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Case StudyMartine De Bovieu is a 28 year old French tourist who with her long term partner Vincent, has been travelling Australia for the last 2 months of January and February, when temperatures ranged from 38 – 40 O C. Martine normally works as a li Essay Example

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Reflective Clinical Case Study15

Reflective Clinical Case Study



In this paper, I will discuss several issues that bind nursing practice with questions of sociology, management and ethics, the discussion will be about proper diagnosis in nursing care and then try examining how best a patient can be given the right treatment. In this paper, the case study I will talk about is a patient by the name Martine De Bovieu; aged 28 years who together with her partners have been have been travelling Australia for the last 2 months of January and February, when temperature recoded ranges from 38-40 degree centigrade. For the last one week, Martine had complained to her partner she was feeling unwell and might be due urinary tract infection. Martine has been feeling hot, thirsty, fatigue, she pass small urine with a burning on micturition and suprapubic pain. In addition, Martine symptoms include: frequency, dysuria and her urine was cloudy with a distinct fishy odour, and was finding it difficult to locate the toilets. Further tests were carried out, and it was found she was suffering from E. coli urinary tract infection resistant to trimethoprim and so Ciprofixins was commenced.

The Medical Management and Treatment modalities

Definition of condition: — Urinary tract (comprises of the ureters, kidneys, urethra, and bladder) infections is caused by any number of bacteria but are mostly caused by Escherichia coli (E.coli) bacteria. E.coli is a common bacterium that is found in the lower intestine of human being (Jones and Woodman, 2009). Sign and symptoms for E.coli urinary tract infection include: the patient urge to urinate frequently, which may recur immediately after the bladder is emptied; Pain in the pelvic area or back; discomfort or pressure in the lower abdomen; occasionally, fever develops; a painful burning sensation when urinating; and urine often has a strong smell, contains blood or looks cloudy (Abrahamian, Moran and Talan, 2008).

Medical management: — The goal of medical management is to minimize E.coli Urinary tract infection, preserve E.coli Urinary Tract Infection function and prevent complications. The diagnosis of Urinary tract infection requires patient specimen collection, and lab tests should be carried out for presumptive diagnosis. Lab tests for UTI include the following: Urinalysis is used to analyze various components of the patient urine sample. Urinalysis involves looking at the patient urine clarity and color, and then a dipstick is used to do different chemical testing (Brown & Edwards, 2008). In addition, some of the urine sample can be inspected underneath a microscope. Urine culture should be performed; this involves incubating and growing the bacteria that is found in the urine sample (Brown & Edwards, 2008). Urine culture will be used to help the doctor identify the specific bacteria that caused the infection, and determine which appropriate antibiotic can be used in treating the patient. Mostly, Urine Culture is used if urinalysis does not show signs of infection but the medical practitioner suspects a Urinary Tract Infections is causing the symptoms. To some extent, a doctor can order intravenous pyelogram tests, which gives x-ray images of the kidneys, bladder and ureters. A dye which is visible on x-ray imaging is injected into the patient vein, and x-ray taken. The film will then take an outline of the urinary tract that will reveal small changes in the structure of the patient tract (Brown & Edwards, 2008).. In our case the medical practitioner should have ordered for Urine Culture to ascertain that the patient was suffering from E.coli UTI, to some extent he should have ordered for intravenous pyelogram to be certain for the damages caused.

Treatment: — The main aim is to prevent further complications. Antibiotics are the mainstay of treatment in E.coli infections. A high fluid intake is essential to patient. The patient taking alkaline substances, such as citrates combine with water might improve the patient symptoms. For the reasons when the patient urine is more alkaline, they make the environment more hostile to bacterial growth and improve the results of antibiotic therapy (Leydon, Turner, Smith and Little, 2010). In studies carried out at the Adelaide and Meath Hospital in Dublin, resistant rates for E.coli bacteria were 33.8 per cent for trimethoprim and 58.3 per cent for ampicillin. These two types of antibiotic are least active agents and are not effective to be used in first-line empirical therapies. While in urology resistance rate of E.coli bacteria to Gentamicin antibiotic was 6.4 per cent (Mehnert-Kay, 2005). In relationship to our case study, Ciprofloxacin remained effective in treating E.coli infections, with no significant change in resistance. Alternative to Ciprofloxacin, the patient can be treated with nitrofurantoin. Study carried out at the Adelaide and Meath Hospital in Dublin showed that nitrofurantoin has an overall rate of 2.1 per cent and Ciprofloxacin overall rate of 2.6 per cent are appropriate empirical first-line agents to be used to treat E.coli UTI infections (Little, Moore, Turner, Rumsby, Warner, Lowes, et al, 2010).

In assessment, The patients complain of the following: frequency, burning, urgency, nocturia, blood in the urine, and suprapubic fullness; a feeling of warmth during urination; itching; nocturia. Other complains including low back pain, vomiting, nausea, malaise, tenderness over the bladder, flank pain, and chills. On measuring, the patient temperature has risen to 39.2 degree centigrade, and her blood pressure was low at 85/46. The patient body temperature was above recommended body temperature of 36 o C, while, blood pressure was below the recommended blood pressure of 120/80 (systolic/diastolic). Under the guidance of the doctor, I was told to examine physically the patient. On examination, I examine the patient pelvic and vaginal area, and there was discharge from the urethra, when I exerted pressure above the pelvic bone; the patient felt pain in response to pressure; and pelvic or rectal examination found abnormalities. Numerical scale and PQRST should be used to measure the patient pain (Molander, Arvidsson, Milsom and Sandberg, 2003).

