Problem-solving in nursing practice
I worked in the dialysis unit during my first few years as a nurse practitioner in the nursing profession and had an interest in one particular patient. The patient was a 64-year old male who had been diagnosed with diabetes and hypertension a decade ago. He reported compliance with medications, diet restrictions, and physical activity but then developed chronic kidney disease seven years later. So, he was scheduled for dialysis three sessions per week. Every time the patient came in, his condition appeared to have worsened. He gained substantial weight, never kept eye contact while communicating with healthcare professionals. During the four-hour dialysis session, I noted that the patient was often absent-minded and appeared to be in deep thoughts. As a nurse, I inquired about what the patient was troubled with. The patient stated he is facing a lot of stressors, ranging from financial constraints to managing his trips to the hospital, and lifestyle changes. On inquiry about his sleep and nutrition patterns, the patient reported that he regularly had insomnia and had lost his appetite and only ate when his daughter pled with him to eat. I realized that the patient had signs of depression and immediately informed the physician. The patient was reviewed and diagnosed with major depression; he was referred to the psychiatric unit for further management, which I objected to due to exposure to additional stress. However, the physician maintained his decision.
The intuitive decision-making model was employed to solve the patient’s problem. According to (RR), intuition is often a rapid and automatic process which nurses use in recognizing familiar problems promptly and use their expertise to solve them. However, intuition is a gut-feeling; it should be used in combination with evidence-based practice to realize quality patient outcomes. Palmer et al., (2013) cites that it is common for individuals diagnosed with chronic kidney disease to develop mental illnesses, especially depression. This is due to the significant number of stressors they face due to their illness. If I faced the same situation today, I would recommend the patient to be managed for his depression from an outpatient clinic since admitting him to a psychiatric unit would expose him to more stressors. At that moment, I was not in a managerial or leadership position in the unit. If I were, I would recommend that the patient should be managed from an environment that does not expose the patient to additional stressors.
References
Palmer, S., Vecchio, M., Craig, J. C., Tonelli, M., Johnson, D. W., Nicolucci, A., … & Strippoli, G. F. (2013). Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney international, 84(1), 179-191. https:// doi: 10.1038/ki.2013.77.
Marquis, B.L. & Huston, C.J. (2017). Leadership roles and management functions in nursing: Theory and application (9 th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.