Verbal Presentation Example2


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Verbal Presentation Example2

  1. 1. CRITICAL INCIDENT PRESENTATION Presented by: Arthur Aquino
  2. 2. Introduction <ul><li>Description of the incident </li></ul><ul><li>The impact of this incident to Mr. D </li></ul><ul><li>The bigger picture </li></ul><ul><ul><li>Pathophysiology </li></ul></ul><ul><li>Issues that emerge from this incident will be identified and analysed </li></ul><ul><li>My position in relation to this incident will be identified and the roles of the nurse will be discussed. </li></ul><ul><li>My recommendations will be identified and explored. </li></ul><ul><li>Conclusion </li></ul>
  3. 3. The Incident <ul><li>The Tesio Catheter Insertion and the Fistula </li></ul>
  4. 4. The meaning <ul><li>Impact on Mr. D </li></ul><ul><ul><li>Mr. D was not ready physically, mentally, and emotionally to have the procedure done that day. </li></ul></ul><ul><ul><li>Not included when the team had a meeting prior to the doctor’s round. </li></ul></ul><ul><ul><li>Mr. D was disempowered </li></ul></ul>
  5. 5. Looking at the bigger picture <ul><li>Pathophysiology </li></ul><ul><ul><li>End stage renal failure </li></ul></ul><ul><ul><li>Kidneys are unable to perform excretory, regulatory and metabolic functions. (Brown & Edwards, 2005) </li></ul></ul><ul><ul><li>Mr. D’s blood test showed elevated serum creatinine and urea </li></ul></ul><ul><ul><li>Clinical manifestations such as lethargy, SOB, slight peripheral oedema, pruritus, and urine-like odour on his breath </li></ul></ul>
  6. 6. Looking at the bigger picture <ul><li>Pathophysiology </li></ul><ul><ul><li>Mr. D comes for regular haemodialysis 3x/week but does not get the optimum benefits of HD </li></ul></ul><ul><ul><li>Fistula needs repair because of venous stenosis or narrowing of the vessel </li></ul></ul><ul><ul><li>The tesio catheter insertion is necessary as a temporary vascular access while waiting for the fistula to be repaired or a creation of a new fistula. </li></ul></ul>
  7. 7. Analysis/Reflection on the issues that emerge from the incident <ul><li>1.Power </li></ul><ul><ul><li>Expert Power is defined as the ability to influence the decision making ability of others through the possession of skills and knowledge that are useful to others (Kubsch, as cited in Manojlovich,2007) </li></ul></ul><ul><ul><li>Mr. D could be intimidated, scared, and shy </li></ul></ul><ul><ul><li>Power dimension in the patient-nurse relationship is a barrier to patient active participation to his own care (Crumbie & Lawrence, 2002) </li></ul></ul>
  8. 8. 1. Power <ul><li>Patient tend to be submissive to the EXPERT KNOWLEDGE of the medical professionals and eventually AGREED to the health team’s plan (Crumbie & Lawrence, 2002) </li></ul><ul><li>Mr. D became vulnerable because of the chronic illness and limited knowledge to his medical condition. He did not have much of a choice because he needed the procedure. </li></ul>
  9. 9. 1. Power <ul><li>The nurse should maintain the balance of power within the nurse-patient relationship by considering factors such as patient’s emotions, social support, health beliefs, attitudes, lifestyle preference, knowledge and understanding and personality (Crumbie & Lawrence, 2002) </li></ul><ul><li>Effects of resolving power differential </li></ul><ul><ul><li>Patient taking control </li></ul></ul><ul><ul><li>Patient becomes active participant of their care </li></ul></ul><ul><ul><li>Involve in decision making process </li></ul></ul><ul><ul><li>Patients are consulted on an issue that concerns about them </li></ul></ul><ul><ul><li>(Obeid, 2000) </li></ul></ul>
  10. 10. 2. Advocacy <ul><li>Advocacy means someone who intercedes on behalf of another (Bu & Jezewski, 2006) </li></ul><ul><li>Konhke's model of advocacy is focused on </li></ul><ul><ul><li>The patient's right to self-determination and this is achieved by informing the patients and then supporting the decisions they make. </li></ul></ul><ul><ul><ul><ul><li>(as cited in Bu & Jezewski, 2006) </li></ul></ul></ul></ul>
  11. 11. 2. Advocacy <ul><li>Another aspect of advocacy is preserving and representing patient’s values, benefits, and rights in a situation where patients are unable to help and represent themselves. (Bu & Jezewski, 2006) </li></ul><ul><li>Based on this aspect of advocacy, the 3 rd principle of the Code of Conduct issued by the Nursing Council of New Zealand (2006) states that the nurse respects the rights of patients by providing information to enable patient to exercise informed choice and consent to the delivery of nursing care. </li></ul>
