Nursing Care of an Orthopaedic Patient Essay

Hey there!

As I finish up my last few shifts on Port Phillip I thought I’d better write again before moving on to my next rotation. This time I promise to include something a little more clinical than my last posts.Nursing Care of an Orthopaedic Patient Essay

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On reflection of these last four months spent as an Orthopaedic nurse, I have to laugh a little. Mostly because when I found out I was rotating through orthopaedics I couldn’t think of anything worse. Why? Because every nurse has their kryptonite. That one thing that makes them cringe and question why they ever decided to pursue nursing. For some it is sputum, others vomit. For me, it’s broken bones and dislocations (I think, because even though I’ve never broken or dislocated anything, ‘touch wood’ I can imagine the pain so vividly it makes me feel ill! Also, they look pretty gross).

Lucky for me though, I haven’t struggled with this as much as I thought I would. Mostly because by the time the patient has come into my care, any deformities from broken bones or dislocations have been fixed and I can’t necessarily tell that it’s been injured (with the exception of some pretty impressive bruises).

That aside, I reflect on what I have learnt.

Four months ago I knew next to nothing about Orthopaedics (mostly because I’d been avoiding it for so long). But now, I know about the different surgical methods to fix fractured hips or to repair knees. I can care for someone using Patient Controlled Analgesia. I know how to fit slings and knee splints. I understand the importance of venous thromboembolic prophylaxis! I am near earning my expert badge at drawing up IV antibiotics and doing peripheral neurovascular observations. I can even do negative pressure wound dressings!Nursing Care of an Orthopaedic Patient Essay

They might all seem insignificant, but for me they are great milestones. But the greatest milestone of all came a last week.

Prior to my time on Port Phillip I had never been involved in a MET call. And for the first month or so I was terrified every time I heard a MET called on our ward. I’d go down to the room, poke my head in and say a gracious “are you guys ok in here?” and gladly walk back out to keep an eye on all the other patients when they said they were ok.

Then a few weeks ago, I had to call a MET for my own patient and there was no walking out on that one.

My patient was febrile with a temperature of 39.2 and was experiencing rigors after a surgical procedure 2 days prior. My hands were nearly shaking as much as my patient’s body I was so nervous. But as happens in a MET call, all of a sudden I had help left, right and centre.

The doctors and nurses came in and helped take bloods, do basic observations, perform an ECG, while I stood at the door updating anyone new who walked through, on the current situation. At the end of the MET I was a little disappointed I’d done nothing more than ‘talk’, however a fellow nurse assured me for my first MET call I did what was required of me – escalated to get help when both my patient and I needed it.Nursing Care of an Orthopaedic Patient Essay

The next week I was involved in another two MET calls. So all of a sudden I went from having seen none, to having been involved in three in seven days!

The first was for a post-operative patient who became increasingly drowsy and difficult to rouse. This time instead of just standing at the door, I was the one doing the observations while updating everyone on the patient’s current situation. It turned out to be analgesia related and was easily fixed with some Naloxone.

The second was for a patient who’d reported feeling ‘off’ to their nurse. With not a lot to work with, the nurse decided to perform an ECG only to find him in rapid atrial fibrillation (no wonder he was feeling ‘off’!). During this MET I helped draw up IV digoxin and IV magnesium.

Slowly but surely with each MET call I am involved in, I gain more confidence. To the point that last week when another MET was called, instead of walking in the opposite direction, I was the one who grabbed the ECG machine.

It was an odd moment for me, as I was madly wheeling the ECG machine to the room, because in that split second I had an ‘I’m so proud’ moment, where I was proud not only of the milestones I’d reached, but to call myself a nurse and know that whatever I was about to walk in on, I was going to be able to help this patient when they needed it most.

I honestly can’t believe I have already reached the end of my first rotation. I’ve never loved saying goodbye, and this time is no different. I cannot fault the work of any of my colleagues on Port Phillip and will miss their encouragement, support and smiles more than I’d like to admit.Nursing Care of an Orthopaedic Patient Essay

A massive thank you to our NUM, the ANUMs, nurses, doctors, PSAs, ward clerks, physios, OTs, dieticians, speachies, pharmacists, phlebotomists, food services ladies and the pink ladies.

You have all made my first four months of nursing truly memorable. For someone who was terrified about the prospect of working with broken bones, joint replacements and dislocations everyday, I’ve thoroughly enjoyed my time here.

Take care in the Penthouse and because I don’t like goodbyes, I’ll say until next time.

