Ways of Knowing in a Nursing Situation

Assignment:

Reflect upon a patient care encounter from personal practice in which multiple “ways of knowing” were used. Illustrate how each fundamental pattern for nursing knowledge contributed to the care of this patient.

Select a particular area of nursing that is of interest to you. Elaborate on the specifics of nursing research in relation to this area— what can be accomplished by it, and why you believe it to be valuable. Include an explanation of the following questions in your response.

What role does nursing research play in the development of applied medicine?

What are the best methods for conducting such research? Include specific topics you will cover, and how this relates to your literature review.

How do you know whether a topic qualifies as research worthy? What criteria make a topic acceptable for research?

The assignment should be between 1500 and 2000 words in length and contain at least two scholarly sources, in addition to the textbook and provided material.  Please submit your assignment in one APA formatted document.

Either use hypertension or diabetes

 

SOLUTION

Ways of Knowing in a Nursing Situation

Multiple ways of knowing have been established and employed in nursing practice. Historically, four distinct patterns of nursing knowledge have been extensively applied in nursing profession. These include: personal, ethical, empirical, and aesthetic knowing (McEwen & Wills, 2011).

A combination of the four patterns of knowing is critical to a nurse since it provides a solid clinical knowledge that drives nursing actions in different scenarios. The following patient encounter situation demonstrates how the multiple ways of knowing can be applied in a patient care scenario.

Patient Encounter

A 52-year-old male is admitted to a medical ward with an initial diagnosis of type 2 diabetes mellituspatient care . The patient was initially diagnosed with the condition in 2006, and has been on follow up in the diabetes clinic. The patient has also been bedridden for 15 days. He has not been complaint on walking exercises orders and appear helpless when asked to perform activities of daily living without help.

On assessment, I found the patient alert and oriented. He reports non-compliance of his medication and know presents with the complications of diabetes. The chief complaint was frequent urination, drinking too much water and increased appetite. He also complains of painful peripheral neuropathy that has been there for a year know.

It was associated with loss of sensation on the dorsum of the foot and a chronic un-healing ulcer. He also complains of poor vision where he describes it as seeing two things when his wife could only see one. This patient also has a comorbidity of hypertension and hyperlipidemia.

Upon further assessment, vesicular and bronchial sounds were clear but diminished in the bases. Breathing is regular at a rate of 16 breathe per minute, no distress in respiration. Oxygen saturation was 97 % at room temperature. I found glucose levels of 16 mmol/l. Urinalysis increased ketone bodies. There is also increased ketone levels in blood.

The patient skin turgor is also poor. The patient has compressions devices on his side bed, when asked why they are not on, he explains that it makes him uncomfortable.

His medications are administered, including 500 mg metformin, angiotensin -converting enzyme inhibitor enalapril 5mg daily and statins. He stated that too many medications would make him sicker. The medications are his normal regimen to control diabetes and other comorbidities- hypertension and hyperlipidemia.

Later, I took the routine vital signs and found oxygen saturation of 74 % on room air. The patient breathing pattern is shallow and states that he has difficulty in catching his breath. I conducted a telemetry on the patient which shows he is sinus tachycardia with a rate 120 to 150. I placed the patient on 100% oxygen.

The patient was shaking, sweating and confused. Blood glucose levels showed glucose level of 3 mmol/l which warranted me to administer dextrose IV. After sometime oxygen saturation was 81% and glucose levels rose to 6 mmol/l.

On titration, his oxygen saturation was 96% at 4.5 liter of oxygen. A D-dimer test was done and it was elevated twofold, and a subsequent scan demonstrated a pulmonary embolism. The patient is transferred to ICU and anticoagulation therapy initiated immediately.

Empirical Knowledge

This pattern of knowing describes the knowledge that is scientific and objective, and it is gained mainly from research. It is organized systematically into general laws and theories. It is often referred to as the science of nursing (Chinn & Kramer, 2014). In this case, empirical knowledge allows the nurse to know that a glucose levels of 2 mmol/l is too low and could lead to hypoglycemic coma.

The value is abnormal and is based on the previous experimentation and observable phenomena. Similarly, empirical knowledge allows a nurse to understand oxygen saturation of 74 % is dangerous to the patient hence instituting measures to solve it. In the same vein, empirical knowledge is applied in the elevated D- dimer which is an indication of increased clotting activity in the blood which also poses danger to the patient.

Ethical Knowledge

Ethical knowledge describes the moral values that guide nursing practice. In essence, it is the sense of deciphering what is wrong and right. For nurses, ethics is based on our obligation to protect and respect human life. The nurses’ deliberate personal actions are guided by ethical knowledge. The “Code of Ethics for Nurses” (American Nurses Association, 2015) guides nurses on the moral code.

In this case, ethical knowledge is demonstrated by ensuring timely administration of medications and other non-pharmacologic interventions to reduce the risk of death or permanent organ damage because it was morally upright to do so. This is regardless of any personal feelings related to the patient’s non-compliance and perceived helplessness.

Clinical Knowledge

Clinical knowledge is a way of knowing that is gained from nursing experience. It is a combination of personal knowledge, empirical knowledge, subjective knowing and intuition (McEwen & Wills, 2011). Most clinical decision makings skills are influenced by clinical knowledge in most cases. In essence, the nurse clinical knowledge, gathered from text books and experience is what inspired the swift actions in this specific patient situation.

