Running head: THINKING LIKE A NURSE

Thinking Like a Nurse

Running head: THINKING LIKE A NURSE

Thinking Like a Nurse

Working in the health care profession for fourteen years, I have taken care of hundreds,
maybe even thousands of patients that have touched my life and changed me for the better. As a
nurse, every patient that I have cared for has had an impact on me in some way whether big or
small, but there is one patient that really stands out as special. This patient will always be a part
of me because he was the first patient that I took care of as a new graduate. Taking care of him
was one of the toughest and best learning experiences of my professional career thus far. Caring
for this patient has had the greatest impact on my approach in patient care and critical thinking.
I was a new nurse on the Progressive Care Unit and it was my first day off of orientation.
My charge nurse that day remembered how nervous she was her first day being a Big Girl
Nurse, so she had mersey on me when it came to making the assignments and gave me the least
amount of patients with the lowest acuity, with the exception of one patient. According to the
report sheet, his diagnosis was a CVA with right sided paralysis and aphasia. He was admitted
just three months earlier with a diagnosis of Carotid artery disease with 99% blockage of the left
carotid and 75% blockage of the right. He had an angioplasty done, post-op everything was
successful and the he was discharged home. The patient came back a week ago to have an
angioplasty done on the right carotid. The procedure went well, but during post-op, he had a
sentinel event and was taken to ICU to be placed on a ventilator until he could maintain his own
airway. In the physicians notes, he described how a piece of plaque from the patients artery
dislodged during surgery and traveled to his brain, which caused the stroke. This was a sixtyseven-year-old white male that was healthy, active, loved to travel and full of life prior to this
happening. Now, he is completely flaccid on his right side, has right sided facial drooping and

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cant speak. He needs assistance with eating, bathing, ambulating and using the restroom. This
patient is now totally dependent upon others to take care for him, and I very early on made the
assumption, based on the were so sorry expressions upon the two gentlemens faces standing
at the patients bedside as I walked into the room to introduce myself, that he wasnt going to be
receptive to care.
My first impression of this patient was negative and already I wasnt too thrilled about
taking care of him. I walked over to him slumped in bed, favoring his right side and I said in a
polite yet fake voice, Im Amber and I will be the nurse taking care of you today. The patient
never looked up to acknowledged my presence, but continued to flip through the T.V. channels
with the remote in his left hand as he had done from the time I had entered his room, as if I
wasnt even there. The two men in the room were the patients best friends. These two great
men had been at the hospital everyday with the patient, praying his strength, encouraging him
and just trying to be there for him in his time of need. The patient had just recently begun to
accept visitors of any kind even his two best friends of over forty years who love him dearly. I
received an update from my Tech just before meeting the patient that he had been really rude to
staff, refusing treatment, not eating and insisting upon holding the remote even when he went to
sleep. I went over to him and stood directly beside the bed. I gently grabbed the remote from his
hand and said, Ill take this now so that I can give you, your morning medications and set you
up to feed you your breakfast. Before I could even get that sentence out completely he had
reached over with his left hand, nearly falling out of bed, and snatched the remote back as hard
as he could. He sat up, swaying back and forth do to being flaccid on his right side, snarling at
me with his lip quivering so much that he began to drool. It was in that moment that I saw him

Running head: THINKING LIKE A NURSE

or should I say I saw me. Before now I had judged him and made assumptions about his
character. I was too invested in and concerned about how I felt to truly do and really mean what
I said when I first introduced myself to him, I will be the nurse taking care of you. I was
doing the direct opposite of this. What I was exhibiting was poor judgment, poor
communication skills, poor critical thinking skills and just poor nursing care and I was ashamed.
After giving my patient about ten minutes to calm down and stop shaking, with the help
and coasting of his two best friends still at the bedside of course. I began to right my wrongs and
started to Think Like a Nurse. All of the reasons I became a nurse and the important values I
hold dearly in terms of patient care started to envelope me and I began to change. Just as I stated
in my Nursing Philosophy, I believe that nursing is just as much who I am as it is what I do.
Providing compassionate, efficient and safe health care is essential. Caring for the injured, sick
and dying is my passion. Possessing the ability to build a good rapport with patients and their
loved ones during their time of need is a ministry. Being able to look beyond the here and now
knowing that patients are more than just their presenting need, but a whole person, allows for a
more holistic approach to patient care. I began to think about my patients total care. I took the
time to ask him why he kept the remote in his hand and just by taking the time to spend time
with my patient I realized he just wanted something in that left hand because he felt like if he let
go he would lose the little control that he had left. I got him a marker and a dry erase board to
write on and communicate with. He really appreciated that. I started to ask him how he felt and
what he wanted instead of telling him what to do or how to do things involving him in his plan of
care. His best friend asked if it was okay for him to bring some razors up so that he could shave
the patient and I gave the suggestion to the friend, to shave one side, then allow the patient to

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attempt to shave the other side with his left hand and my patient liked that idea. According to
Nunnery (2016), Nursing practice is directed toward respecting quality of life as perceived by the
person and the family. (p.48). There was an obvious need for a sense of independence and as a
nurse it was important for me to help him along with the help of his friends, work towards
reaching that goal. When he laid down for his evening nap he wanted to keep the remote in his
hand, but I suggested the hand held stress relief ball given to him by the occupational therapist
earlier in the week would be more appropriate and beneficial with strengthening. At lunch time
I asked if he would be willing to try something new and sit up in the recliner to eat. I told him it
may also be a good idea if he were to try to feed himself with his left hand. Encouraging the
patient to do more for himself really helped his self-image and he wanted to get stronger.
According to Nunnery (2016), Critical thinking presumes a disposition toward thinking
analytically. Uncritical acceptance of all data is antithetical to critical thinking. (p. 116.).
Sitting up straight in a chair would be better for the patient in terms of swallowing decreasing his
chancing of aspirating and it would also be a lot more comfortable than eating slumped in a bed.
Suggesting that he feed himself will help with strengthening of his left hand and help with hand
eye coordination. By implementing these nursing interventions into my patients plan of care I
would like to see improvements or a resolve of current problems and hopefully an increase his
overall quality of life.
This refection exercise really made me think back, not only to a time of immaturity and
humility, but it also allowed for reflection on my career in the present. I am constantly learning
from those around me, growing from past and present mistakes and changing through different
experiences. While writing this paper, I realized all the more just how important it is as a patient

Running head: THINKING LIKE A NURSE

care provider to be unbiased, open minded and nonjudgmental, in order to make truly sound
nursing judgments when it comes to my ability to critically think. This is the only way that I can
give patients what they need most when they are at their most vulnerable, and that is to provide
compassionate and efficient health care.

Running head: THINKING LIKE A NURSE

References
Kearney-Nunnery, R. (2016). Advancing your career (6th ed.). Philadelphia: F. A. Davis
Company.