Lastly, to my beautiful fellow Port Phillip grads, THANK YOU. Thank you for sharing many tears, laughs, hugs and light bulb moments with me. You are all well and truly on your way to becoming wonderful nurses and I wish you all the very best on your next rotations. Stay in contact and I look forward to seeing your smiling faces around the hospital.

An orthopedic disease progresses slowly and the process is usually painful and compromises the patient’s daily activities and quality of life. Orthopedic traumas appear suddenly and may cause important physical, emotional and/or social impairment. Traumas in the musculoskeletal system may trigger events that directly or indirectly compromise other systems and, therefore, should be subject of immediate intervention(2).Nursing Care of an Orthopaedic Patient Essay

In this context, the condition of these patients considerably influences students, determining care delivery and the development of specific abilities. In general, such an impact may be either verbally or non-verbally expressed and interferes in learning and the quality of care delivery. An analysis of the students’ trajectory does not always clearly reveal the problems that actually interfere with learning and care provided to patients in this specialty, especially when one takes into account that human beings have desires, needs, feelings, fears and also a lack of knowledge.

This study presents some manifestations of the imagination of undergraduate nursing students concerning care provided to patients with trauma and/or orthopedic disorders.

Identifying the aspects that can influence learning and quality of care delivered in the field of orthopedic nursing can enable reassessing the teaching-learning process in the undergraduate program based on the real needs of students and care provided in this specialty.

Method

The Social Poetic method was used to produce data in this study in which the subjects are those who develop knowledge through the free expression of their cognitive potential, sensations, emotions, imagination, intuition and reason, promoting artistic creativity in learning, knowledge, research and care delivery(3).

A round of workshops was developed, however data presented here are concerned only with the workshop entitled “student” held on April 27th 2007. This workshop was digitally recorded and photographed.

Data were produced by a Researcher-Group composed of 15 students: 14 women and one man, who at the time of data production, were enrolled in the 6th academic semester of the Nursing and Obstetrics Undergraduate program of a public university in the city of Rio de Janeiro, RJ, Brazil.Nursing Care of an Orthopaedic Patient Essay

The development of this project was approved by the Ethics Research Committee at the Francisco de Assis university Hospital at the Anna Nery Nursing School (HESFA-EEAN) protocol no 025/07. Confidentiality of the study’s participants was ensured through the use of one or two capital letters at the end of their testimonies.

The workshop was initiated with the so-called “Affective Coffee”, a breakfast characterized as a meeting that promoted physical and emotional proximity among the participants. After a relaxing time, during which the participants were asked to think about themselves as students in the Orthopedic division by making free associations, material was distributed for drawing and collage (white cardboard, crayons, colored pencils, hydrographic pens, colored glue, gouache and brush, colored paper, magazines, scissors, white glue, screws, nails, wire, etc.) for their individual development of “Free Creation Technique”(4) products for them to express images and thoughts that emerged during the relaxing phase.

Afterwards, produced data were immediately shown and analyzed based on individual and collective meanings in order to permit the discovery of the structure of the thought of the group in its heterogeneity(5).

This workshop produced posters with abundant images, words and expressions reflecting a positive and welcoming atmosphere, where students agreed to show, write and tell what is authentic for them, permitting us to integrate thoughts and testimonies in a collective process.

Recordings were transcribed and then data analysis was initiated. Data comprised drawings, written records, individual expressions and collective discussions. This material was gathered based on the practice of convergence and placed into thematic categories, which were then more finely grouped into subcategories.Nursing Care of an Orthopaedic Patient Essay

Results

When the students projected their imagination upon themselves, they did not dissociate it from the image of the patient they cared for. They consider themselves to be students who provide care only because there is a patient to care for and to whom they dedicate themselves. Based on this, the first classification was defined, and data exclusively related to the student were selected from those directly related to the trauma and/or orthopedic patient. This process was required because there were distinct situations, meanings, and understandings among them.

Only some of the categories and subcategories related to the students are presented. Some of the participants’ testimonies, in italics and identified by letters, are presented as examples.

Category 1: Care delivered to patients

Quality care delivery

This subcategory includes data that indicate experiences are a result of the relation of humanized and committed care that students delivered to patients and their family members.

