What is a proffesional nurse? This essay will try to answer on this question and discuss various components related to the work of a professional nurse. Such as knowledge of biopsychosocial health conditions and the impact on everyone involved in the case study of 82-year-old Mrs. Mary Rodgers who is recovering from a recent surgery. It will also give information regarding ethics, law, and professionalism. The essay will go into a brief depth around certain subjects within these areas. Also highlights the role of the professional nurse.
The main biological factors that can be seen within the case study are Mrs. Rodgers pain with arthritis, indigestion, and gastric ulcer. The essay will be emphasizing her gastric ulcer, this is the most integral biological factor.
Mrs. Rodgers states to the nurse that she has black feces and dark brown vomit. Looking at Mrs. Rodger's case study states that she buys ibuprofen over the counter, which is a non-steroidal anti-inflammatory drug (NSAID) (NICE, 2020). Ibuprofen can cause indigestion and gastric ulcers especially if it has been taken for a long time or at high doses (Seager and Hawkey 2001). She takes Ibuprofen to ease the pain of arthritis she also takes Gaviscon to ease the uncomfortable feeling of indigestion without any medical input. Indigestion occurs when the stomach acid meets the stomach's protective lining in the digestive system (also known as mucosa) (Waugh and Grant 2018). The acid can break down the lining which then can lead to irritation and painful inflammation (NHSinform.scot, 2020). Gastric ulcers are a break in the lining of the stomach (like a sore). To help digest food, acid and pepsin are produced. These two components do not usually damage the stomach. However, if the stomach's defenses fail, they both may cause an ulcer (NICE, 2020).
The role of the nurse is to be aware of the medications and doses that Mrs. Rodgers is taking to ease the pain of her arthritis and to understand her symptoms. The nurse should also promote health regarding safe medication. The nurse should be working closely with Mrs. Rodgers, assessing and facilitating to promote safety within the medication, before, during, and after administration. This will then hopefully avoid any medication errors with Mrs. Rodgers (Rohde and Domm 2017). If Mrs. Rodgers went to a general practitioner (GP) or consulted a nurse the likelihood is that they would have identified the problem and properly medicated her to stop the amount of stomach acid she is producing and prevent the gastric ulcer from occurring altogether (Nurse Journal, 2019). The nurse should have also communicated with Mrs. Rodgers and should have followed part of the nursing process (Martin 1987). Apart from this would be completing a NEWS 2 form to check the urgency of her condition.
Some of the complications of a gastric ulcer are hypovolemia (low blood volume). Low blood cells and low oxygen can cause ischemia, this is when the tissue has a blood restriction, meaning a shortage of oxygen, which is needed for cellular metabolism which is needed to keep cells alive (Waugh and Grant 2018). Another is Pyloric Stenosis (Gastric outflow obstruction) which is when fibrous tissue forms as an ulcer heal, causing narrowing of the pylorus the outflow from the stomach is then narrowed and causes a blockage. This results in persistent vomiting. Both complications stated are life-threatening (Waugh and Grant 2018).
The psychological factors that can be pinpointed in Mrs. Rodger's case study are pain, and stress relating to her role as a carer. Grief related to husband’s condition, Resilience. The psychological factor that will be addressed in further detail is anxiety.
The reason Mary is anxious is due to her black tarry feces and dark brown vomit which are warning signs of a gastric ulcer and an internal bleed (Healthline, 2020). Mary has recognized that this is not normal and has identified her concerns to the nurse. Anxiety is psychological distress; it is an uneasy feeling of dread that can be linked to depression. Anxiety can be used as a rational response to daily life stresses or danger (Backman 2006). However, it can become very problematic when it starts to cause the individual to stop participating in their everyday routine. Long-term anxiety can also cause headaches, and difficulty in falling to sleep, and may also result in feelings of shortness of breath and dizziness (Generalised anxiety disorder in adults, 2011). When taking Mrs. Rodgers's age into account these symptoms could potentially lead to falls and further health issues.
