1

Therapeutic Practitioner

Student’s Name

Institutional Affiliation

Course Name

Instructor’s Name

Due Date

Author’s Note
 2

Therapeutic Practitioner

Introduction

Orthopaedics has seen a significant increase in nursing over the past century.

The medical field of orthopaedics focuses on understanding, diagnosing, and

treating conditions affecting the tendons, bones, ligaments, and skeletal muscles.

Since the turn of the century, orthopaedics has undergone extensive study,

developing into the related fields of elective and trauma care. Planned procedures to

treat known conditions that cause pain or disability are called elective care. Trauma

care, however, involves the management of patient care and rehabilitation following

unplanned events like falls, car accidents, and other mechanisms of injury (Santy-

Tomlinson & Clarke, 2016).

In this essay, I will discuss the care I provided in a regional hospital. Patient

confidentiality is emphasised as a legal obligation by the Nursing and Midwifery

Council (NMC, 2018). The pseudonym Marta is used to concealing the patient's

identity. Marta, who is seventy-nine, was brought into the ward. As a student nurse, I

worked in a regional hospital's trauma and orthopaedic ward. Marta, who had a

fractured right intracapsular neck of the femur from a fall at home, was admitted as a

trauma patient. Marta had a complete hip replacement operation. Total hip

replacement means the damaged bone and cartilage are removed and replaced with

artificial parts. Marta needed holistic care, provided by the various caregiving

aspects and nursing expertise, to achieve therapeutic nursing. Through various

therapeutic techniques and interventions, therapeutic care treats and manages

physical, emotional, and psychological conditions. Marta will need additional

investigation of communication, partnership, practising needs, pharmacology, and

self-evaluation to improve her individualised therapeutic care.

 3

Pharmacology

Pharmacology is the study of how drugs affect and interact with living things. The

field of pharmacology encompasses all medications, whether legal or illegal, natural

or synthetic, exogenous or endogenous, and beneficial, detrimental, or neutral

regarding their impact on human health (Currie, 2018). Marta is not allergic to any

drug. Marta takes antidepressants, paracetamol, morphine, amlodipine, and

tetracycline. Marta was given citalopram 20mg as a tranquilliser to ease her anxiety

as she waits for cataract surgery, which will help her feel less depressed. Citalopram

works by elevating serotonin levels in the brain, which can help elevate mood and

lessen anxiety symptoms (NHS, 2022). I told Marta that citalopram frequently causes

nausea, headaches, drowsiness, and sleeplessness. I advised Marta to take the

medication as the doctor directed and call the local hospital helpline if she

experienced any problems or unwanted effects.

Most patients are well-tolerated on citalopram since it has fewer adverse

effects than other antidepressants. Citalopram shows fewer anticholinergic side

effects, unlike most tricyclic antidepressants, and thus the best drug for Marta (Milne

& Goa, 1991). Citalopram has a favourable tolerability profile and gives the same

therapeutic efficacy as tricyclic antidepressants. Also, it is highly effective in people

who cannot take tricyclic antidepressants due to anticholinergic or cardiovascular

side effects.

Marta was nonetheless given a prescription for tetracycline to treat her acne

and prevent infections from spreading to the wound. They prevent bacterial

development by preventing the production of specific proteins required for bacterial

survival. Tetracyclines often have few or no side effects; however, they can
 4

occasionally result in allergic reactions, nausea, and diarrhoea (NHS, 2019). Marta

has been using this medication for a couple of weeks now. However, she has never

reported experiencing any allergic reactions or negative side effects. Marta

complained of intense pain on her second admission day, so morphine and

paracetamol were provided. Although both morphine and paracetamol are efficient in

reducing pain and enhancing patient comfort, their mechanisms of action are

different, and combining the two medications may result in more pain relief than

using either one alone (Zeidan et al., 2014). I suggested to Marta that she only take

morphine for three days before shifting to paracetamol for the remaining days until

the pain subsided. Amlodipine is important to control blood pressure and reduce the

risk of cardiovascular diseases because Marta spends one or two days a week

outside. Amlodipine widens blood arteries by relaxing the muscles that limit them

(NHS, 2018). I told her about the typical adverse effects, which included headache,

dizziness, and ankle or foot swelling. In order to reduce the chance of foot swelling, I

also suggested that she walk around her compound.

Communication

Communication and interpersonal skills are the foundation of providing

patient-centred, customised, and patient-centred care (Webb, 2020). I went to

answer the buzzer and made a kind, helpful introduction of myself. Respectful

communication can eliminate uncertainty, improve patient-centred care, and provide

favourable results (Kwame & Petrucka, 2021). Marta was in tears and looked

nervous, searching for something in her handbag. I created privacy and lowered it to

the same level as Marta. Positioning at the same height as the patients reduces

attitudes of superiority and inferiority (Kraszewski & Abayomi Mcewen, 2010). My

explorations affected Marta's actions and emotions, which altered how I approached
 5

her. Marta resisted answering my questions concerning her social and physical

requirements and did not do it as required. Marta typically nodded her head in

agreement or disagreement. Later, I realised that body language or nonverbal

communication was a potent tool I could use to connect positively with Marta and

strengthen our mutual respect and understanding.