(…) she (the patient) was crying at the end of the stage because it didn’t hurt! We had bathed her, manipulated, turned her on her side, changed the sheet and she hadn’t felt pain. She was crying because she didn’t feel pain… Actually, the entire group started to cry, their eyes filled with tears, everybody discretely left the room, to avoid crying in front of her, it is very good to have this reward, to know that we make a difference. (G)Nursing Care of an Orthopaedic Patient Essay

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Being acknowledged by the patient for the quality of care delivered

The students report being acknowledged by patients for the quality of care delivered and their importance to the patient.

(…) she said at the end “thank you very much, thank you very much, thank you very much”. We did nothing, nothing! A bath, medication, a bath, changed sheets, but we didn’t do anything special! But for that person who completely lost perspective on her life, that was everything. (G)

The students suffer from the patient’s condition

Here the students show they sympathize and experience suffering for perceiving the patient’s suffering.

(…) when I looked at that person (patient) I said: look, if I had to go through that procedure (traction) to heal my leg and go home, I wouldn’t suffer so much. But if I had to go through it and stay here for two months as he is here at the hospital, I couldn’t take it… People, I couldn’t bear it. I don’t think so. (P)

Respect for the patient

This category is related to all the patient’s feelings and behaviors and his/her family, which are respected by the students and are related to the patient’s needs.

It is with respect that everything happens. It is by respecting the person that you start treating her/him well, gives comfort (…) I think that respect is the best thing we can do for someone. It is being respectful to people. (MS)Nursing Care of an Orthopaedic Patient Essay

Death

The students indicate coping with the end of life and death as an extremely difficult and striking moment.

(…) we fear those wires. I put a lot of blood in my poster though obviously this is not how a person dies. So, you dedicate yourself… I guess that you suffer a lot with someone’s death. (G)

Category 2: Knowledge and experience

Knowledge and experience are sources of the self-confidence to deliver care

The students indicate that technical-scientific competence and experience are essential to deliver care.

(…) I realized I had to study, that I really had to study, I realized that if I got there without reading, without having studied something, it’d be worse. It would have been impossible to perform any procedure without studying (…) So, I realized that studying and participating, the care I delivered was different. (L)

Lack of knowledge and experience

This subcategory addresses the difficulties students had dealing with a lack of the knowledge, experience and skills required in the specialty.

(…) then, at the classroom the professor talked about the splints and things, so I got scared of what to do with the patient, you know. I said “there’s no point in studying it if I’ll get there and won’t know what to do”. And then this is a time of distress” (L)Nursing Care of an Orthopaedic Patient Essay

Category 3: The impact of the specialty

Affinity with the specialty

The results reveal the sort of relationships that are established when there is an affinity or the lack of one with the specialty and the need of specific competencies in the field of knowledge and in relation to the clientele.

If you choose orthopedics, do it because you like it, and do it with love for those who are in need, those who are there depending on us (…), make that these two, eight months are, I won’t say pleasurable, but at least bearable for the patient. (MS)

Specialty with good learning experiences

The students recognized that the supervised training in orthopedic nursing was important for their education.

It was really bad until the training ended. And then when it was at the end, I was almost crying: “No! Is it already finishing? Now that it finally kicked in? Now that it got cool?” (…) It was good after the first day, after the shock passed away, everything was all right (…). (L)

Discussion

The time when students meet the trauma and/or orthopedic patient in a hospital environment, both unknown to each other until then, requires skills to deal not only with their own emotions and knowledge, but also with others’ emotions, which make students feel unprepared to deal with certain situations. The practice is an action that encourages a reflexive process and care should emerge from an eminently dialogical and mutually educational practice, which occurs in the individual and collective sensitization and transformation(6).

Living with and carefully observing the living conditions of patients with trauma and/or orthopedic disorders is a teaching opportunity for life and for enabling positive behavioral changes. It shows the importance of this event for the students because it broadens their understanding and responsibility of nursing. These experiences are the result of the relation of care they develop with their patients when knowledge is no longer the purpose of the learning process and becomes a tool serving students to help them to identify the variables present in a situation and potential ways to control them(7).Nursing Care of an Orthopaedic Patient Essay

Hospitals are good spaces for learning because learning processes are linked to work processes. Supervised training at the hospital is a good source of scientific knowledge and provides tools to care for patients and to learn to relate with them and team members(8-9). The students recognize their engagement with the patient and with care that is ethical, of good quality, responsible, and sympathetic. Delivering quality care is seen by the students as the ability to meet the different needs of patients and their families, while planning and implementing orthopedic nursing care. They show themselves to be capable, even if in an intuitive way, of establishing priorities and including not only the biological system but also the psychosocial and spiritual dimensions. It is about perceiving their responsibility to care, considering the consequences of their acts, ensuring integrality, coherence, harmony with what they believe, as well as seeking to base their practice and conduct on ethical and educational principles(10).Nursing Care of an Orthopaedic Patient Essay

