursing school was a grand opportunity. The privilege to attend a government subsidized school where top students in the region compete to get into the program that allowed only 60 students per year was indeed a blessing. As clinical rotations began, what was once considered a mere opportunity evolved into a true passion for caring as I truly love and enjoy nursing and helping people.
Information processing theory The information processing theory is a structure which rationalises how people obtain; process and store information and knowledge (Tangen & Borders 2017, p. 99). The Information processing theory involves the clinical reasoning cycle and the information processing model. The clinical reasoning cycle is a model which guides nurses and other health practitioners in making clinical judgements (Levett-Jones 2018, p. 4).
In that situation, family members who are present at the time of attempted resuscitation are at high risk for emotional and physical burdens.1On the other hand, being family present during resuscitation may help the family members understand that everything possible to bring the patient back to life has been implemented.1 In addition to quelling suspicion about behind-closed-doors resuscitation efforts and unrealistic expectations of such efforts, the family member's presence may offer the opportunity for a last goodbye and help that person grasp the reality of death, with the hope that the bereavement process will not be prolonged or post-traumatic stress disorder (PTSD). Although, the benefits and drawbacks of family presence during resuscitation have been argued since 1987,1 the potential benefits must be weighed against the possibility of stress induced in health care providers and an increase in the emotional burden on family members, as well as the risk of legal claims
These factors provide guidelines for nurse-patient relationship, and the goal of nursing to help persons attain a higher level of harmony within the mind-body-spirit, healing and health. The 10 caritas processes include the practice of loving kindness, equanimity, and belief system for oneself and other. She promotes cultivation one’s world spiritual practices, self-awareness, authentic relationship with the patient, and support patient’s expression of feelings. In addition, she encourage to creatively use the nursing knowledge as part of the caring process, engage in genuine teaching-learning experience, and create a healing environment at all levels. Watson believes that the nurse’s assistance with patient’s basic needs potentiate alignment of the mind-body-spirit.
It is created through analysis of research and construction of concepts and theories (Busso, Poles, & Monteiro da Cruz, 2014). Concept analysis serve a purpose within theory development as it represents continuation of knowledge in nursing profession. When theories and concepts are developed, it must be practiced in a clinical setting to validate research. The caring concept applies to Jean Watson’s Theory of Human Caring as it creates an environment for healing, bonding, and improving patient outcomes. The concept of caring depicts the attitude of the nurse and the inclination given to meet the needs of the patient from emotional or physical standpoints (Emerson, 2017).
In the past I have shown my strength in this area of nursing care when looking after family members that have fallen victim to sickness. Whenever someone tells me that they are not feeling well, I immediately jump into action and try my best to make sure that they feel “cared for” .The feeling of pride and satisfaction I experience after caring for a person that is unwell is what originally made me choose nursing as a career. Caring is a basic attribute of human growth and development (Griffin 1983). This is why, as a nursing student I know it is such an important strength to be utilised when helping a patient to feel better.
This paper addresses the effects of nursing interventions on the prevention and management of intensive care unit (ICU) psychosis. ICU psychosis (or ICU delirium) is a sudden onset of confusion, lethargy, hallucinations, and distress during an ICU stay. ICU psychosis is distressing to the patient, family, and nursing staff, and can result in detrimental health outcomes. ICU psychosis is relatively unstudied and untreated, yet highly prevalent in the ICU (Idemoto, 2007). With the implementation of the Confusion Assessment Method in the ICU (CAM-ICU), it is now estimated that 87% of all ICU patients experience delirium (Dimensions of Critical Care Nursing).
Family theories have been used throughout the history of nursing to help guide patient care and provide the best patient outcomes. Certain theories may be more applicable to the specific patient encounter; however, each theory has benefits and drawbacks to their use. The purpose of this paper is to examine two selected theories, comparing their strengths and weaknesses. I will also discuss a theoretical family in relation to one theory, and how that theory can be best integrated into the care provided by an Advanced Practice Nurse (APN). Description of Theories
Examples from my personal experience within my family were provided to gain a better understanding of the application of each approach to family care. While one approach is not better than another, each approach is situational. It is important as a nurse to interview the patient and family to gather an understanding of their culture, needs, and expectations. The nurse should then assess the entire situation and plan appropriate interventions that would best fit the family and situation that is presented. This allows for a higher quality of care, better outcomes, and increased compliance to support the well-being of the
Open ended questions are a good way to obtain fuller information, rather than a closed ended question that requires more than a simple yes or no answer. This therapeutic communication technique is particularly useful when the nurse wants fuller and deeper information from the client and wants to know the patient’s feelings and beliefs about their current health situation. Closed ended questions are useful when the client is cognitively impaired or they are on mechanical ventilation with intubation and not able to speak with the nurse and others. Nontherapeutic communication, like giving false reassurance or sympathy or just asking “why” questions, verbally or nonverbally, can make patients feel defensive. If we try to make assumptions about his/her feelings, we might jump to the wrong conclusions.
Providing education to the family and patient about what to expect will relieve the stress of the unknown. It is necessary to readdress taught information as reinforcement will provide an increase in confidence. In addition to providing emotional support, it will be important to help the family organize the patient’s environment. Setting up a hospital bed up in an area that is free of clutter, with room for family members to deliver care. Teaching patients how to change linens on the patient 's bed when the patient is unable to