case 1 

• 76-year-old Black/African-American male with disabilities living in an urban setting.
• Adolescent Hispanic/Latino boy living in a middle-class suburb

Week 1 Discussion, Case Study 1

There are a few different interpersonal barriers to effective communication.  The first being a language barrier, English is a very complex language, we have many words that have multiple meanings, and many slang words.  This can be very confusing for patients that English is not their first language.  Psychological barriers can include being embarrassed, shy, cognitive issues, and mental disabilities.  Cultural barriers between patient and provider can cause strained relationships.  Some cultures find it offensive to maintain eye contact, while some find the simple touch as being offensive.  Environmental barriers should also be considered, these include noise, lack of privacy, and room being too hot or too cold.  Taking into consideration the physiological barriers that patient may have including hearing deficits and potential stress the patient may be under that would cause a patient to not understand what we are asking or teaching them.

Taking these barriers into consideration while caring for our 76 year old African-American man with disabilities living in an urban setting, we would be considering the type of disability the patient has.  The case study does not define this disability as physical or mental.  If the patient has a mental disability we would be up against the psychological barriers and would need to be cognizant of our approach with trying to navigate this barrier.  There is also a potential for a language barrier with this patient, while most African-Americans speak English, there is still the aspect of the slang words that can have different meanings based on culture, and there is a potential for cultural barriers to be present as the patient may have beliefs that differ from my own.

In caring for this patient, I would first explain to the patient exactly what I am going to be doing, and would show him the equipment that I will be using and explain what each item is for.  If the patient has mental disabilities, I would also demonstrate for him either on myself or another family member of the patients the procedures.  Building trust with the patient is the first item that needs to happen in order to provide this patient with the best possible care.

Caring for an adolescent Hispanic boy, we also have the potential for a language barrier.  This child may speak English as a second language and may have difficulty in interpreting what is being stated to him.  There may be psychological barriers, due to the patient being an adolescent male and myself being female.  The patient may be shy or uncomfortable speaking with a female healthcare professional.  There may be cultural barriers as well,  Hispanics are very tight-knit families, and can tend to be over-emotional.  Hispanics also tend to be more “touchy-feely”. 

In caring for this patient, I would also explain to him exactly what I am going to be doing.  I would also show him the equipment and would explain what each item is for.  I would allow him to hold the equipment, to allow him to see how it works.  Should this patient need a demonstration on another person, or a stuffed animal, I would provide this demonstration prior to performing the procedure on him.

“The most common approach for documenting a history and physical is the subjective data, objective data, assessment, and plan (SOAP) format” (Rhodes & Petersen, 2021). The subjective data includes patient identifiers, the chief complaint, history of present illness, past medical history, family history, social history, and the review of system.  The objective date includes the physical examination, and any diagnostic tests results that were completed.  The assessment portion has three categories, new diagnoses and any preexisting diagnoses, differential diagnoses, and a problem list.  The plan section is the final section, in this section the healthcare practitioner would lay out what the treatment plan is for the patient.  This would include: nonpharmacological interventions, pharmacological inerventions, educational needs, follow-up, and referrals.

References

Rhoads, J., & Wiggins Petersen, S. (2021). Advanced Health Assessment and Diagnostic Reasoning. Burlington, MA: Jones and Bartlett Learning.

Wainwright, N. (2017).  Barriers to Effective Interpersonal Communication.  https://bizfluent.com/list-7422303-barriers-effective-interpersonal-communication.html

 Week 1 

Evidence based practice, research and theory are the pillars of the nursing profession. The interaction of these three principles is mutual and aids with the collaboration of educating novice nurses. Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science (Marrs, 2006).To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. Florence Nightingale, the mother of nursing, defined nursing in her “Environmental Theory” as “the act of utilizing the environment of the patient to assist in recovery”.

For theory, clinical evidence-based practice creates research questions and knowledge. Research drives evidence based practice and develops knowledge through the advancement of theories. Theory guides research and improves evidence-based practice. Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based upon.

The aim of the research is enrichment of knowledge in any field. Research seeks for the truth that is already there but needs to be explored. Successful nursing practice involves the use of knowledge, skills, care, and creativity in an efficient, effective, and considerate manner to treat patients (Marrs, 2006). Research findings provide an important part of the knowledge involved in making health decisions in nursing. Moreover, all recommendations on medical care should be focused on evidence from research. To establish a protocol, research results are used and the plan is implemented in everyday clinical practice.

Using research in day-to-day nursing practice will enhance patient care and nursing practice, and can help to provide safe and cost-effective care. The survival of nursing as a profession depends on nurses’ ability to understand and apply theory while providing optimum care. An ongoing challenge to the nursing profession is to keep the important relationship between research, theory and practice in force (Veloza, 2016). As a proficient clinician, we rely strongly on research and practice to determine the treatment that will be rendered. At times, I tend to analyze situations, regardless of what the physician orders because they are not visually viewing the patients.

The relationship between research and theory is reciprocal where research generate more knowledge and theory. Theory is central to the research process, where it is necessary to use theory as a context to support the research with insight and direction. Theory may be used by creating and evaluating hypotheses of interest to direct the research process. The relationship between theory and evidence based practice reciprocal. Practice is the basis for the development of nursing theory whereas nursing theory must be validated in practice (Marrs, 2006).

Research relies on theory and vice-versa. The scenario of nursing practice that is distinguished by good care must be supported by nursing science in which the development and spread of knowledge through research is a two-way street between theory, founded on the concepts and propositions of nursing science and practice (Veloza, 2016). Nursing is based on the theory of what nursing is, what nurses do, and why nurses exist. We are the foundation of healthcare and without nurses, the body of healthcare will never be the same.

References: 

Nursing theory and practice: connecting the dots. Marrs JA, Lowry LW. Nurs Sci Q. 2006 Jan;19(1):44-50. doi: 10.1177/0894318405283547. PMID: 16407599

Veloza-Gomez M. The Research-Theory-Practice Relationship a Reference for the Discipline of

Nursing. Ann Nurs Res Pract. 2016; 1(1): 1004.