Sample Masters Nursing Report
Published byat December 13th, 2022 , Revised On January 26, 2023
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Level 7: Student assessment: Reflection
In the following reflective report, the case of a woman has been presented whereby the following fall was treated using a dynamic hip screw (DHS). However, post-treatment, the woman was bedridden for quite some time until physiotherapies were provided, and the patient was able to move again.
DHS is done in cases when the femur or the thigh bone fractures, and during this process, screws are implanted so that the fracture is restored and the patient can improve their movement (Schwartsmann et al. 2014). However, in this reflection, the critical assessment of the patient and the experiences has been presented and how the patient was motivated innovatively to improve her movement.
The patient I have experienced was a late 50 years old woman living alone and recently had a fall at her home. After post fall and different diagnostics, she went for rehabilitation, whereby she was helped to improve her movement and ability to be dependent.
After a few months of training and rehabilitation, she failed to make progress either because she was not motivated or scared of old age. This I can relate to the study by Maciejuk-Płońska et al. (2012), who stated that older people’s whole face femoral neck fractures are also affected by psychological aspects like the belief that the patient will never walk and loss of hope and others.
I believe this is why the patient, in my case, was not motivated and failed the rehabilitation programme to help her. In critical cases, the patients are usually advised with dynamic hip screw treatment, as mentioned by Rupprecht et al. (2011), and it helps improve the patient’s condition concerning movement and others.
On the other hand, as Ronga et al. (2017) indicated post-DHS physiotherapy is very important to help patients improve their movement and other activities. Therefore, I was able to help her with a physiotherapy specialist who laid down different steps and milestones to help the woman move and increase her mobility.
After 3 months post-treatment, we saw positive results showing where the patient could move using support like frames and walking sticks. This is a positive result which I can further relate to the study of Hamdulay and Beresford (2021), who also found that post-DHS, the patients, when treated with exercises and physiotherapies, showed improvement in moving.
Gokulakrishnan et al. (2017), on the other hand, mentioned that in many cases, the conditions may be psychological whereby the patients may fear falling, and that is why they show low motivation to move or get out of bed resulting in permanent movement-related issues.
During the situation post-DHS, I support the aspects presented by Gokulakrishnan et al. (2017). They stated that in many cases when patients fall on their own, they gather a fear of repeated falls even after being treated. This is mainly because they either live alone or have no one to look after; in that case, they feel that if they depend on someone, there is less chance of falling.
I felt the same way, and this is why I considered the help of a physiotherapist who could help the women set goals to help improve their movement and get out of bed. Physiotherapy post-DHS has been seen to help improve movement, according to the study of Kalsbeek et al. (2020), and I was able to see the same results in the case.
The fear of falling is common among patients post-DHS, according to Taheri, Blicblau, and Singh (2011), and on this basis, I feel that the women had the same perceptions post-DHS. However, reflecting on my decisions, I feel that my decision to take the help of physiotherapy for the case patient was right as it was both effective and supported my understating from the previous medical cases.
Reflecting on my decisions taken in the past for the patient post-DHS I feel that I took the right decision. Most of the things went well for me as well as the patient; first of all, the patient was able to stand and walk using support and frames, and this was a positive sign of proving the patient’s mentality wrong.
The patient was more confident and completed the entire physiotherapy programme. Secondly, the fear of falling the patient started to disappear; I believe because the patient got more engaged with the programme and was determined to walk and remain independent before the fall (Taheri et al. 2011).
However, one thing that did not go well was making the patient believe in the beginning that she could walk post-surgery again as she had almost lost hope that she could walk again. The contribution of the physiotherapist can also be considered a factor in improving the patient’s condition.
For instance, the physiotherapist could understand the patient’s conditions, and the program developed specifically for the patient was helpful. The exercises included walking, sitting, bed exercises, standing exercises, chair exercises, using stairs and others (Jagdishbhai and Shinde, 2017).
Based on the understanding from the current situation and relating to past cases, I was able to positively assess the patient’s fear of falling again as she had recently gone through post-DHS. Based on the techniques and the assessments of Ronga et al. (2017) and Gokulakrishnan et al. (2017) falling is common amongst patients to post hip surgeries and this may be one of the reasons that patients feel unsafe for movement.
However, based on the studies of Rupprecht et al. (2011) and others, physiotherapy using different methods and exercises and programmes, patients with post-DHS showed improvement in walking and movement. After engagement for the exercises and the programme, the patient showed improvement and confidence which I aimed for and I believe my understanding of the situation was correct.
It helped the patient to be able to walk again. I believe in future cases as well I can try to assign patients post-DHS patients into the same programmes to help improve their movement and gain confidence. Given the strategies and the evaluations, falling is basic among patients post-hip medical procedures and this might be one reason that patients feel dangerous for development.
Nonetheless, in light of the investigations of Rupprecht et al. (2011) and others, physiotherapy utilizing various techniques and activities and projects, patients with post-DHS showed improvement in strolling and development. Post commitment for the activities and the program, the patient showed improvement and certainty which I focused on. I accept that my method of understanding the circumstance was right and assisted the patient with the option to walk once more.
