NR 509 Week 4 Discussion: Client Challenges

Sample Answer for NR 509 Week 4 Discussion: Client Challenges

The scenario for NR 509 Week 4 Discussion: Client Challenges is located in a busy primary care office in a racially diverse area of a large city. The schedule is full today for a newly employed nurse practitioner. Just after lunch she is expecting S.S. to come in to establish care as a new patient. According to the schedule he has multiple comorbidities that will need to be addressed. The medical assistant has not come back from lunch and the NP does not want to fall behind. She goes to the waiting room to bring the patient back herself. At first glance she notices that the patient seems uneasy, glaring at other people in the waiting room from other ethnic backgrounds.  As she brings the patient toward the back office the patient seems disgruntled and makes several derogatory and racially insensitive comments.  This makes the NP feel uneasy. As she begins the appointment the patient implies concern over her competence based on her ethnicity.

Racist challenging behavior has a negative impact on the provider and client relationships. This creates a hostile environment for other patients in the waiting room and for the NP. The NP may feel offended and  angry while it is often expected of healthcare workers to remain courteous to the patient (Chary, Fofana & Kohli, 2021). This can make it a challenge to provide the best or effective care. Mutual respect is the foundation of a good relationship between provider and patient (Xue & Heffernan, 2021). The patient may not follow the advice he receives at this appointment even if it is in his best interest. It may make other patients in the waiting room feel uncomfortable and decide to get care elsewhere.

To enhance communication the NP should calm but assertive to end the racist remarks. The racist behavior should not be ignored. The NP can firmly but calmly tell the patient, “I am doing my best to take great care of you. Please be respectful and refrain from making racist statements (Chary, Fofana & Kohli, 2021).”  Should the patient continue the challenging behavior despite the NP creating a boundary a supervisor may need to become involved in the situation.  However, in this scenario the patient agrees to the NPs request and continues the appointment.  In this situation the communication technique of active listening will be especially important as the NP may have a tendency to be thinking of the racist encounter or what other racist remarks the patient may make. Active listening is necessary to gather all the information in order to to make the best clinical recommendations.

A sample of a note that could be included in the chart could be:

At the onset of the visit S.S. verbalized racially insensitive comments to other patients in the waiting room and to the provider. The NP addressed this behavior instructing the patient to refrain from making racist remarks and emphasized the need to maintain a culture of mutual respect. The NP was able to listen to the patient despite the challenging encounter and provide appropriate medical care and provide a patient centered plan of care.

NR 509 Week 4 Discussion: Client Challenges References

Chary, A. N., Fofana, M. O., & Kohli, H. S. (2021). Racial discrimination from patients: institutional strategies to establish respectful emergency department environments. The western journal of emergency medicine, 22(4), 898–902. https://doi.org/10.5811/westjem.2021.3.51582Links to an external site.

Xue, & Heffernan, C. (2021). Therapeutic communication within the nurse–patient relationship: A concept analysis. International Journal of Nursing Practice, 27(6), e12938–n/a. https://doi.org/10.1111/ijn.12938

Sample Answer 2 for NR 509 Week 4 Discussion: Client Challenges

Outstanding case scenario and examples of the nurse could approach each situation. Racial discrimination is a complex and distressing situation. It can start as verbal assaults to complete violation of human rights. In health care, even more racism can lead to poor health outcomes such as preterm births, increase risk of cancer, or deterioration of mental health. 

Remember for providers it is not enough to say “I am not a racist”, it is important we acknowledge and actively work to combative negative behaviors and comments. That said, Nicole you are correct that while the patient had serious negative and inappropriate comments, the higher professional role is to ensure high quality health outcomes – addressing the tachycardia.

Lastly, as the provider for you are responsible for the safety (mental and physical) of your staff. Meaning, make sure you protect against verbal or harassing comments, aligning to NR 509 Week 4 Discussion: Client Challenges requirements.

Sample Answer 3 for NR 509 Week 4 Discussion: Client Challenges

This is a good post since we cannot deny that this situation can happen in our future practice. Racism perpetuates an offensive hit to our moral integrity and has been an on-going health crisis that affects the mental, physical, and spiritual health of health care workers through biases, prejudices, and feelings of superiority (American Nurses Association, 2021). As care providers, we must be equipped with a culturally sensitive demeanor so as we will know how to respond and address the issue. A challenging patient’s behavior can pose a risk that can hinder care and effective communication such that clinicians need to be firm but sensitive in dealing with such situations. Good communication is our best strategy through the integration of positive behavior in transmitting, receiving, and understanding information with precision and mutual respect (Moreira et al, 2019). We can be good listeners as well as good patient advocates by being aware of the nonverbal cues, body language, and tone of voice we use in dealing with patients.

