Student number: 06974264

Analysing a decision made by a nurse in the practice setting

We are going to analyse the decision taken by a nurse to use compression bandages therapy onto a patient who had a venous leg ulcer.

 This decision was taken using guidelines and suggested methods, along with their ability to critically question practice in an organise manner, consequently developing the process of decision making (Lipman et al, 1997). Using these and prior knowledge and understanding of the areas we work, an evidence and knowledge based decision can be made, giving the patient options so that they can decide what care they wish to receive. Many studies show that most patients prefer to be involved in decision making, sharing information and decicions with the patient usually means a satisfied patient. It is important to maintain an effective holistic care management and assertive behaviour to create accurate decisions based on all facts and opinions of both parties (Nursing times, 2004). It is essential to have ethical principles in order to provide and maximise the effectiveness of the care provided (Doh, 2006) and ensure that the patient can lead the best possible life that they wish to, for as long as possible.

The patient being cared for is a fifty-three year old man who had various wounds in his right leg. The patient suffers from type II diabetes and is obese; his past medical history is arthritis, bronchitis and leg ulcers. He has decreased mobility and is not able to go to the treatment room at the health centre; therefore he has been referred to the district nurses team. In the first visit, the nurse, needs to assess the patient and the wound. He lives in a council house with his wife and six young children, he said he is monitoring his sugar level every day and they have been constant, patient has stopped smoking and tries to follow a healthy diet but he doesn’t do any exercise.  He doesn’t have any social service coming to his house; his wife is the main carer. The assessment showed that the patient could carry out most of his daily routines on his own and only needs minimal assistance from his wife in things like washing his back or to put socks on. He has no hearing, verbal or cognitive problems and he wears glasses at all times. His wounds have been open for about five weeks; they looked clean and have no sign of infection. The nurse decided that in the next visit she will need to do a Doppler assessment. The nurse decided to do this based on his past medical history of previous leg ulcers, knowing that after six weeks a chronic wound that remains unhealed becomes an ulcer (Collins et al, 2002). She also did an assessment on the patient’s wound and surrounding skin, she assessed his weight and nutritional aspects and she took into account the patient’s diabetes. The fact that he has decreased mobility since the wound first appeared and the pain he was suffering were affecting his quality of life (Nursing Standard, 2005). The patient understood what a Doppler assessment meant and agreed to carry on with the procedure.

According to the RCN Guidelines (1998), all patients should have access to the Doppler assessment to help evaluate their ABPI (ankle-brachial pressure index) to ensure more thorough detection of any arterial problems. The key issue for the nurse was to recognize and to correct the underlying cause to enable the healing process (Journal of Community Nursing, 2007).

The next week the nurse went to visit the patient and do the Doppler assessment. The Doppler will measure the pulse strength in the feet and ankle and give an accurate diagnosis to determine the route of the leg ulcer. The result of the Doppler showed that the patient has a venous leg ulcer, a venous problem would mean that the valves in the veins are incorrectly working and backflow or blood remain in the feet and lower parts of the leg, causing oedema, nerve endings to die and a build up of toxins (Dougherty et al, 2004). The patient’s Doppler reading told the nurse that he was suitable for compression therapy. However, the nurse knew that the patient’s chronic condition, diabetes, can give abnormal readings due to obesity and old ulcers that may have damaged part of the venous system (, 2008). The patient’s readings were high, his A.B.P.I were 1 and 1.17 for the left and the right leg respectivily, this means that the patient was at the boundary for the compression therapy and may need to be referred to the vascular team (Leg Ulcer Care Pathway Form, 2006). The nurse wanted to make sure she was going to give the right treatment so she asked for advice from the leg ulcer specialist nurse. The specialist nurse advised her to put four layer compression bandages on the right leg of the patient and a hosiery for his left leg. The nurse, then, using her previous knowledge and experience decided to change the patient wound dressing, Allevyn adhesive, to a non-adhesive, non-medicated impregnated dressing to absorb and protect the wound (Autraman). Then, she put the four layer compression bandages on the patient’s right leg and the hosiery class II on his left leg.  In making this decision the nurse used a rational approach, which uses logic, policies, protocols and guidelines (Hudson, 2005). According to government policy, the application of a compression bandage can only be applied by a trained and qualified member of staff. The incorrect application of compression bandages can lead to a deteroriation of the genaral condition of the leg (NHS, 2003). 

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Using a combination of rational and phenomenological theories, using the guidelines of the local trust, past knowledge and experience, the nurse was able to make a decision. This decision would be the best option to take regarding the patient condition and quality of life.

From the rationalist perspective, the nurse used her experience to follow the nursing process, analysing the situation and taking the appropriate action, which leads to the best decision. According to Moore (1996), the nursing process should be rational and logical where decisions are made following a progression of events and circumstances, which involves deliberation and ...

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