Jennifer Collins September 23, 2010 Providing Quality Care In A Heartbeat

NUR 505-01 Memorable Clinical Experience paper #1

In todays clinical setting, nurses must be able to effectively apply knowledge learned from previous experiences in order to provide quality care to their patients. Unfortunately, this often becomes difficult for the nurse when others are not as in tuned with the situation at hand. In such instances, the nurse must escalate patient advocacy efforts in order to properly help the patient in need. Recently, I found myself in such a situation, after a transfer from a Telemetry unit onto an Ambulatory Surgical floor. By relying on my previous experiences on the Telemetry floor, I was able to recognize symptoms of congestive heart failure, which had been ignored and belittled by my colleagues, and advocate for my patient in order to receive proper treatment. This paper will discuss the events that led to my insight on the situation, the reasons why others did not see what I saw, and what I learned from this experience. The background of the event takes place at a small local hospital on an Ambulatory Post Operative floor. On my previous Telemetry floor, the cases were more complex, often with numerous congestive heart failure patients. I was expected to recognize symptoms and various treatments, often involving several systems of the body. Educating these patients on the prevention and management of the condition was important for their care. However, in the Ambulatory Surgical setting, the scenario population for the patient population is different, as the majority of the patients are discharged that same day, and the education and assessments involve short term instructions relating to the healing of a specific part of the body. On one particular day in the Ambulatory Surgical unit, I had received a 70-year old female patient that had undergone surgery to her repair a torn rotator cuff. On assessment, the shoulder dressing was clean, dry and intact, with extremities warm and mobile, but the patients voice was hoarse and she began complaining of difficulty breathing, with oxygen saturation in the low 90s. My colleagues insisted that her condition was a result of the anesthesia, and advised that I should encourage her to use the incentive spirometer to assist in oxygen consumption. However, as I was aware that congestive heart failure was indicated in the patients history, I became concerned and felt that her condition was much more serious. Upon auscultation, crackles were noted in scattered lung fields, a symptom of congestive heart failure, and on her medical reconciliation it listed that her last dose of Lasix, a common medication used to treat congestive heart failure, had not been taken in two whole days. Acting on my instincts, I stopped her intravenous fluids, which had been going at a rate of 120ml/hour, and phoned the surgical resident. The surgical resident, like my colleagues, insisted that the symptoms were only from the effects of anesthesia, and ordered the patient to continue using the incentive spirometer. At this time the patients oxygen saturation was 87%, and her breathing became labored. I again phoned the surgical resident, who reluctantly came to assess the patient. I explained my concerns due to my previous experiences, and indicated that I believed that it would be in the

patients best interest to be seen by a cardiologist. When he disagreed, I had a nursing supervisor called, and eventually the patient was seen by a cardiologist, who diagnosed her with experiencing a relapse in congestive heart failure, and ordered an intravenous dose of Lasix to be administered stat. The patient thereby obtained relief and was admitted to another floor for observation. I believe that if it wasnt for my persistence in providing a cardiac consult for my patients condition based on my previous knowledge and experience, the patient may have become compromised and put in critical condition. In the medical profession, one must never make assumptions regarding someones health, but rather be able to think critically and allow for the suggestions of colleagues. I feel that it is common for a nurse to easily make assumptions regarding a patients condition while consistently working on a floor with similar patient populations. I believe that the nurses and resident that I worked with that day were accustomed to healthy patients in the ambulatory setting who were discharged quickly and without complications, and because of this, were not thinking critically. I additionally believe that the staff was also hesitant to agree with me because I was new to the unit, and most likely felt they had more insight and skill in caring for post operative ambulatory patients. From this experience, I have learned firsthand not only the importance of advocating for your patient to ensure safe and effective care, but of escalating the chain of command in order to facilitate the process. I further believe that my colleagues have learned from this experience as well, as they now appear to be more open to the suggestions of others regarding patient care. Being receptive to the insight of others based on past clinical experiences does indeed prove vital in providing effective nursing care. While I had recognized the symptoms in a patient that I had observed on a previous floor, medical care still had to be delayed because I had to first advocate for my patient to be properly assessed and treated. In the future, my hope is for all staff to be more in tuned with the situation at hand and open to the suggestions of others, thinking critically about what might truly be going on with a patient. In this way, we may prevent avoidable complications, and ultimately provide quality care and sustainable health, both quickly and effectively.