Interdisciplinary Care

Interdisciplinary clinical practice can be defined as a joint decision-making or collaboration and communication process among healthcare practitioners or healthcare providers with the goal of satisfying the needs of the patients while respecting the unique abilities of each professional that is involved in providing that care (Molander, Arvidsson, Milsom and Sandberg, 2003). Evidence indicate that interdisciplinary care improves continuity of care and expands preventive care counseling, thus increasing the patient satisfaction and decrease death and hospitalizations rates. One area in which interdisciplinary care can be achieved is through clinical integration and service delivery networks across the continuum of care. In community collaboration, the network has been able to drawn both private sector and public sectors health care institutions such as private health providers, health departments, business coalitions, managed care organizations into partnership to focus on the health of patients, seamless management within fixed resources, continuum of care and patient treatment accountability (Jepson & Craig, 2008).

Interdisciplinary care in relationship to treatment of E.coli UTI should concentrate on heavily on seven areas (Crisp & Taylor, 2009). These areas includes: preventing health and education, behavioral health, cost effectiveness and expenditure control, community assessment of health needs, community reporting and coordination of services. The seven areas which health care facilities can concentrate on clearly blend individual and traditional public health care. In addition, it provide a frame work in which collaborative interventions can be proposed in healthcare facilities. In addition, other areas for interventions that can be used to improve the patient health and at same time correct health care disparities are: strengthen community cohesion, increase socioeconomic well-being, modulate hierarchical structuring and enhance opportunities for self-fulfillment. Many findings from studies which have been conducted about Interdisciplinary care have shown evidence of improved outcomes for both chronically and acutely ill patients. Interdisciplinary care programs in health care facilities should put much emphasis on conflict resolution, teamwork, and the use of informatics to promote collaboration in patient care planning and implementation (Fischer, 2010).

In this era of medical practitioner’s shortages and the expanding need for high standard nursing care as results of the changes brought about by the socio-demographics of the healthcare system and population itself. There is the need to utilize the knowledge and skills of registered nurses in the nursing profession as well as attract individual into the professional. Therefore, Interdisciplinary care programs are able to support and optimize professional nursing practice and allow the baccalaureate- and higher degree-prepared nurse to practice to their full potential are identified.

Education and prevention

Many methods have been recommended to prevent or reduce Urinary tract infections (UTIs). Some of these methods are considered to be home remedies and will be discussed in this paragraph. These preventive measures includes: good hygiene for females is useful; women should wipe anal from front to back, as this will help them keep bacteria or pathogens that may pass or reside through the anal opening away from the urethra. Finding from many studies suggests that women should not wear anything that will cause irritation in their genital areas. For example, deodorant sprays, tight pants, or other feminine products (van der Starre, 2010), for these will encourage Urinary tract infections (UTIs) development. Women should always wear pants that are adsorptive, for example cotton pants; will help wick away urine drops that otherwise may encourage the growth of pathogen around the urethra. Women should not delay urinating after they have felt the urge to do so, when a woman hold back urine; she will allow the bacteria more time to multiply and the more the bacteria are in the bladder the more it will be harder to remove them from the bladder (Olso, Harrell and Kaye, 2009). In other words, bacteria are able survive and multiply easier in a non-flowing system; but every urination, bacteria get rid from the bladder. After and before sexual intercourse (van der Starre, 2010), women should urinate; the act of sexual intercourse will allow the transfer of pathogen or bacteria through the urethra. At the same time, urinating before sexual intercourse will help flush away any pathogen or bacteria that can be pushed into the urethra during the act of sexual intercourse (van der Starre, 2010).

Reflective practice in nursing profession is guided by models of reflection, this model act as a framework in within which nursing professions can work. In addition, the model will help a person in determining what was positive or negative or a learning experience within the nursing profession. While, reflective practice bring out the importance of student learning from his/her experiences, after thinking about an incident (practical experience) and then relates that practical experience with theoretical learning approaches. In this assignment, Gibbs’ model of reflection (1988) was used to reflect on the situation that took place during my clinical placement.

Case StudyMartine De Bovieu is a 28 year old French tourist who with her long term partner Vincent, has been travelling Australia for the last 2 months of January and February, when temperatures ranged from 38 – 40 O C.  Martine normally works as a li

Gibbs’ model of reflection (1988)

Gibbs’ model of reflection (1988) is a recognize framework for my reflection. The model consists of six stages to complete one cycle. This cycle will help me improve my nursing profession, and also put into practice things from my experience (Fischer, 2010). The first state of the cycle is description of the incident, second stage deals with analysis of the feelings, third stage concerns with evaluating the experience, fourth stage is an analysis to make sense of the experience, fifth stage deals with conclusion of what else could I have done, and the last stage deals with action plan (Fischer, 2010).