Conclusion from the experience
Based on the current experience, I learnt a few new things, first of all, post-DHS patients tend to have fear fall and many patients in the past have fallen and have a weakness to move. However, I have learnt that with effective treatment using programmes and exercises like physiotherapies the patients can be helped and their movement can be improved.
However, this was only one case of DHS that I dealt with; there may be other medical reasons why the patients remain bedridden post-surgery. Therefore, I must further improve my skills to understand patient situations, especially when patients had orthopaedic surgeries and histories of falls, including psychological issues.
In the current experience, I took in a couple of new things, most importantly post-DHS patients tend to dread falling and numerous patients in the past have fallen just as they have a shortcoming to move.
Nonetheless, I have discovered that with successful treatment utilizing projects and activities like physiotherapies the patients might benefit from some intervention and their development can be improved. In any case, this was just one instance of DHS that I managed; there might be other explanations like clinical reasons concerning why the patients remain confined to bed post-medical procedure.
Consequently, I should improve my abilities to comprehend the patient circumstances, particularly when patients had muscular medical procedures and chronicles of fall including mental issues. Based on the finding, I have presented the following action plan to improve areas I need in career development and my skills for quality patient care.
The first on my list for patient care is to learn about different programmes available for patients post-DHS. First, I must understand that any hip surgery is anguishing. After the movement, the patient will expect physiotherapy to attract them to get the improvement back in their hip and to have the choice to walk around as well as anticipated.
As such controlling the pain and fear is principal. The exercises physiotherapist gives will help the patients achieve the best improvement in their hip possible. To engage them, I have to gather this skill to be generally essentially as versatile as could truly be anticipated.
Various exercises are available and offered to widen the unanticipated turn of events and strength in the legs, especially the one on which they have been operated. Set forth an endeavour not to be terrified if your worked leg feels more delicate or stiffer than the other leg.
This way I will be able to strategize plans for the patient improvement and improve their quality of care and life. In addition, I will also plan to work on other orthopaedic cases where the patients need rehabilitation and physiotherapeutic orthopaedic post-surgeries to improve my understanding of different cases.
In this report, the main aim was to critically reflect upon a case-patient I had experience and the strategies I implemented and the situation has been presented and assessed. The case was that of a late 50-year-old woman who had a fall and post-DHS underwent physiotherapy to help improve the condition of movement. Based on these aspects the experiences have been presented and assessed as well as the innovative methods I used like searching through past knowledge I was able to understand the patient’s situation and help her accordingly.
Gokulakrishnan, P.P., Manivannan, A.G., Annamalai, S. and Umamaheshwaran, B., 2017. Minimal Invasive Dynamic Hip Screw Fixation Technique in Patient with Cardiac Complications: A Case Scenario. Journal of orthopaedic case reports, 7(5), p.34.
Hamdulay, K.A. and Beresford, T.P., 2021. Profunda femoris pseudoaneurysm rupture post dynamic hip screw fixation after physiotherapy. The Annals of The Royal College of Surgeons of England, 103(3), pp.e81-e84.
Jagdishbhai, S.R. and Shinde, S.B., 2017. Effect of closed kinetic chain exercises in subjects with proximal femur fracture operated with dynamic hip screw and plate fixation. Website: www. ijpot. com, 11(2), p.98.
Kalsbeek, J.H., Roerdink, W.H., Krijnen, P., van den Akker-van Marle, M.E. and Schipper, I.B., 2020. Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger. BMC musculoskeletal disorders, 21(1), pp.1-6.
Maciejuk-Płońska, A., Nasiłowska-Barud, A., Kostecka, P. and Fedorovich, V., 2012. Psychological aspects of rehabilitation of the elderly people after femoral neck fracture. Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego, 32(187), pp.79-81.
Ronga, M., Bonzini, D., Valoroso, M., La Barbera, G., Tamini, J., Cherubino, M. and Cherubino, P., 2017. Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail. Injury, 48, pp.S44-S47.
Rupprecht, M., Grossterlinden, L., Ruecker, A.H., de Oliveira, A.N., Sellenschloh, K., Nüchtern, J., Püschel, K., Morlock, M., Rueger, J.M. and Lehmann, W., 2011. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. Journal of Trauma and Acute Care Surgery, 71(3), pp.625-634.
Schwartsmann, C.R., Jacobus, L.S., Spinelli, L.D.F., Boschin, L.C., Gonçalves, R.Z., Yépez, A.K., Barreto, R.P.G. and Silva, M.F., 2014. Dynamic hip screw for treating femoral neck fractures: a prospective study with 96 patients. International Scholarly Research Notices, 2014.
Taheri, N.S., Blicblau, A.S. and Singh, M., 2011. Comparative study of two materials for dynamic hip screw during fall and gait loading: titanium alloy and stainless steel. Journal of Orthopaedic Science, 16(6), pp.805-813.