A case study: A patient’s Advocacy

An insight of renal nurse’s inpatient experience in Emergency Department (ED) promoting a person-centred care (PCC)

Presentation's contents

• 1: Renal nurse’s inpatient event in ED

• 2: Reflection using (GIBBS) Cycle on rendered care

• 3: Contemporary clinical practice’s & adverse impacts

• 4: PCC approach in caring for end stage kidney disease

(ESKD) population

• 5: Take home key message: PCC & nursing advocacy •

Reflection using (GIBBS) Cycle

Renal nurse’s inpatient event

1: 46 year old woman, living with family 2: Admitted twice to ED with acute pain 3: Headache, black outs, nausea & projectile vomiting 4: Got operated & received speedy recovery

Reflection using (GIBBS) Cycle: On first physician’ care

Description: • Patient was kept

in vulnerable position

Feelings: • Young & active

person / sudden illness / severe clinical presentations

Evaluation: Missed clinical judgement in making clinical

diagnosis

Reflection using (GIBBS) Cycle: On first physician’ care

Conclusion: Discharge home

without treating the root cause

Action: Negligence Near miss event or an adverse event

Critical thinking on near miss event’s outcome

Near miss or adverse event impacts:

• Poor patient’s outcome: Stroke / Brain death

• Disability / Death

• Impacting client's family

• Impacting to their community

Reflection using (GIBBS) Cycle: Second doctor’s care decisions

Description: • Patient autonomy

is respected • PCC by listening

to the client

Feelings: • Physician

comprehended client’s situation / strived to make right clinical judgement

Evaluation: Right clinical assumption

was made

Reflection using (GIBBS) Cycle: Second doctor’s care decisions

Conclusion: Transfer to right

health care facility to treat root cause

Action: Promoting PCC

Life saving event Positive client

outcome Pleasant inpatient

experience

Contemporary clinical practice and impacts

• 1: Early discharge

• 2: The culture of professional practice in ED

• 3: A pre-set clinical guidelines and organisational policies

• 4: Increased number of patient admissions

• 5: Shortage of heath care professionals

Learnt insight principles from our case study & renal care application:

Importance of

• Application of PCC approach

• Application of nursing advocacy role

• Application of GIBBS reflective critical thinking cycle

• In preventing near miss & adverse events

Case study’s insight – PCC application for ESKD population

• Available to Walk an extra mile with our clients

• Listening to their present problems

• Supporting them with information to resolve

• Involving them in chronic disease management

• Empowering them to live with improved quality of life

Case study’s insight – PCC application (ESKD people)

• Shared decision making

• Informed decision making

• Conservative renal care approach

• Collaborative chronic care approach

• Home dialysis decision making

• Refusal to dialysis treatment

Renal Nursing advocacy & Near miss or adverse events

• Renal nurses can prevent near miss or adverse events:

• 1: By being great resource

• 2: By updating clinical knowledge & skills

• 3: By involving right interdisciplinary team member

• 4: By identifying abnormal variants AEAP

Take home key message: PCC & client’s positive outcome

PCC:

Reflective clinical practice / Clients positive outcome

Nurses-patient therapeutic relationship role / Education

Importance of nursing advocacy / vulnerable clients

Empowerment of clients / choosing their treatment

This case study’s client is not anybody else & is about myself

Reference

Alfaro-LeFevre, R. (2013). Critical Thinking, Clinical Reasoning, and Clinical

Judgement: a Practical Approach (5th ed.). USA: Saunders: Elsevier Inc.

Australian Commission on Safety and Quality Care. (2008). Australian Charter of Healthcare Rights. Australia: Australian Commission on Safety and Quality Care.

• Browne, G., Cashin, A., & Graham, I. (2012). The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do! Journal of Psychiatric & Mental Health Nursing, 19(9), 839-843. doi: 10.1111/j.1365-2850.2012.01944.x

Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development of a therapeutic relationship. British Journal of Community Nursing, 19(10), 502-507. doi: 10.12968/bjcn.2014.19.10.502

Reference

Fact Sheet. Subdural haematomas. Retrieved 04-09-2012, from Better health Channel http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Subdural_haematomas/$File/Subdural_haematomas.pdf

Murray, M. A., Bissonnette, J., Kryworuchko, J., Gifford, W., & Calverley, S. (2013). Whose choice is it? Shared decision making in nephrology care. Seminars In Dialysis, 26(2), 169-174. doi: 10.1111/sdi.12056

• Mollicone, D., Pulliam, J., & Lacson, E., Jr. (2013). The culture of education in a large dialysis organization: informing patient-centred decision making on treatment options for renal replacement therapy. Seminars In Dialysis, 26(2), 143-147. doi: 10.1111/sdi.12053

• Victorian Auditor-General’s Report. (2008). Managing acute patient flows. 2015, from http://www.audit.vic.gov.au/publications/2008-09/20081112-Managing-Acute-Patient-Flows.pdf

Thank You & Questions