The Nursing and Midwifery Council (NMC) has set out at least four domains of competencies for entry to the register in Adult Nursing. In this brief, I will focus on the second domain of communication and interpersonal skills. Communication plays a crucial role in addressing the needs of the patients. Adult nurses are expected to communicate effectively, listen with empathy and advocate for their patients (Department of Health, 2012a, 2012b). Specifically, the Department of Health (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser, 2012) has introduced the 6 Cs of nursing, which encompasses compassion in nursing practice. Compassion in care is only possible when patients feel that their nurses understand their feelings and show empathy (Chambers and Ryder, 2009). Communication is essential in helping patients articulate their needs (Hall, 2005). Similarly, poor communication could result to misunderstanding, anxiety for the patients and poor quality of care (Chambers and Ryder, 2009).Nursing Care of an Orthopaedic Patient Essay

In this brief I will focus on the domain of communication and interpersonal skills since these form the foundation of my relationships with my patients. Developing my competency in this domain would help me identify both verbal and non-verbal messages of the patients and address their needs accordingly. Meanwhile, effective communication is needed when I communicate with my colleagues and other healthcare practitioners. A focus on my communication skills with my patients will be made in this reflective brief. Communicating effectively with my patients and other health and social care professionals would help improve the care received by my patients. Benner’s (1984) stages of clinical competence would be used to underpin my development from novice to competent. Gibb’s (1988) reflective model will be utilised to reflect on my experiences in the last three years from novice to competent.

Professional Development from Novice to Competent Level
Reflective practice (Gibbs, 1988) allows healthcare practitioners to improve current practice by learning from incidents and one’s own experiences. Pearson et al. (2009) explains that one’s own experiences are another form of evidence in healthcare. With the focus on patient-centred care, the NHS (Department of Health, 2012b) has encouraged evidence-based care when addressing the needs of the patients. I will use Gibbs (1988) model in reflecting on my communication experiences in years 1 to 3. This model starts with a description of an incident followed by analysis, evaluation, conclusion and action plan.Nursing Care of an Orthopaedic Patient Essay

An incident during my year 1 exemplifies how I developed my communication and interpersonal skills as a novice. I was assigned to the mental health ward and assisted an elderly patient with dementia who was admitted for pneumonia. During his first day in the hospital, my senior nurse performed a nutritional assessment and informed me that I should assist the patient during feeding time. This was consistent with the Patient Mealtime Initiative (PMI) (NHS, 2007) implemented in our ward. As a student nurse, I would be assist the patient to self-feed and make his environment comfortable and uncluttered. During mealtime, I talked to the patient and informed him that I would assist him in eating his food. He stared at the wall and did not respond. I gently asked him if he was ready to eat. When he turned to me, I informed him that he could now start eating. He only stared at his food and did not seem to understand my instructions. I placed the utensils near his hand so he could grab it and eat. When he did not respond, I asked him if he wanted me to help him eat. After a few minutes, he got his spoon and held it for a few minutes. I began to realise that he did not seem to understand my instructions so I started to place the spoon with food in his mouth and gently touched his chin to remind him to chew his food. My senior nurse passed by and informed that I have to put some pressure on the patient’s chin and make some chewing motions to help remind him that he needs to chew his food. It took me an hour to feed my patient.Nursing Care of an Orthopaedic Patient Essay

On reflection, communicating with older patients with dementia could be a challenge. Most of these patients suffer from cognitive impairments, which make it difficult for them to communicate their feelings and concerns (NICE, 2006). A significant number of older patients with dementia who are admitted in hospital wards are underweight (World Health Organization, 2014). Jensen et al. (2010) explain that many of these patients have forgotten how to eat and chew their food while others lack cognitive abilities in understanding instructions on feeding. Hence, the National Institute for Health and Clinical Excellence (NICE, 2006) guideline on nutrition for older patients highlights the importance of assisting the patients during feeding. For patients in the advanced stages of dementia, the main aim of nutrition is to maintain hydration and comfort feeding. Meanwhile, some patients could also suffer from swallowing problems, making it more difficult to ingest food (Lin et al., 2010).Nursing Care of an Orthopaedic Patient Essay

