Xavier University-Ateneo de Cagayan

College of Nursing
A.Y 2021-2022

In Partial Fulfilment of the Requirements of

Nursing Care Management 119:
Nursing Leadership, Management and Professional Adjustment

Submitted to
Mr. Jethro C. Daños, RN, MAN
Clinical Instructor

Submitted by:
BSN – 4NF RLE 3

Ondap, Matt Anderson

Orcullo, Gerel Angela
Pacana, Audrey Brina
Payla, Fatima Althea
Payot, Czarena Ysabelle
Puertas, Kent Joven
Rajput, Sunder Singh
Sandig, Lynette
Tacandong, Marc Roden
Tarife, Rhea Marie
Trajano, Mary Sophia
Tolinero, Will Peter
Yasay, Korinne Andrea

August 28, 2021

 NCM 119 – CLINICAL APPLICATION ACTIVITY

THE CASE

You are a night shift nurse caring for Mr. J.. In the AM he is scheduled for PEG
insertion to replace his temporary gastric feeding (NGT). Hospital policy states that no
visitor may stay all night with a patient unless a patient is critically ill. Mr. and Mrs. J are
both requesting that Mrs. J stays all night in a chair beside the patient's bed because both
are anxious about his upcoming procedure.

APPROACH

The group utilized the IDEALS Model in coming up with a plan of action towards
the situation and eventually coming up with a sound decision. In implementing the
IDEALS model, the group was able to dissect the given case scenario into essential parts
which we were able to individually assess and evaluate. The group implemented the
following steps:

I. Identify the problem

• First problem identified in the case scenario was the reason behind the
request to stay overnight - anxiety towards the procedure, felt by the patient
and the significant other.
• Another problem to address is deciding whether we should consider the
request and allow Mr. J’s significant other to stay, which is against the
hospital policy, or we should ask her to return to the hospital the next day,
compliant to the hospital policy.

II. Define the context

• Anxiety Concern
o Lack of knowledge: Mr. and Mrs. J's problem could stem from their
apprehension of the unfamiliar procedure of PEG insertion. If the
nurse fails to explain clearly the procedure to the patient, anxiety may
develop. One of the 13 Patients' Rights is the Right to Information,
which is defined by the Department of Health (2021) as "in the course
of his/her treatment and hospital care, the patient or his/her legal
guardian has a right to be informed of... any other additional or further
contemplated medical treatment, surgical procedure or
procedures." Mr. J also has the right to uphold his Right to Informed
Consent that states, “The patient has a right to a clear, truthful, and
substantial explanation, in a manner and language understandable
to the patient, of all proposed procedures.” This is to recognize full
disclosure of information being done to the patient in order to
alleviate their anxiety.
o Safety needs: Maslow stated in his theory “Hierarchy of Needs”, that
safety needs come in after physiological needs and these are
inclusive of personal security and health and well-being. Further, a
journal article by Zheng et al. (2021) states that, “safety worrying is
the main reason for mental disorders like anxiety, phobia, and
depression.” Hence, nurses should conform as sympathetic, which
implies that the patient's comfort and safety should come first, before
anything else. If the patient truly requires a companion, which may
negate the effects of separation, the nurse may opt to allow Mrs. J to
accompany her husband. Nurses, after all, serve as patient
advocates.
 • Overnight Concern. Allowing Mrs. J to stay overnight would be beneficial
for the patient, since it will be reassuring for him to have his significant other
to keep him company, considering that they are both anxious of the PEG
insertion. Mr. J, as described in the case, is in a physically stable condition
knowing that he is just waiting for the procedure, hence, admitted early, and
has not been showing any clinical manifestations that should be addressed
immediately. This is a problem because it is against the hospital policy
indicating that overnight stay of visitors is not allowable, unless the patient’s
condition is critical. Data from the Department of Health (2021) states 13
Patient’s Rights and one of them indicates the Right to Correspondence and
Receive Visitors which says that, “The patient has the right
to communicate with relatives and other persons and to receive visitors
subject to reasonable limits prescribed by the rules and regulations of the
health care institution.”

III. Enumerate choices

• Option 1: Do not explain the procedure & policy, don't allow overnight stay.
• Option 2: Do not explain the procedure & policy, allow overnight stay.
• Option 3: Explain the procedure & policy, don't allow overnight stay.
• Option 4: Explain the procedure & policy, allow overnight stay.

