On a Speccific patient/consultation( e.g.good assessment/prescribing decision)

I would like to present one critical incident from which I have gained a lot of insight . This concerns the case of a 92-year-old patient who lives with his wife in a 2-bedroom flat . He has gone to the hospital with intent to validate whether or not he had DVD after a few days , it has been confirmed that he was free of DVD . I have taken his full history and I have garnered that he has had COPD since four years ago and had taken Salbutamol and Spiriva for his condition . My full

br examination excluded muscolosketal origins of the problem and his hospital discharge letter confirmed that he was indeed free from any DVD . I would like to reflect on the idea that the practitioner ought to go beyond the patient 's query and try to seek a viable explanation for his condition apart from what the patient is inquiring about . Moreover I have also realized that the medication that he was taking may have had side effects on the patient

A comprehensive review of the patient 's history and my own examination lead to juxtaposing these with BNF and NICE guidelines , from which I have found that these medications are probable causes of his problems The first medication is Simvastatin , which is a probable causative agent of myalgia , myositis and myopathy . The second drug , which was Salbutamol may cause pain at the intramuscular junctions or hypokalaemia which may be an outcome of overdose . Overall , this may cause discomfort while sitting and generalized weakness

As an action step , I contacted the patient 's GP and arranged a joint visit , during which we have discussed the probable causes of his condition . From this experience , I have realized that it is important to have much clinical exposure to be able to detect and be adept at determining the possible causes of a patient 's condition . This also requires an advanced level of critical thinking

I have then proceeded to discuss this incident with my DMP during consultation and he has suggested that the patient be recommended for physiotherapy . Muscle weakness due to atrophy was still another outcome of his condition which could be addressed through this course of action There are still no blood test results available but we thought it best to push through with the recommendation for physiotherapy

On the self-development side , the experience has allowed me to apply knowledge of COPD prescription where I was given the opportunity to research through books , journals , online references , as well as interaction with my colleagues . I have also learned substantially from the joint visit made with the GP where we had important exchange of ideas . This also made me realize the true value of mentoring in the learning process . Finally , I have learned the importance of clinical exposure and the use of critical thinking in medical prescription

The novice acquires clinical judgment and skill over time . Knowledge is refined through actual clinical experience this moves her from a rule-based , context-free stage to a more analytical , logical and intentional pattern of thinking (Benner , Tanner Chelsea , 1996 . To effectively provide a conducive learning environment , new nurses need venues for examining and developing their problem solving and reasoning skills towards making clinical judgments (Miller , 1992 . Such venues transpire through numerous learning experiences

Participating in varied learning experiences offers the chance to apply classroom theory in the clinical setting . These experiences can help them in developing the learner from the novice phase to advanced beginner . The advanced beginner has been exposed to choice real-life situations and therefore has more contextual rules . Advanced beginners however , are in greater need for supervision and guidance . They are only starting to learn repetitive meaningful patterns in clinical practice

References

Benner ,

(1982 . From novice to expert . American Journal of Nursing 82

Benner

, Tanner C .A Chelsea C .A (1996 . Expertise in nursing caring , clinical judgment and ethics . New York : Springer

Miller , M .A (1992 . Outcome evaluation : measuring critical thinking Journal of Advanced Nursing . 17 , 1401-1407 ...