The hospital ward environment is also new to older patients with dementia and might trigger anxiety and fear (Lin et al., 2010). Since patients are in unfamiliar surroundings with unfamiliar people, they might express their fears and anxieties through aversive behaviours (NICE, 2006). It is shown that nurses react negatively to aversive behaviours of older patients with dementia (Jensen et al., 2010). On reflection, the incident taught me to be more patient and to understand both verbal and non-verbal messages. It took some time for me to realise that I have to feed the patient since he appeared confused. I was also unprepared on how to communicate with an older patient with dementia. As a novice nurse, my feelings and apprehensions are normal and are also shared by other nurses (Cole, 2012; Murray, 2006). Best and Evans (2013) have shown that nurses feel unprepared to communicate and care for older patients with dementia. On reflection, I should continue with my professional development by joining training and seminar on how to communicate with older patients with dementia and address their nutritional needs. When faced with a similar situation in the future, I am better prepared and would not need more supervision from senior nurses on how to communicate with older patients with dementia and address their needs. For instance, I am now aware that these patients have difficulty verbalising their needs and I have to be sensitive of non-verbal cues and interpret aversive behaviour as possible signs of distress, anxiety or fear (Best and Evans, 2013).Nursing Care of an Orthopaedic Patient Essay

The second incident occurred during year 2 in my placement in the Urology Department. At this stage, I already considered myself as an advanced beginner (Benner, 1984). I was assigned to care for a 45-year old male patient who was admitted due to testicular pain. I introduced myself to the patient and informed him that I was part of a team that would be caring for him during his hospital admission. I noticed that he was uncomfortable communicating with a student nurse and asked for a more senior nurse. I gently informed him that my senior nurse was supervising other student nurses and he was left to my care. I tried to communicate and noticed that he had difficulty with the English language. I asked him if he needed a language interpreter. Once an interpreter was identified and assisted me with communicating with my patient, I noticed a change in his behaviour. He began to open up and was willing to take his prescribed medications. I slowly understood that he was anxious about his condition and wanted a male nurse with the same ethnic background to be his nurse. When he realised that most of the nursing staff are composed of female nurses, he began to accept me as his nurse.Nursing Care of an Orthopaedic Patient Essay

On reflection, this incident illustrates the importance of taking into account individual differences and using communication strategies to understand the patient’s needs. Specifically, I became aware that he had difficulty with the English language. The act of getting an interpreter greatly improved our communication. One of the competencies stated under communication states that nurses should be able to use different communication strategies in order to identify and address the patient’s needs (Nursing and Midwifery Council, 2010; National Patient Safety Association, 2009). It was apparent that the patient was self-conscious that a female nurse was addressing his needs. It is shown that a patient’s perception about his condition is also influenced by their cultural beliefs and ethnicity (Department of Health, 2012b). He was uncomfortable that a female nurse was providing care when he was suffering from testicular pain. However, the patient shares similar ethnic background as the interpreter and only became comfortable when the interpreter assured him that he could trust me. I realised that patients with different cultural background could be anxious about their treatment and might have difficulty communicating.Nursing Care of an Orthopaedic Patient Essay

On evaluation, I felt that I was able to address the immediate language barrier gap by getting an interpreter to help me communicate with the patient. My experiences during my first year in placement with patients who have different ethnic backgrounds and have difficulty expressing themselves in English helped me prepare for this situation. As Benner (1984) stated, nurses develop competency through experiences. I felt that I have improved on my communication skills and have achieved the advanced beginner level during year 2. Being sensitive to the communication needs of my patient is also consistent with the 6 Cs of nursing (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser). In this policy paper, nurses are encouraged to show compassion in caring through effective communication.

On analysis, I could have improved my communication skills by learning how to communicate with patients with different cultural beliefs about human sexuality. The patient was shy that a female nurse is part of the healthcare team managing his testicular pain. As part of my professional development and action plan, I will participate in training and seminars on how to communicate about health issues, such as testicular pain, that are considered sensitive and may carry some cultural taboo.Nursing Care of an Orthopaedic Patient Essay

The third incident happened during year 3, in my placement in the surgical ward for orthopaedic patients. At this stage, my previous experiences in communicating with patients during year 1 and 2 have helped me develop important communication skills. These included recognising non-verbal messages, understanding how culture influences my patients’ perceptions of nurses and the care they receive. Culture plays a crucial role in how patients place meanings on the words and symbols I use when communicating (Funnell et al., 2009). Apart from culture, I realised that the patient’s own perceptions of the illness and pain they are experiencing could also influence the quality of our communication.