The flow of information between people that does not include spoken

language is known as nonverbal communication (Vogel et al., 2018). I could tell from

Marta's body language—such as her open, relaxed posture and lack of avoidance of

eye contact—what information she could be withholding from or wishing to convey to

the staff. At this time, I chose to be empathetic. Understanding someone else's

viewpoints and being able to relate to their emotions and experiences is known as

empathising with them. A person in worry, anxiety, or helplessness wants to hear

pleasant words from others (Bramhall, 2014). As I gained Marta's trust, she felt free

to open up to me about her innermost feelings and concerns, and I could address

them and ensure she understood my responses.

The patient eventually learned to communicate her needs through her body

language. I concluded from the information that Marta had trouble keeping to her

prescription routine. Loneliness can adversely affect a person's emotional and

physical health, resulting in depression and other health issues (Mushtaq et al.,

2014). Marta's loneliness may make taking her pills and carrying out her everyday

tasks more difficult. I suggested to Marta that she have her grandchild, whom she

loves and trusts. I also introduced her to a group she could be interested in and the

community events offered. I also put her in touch with a therapist or counsellor who

can help with the emotional effects of loneliness. Days later, the staff saw a change
 6

in her attitude and treatment, and she could express her needs and wants more

clearly.

Partnership

A partnership is an equitable power structure that promotes communication,

cooperation, and joint decision-making. Partnership in nursing means involving

relatives and family members in the patients' care plans (Vahdat et al., 2014). It is

built around the notion that nurses have the knowledge and training to deliver high-

quality care while patients and families have unique insights and views that can help

with patient care and treatment. Together, they can ensure that the patient's needs

and preferences are considered and that the care is safe, efficient, and patient-

centred.

Due to Marta's multiple problems, including anxiety, a fractured right

intracapsular neck of the femur, lens cloudiness, and hypercholesterolemia, I sought

the assistance of other doctors to look into various treatments for her situation. I

suggested the services of an orthopaedic surgeon, a primary care physician, a

cardiologist, an endocrinologist, an ophthalmologist, a psychologist, and an

endocrinologist. To develop a treatment strategy that considers the patient's

symptoms and enhances their general health, they might also seek the advice of

other experts, like dietitians. I also spoke with Marta's older granddaughter over the

phone and described the patient's needs at home, including following the

prescription regimen. I also put Marta in touch with a physiotherapist who helps

patients move more freely, have less pain, and stay healthy in the future. Exercises,

manual therapy, and electrotherapy are just a few of the methods physiotherapists

employ to assist patients in regaining their strength, flexibility, and function (NHS,
 7

2018). Marta receives excellent care as a result and is already showing signs of

improvement.

Practising Needs- Safety and Risk

Patient safety refers to minimising to an acceptable level the risk of

unnecessary harm linked with medical care (De Gruyter, 2013). This entails

preventing mistakes and adverse incidents and fostering a safety culture within the

healthcare industry. The National Health Service (NHS) guarantees patient safety by

providing high-quality care and minimising possible patient damage. These steps

include adopting new technology, teaching staff members to identify and report

incidents, and enforcing existing policies and procedures.

Because of her femur fractures, Marta is vulnerable to falls and other traumas.

So, it is crucial to impart to Marta the postoperative instructions the surgeon gave to

protect her safety. I suggested that Marta seek physical therapy, avoid strenuous

activities, and take medication to lessen inflammation. In order to track her progress

and deal with any potential issues, I also urged the patient to go to her follow-up

sessions with the surgeon. The surgeon suggested crutches to help shift weight

away from the hip and lessen pressure on the fracture, promoting recovery. Also,

they offer support and stability so the patient may move around safely. Marta was

told to return for cataract surgery in a week on the third day of the checkup. She was

advised to walk shorter distances to lessen the danger of harm from lens cloudiness

and hip fracture.

Self-Evaluation

There are enough opportunities for reflection and learning new skills in daily

nursing practice. Analysing how we behave in particular circumstances can lead to

potential improvements. I can handle a similar circumstance in the future because of

 8

the awareness and assurance I gained through reflecting on how I handled this

situation. I made careful to prioritise patients and practise effectively per the NMC's

code of professionalism (NMC, 2018). When Marta's cataract surgery was

postponed, and her hypertension medications were delayed, I advocated for her

when it came to prioritising people. I brought up this issue, being careful not to

assign blame but rather to make it educational for everyone. The nurse-patient

relationship is enhanced when a nurse continues to be professional while speaking

up for a patient.

After assessing my knowledge and abilities, I felt confident in including a

collaborative team in Marta's treatment because I could not meet the patient's needs

alone. I valued their capabilities, knowledge, and achievements, so I knew working

with them would be more efficient whenever I felt it was necessary or appropriate

(NMC, 2018). It is advised that people regularly assess their performance and make

changes to advance their abilities and close any gaps they may have.

