N 522PE 20A Module 1 Assignment 1 Assignment 1 Instructions: Write a three-page paper on the use of clinical reasoning in developing and applying advanced health history and physical assessment skills at the graduate level.

Discussion 1 Solution Example

A planned approach to communication:

 Communication is a key element in every aspect of life. When an individual is in the hospital, at any age, they are frightened, having a fear of the unknown. Just being in the hospital may raise a person’s level of anxiety. When you combine anxiety with the inability to communicate this sets up a whole potential negative environment, one where an error could occur. The key to patient care is making the patient feel that they were heard and understood while educating them to be competent in caring for themselves when they leave the hospital.

There was a communication barrier between my patient and me this past weekend. The mother I was caring for and her husband just moved to the United States from Puerto Rico a few weeks before delivering their twin boys at 37 weeks-gestation on September 18th, 2020. This was extra difficult because not only was I educating the new first-time mom on caring for herself, the changes she would experience, and the postpartum warning signs, but I was also educating the couple on how to care for their newborn twins as well. This was very overwhelming for the patient and her husband.

My first thought was to utilize the interpreter’s phone. Unfortunately, the interpreter phone was nowhere to be found. I then tried to utilize my cell phone and was not able to secure a consistent site due to sporadic internet connections, making communication

unreliable. I finally utilized the language line from my vocera, securing a fluent Spanish speaking interpreter. Using my vocera was convenient for both the patient and me as well as the assurance of not violating the Health Insurance Portability and Accountability Act (HIPAA).

Fortunately, the vocera was accessible through my place of employment with the interpreter in my vocera giving me her name and identification information which I needed to place in the Electronic Medical Record (EMR). The Physician Assistant (PA-C) and I were then able to go into the patient’s room together, decreasing traffic, to address the daily plan of care (POC) utilizing our vocera for communication/translation.

Questions asked:

From the moment I entered the room, I began asking the patient questions. These questions are going to be open-ended questions directed to yield specific answers regarding the assessment, bleeding, pain, and how the patient is currently feeling. Before assessing the patient, I asked her permission to examine her as I would be palpating her uterus, incision, and legs for warmth, redness, and edema.

I asked the patient if I could listen by auscultating her heart, lung, and bowel sounds. I also informed my patient that I would be doing a neurological exam since she was pre-eclamptic throughout her last few weeks of pregnancy. Not only was I asking questions while assessing my patient, but I was also educating her along the way. 

When the patient is admitted we begin to educate them with discharge in mind, this is done to provide the patient with continual reinforcement of education. Breastfeeding, supplemental formula feeding, related to late preterm twins, as well as assessments of the twin, was another topic of conversation.

Without proper communication, due to language barriers, this would have not been possible. This would have been disastrous and frustrating for the patient as well as potentially causing adverse effects for the patient who is the one that should be excited, enjoying her newborns rather than being stressed.

How communication impacts the concept of clinical reasoning in nursing: Communication, as previously mentioned, is essential in all aspects of life. When caring for a patient, you want to make them feel comfortable with the care you are providing while educating them. The more comfortable the patient is with you, the more likely they will trust you. This dedication and trust that is established between you and the patient will be associated with positive patient compliance (Ali & Watson, 2018).

The more you understand the patient’s needs, the better you will be meeting their needs. Errors in communication could potentially cause medication errors, treatment errors, as well as great dissatisfaction, creating a negative environment placing a negative impact on decreasing patient compliance (Ali & Watson, 2018).

In conclusion;

Learning disabilities, education level, and language barriers should all be taken into consideration while caring for the patient. Being attentive to the needs of the patient, how they communicate, understanding the best way to educate them will enhance patient experience thus achieve positive patient compliance (Ali & Watson, 2018).

I did not feel there was a language barrier while viewing the orientation video