In the incident, I was assigned to assess the level of post-operative pain of a patient after surgical operation. He was a 32-year old male and was unable to communicate even after four hours of surgery. I tried to communicate with him to help assess his level of pain. Since he could not verbalise his level of pain, I used the visual analogue scale (VAS) to identify the level of pain. On analysis, I felt that I have done the right thing and have fulfilled one of the competencies under the domain of communication. Specifically, the NMC (2010) states that nurses should be able to use different communication strategies to support patient-centred care. The use of the VAS helped the patient articulate his level of pain. The VAS is often used as a tool in healthcare practice when assessing the patient’s level of pain. This tool is reliable and has been validated in different settings (Fadaizadeh et al., 2009). On analysis, my personal experiences in the last three years helped me become acquainted with current guidelines on pain assessment. It also helped me identify a simple but valid and reliable tool in assessing patient’s level of pain.Nursing Care of an Orthopaedic Patient Essay

Pain perception in post-operative patients is highly subjective and could be influenced by several factors (Gagliese and Katz, 2003). These include age, gender, prior pain experience, medications and culture (Lavernia et al., 2011; Grinstein-Cohen et al., 2009; Gagliese and Katz, 2003). Regardless of the factors that influence pain, nurses should be able to assess the patient’s pain accurately and communicate with the patient strategies on how to control pain (Clancy et al., 2005). Hence, communication is crucial in ensuring quality post-operative care. On reflection, I was aware that the patient has difficulty communicating. Hence, choosing a more complex tool in assessing pain could add to more distress and anxiety for the patient (Gagliese and Katz, 2003). I realised that choosing a simple assessment tool helped calm down the patient since I was able to deliver care appropriately.Nursing Care of an Orthopaedic Patient Essay

On reflection, I would follow similar procedures in the future. However, I would improve my knowledge on pain assessment by participating in pain education nursing classes in university or in the hospital where I am assigned. This would form part of my continuing professional development and action plan. Abdalrahim et al. (2011) argue that nurses with high knowledge on patient education are more likely to accurately assess patient pain, leading to earlier relief and management of the patient’s pain. However, Francis and Fitzpatrick (2013) express that despite high levels of knowledge on pain management, there are some nurses who have difficulty translating this knowledge into actual practice. One of my roles as a nurse in an orthopaedic surgical ward is to manage post-operative pain of my patients. Failing to manage pain could lead to chronic pain, longer hospital stays and poorer health outcomes (Grinstein-Cohen et al., 2009). I also realised that effective communication with patients is needed to ensure that the patient’s needs are addressed.Nursing Care of an Orthopaedic Patient Essay

Conclusion
In conclusion, the three incidents portrayed in this reflective brief demonstrate how I evolved as a nurse practitioner from novice to competent. Specifically, my communication skills have developed from year 1 until Year 3. In the first incident, I had difficulty communicating with older patients with dementia. Beginner nurse practitioners have no experience in the situations they find themselves in. This was true in my experience with the older patient with dementia. It was my first time at communicating with a patient with cognitive impairment and feeding him. I lacked confidence in carrying out the task and only improved after several meetings with the client. However, in year 2, my communication skills improved. For instance, I was able to immediately identify the needs of the patients by depending on verbal cues and non-verbal messages of the client. I was able to get an interpreter and communicate with him. However, I also realised that I still need to improve by participating in classes and training on how to communicate effectively with patients with different ethnic background.Nursing Care of an Orthopaedic Patient Essay

Finally, in year 3, I was now more competent in communicating with patients. Even when the patient in post-operative care could not communicate, I was aware that he was in pain. I was also able to use an appropriate assessment tool that is consistent with the guidelines in our hospital. I realised that I possess more confidence in communicating with the patient and identifying his needs. My previous experiences in communicating with different groups of patients helped me become competent in identifying the needs of the patients. Importantly, care was delivered promptly since I was able to appropriately assess the level of pain of the patient. All these three experiences show that I could hone my skills in communication. My communication experiences in nursing will help me become more competent and ready as a future nurse registrant.Nursing Care of an Orthopaedic Patient Essay