  12. 12. 3. Principle of Beneficence <ul><li>Beneficence refers to the concept of doing good ; performing the action and the outcome regarded as worthwhile, now or in the future. </li></ul><ul><li>Beneficence, in a nurse-client relationship, requires a partnership with the patient and the result of that partnership is viewed by the patient as beneficial to their own interpretation </li></ul><ul><li>(New Zealand Nurses Organisation [NZNO], 2001) </li></ul>
  13. 13. My Position <ul><li>To be there with the patient </li></ul><ul><li>To identify patient’s concerns </li></ul><ul><li>To facilitate informed consent </li></ul><ul><li>To support patient’s decision </li></ul>
  14. 14. Roles of the Nurse <ul><li>Protector and client advocate </li></ul><ul><li>Communicator </li></ul><ul><ul><li>Maintain therapeutic communication </li></ul></ul><ul><ul><ul><li>Help the patient learn about their illness, coping mechanisms (i.e. pain), and to assure the patient that someone is there to be with them to ease their suffering or anxiety (Arnold & Boggs, 2003) </li></ul></ul></ul>
  15. 15. Roles of the Nurse <ul><li>Critical decision maker </li></ul><ul><ul><li>Using critical thinking and problem solving skills, keeping in mind the patient remains the core of the entire process (Rogers & Niven, 2003) </li></ul></ul><ul><ul><li>Makes decision in collaboration with patient and family (Crisp & Taylor, 2001) </li></ul></ul>
  16. 16. My Recommendations <ul><li>1. Focus on patient-centred care by: </li></ul><ul><ul><li>Valuing and acknowledging patient’s own way of interpreting what is happening to him. Take time to sit down with the patient and ask his own views regarding his condition. </li></ul></ul><ul><ul><li>Identifying verbal and non-verbal messages from Mr. D during the doctor’s rounds. </li></ul></ul><ul><ul><li>Sharing knowledge about patient’s medical condition, resources, support groups available to the patient and encourage the patient to share personal information leading to a shared decision making. </li></ul></ul>
  17. 17. My Recommendations <ul><li>2. Informed Consent </li></ul><ul><ul><li>Ask surgeon to explain the procedure (risks and benefits), alternative procedures as well as its risks and benefits, and the success rate. </li></ul></ul><ul><ul><li>Confirm if the patient has understood what the surgeon has explained. </li></ul></ul><ul><ul><li>Ask if patient wants his family to be present </li></ul></ul><ul><ul><li>Provide leaflets containing patients rights as stated in the Health and Disability Consumers Rights and explain. </li></ul></ul><ul><ul><ul><li>Right 7 = receive a service ONLY when patient has made an informed choice and informed consent. Also, patient may refuse services and withdraw consent (Rogers & Niven, 2003) </li></ul></ul></ul>
  18. 18. My Recommendations <ul><li>3. Preoperative Assessment </li></ul><ul><ul><li>Knowing patient’s surgical history and identify coping mechanisms to the surgical procedure Assess patient’s knowledge of the procedure (ask what the patient know) </li></ul></ul><ul><ul><li>Assess patient’s learning style (audio, visual, physical) </li></ul></ul><ul><ul><li>Preoperative Teaching </li></ul></ul><ul><ul><ul><li>What they will hear, smell, and feel during the procedure </li></ul></ul></ul><ul><ul><ul><li>The sequence of events </li></ul></ul></ul><ul><ul><ul><li>Show video or photos of the actual procedure </li></ul></ul></ul><ul><ul><li>Assess the need for sedation </li></ul></ul>
  19. 19. My Recommendations <ul><li>4. Involve the family </li></ul><ul><ul><li>To facilitate meeting to address issues that may affect the family’s ability to support the patient. </li></ul></ul><ul><ul><li>Family also provides key information about the patient which is necessary to the delivery of nursing care that is tailored to the needs of the patient. </li></ul></ul>
  20. 20. Conclusion <ul><li>I have described the incident and its impact on Mr. D </li></ul><ul><li>Pathophysiology of ESRF is discussed </li></ul><ul><li>Issues on power, advocacy and beneficence are analysed </li></ul><ul><li>My position as a Student Nurse is identified and the roles of the nurse are explained. </li></ul><ul><li>Recommendations focusing of patient centred approach, informed consent, preoperative assessment and family involvement are explored. </li></ul>