According to Crisp & Taylor (2009), reflection is important to a person because it generate practice knowledge, assist student to adapt to new situations, develop self-esteem and satisfaction as well as to develop, value and professionalizing practice. This point is supported by Siviter (2004, p.165), who said student reflection is about identify and to improve, gaining self-confidence, learning from own behavior and mistakes, being self-aware, learning from other people perspectives (Crisp & Taylor, 2009), and student improving their future through learning about the past. Reflection involves the developing of concepts, skills and knowledge and values for the promotion of an individual. It is important that a good relationship is built between me and the patient and this was enhanced through the good communication and interpersonal skills that I displayed to the patient. Reflection is all about practicing the knowledge that will assist in handling any new situation that may arise. As a nurse I should be able understand the patient and also learn from the mistakes so that I can be able to improve the future of my practice (Jepson & Craig, 2008).

Discharge Management

Discharge Management planning is a process that is used to improve the coordination of patient care after discharge from health care facility and this is through considering the patient needs in the community (Shepperd, Parkes, McClaren & Phillips, 2004). The aim of discharge planning is to bridge the gap between the health care facility in which the patient was admitted and place to which the patient is discharged, reduce unplanned readmission to hospital and reduce length of stay of the patient in the health care facility. Discharge Management at the hospital should use an interdisciplinary approach that ensures the discharge plan for the patient is appropriate to the need of the patient (Kwok, Lau, Woo, Luk, Wong, Sham et al, 2005).

Currently, there is little evidence that exist on which hospitals can base their recommendations for effective Discharge Management planning. According to the Department of Health’s guidance for England, says that Discharge Management planning is a process and not an isolated event, and this process should start at the earliest opportunity (Crisp & Taylor, 2009). In relation to our Case Study, discharge planning should start during the routine preparation for a patient admission, for example, at the preadmission clinic. And this involves consulting the patient, their social environment, the family, the medical team and the interdisciplinary team that was involved in order to develop an appropriate discharge plan. The hospital should develop a personalized discharge plan for the patient. The plan will be involve communication between the patient who has been admitted and his family or social network or both. The first time the patient was admitted to be suffering from Urinary Tract Infection, the patient must inform the medical practitioners of any existing or concerns or potential problems that will prevent her from returning home after her discharge (Kwok, Lau, Woo, Luk, Wong, Sham et al, 2005). The early Identification of factors which may prevent the admitted patient from returning home will allow the Discharge Management team at the hospital and other health care professionals to develop an appropriate plan that will best meet the expectations and needs of the patient.

After the admission, admitted patient should have their discharge potential assessed regularly. Such assessment includes: identifying the medical problems; duration of in-hospital treatment; and identification of factors that will influence the patient safe discharge- this includes the patient employment, family circumstances, accommodation, mobility, reliance on others for aspects of social care, and ability to perform activities of daily living. According to the Department of Health’s guidelines recommend that discharge planning should have a provisional date of the patient discharge. Whenever possible, on the day of admission and should be subsequently regularly reviewed. Hospital staff should be involved, in the hospital the process of discharge should be coordinated by the discharged coordinator. The role of a coordinator is to provide a single point of contact for all those who are involved in the patient discharge planning process. And the responsibility of the coordinator is to ensure timely discharge and appropriate safe or transfer of care to the community (Kwok, Lau, Woo, Luk, Wong, Sham et al, 2005). The whole process of planning requires effective multidisciplinary people that work as a team, and this will include understanding medical problem of the admitted patient, including: prognosis and ongoing treatment (Chu & Pei, 2003).

Patient admission to healthcare facilities is a vulnerable time both for the patient and his/her family (Chu & Pei, 2003). As a result of sickness, most patients often experience a loss of functional ability and require social support. In ideal situation, patients need to return to their previous level of functional ability(Weinberger, Oddone & Henderson, 2004). However, the time the patient has been admitted is short and may not be long enough to allow the patient to fully recover. So in such a case, patient discharge planner must consider if a patient can benefit from a period of rehabilitation, either in the community or as an inpatient. In relationship to our Case Study, the patient will require intermediate care. At this point, the involvement of the patient family, career and patient herself is crucial to timely and successful discharge planning. According to a survey by the charity Carers Australia found that 43 per cent of the 2 million carers in Australia felt inadequately supported by their family when the patient returned home (Weinberger, Oddone & Henderson, 2004).

The ongoing needs of the patient must be put into perspective and provided for before he leaves the health care facility. This process will include arranging appropriate follow-up for the patient in primary or secondary care or both. This process ensures appropriate drug treatment (with length of course, detail of indications, planned dose changes); ensuring adequate support at home; and patient specific warning signs and symptoms that would require prompt medical attention (Shepperd, Parkes, McClaren & Phillips, 2004). The aim of discharge is to ensure there is a continuity of care that ensure good patient outcome, thus effective handover to primary care. This process will be achieved through immediate discharge documents. Data which are available on discharge documentations include new diagnoses, follow-up arrangements and accurate medication lists (Nazareh, Burton, Shalman, Smith & Haines, 2005).


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