Question 1: Think of a surprising or challenging practice situation in which you felt underprepared, unprepared, or uncomfortable.

In a particularly challenging situation, I was assigned to care for a patient who had been admitted following a stroke. The patient had a pacemaker, preventing the use of MRI to determine the stroke’s exact location. Over several nights, I monitored her condition. On the fifth night, I noticed the patient had developed a fever of 100.5°F since the morning, but no interventions had been implemented. Upon assessment, she was lethargic and unresponsive to verbal stimuli, a significant deviation from her baseline. She exhibited no acute distress, but I detected crackles and wheezing in her right lung during auscultation. Despite my concerns, the on-call doctor deferred any immediate action until morning. After escalating the issue to the charge nurse and nursing supervisor, the necessary orders were finally placed. Subsequent tests revealed a urinary tract infection (UTI) with E. coli and pleural effusions, requiring thoracentesis. This experience underscored my feelings of unpreparedness in advocating for timely medical interventions.

Question 2: Select an important nursing issue/topic that was inherent to the identified situation.

The significant nursing issue inherent in this situation was patient advocacy. As nurses, we are often the first to recognize changes in a patient’s condition and must advocate for appropriate medical interventions, especially when initial attempts to secure timely medical attention are unsuccessful.

Question 3: Briefly explain the situation.

Initially admitted for a stroke, the patient I had been caring for developed a fever that went unaddressed despite my repeated assessments and concerns. The on-call doctor dismissed my reports and deferred action until the morning. After involving the charge nurse and nursing supervisor, appropriate diagnostic tests were ordered, revealing a UTI and pleural effusions. The patient required further medical intervention, highlighting the critical need for persistent advocacy in nursing practice.

Question 4: Identify the nursing issue inherent in the identified situation.

The nursing issue was the necessity of effective patient advocacy. This situation highlighted the challenges nurses face when their clinical assessments and concerns are not immediately acknowledged by the medical team, necessitating persistence and escalation to ensure patient safety and appropriate care.

Analysis Using Carper’s Patterns of Knowing

Underlying Reason for the Situation (Esthetics):

From an esthetic perspective, the underlying reason for the situation was the inherent complexity and unpredictability of patient conditions. Nursing practice often involves managing intricate health issues where timely interventions are critical. The on-call doctor’s initial reluctance to act may have been due to a lack of immediate visual evidence of acute distress, underscoring the need for nurses to use their clinical judgment and intuition to advocate effectively for their patients.

Thoughts and Feelings in the Situation (Personal):

Personally, I felt a profound sense of responsibility and frustration. Despite recognizing the patient’s deteriorating condition, I initially felt powerless when my concerns were dismissed. This experience emphasized the emotional and psychological burden nurses carry as patient advocates, balancing professional duties with the emotional impact of ensuring patient safety in the face of resistance.

Personal Belief that Impacted Actions (Ethics):

A core ethical belief that influenced my actions was the commitment to patient well-being and the moral obligation to advocate for necessary care. This belief is rooted in the ethical principles of beneficence and non-maleficence, which emphasize the importance of doing good and preventing harm. My determination to secure the appropriate medical response was driven by this ethical framework, guiding my persistent advocacy efforts.

Evidence in Nursing Literature (Empirical):

Empirical evidence supports the critical role of nurse advocacy in improving patient outcomes. Studies indicate that effective nurse advocacy can lead to timely interventions and reduced complications, ultimately enhancing patient safety and care quality. For instance, a study by Twigg et al. (2015) found that inadequate staffing and delayed medical responses can significantly impact nurse-sensitive outcomes, emphasizing the importance of proactive nursing interventions.

New Insights and Application to Practice (Reflective Practice):

Reflective practice in this situation has provided valuable insights into the importance of persistence in patient advocacy. Moving forward, I will apply these lessons to my practice as a nurse practitioner by continually advocating for my patients' needs, even in challenging situations. Understanding Carper’s Patterns of Knowing has reinforced the value of integrating empirical evidence, personal ethics, and esthetic intuition in clinical decision-making. This holistic approach will guide my future practice, ensuring comprehensive and compassionate care.

References

Carper, A. B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 38, 13-24.

Twigg, D. E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nurse-sensitive outcomes. Journal of Advanced Nursing, 71(7), 1564–1572.

Zander, P. E. (2007). Ways of knowing in nursing: The historical evolution of a concept. Journal of Theory Construction & Testing, 11(1), 7.