Conclusion

By examining every aspect of Marta's care, I can now see how each part

interacts with the others to deliver the best outcomes for the patient and their family

members. I established a therapeutic relationship with Marta and felt competent to

provide her with the medical attention she required. I am confident in my ability to put

the concepts I have learnt into practice and to deliver patient-centred care as a result

of my self-reflection. I upheld professionalism by abiding by the NMC code and

giving care that is collaborative, person-centred, and compassionate (NMC, 2018). I

developed a therapeutic relationship with Marta based on our interactions and the

services I provided, which ultimately improved her health and well-being.

 9

Reference

Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing

Standard, 29(14), 53–59. https://doi.org/10.7748/ns.29.14.53.e9355

Clarke, S., & Santy-Tomlinson, J. (2014). Orthopaedic and trauma nursing: an

evidence-based approach to musculoskeletal care. Wiley Blackwell.

Currie, G. M. (2018). Pharmacology, Part 1: Introduction to Pharmacology and

Pharmacodynamics. Journal of Nuclear Medicine Technology, 46(2), 81–86.

 10

Available at: https://doi.org/10.2967/jnmt.117.199588 (Accessed: 24 January

2023)

De Gruyter. (2013). 2 Patient safety: definitions, theories, and measurement. Patient

Safety - a Psychological Perspective, 7–16.

https://doi.org/10.1515/9783110281927.7

Kraszewski, S., & Abayomi Mcewen. (2010). Communication skills for adult nurses.

New York Mcgraw Hill Professional.

Kwame, A., & Petrucka, P. M. (2020). Communication in nurse-patient interaction in

healthcare settings in sub-Saharan Africa: A scoping review. International

Journal of Africa Nursing Sciences, 12(100198), 100198.

https://doi.org/10.1016/j.ijans.2020.100198

Kwame, A., & Petrucka, P. M. (2021). A Literature-Based Study of Patient-centered

Care and Communication in nurse-patient interactions: barriers, facilitators,

and the Way Forward. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-

021-00684-2

Milne, R. J., & Goa, K. L. (1991). Citalopram. Drugs, 41(3), 450–477.

https://doi.org/10.2165/00003495-199141030-00008\

Mushtaq, R., Shoib, S., Shah, T., & Mushtaq, S. (2014). Relationship Between

Loneliness, Psychiatric Disorders and Physical Health? A Review on the

Psychological Aspects of Loneliness. Journal of Clinical and Diagnostic

Research, 8(9). https://doi.org/10.7860/jcdr/2014/10077.4828

NHS. (2018). Amlodipine: medicine to treat high blood pressure. Nhs. uk. Available

at: https://www.nhs.uk/medicines/amlodipine/ (Accessed: 24 January 2023)

NHS. (2018). Overview - Physiotherapy. NHS; NHS. Available at:

https://www.nhs.uk/conditions/physiotherapy/ (Accessed: 24 January 2023)

 11

NHS. (2019). Overview - Antibiotics. Antibiotics. Available at:

https://www.nhs.uk/conditions/antibiotics/ (Accessed: 24 January 2023)

NHS. (2022). About citalopram. Nhs. uk. Available at:

https://www.nhs.uk/medicines/citalopram/about-citalopram/ (Accessed: 24

January 2023)

Nursing and Midwifery Council. (2018). The Code: Professional Standards of

Practice and Behaviour for Midwives and Nursing Associates. Nmc.org.uk;

NMC. Available at: https://www.nmc.org.uk/standards/code/ (Accessed: 24

January 2023)

Santy-Tomlinson, J., & Clarke, S. (2016). An introduction to orthopaedic and trauma

care. Clinical Gate. Available at: https://clinicalgate.com/an-introduction-to-

orthopaedic-and-trauma-care (Accessed: 24 January 2023)

Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014). Patient

Involvement in Health Care Decision Making: a Review. Iranian Red Crescent

Medical Journal, 16(1).

Vogel, D., Meyer, M., & Harendza, S. (2018). Verbal and non-verbal communication

skills, including empathy during history taking of undergraduate medical

students. BMC Medical Education, 18(1). https://doi.org/10.1186/s12909-018-

1260-9

Wanko Keutchafo, E. L., Kerr, J., & Jarvis, M. A. (2020). Evidence of Nonverbal

Communication between Nurses and Older adults: a Scoping Review. BMC

Nursing, 19(1). https://doi.org/10.1186/s12912-020-00443-9

Webb, L. (2011). Nursing: communication skills in practice. Oxford University Press.

Zeidan, A., Mazoit, J. X., Abdullah, M. A., Maaliki, H., Ghattas, T. H., & Saifan, A.

(2014). Median effective dose (ED50) of paracetamol and morphine for

 12

postoperative pain: a study of interaction. British Journal of Anaesthesia,

112(1), 118–123. https://doi.org/10.1093/bja/aet306