Healthcare providers are responsible for collaborating with other agencies, humanities, and other disciplines to help heal a longstanding systemic racism (Hassen et al, 2021). This issue needed to be recognized and addressed instantly since it can threaten the client-provider relationship. Trust and respect should be the basis of the relationship and missing one of them can compromise patient’s safety as well as the care provider’s decision-making skill that can result to poor patient outcomes.

REFERENCES

American Nurses Association. (2021). National Commission to Address Racism in Nursing. https://www.nursingworld.org/practice-policy/workforce/racism-in-nursing/

Hassen, N., Lofters, A., Michael, S., Mall, A., Pinto, A.D., & Rackal, J. (2021). National Library of Medicine. National Center for Biotechnology Information. Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. International journal of environmental research and public health, 18(6), 2993. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000324/

Moreira, F.T.L.D.S., Callou, R.C.M., Albuquerque, G.A., & Oliveira, R.M. (2019). National Library of Medicine. National Center for Biotechnology Information. Effective Communication Strategies for Managing Disruptive Behaviors and Promoting Patient Safety. https://pubmed.ncbi.nlm.nih.gov/31038600/

NR 509 Week 6 iHuman Virtual Patient Encounter – Neurologic Assessment Graded

Week 6 iHuman Assignment Reflection Worksheet 

Address the following question. Write on this template and include the following components: 

1. i. write 150-300 words in a Microsoft Word document
2. demonstrate clinical judgment appropriate to the virtual patient scenario

iii. cite at least one relevant scholarly source as defined by program expectations 

1. communicate with minimal errors in English grammar, spelling, syntax, and punctuation

One rule is to always include “the worst-case scenario” in your differential diagnosis and make sure you have ruled out this possibility based on your findings and patient assessment. Your goal is to minimize the risk of missing unusual or infrequent conditions such as meningococcal meningitis, bacterial endocarditis, pulmonary embolus, or subdural hematoma that are particularly ominous.  

What are the “red flags” in this case?  

Red flags are critical signs that show a condition is manifesting in the body. In this case, red flags will be vital signs describing different conditions. The core red flags are severe headaches, neck muscle stiffness, vomiting, general body weakness, and nausea. Although there are several infections with similar symptoms, the practitioner can infer meningitis because of the severity of the underlying symptoms (Cibrelus et al., 2018). The condition can be confused with subdural hematoma or pulmonary embolism because they have shared red flags. However, there is the ease of ruling them out.     

Based on your pertinent key findings, what is “the worst-case scenario”?  

This case outlines meningitis as the worst-case scenario, and its symptoms describe how the condition is fatal. Most people suffering from meningitis believe a virus causes it, although some attribute it to bacteria and other related species. Based on the findings, the condition occurs as a form of inflammation. When the brain membrane swells, the brain and the spine are subjected to risk. Therefore, meningitis requires urgent treatment for chronic symptoms such as severe headaches, coma and neck stiffness.       

What lessons did you learn from this case that you can apply to your future professional practice? 

The case scenario has been informative, and I can draw several lessons to reinforce my future practice.  Firstly, checking the unexpected or worst scenario during the clinical evaluation of a patient is a critical lesson. Based on this case, meningitis was the worst scenario and a life-threatening condition (Azure et al., 2023). This lesson will be applicable in any clinical setting whenever I am undertaking a clinical assessment of patients. Another vital lesson from this scenario is always considering rare illnesses when assessing patients in clinical settings. In our case, meningitis was a rare condition, and it was discovered through assessment and ruling other similar conditions out based on the presented symptoms.    

References 

Azure, S., Abdul-Karim, A., Abubakari, B. B., Eleeza, J. B., Agboyie, D. D. A., Weyori, E. W., & Choi, J. Y. (2023). Trends in Neisseria meningitidis serogroups amongst patients with suspected cerebrospinal meningitis in the meningitis belt of Ghana: a 5-year retrospective study. BMC Infectious Diseases, 23(1), 202. 

Cibrelus, L., Lingani, C., Fernandez, K., Djingarey, M. H., Perea, W. A., & Hugonnet, S. (2018). Risk assessment and meningococcal A conjugate vaccine introduction in Africa: the district prioritization tool. Clinical Infectious Diseases, 61(suppl_5), S442-S450.