Sunday, July 3, 2011

A Personal Experience and Application of Caring

by Ray Dominic R. Ladera 

When I was transferred from the OB ward to the medical ward, it was the first time I handled Mrs. A, an 81-year old widow who suffered from ischemic stroke and was comatose for nearly a week when I nursed her. She was on a continuous I & O, VS and NVS monitoring, repositioning every 2 hours, and was on Dopamine side drip PRN.

She was on PNSS and has NGT for OF 3x/day, on indwelling catheter and O2 inhalation at 4 LPM. Her BP fluctuates from 100/70 to 70/50, her NVS was averaging between 4 to 6, and later she was developing edema of the extremitiesShe had ample of medications for her BP and for her brainThese were just a few things I remembered about her.  But she died around 3 am of my shift, four weeks after our first meeting without ever recovering from comatose.  

But before her expected death, I remembered doing these with her.
  • ·      During my shift I was the one doing her feeding.  Every time I would enter, I would always say “kumusta na po kayo lola (how are you grandma?), and I would always expect her to wake up and talk to me.  But despite the fact that it was difficult for her to recover from comatose, I would always talk to her before giving feeding, asking her to accept the food and even if she cannot taste it, (although it was OF) telling her that I will raise the HOB before feeding, and tell her about her medications which were taken simultaneously with her meals.
  • ·         In getting her vital signs, I would tell her that I’ll be getting her BP, temperature, and the rest, even including her urine output. And after getting them, I would tell her about her vital signs particularly if she was showing great improvements.  She seemed to smile at me for some time, I would particularly aim that she’ll recognize my voice over time, even though she didn’t know me at all.
  • ·         She seemed to dislike her oxygen cannula, but then again she had frequent DOB so I have to put it back, make sure it wasn't too tight and ensuring that humidification were just right.
  • ·         I would always encourage her significant others to talk to her and encouraged her to recover fast.  I would often discuss few nursing interventions over her bedside while her immediate family or the watcher was around so as to facilitate independence for their part in ensuring safety of their patient.  Often we could see her shed tears whenever her grandchildren were around and wanting her to wake up. She was very religious, we encouraged the significant others to pray for her always.
  • ·         Since she was bedridden and unconscious, re positioning was very crucial.  So at every two hour at least, we (either the family or the staff nurses) implement re positioning of the patient and massage at pressure points to maintain skin integrity.  She only developed small bedsores over a month or so of being hospitalized.
  • ·         She was a patient of ours, but more often I could see my own grandmother in her. I wanted her to recover.

Application: Here, I know that can be applied to her situation.
  • ·         Instilling faith and hope, incorporating humanistic and altruistic values, facilitates the holistic nursing care and positive health within the patient
  • ·         Cultivating sensitivity to self and to the others; recognizing that feelings lead to self actualization through acceptance for both the nurse and the patient.
  • ·         Developing a helping-trust relationship between the nurse and the patient as a crucial part for transpersonal caring. It involves congruence, empathy, non possessive warmth, and effective communication.
  • ·         Provision for supportive, protective, and corrective mental, physical, sociocultural, and spiritual environment that recognizes the influence that internal and external environments have on the health and illness of the individual.
  • ·         Assistance with the gratification of human needs which recognizes the biophysical, psychological, interpersonal and psychophysical needs of the patient.
  • ·         Allowance for existential phenomenological forces.

            Tomey, et al, Nursing Theorists and Their Work 5th edition. Mosby 2005 

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