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In a movement of profound solidarity, the students experience the patient’s suffering. This solidarity is seen as a form of caring, the commitment of a being with another. This requires availability, spontaneity, interest and allows the other to feel safe. In these conditions, students are open to understanding, identifying or adhering to their references. They support themselves on empathy, on feeling, recognizing another’s unconditional acceptance. In this exercise, they take time to listen to the patient and monitor their condition. Based on dialogue, an encounter with another is possible, enabling action, reflection, and guidance for a world that requires transformation and humanization.Nursing Care of an Orthopaedic Patient Essay

There is a strong tendency among students “to put themselves in the shoes” of those who they care for. It seems they care for the patient, while living in and appropriating the patient’s world. Somehow, by making this very world a movement of action and reaction, they care for the patient the way they would like to be cared for or do what they would like people to do for them if they were in the same situation. Part of the pedagogical process is to lead students interact with the reality in which they find themselves and transform themselves based on the experiences they have so that they grow as individuals and future professionals. This empathetic feeling, the result of an impulse to put themselves in someone else’s situation, is a therapeutic way of being and favors recovery and wellbeing because it encourages them to be committed to life and to another person.Nursing Care of an Orthopaedic Patient Essay

The possibility of death in an orthopedic division, which may occur suddenly or by slow progression, seems to derail students. These situations of the end of life and occurrence of death cause great suffering and nonconformity and are indicated as a time profoundly difficult because these situations arouse intense feelings, especially of powerlessness and an inability to impede death. It is difficult for these young individuals to understand terminality because they see death as a punishment or injustice and not as a stage in the process of being human. Severe, terminal diseases and imminent death are a reality for trauma and/or orthopedic patients and highlight the students’ personalities leading them to reconsider concepts, personal values and academic practices. Despite their lack of experience, and because they do not know how to deal with their own feelings, they understand that the dialogue, reception, comfort and clarification they provide are the best and most correct way for the patient and family to cope with terminality. It is important to introduce a critical-reflexive view of the death process and dying in academic education so that these professionals are able to deal with death naturally without the sensation of personal failure and frustration(11).Nursing Care of an Orthopaedic Patient Essay

The students understand that good care is respectful and respect for the patient refers to the person and quality of care in a condition of being entirely with another, in a dynamic presence that transforms and helps another to transcend his/her condition of pain and suffering(6). This wisdom is applied with a sensitivity that fits in the perspectives of care, which recognizes the one who provides care and the one who receives care to be in a constant relation of exchange(12). It is this sensitivity that causes them to associate the most varied feelings with attitude and behavior aimed to promote the patients’ wellbeing. When they realize the difference they do make in the lives of these people, they are encouraged to seek improved quality care. The nurses are able to locate the patient in the subjective and social context of life, which is not always valued in a hospital environment, and are acknowledged by their knowledge, technical skills, and the complexity of what they do in different abilities.Nursing Care of an Orthopaedic Patient Essay

Orthopedic supervised training was considered to be significant in the education of future nurses. Among the diverse learning aspects of college students, the development of their intellectual, human and professional abilities stands out in addition to attitudes and values integrating professional life(13). Hence, it is established that a well-structured base of knowledge is essential for providing safe and efficient care in the orthopedic nursing field, meaning that one cannot provide care to this type of clientele without previous preparation.

The encounter of nursing students with the diverse facets of care enables them to include the new through the acquisition of knowledge and the experience of apprehension and fear, which are present when one is coping with the new(12). Good and bad experiences enrich them as individuals and as future professionals without their realizing it. The internalization of care as value requires a sequential process that is developed over time while students progress in their education, from a guided to an independent practice.Nursing Care of an Orthopaedic Patient Essay

Students consider knowledge and experience to be essential to making them feel self-confident in providing good care. Undoubtedly, the most useful learning in the modern world is that learning that enables continuous opportunities to acquire experience and to incorporate processes of change. When we acquire experiences, we obtain achievements that are then expressed in our secure attitudes demonstrated through actions where acquired knowledge is implemented, in order to permit students gradually to become autonomous individuals(12). In a liberating education they become critical, independent, inquisitive, capable individuals with the tools to reflect and intervene upon their realities(14). Therefore, it is the role of the student to orient their desire to learn taking into account their potentialities and aptitudes.