The knowledge that the patient has been a diabetic since 2012, non-compliance to medications put this patient at a risk of complications of diabetes as outlined above. Similarly, the nurse knowledge on sedentary aspect of the patient for several days and the patient non-compliance to the deep vein thrombosis prophylaxis put this patient on risk of pulmonary embolism due to embolization of the thrombi from the leg to the pulmonary artery.

Excessive sweating, shakiness and confusion could have been caused by large doses of metformin and exercises before meals that resulted in hypoglycemia. The nurse was aware of this therefore instituting measures to return the glucose levels back to normal- administration of glucose to prevent coma.

The nurse was also aware that the lack of significant increase in oxygen saturation was due to pulmonary embolism which prevents saturation, this guided the decision of removing sequential compassion devices to prevent any further embolization.

Nursing Research in Diabetes

Research in nursing is significant as it ensures diabetes nurses focus on evidence based practice in the current health situations. Nurses working in diabetes have a mandate to research, and use the findings to inform their practice (Dunning, 2011). Establishing what is already known is important step to improving the existing research through systematic literature review.

Systematic literature review is important in finding research about diabetes as it allows one to find information timely and efficiently. For instance, research can then be applied to inform care guidelines in diabetic patients. Once a nurse has been informed about relevant evidence, diabetes nurses are in the position to utilize it in improving care.

Challenges abound in the process of research that serves to inform and implement clinical guidelines and pathway to decision making (Miller and Kearney, 2004). However, diabetes nurses possess the authority that can be tapped to help improve their practice. Other than systematic literature reviews, audits and case studies can also be use a method of research in nursing.

Audit is method of research that assess the improvements or outcomes assuming the intervention that was made were desired. Audit method is applied through a series of service evaluation   processes. Similarly, case studies can be used as a method of research in nursing practice.

The Specifics of nursing research in diabetes include: patient self-management, glycemic control, foot care measures, diabetes self-education, management of complications of diabetes and hypoglycemia.

Patient self-management research is important as care for diabetics is patient centered. There is need for nurses to research on the best ways to enhance patient’s management through education on diabetes and how to administer medications by themselves. Similarly, importance of daily glucose monitoring should also be made clear to the patient.

Diabetics should own a glucometer so that they can monitor their sugars daily. This reduces risks of hypoglycemic or hyperglycemic coma. In addition, it ensures glucose levels are properly controlled to prevent the complications of diabetes from staging in.

Research on diabetic patient foot care is also of great significance. Incidence of below knee amputations are on the rise due poor glucose control and foot care negligence. Diabetes damages the microvasculature of the lower limbs making it ischemic. It also damages the nerves leading to loss of sensation. A combination of the two: microvascular and nerve damage predisposes the patient to chronic foot ulcer.

The foot ulcer, without proper foot care methods, can lead to a gangrenous foot that requires amputation to serve the rest of the leg. Thus, importance of nursing research on foot care cannot be underestimated.

Research on achieving a desired glycemic control is also imperative as far as nursing research is concerned. A desired glycemic control ensures glucose levels remain within the physiological ranges. This has numerous positive implications on the patient outcomes. It delays the onset of diabetes complications and thus improving the health of the patient. A desired glycemic control is also compatible of long life.

Research on hypoglycemia in diabetic patient is also significant. Hypoglycemia, in diabetic patients, develop when there is: an overdose of the medications such as insulin, vigorous exercise and inadequate carbohydrate intake. It is a life-threatening condition as it can lead to coma or even permanent brain death of the brain cells. This serves to underscores the significance of research on hypoglycemia in order to manage the condition effectively when it arises.

Criteria of Selecting a Research Topic

Each topic that has been proposed for research has to be subjected to judgment according to research criteria. Traditionally, there are many research guidelines. These include relevance, avoidance of duplication, feasibility, applicability of the results and recommendations and ethical acceptability. Relevance addresses the priority problem that the topic addresses. The problem must be wide spread and severe for it to be considered relevant.

Avoidance of duplication criteria ensures that there is no similar research or rather answers to the topic to be researched are nor easily found. The research topic should also be feasible considering the complexity of the problem and the resources needed to carry out the study. In addition, a research topic should be ethically acceptable. In essence, the research topic should not inflict any harm while carrying out the study. Finally, the results and recommendations of the research topic should be applicable practically.

 

References

American Nurses Association. (2005). Code of ethics for nurses with interpretive statements. Nursesbooks. Org.

Chinn, P. L., & Kramer, M. K. (2014). Knowledge development in nursing: Theory and process.   Elsevier Health Sciences.

Dunning, T. (2011). Research and Diabetes nursing. Part 1: Terms of engagement. Journal of        Diabetes Nursing, 15(1), 9.

McEwen, M., & Wills, E. M. (2002). Theoretical basis for nursing. Philadelphia: Lippincott           Williams & Wilkins.

Miller, M., & Kearney, N. (2004). Guidelines for clinical practice: development, dissemination      and implementation. International journal of nursing studies, 41(7), 813-821.

Also check: Theories Applied to the Nursing Profession