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Clinical Decision Making Framework Sample Answer
Clinical decision making framework
Pre-operative care, the patient should not feed or drink anything 12 hours before surgery. No form of any drug should be ingested. Medications that are blood thinners, herbal remedies and supplements should be avoided a week before surgery unless the physician directs otherwise. PACU analysis using aldrete score should be performed immediately after surgery (Smeeing Et al., 2015). After open reduction and internal fixation (ORIF), the patient must maintain high hygiene to avoid risk of infections. The splint must remain clean and very dry. Once the splint of Ben is removed, he can be bathed directly. Before then, the patient should take care to ensure that the splint does not get wet as he showers, this is because it will make the plaster soft and weak (Pakarinen Et al., 2012). The second important postoperative requirement is to reduce swelling around the ankle and to increase experiences. This can be achieved through application of ice and keeping the leg elevated. Evidence based practice recommends Ice application for 20 minutes for every two hours. This is very helpful within the first 48 hours.
Ben’s mobility must be restricted to ensure that the injured leg is not exposed to excess weight. Mobility assistive devices such as walker or crutches can be applied (Smeeing Et al., 2015). Pain management is important aspect of post-operative care. Most of the pain medication administered during the process wears off with 8-12 hours after the process. In some cases, the pain can be accompanied by other side effects such as constipation, drowsiness and nausea. To relive pain, the patient can be administered narcotics and analgesics (Li Et al., 2011). For constipation cases, the patient can be given some laxatives. The high temperature experienced by Ben could be due to infection. To reduce nausea and vomits the patient can be given antiemetics. After 48 hours, the patient can start physiotherapy. Ben should be trained some few exercise he can use at home to ensure that muscle strength is regained (Milby Et al., 2013).
Psychosocial impact includes emotional effects attributable to the fracture. Ben seems to suffer from anxiety, tiredness and also increased frustration. Ben indicated that this was the lowest time of his life and is worried that he will never manage to participate in his favorite leisure and recreational activities (Johnstone, 2010). This affects his social part of life too. The parents and relative activities are affected by the episodic illness. Ben needs care from his family to carry out most of the activities. This could be challenging considering that the parent’s busy schedule. This increases burden to the family members. This is partly due to unpaid sick leave to take care of the boy and increased overreliance on the family savings to meet medical cost (Murakami Et al., 2012).
Nursing intervention for this therapy for this episodic health illness will follow the Maslow’s hierarchy of needs and cognitive dissonance theory (Fontenot, Hawkins & Weiss, 2012). The cognitive dissonance theory will be applied to intervene to the numerous stressors being faced by Ben which are associated with the health risks associated with his illness (Butler Et al., 2013). The nurse will interact with psychiatrist to change Ben way of thinking that the ankle fracture is a death sentence due to the changes it comes with such as reduced mobility. This will ensure that he does not refuse assistance in all other programs which will promote healing processes (Johnstone, 2010).
Using Maslow hierarchy of needs, the nurse will ensure that Ben and the relative psychological needs are met. This includes guidance and offering solutions such as assistive devices for Ben which will make him less dependent on the family members (Jones Et al., 2012). For safety needs, the nurse will ensure that Ben receives adequate medication and empowered to ensure that he can manage post-traumatic stress disorder. The parents and relatives will be encouraged to support Ben through the healing process, this is because shunning and neglect will slow the healing process and affect Ben emotionally. When these needs are met, the patient emotional health is sustained and lead to quick recovery process (Nilsson Et al., 2013).
Clinical Decision Making Framework References
Butler, M., Begley, M., Parahoo, K. and Finn, S. (2013). Getting psychosocial interventions into mental health nursing practice: a survey of skill use and perceived benefits to service users. J Adv Nurs, 70(4), pp.866-877.
Fontenot, H., Hawkins, J. and Weiss, J. (2012). Cognitive dissonance experienced by nurse practitioner faculty. Journal of the American Academy of Nurse Practitioners, 24(8), pp.506-513.
Johnstone, M. (2010). Nursing and justice as a basic human need. Nursing Philosophy, 12(1), pp.34-44.
Jones, J., Williams, W., Jetten, J., Haslam, S., Harris, A. and Gleibs, I. (2012). The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury. British Journal of Health Psychology, 17(4), pp.798-811.
Li, S., Wang, T., Vivienne Wu, S., Liang, S. and Tung, H. (2011). Efficacy of controlling night-time noise and activities to improve patients sleep quality in a surgical intensive care unit. Journal of Clinical Nursing, 20(3-4), pp.396-407.
Milby, A., Bã–hmer, A., Gerbershagen, M., Joppich, R. and Wappler, F. (2013). Quality of post-operative patient handover in the post-anaesthesia care unit: a prospective analysis. Acta Anaesthesiologica Scandinavica, 58(2), pp.192-197.
Murakami, R., Shiromaru, M., Yamane, R., Hikoyama, H., Sato, M., Takahashi, N., Yoshida, S., Nakamura, M. and Kojima, Y. (2012). Implications for better nursing practice: psychological aspects of patients undergoing post-operative wound care. J Clin Nurs, 22(7-8), pp.939-947.
Nilsson, G., Eneroth, M. and Ekdahl, C. (2013). The Swedish version of OMAS is a reliable and valid outcome measure for patients with ankle fractures. BMC Musculoskeletal Disorders, 14(1), p.109.
Pakarinen, H. (2012). Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury. Acta Orthop, 83(S347), pp.1-31.
Smeeing, D., Houwert, R., Briet, J., Kelder, J., Segers, M., Verleisdonk, E., Leenen, L. and Hietbrink, F. (2015). Weight-Bearing and Mobilization in the Postoperative Care of Ankle Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies. PLoS ONE, 10(2), p.e0118320.