IV. Analyze options

• Options 1 and 2 are discarded for obvious reasons, as they violate the
patients' right to full disclosure, correspondence, and to receive visitors. It
also violates the patient's right to information because the patient needs to
be aware of the potential risks of the procedure as well as the procedure
itself.
• Option 3 - Explain thoroughly the procedure and the hospitals’ policy,
politely reject their request of staying overnight but offer self and SO’s
reassurance, implement anxiety reducing interventions as well as
explaining to the patient the possible risk of the procedure and making sure
that the benefit outweighs the risk to ease the anxiety of the SO. With
thorough explanation, the patient must adhere to the policy of the hospital
where visitors are not permitted to stay overnight and offer to stay with the
patient instead.
• Option 4 - Case to case basis, only when separation is detrimental. In the
case of Mr. J, Mrs. J was afraid that she would be separated from Mr. J. In
that case if the patient wishes to have visitors during his procedure then we
shall have to consider the patient’s right which is the right to
correspondence and to receive visitors. Also considering that PEG is not a
major operation we can consider the visitor going with the patient.

V. List reasons explicitly

• Explaining: Patient’s Rights

o As stated, patient education regarding the procedure and the
hospital’s policy should be implemented thoroughly so as to achieve
the goal of lessening the anxiety the patient and SO is experiencing
and their cooperation regarding the hospital’s policy where visitors
are not allowed to stay overnight. This can be supported by the Data
from the Department of Health’s 13 Patient’s Rights (2021) and one
of them indicates the Right to Information which says that, “ In the
course of his/her treatment and hospital care, the patient or his/her
 legal guardian has a right to be informed of the result of the
evaluation of the nature and extent of his/her disease, any other
additional or further contemplated medical treatment on surgical
procedure or procedures,...” The nurse in charge has to ensure that
he/she explains the policy of the hospital and the said procedure
including the equipment needed, the time duration, the possible risk
of the procedure and making sure that the benefit outweighs the risk
to ease the anxiety of the SO. With thorough explanation, the patient
and the significant other will adhere to the hospital’s policy where
visitors are not permitted to stay overnight and their anxiety and
concern regarding the procedure is resolved.

• Reassurance/offering the self: Patient Advocates

• Nurses are positioned to be advocates for the reason that they have
the most direct interaction with the patients. Staying in the hospital
and having procedures done can be lonely and stressful. The
American Nurses Association (ANA) addresses the importance of
advocacy in its Code of Ethics, specifically in Provision 3: “The nurse
promotes, advocates for, and protects the rights, health, and safety
of the patient.” In Mr. and Mrs. J’s situation, they are both anxious
about Mr. J’s PEG insertion procedure. Thus, one of the most basic
ways that nurses may advocate for their patients is to ensure that
they have the ability to make health-related decisions for themselves.
Also, nurses play a significant role in reducing a patient's anxiety.
Talking to the patient is a helpful way in establishing open
communication so that he/she will be comfortable in asking
questions. In addition, the nurse should reassure the patient and SO
that the patient will be kept in company throughout the procedure. In
terms of organization and technological advancement, the
healthcare system is constantly developing. As a result of these
changes, regulations governing the delivery of care and health
services are shifting. Nurses, on the other hand, must stand above
adversities, advocating for their patients with compassion and
respect.

• Reinforcement: Hospital Policies

o The hospital policies are present to ensure compliance of laws and
regulations. They are critical to everyone's health and safety at the
organization and to diminish any legal liabilities that may arise. On
the other hand, patients have rights in the medical setting. However,
there are also certain policies that are needed so that the hospital
decision does not make an illogical, irrational, or possibly, even an
illegal decision that may harm the employees or the patients
themselves. This grounds the delivery of safe and cost-effective
quality care. One of the rights patients have is the Right to
Correspondence and to Receive visitors - The patient has
the right to communicate with relatives and other persons and to
receive visitors subject to reasonable limits prescribed by the rules
and regulations of the health care institution. Thus, the reinforcement
of the hospital policies towards Mr. and Mrs. J regarding the request
of staying overnight, which is unfortunately, against the policy of the
hospital, should be done to ensure the safety of the institution, the
employees and the patient themselves.
VI. Self-correct