Developing such complex abilities to provide care within the orthopedic nursing field requires the ability to use and manipulate cognitive skills to help one to reflect on different situations, analyze, exam, criticize and systematize information(7). It means that for students to achieve providing quality care they need to constantly reflect on their knowledge, skills and attitudes, so as to become capable to maximize strategies to solve the problems they face.Nursing Care of an Orthopaedic Patient Essay

When students begin their education, they start defining care based on a personal reference point. As the program progresses, the students develop a broad definition of care applied to their patients, and their practice serves as a positive reinforcement when they provide appropriate care. Hence, the experiences in the orthopedic nursing field broaden their understanding concerning their role in nursing care and develop qualities and abilities to identify how the patient defines and receives care. At this point in their education, the relationships students establish among several concepts: of nursing is; what it is to be a nurse; and their role as human beings. Through all of these they identify the importance of quality care in orthopedic nursing and its deficiencies.

Having affinity with the orthopedic nursing field directly influences care and personal satisfaction. Even though they recognize the field’s complexity and physical exhaustion, students see themselves as able to care for patients with trauma and/or orthopedic disorders after acquiring experience through supervised training. They understand that when one has no interest in the specialty, care delivery and the exercise of the profession are accompanied by tension, distress, and suffering in the face of the responsibility imposed on nurses and, then, acknowledge that specific knowledge concerning the field has impact on the quality of care. This affinity is identified based on personal interests, technical and specific knowledge related to their clientele. Since the development of concept and conceptions is a process that occurs over the program based on a daily routine, when the individual recognizes interest in the field, the natural tendency, according to students, is to act with technical competence, to assume a reflective, critical, creative attitude and constantly seek to update their knowledge.Nursing Care of an Orthopaedic Patient Essay

The training of future nurses should ensure an education focused on citizenship and discernment in order to ensure that humanized and quality care is delivered to patients. One should rethink the way nursing professionals are being educated, perceiving students as beings with imaginative and creative capacity able to recreate their reality according to their needs, in a pedagogical search that take into account their potentialities, contributing to the education of better qualified professionals, enabling them to recover their needs, value their context and individuality, minimizing flaws and inequality stemming from health and educational policies, as well as to contribute to improving the quality of nursing care and college education(15).Nursing Care of an Orthopaedic Patient Essay

Conclusion

This study revealed that care delivered by undergraduate nursing students is the result of a relation of care that emerges from the students’ sensitivity toward their patients. It is a product of continuous reflection on the different situations they experience, about their own knowledge, skills and attitudes, making them capable to establish strategies to solve problems. These students deliver quality, humanized care that goes beyond the physical and includes the psychosocial, spiritual and environmental dimensions, and are also engaged, ethical, responsible and sympathetic. Being acknowledged for providing quality care is essential for students because it gives them satisfaction and positive reinforcement to their dedication and effort. Orthopedic treatment, equipment, and procedures—which cause great suffering, the possibility of death, of physical impairment, and of compromising the patients’ and their families’ life routines—generate great distress in students, trigger empathic feelings and encourage them to seek out the means to minimize patients’ pain and to ensure quality care in this specialty.Nursing Care of an Orthopaedic Patient Essay

The classical strategies of banking* education do not reduce the fear and insecurity one may have when delivering care in the orthopedic nursing field during the undergraduate program. For this reason, these strategies should be revised. All the aspects that permeate care provided by students in the orthopedic nursing field need to be identified to enable a reassessment of the teaching-learning process, based on the real needs of students and care in this specialty.

Pain is a multilevel phenomenon that incorporates physiological and
psychosocial aspects. Post-operative pain is still undermanaged despite
various interventions, tools and methods of pain management continue to
develop. Effective pain management is vital in the post-operative period to
make sure that patients do not suffer or experience any form of distress or
result in other post-operative pain related complications.
The aim of this literature review was to find out how patient guiding plays a
role in the post operative pain management in the orthopedic patient. In
addition, the aim was to understand how the attitudes of nurses and
patients affect the management of post-operative pain.
This narrative literature review was based on 23 scientific articles. The
databases used for data collection were Cochrane, PubMed and EBSCO.
The inductive content analysis was used as an analysis tool for this
literature review after critical appraisal of the articles to ensure the
compatibility of the articles to the topic.
Findings from this literature review showed the role of the nurse in post Nursing Care of an Orthopaedic Patient Essay
operative pain management through patient guidance, the interventions
that the nurses have used to manage post operative pain especially the
non-pharmacological pain. In addition, the attitudes that both nurses and
patients have that affect pain management as well as the importance of
communication in the management of post operative pain. Patients will
experience less pain if they know what to expect when they are better
prepared to manage one’s pain. This could be one area for further
research.  Nursing Care of an Orthopaedic Patient Essay