The professional nurse needs to identify this; the nurse should practice excellent patient care with Mr. Rodgers and should listen to her concerns. Communication is a strong aspect of nursing. It Is more than just being vocal; the nurse must understand Mrs. Rodgers and use different methods to build a rapport with her. Such as the five important communication aspects. Listening, non-verbal, verbal, questioning, and written (RCNI, 2020). Once Mrs. Rodgers feels trust between her and the nurse and then opens up about her worries the nurse can then start to put the correct treatment in place (Allinson 2016).
Corresponding to Mrs. Rodgers anxiety is her relationship with her husband who has a mild form of dementia and lacks social opportunities. It can be suggested that isolation/loneliness are the main social aspect of Mrs. Rodgers.
Mrs. Rodgers is very happy to see the nurse when she arrives to remove the clips from her recent surgery. She offers tea and states that she doesn’t get out very much. This could be a sign of isolation and loneliness. She may be experiencing this due to her husband's recent dementia diagnosis and that she does not leave the house. There are many adverse impacts regarding loneliness and isolation, such as the increase in the likelihood of mortality. Evidence suggests it could lead to, Dementia, Alzheimer's disease, depression, and anxiety (Bgs.org.uk, n.d.). The role of the nurse would be being able to indicate some simple measures such as health promotions and holistic care. These can include community outings, befriending, and mentoring schemes. These could help the elderly to prolong well-being, restore social networks, and limit the probability of loneliness these would help to make her feel empowered and have a sense of belonging (Price, 2015).
The legal aspect that can be acknowledged is negligence which can be linked to the Legal Duty of Care. Duty of care is the obligation placed on individuals to act positively in line with certain care standards. The law of Duty of Care inflicts on health care professionals where reasonably foreseeable harm might be caused to the patient through their actions. Health care professionals must abide by the relevant standard of care. Failure to uphold this law may be negligence (Delves-Yates, 2018).
Looking back at the biopsychosocial aspects of Mrs. Rodgers case study, it states that she has black tarry feces and dark brown vomit. In the case study, the nurse dismisses Mrs. Rodgers concerns and states that she is only there to remove her surgical clips. The nurse had a Legal Duty of Care toward Mrs. Rodgers and should have been aware of the warning signs of a gastric ulcer. Immediate precautions should have been put in place such as getting her admitted into a hospital. Harm has come to Mrs. Rodgers and the law states whoever has a Duty of Care towards her must take responsibility for that harm (Legal Dictionary, 2017)
According to the Nursing and Midwifery Council (NMC), the main goal is to protect the general public. This means setting out different standards for an umbrella of aspects such as conduct, education, training, and performance (Nmc.org.uk, 2019). Some of which can be linked to the legal aspects of Mrs. Rodgers case study. Nurses should always follow and abide by the NMC code and the NMC guidance. The NMC has a code-named ‘Preserve Safety’ 13.2 of that code states ‘make a timely referral to another practitioner when any action, care or treatment is required’ (The Code, 2015). This means the nurse must make sure that Mrs. Rodgers safety is not affected. The nurse has a professional ‘Duty of Candour’, meaning the nurse must raise concerns as soon as possible and take action to deal with them where appropriate (Royal College of Nursing, 2019). As the nurse neglected Mrs. Rodgers needs and did not refer her for correct treatment, she has failed to follow the code and its relating standards. By breaching the NMC Code the nurse could be reported to the NMC under the Fitness to Practice procedures (Nmc.org.uk, 2019).
Due to negligence playing a strong role in Mrs. Rodgers case study the ruling ethical factor that can be addressed is Non-Maleficence. The main principle of Non-Maleficence is avoiding needless harm. This can be considered as negligence if it imposes reckless and unnecessary harm onto another individual (Chadwick and Gallagher, 2016). Every health care professional throughout their career has the responsibility to remain competent. One of the key elements that a nurse should abide by is a code of ethics that they should follow in their everyday work. The Ethics framework (Gallagher 2008) can be used to in everyday nursing. Failure to follow this framework could result in Professional negligence (Chadwick and Gallagher, 2016). In context, the nurse did act with a degree of competence that was expected of her which was to see Mrs. Rodgers remove her surgical clips. However, according to Non-Maleficence, the nurse must take appropriate action once Mrs. Rodgers expressed her concerns to prevent foreseeable harm (Jacoby and Scruth, 2017).
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