• Assuming all explanations regarding the procedure & hospital policy and
reassurances made by the nurse effectively ease out the patient and
significant other’s anxiety, then we didn't miss anything.
• In the rare case that after all interventions made, and still separation, as
confirmed by the nurse's assessment and judgement, is detrimental to the
client's situation, then self-corrective action would include allowing the
significant other to stay.
 TAKEAWAYS

“Effective decision making requires efficient collaborative communication among

healthcare providers in order to come up with a common goal. It plays a significant part
in our profession as every decision we make could lead to either a positive or negative
effect on our patients and our colleagues, as well.” - Lynette Sandig

“Effective decision making is essential especially for a profession that deals with the
health and lives of people. As early as now, we must develop our own processes or adapt
existing ones, so once we enter the clinical setting our decision-making expertise will help
us deliver optimal patient care.” - Matt Ondap

“Effective decision making is a fundamental value in assisting patients in receiving the

best care that nurses can provide. It is important to be competent in this skill so that we
may apply it not only in our profession but also in our daily lives.” - Gerel Orcullo

“Effective decision making is an essential component of leadership and it involves putting

a clear plan after considering various alternatives for patient care. It is also vital in
acquiring and interpreting patient information, implementing nursing actions, and
evaluating outcomes.” - Korinne Yasay

“Effective decision making is considered to be one of the most important components of

nursing practice that should be instilled to us as registered nurses in the making. This
would determine the competency among healthcare providers in ensuring the well-being
of people who are in need of our care. Developing such skills as early as now can help
us achieve the desired nursing care for those who are in need.” - Audrey Pacana

“Effective decision making is vital in creating good judgement because our judgement can
lead us to become a more competent person which can develop over the years as we
become more and more experienced in our profession. In the clinical setting it is important
decision making for patients to maximize their wellness through proper interventions.” -
Sunder Rajput

“Effective decision making is one of the most important components of professional

nursing practice. It allows us to gather information to choose and implement nursing
actions and evaluate the results. It is very important to be mindful and take consideration
of all aspects in our work environment to provide suitable actions to achieve optimal
outcomes.” - Kent Puertas

“It is important for a nurse to have an effective decision-making process because this
process is essentially the first step that dictates how we should treat our patients
accordingly. It is our goal as nurses to help our patients back to health by providing them
with quality care, and that starts with the right decision.” - Rhea Tarife

“As nurses, the ability to make effective clinical decisions is the most vital factor affecting
the quality of care as the decisions that one makes while performing care to patients make
an impact to their lives and their healthcare experience in general and will likely result in
optimal outcomes of the multidisciplinary team.” Czarena Payot

"Effective decision making is important for us healthcare workers mainly because in that
skill we are able to provide the quality care that our patient needs. Furthermore, this helps
in lowering the casualties and prevents any further mistakes that could risk the life of the
patients." - Marc Tacandong

“In the healthcare setting, decision making plays a vital role as it influences the
effectiveness of nursing practice to patient outcome. Moreover, it helps them to set
priorities and provide specific interventions based on the needs of their patients.” - Mary
Sophia Trajano
“The clinical environment, being an area where decisions are made that could mean the
client’s welfare, effective decision making is a key skill in rendering quality patient care. It
enables health care workers to become more deliberate, thoughtful, and organized as
they are able to take into account all relevant information and consider alternatives based
on value systems and standards of care, resulting in improved patient outcomes.” - Will
Tolinero

“Decisions in our profession have an impact on the lives of others. Thus, understanding
how to use critical thinking abilities to make effective decisions would not only enhance
performance, delivery, and care, but will also aid in maximizing patient outcomes.” -
Fatima Payla
 REFERENCES

Saint Anthony Mother and Child Hospital. (2021). Patients Rights. Republic of the Philippines,
Department of Health, Saint Anthony Mother and Child Hospital.
https://samch.doh.gov.ph/index.php/patients-and-visitors-corner/patients-rights

Zheng, Z., Gu, S., Lei, Y., Lu, S., Wang, W., Li, Y., & Wang, F. (2016). Safety Needs Mediate
Stressful Events Induced Mental Disorders. Neural Plasticity, 2016, 1–6.
https://doi.org/10.1155/2016/8058093