Describe a clinical practice situation which requires the applicant to use problem-solving skills successfully and how the applicant will take a leadership role as an FNP.
Virginia Henderson, a nurse theorist, describes a nurse as one who has the unique function of assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that they would otherwise perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help them to gain independence as rapidly as possible. The nurse must in a sense, get inside the skin of each of her patients in order to know what they need. This means, that the nurse finds herself with a new challenge to handle since each patient is an individual with their own unique needs. Abdellah, F. (1987), in his theory, Topology of 21 Nursing Problems, states problem solving as one of the eleven fundamental skills of a nurse. He further describes people as having physical, emotional and sociological needs hence; a patient is described as the only justification for the existence of nursing.
In my profession as a Family Nurse Practitioner, FNP, I have encountered a myriad of challenges that required me to apply my problem solving skills. It was a few weeks ago when my patient whom I choose to refer to as Mr. X for confidentiality purposes came into the clinic with very low blood sugars that he almost went into a hypoglycaemic coma. He was shaking, sweating profusely and was confused. Hypoglycaemia is a condition in which blood sugar levels are unusually low and it could be fatal if not attended to promptly since the brain may be deprived of glucose leading to its damage.
I had known Mr. X as my patient for one year. He is a fifty three year old man from Iraq who works as a bus driver. He is a father of three and is married to one wife. He was newly diagnosed with type 2 diabetes which is a condition characterized by tissue resistance to the action of insulin combined with a relative deficiency in insulin secretion. Although insulin is produced by the B cells in these patients, it is inadequate to overcome the resistance, resulting in raised blood sugars. He was initially put on oral ant diabetic agents but the sugars were still not controlled hence, he was put on insulin. I had taught Mr. X and his wife the technique of injecting the insulin subcutaneously, the dosage, the time to have it because he was on the 70:30 mixtard preparations and how to properly plan for his meals. He had followed my instructions to the letter and the times he came for revisits, I emphasised on the instructions. In fact, he had been faithful with his exercises and was determined to lose weight and maintain a healthy lifestyle. He had also tried to reduce the number of cigarettes he smoked from twenty to ten in a day. Generally, Mr. X was doing well and his blood glucose was under control until this day that he came in with hypoglycaemia.
Mr. X was put on 25 millilitres of 50% glucose intravenously over three minutes to reverse his hypoglycaemic condition. The blood sugar levels were controlled and a glycosylated Hemoglobin, HbA IC of 5.9% was achieved. The normal level is below 6%. Once he was stable, I decided to discuss his condition with him and to get a more detailed history of what exactly had happened.
Mr. X insisted that he was not sure of what had happened because he had followed his drug regimen faithfully and my instructions too. As we discussed about the aetiology of hypoglycaemia and its complications, the wife interjected saying that perhaps Mr. X suffered from hypoglycaemia due to injecting himself with insulin yet he had not eaten since it was the Muslim Ramadan month. She explained that Ramadan is a month of obligatory daily fasting. It is the ninth month in the Islamic lunar calendar. Daily fasts begin at dawn and end with sunset. Special nightly prayers called, Taraweeh are held and the entire Quran is recited in Mosques all around the world. She explained that they both took part in this fast because they believed that they will draw nearer to Allah who would heal Mr. X of his condition.
This information unravelled the mystery. Mr. X confirmed that he had not eaten the whole day but he had had his insulin shot. As a nurse, I knew this was a critical issue; it touched on religion. I am not Islam but ethically, I had to respect my patient’s beliefs and not impose my views on him. Certainly, this was a situation that needed to be handled carefully because the patient’s health was at stake yet his firm believe had to be respected.
A sombre mood had engulfed the room; I could feel it. Mr. X was not pleased. His wife had spilled the beans and in their culture, women are not to be heard, they are only to be seen. I had to quickly take control and discussed more about starving as a major aetiology of hypoglycaemia and I explained how lack of eating and taking insulin affected the body. I made it clear to Mr. X that it was not a bad thing to fast and that he was justified to do so by his faith. However, I explained to him that there were exceptions to the rule if the fast would be detrimental to his health. As I spoke to him, he seemed adamant and disagreed with what I was saying. At some point, he harshly yelled at me that I spoke like an atheist who knew nothing about Allah.
Noticing the situation was going to get out of hand, I thought of my colleague who was a doctor and was also a Muslim. With the consent of Mr. X, my colleague came in and explained to him. He even called one of the Islamic religious leaders to affirm that there are people exempted from the fast such as Mr. X and that it was not a sin. Mr. X was convinced and he really appreciated us for enlightening him and saving his life. They both left my office a happy couple who would enjoy the rest of the holy month without any health issues.
This was a situation that not only put a demand on my problem solving ability but also on my leadership skills. As an FNP, I had to take control of the situation. First, I had to contain my emotions and not react to Mr. X’s insults. True leaders do not react to situations, they respond instead. I had to respect my patient’s religious beliefs and not judge them or try to impose mine on them. This means as a nurse, one should handle each patient as an individual and holistically. As a leader, critical and quick thinking is a vital skill. One must prioritize their actions like in this situation; I had to ensure that Mr. X was in a stable health condition before making further enquiries on what had happened. This shows that you care about the patient’s welfare. Leadership as an FNP also means that one has to embrace teamwork. In the health profession, teamwork is indispensable and we should work in concerted efforts to provide quality care for the patient, George Julia B. (1990).
Nursing is indeed a profession that presents the nurse with different situations to deal with. Thus, proper problem solving and leadership skills are valuable tools of trade that one must have.
Abdellah, F.G. (1987) Citing websites. In Topology of 21 Nursing Problems, Web.
George Julia B. (1990) Citing website: Nursing theories. In Nursing Research and Theories, Web.