A Concrete Example: Managing Postoperative Pain
One of the most clear-cut examples of problem solving in nursing practice can be seen in the management of postoperative pain. Let's consider a patient, Ms. Jones, who is recovering from a major surgery. Initially, her pain is well-controlled with a patient-controlled analgesia (PCA) pump. However, during a routine assessment, the nurse notices Ms. Jones is becoming restless, her heart rate and blood pressure are elevated, and she reports her pain level is a 9 out of 10, despite pressing her PCA button repeatedly.
Step-by-Step Problem-Solving in Action
1. Assessment: Gathering Information
The nurse immediately begins the assessment phase. They do not simply accept the patient's pain score but investigate further. The nurse checks the PCA pump settings and medication levels, finds that the pump is functioning correctly, and confirms the patient is using it properly. The nurse performs a focused physical assessment, checking Ms. Jones's surgical incision, vital signs, and overall comfort level. The nurse asks Ms. Jones to describe the pain, and she reports it feels like a "deep, burning sensation" in the area around the incision. This is a crucial piece of information, as it differs from the typical incisional pain expected after surgery.
2. Diagnosis: Identifying the Root Cause
Based on the assessment, the nurse begins to analyze the problem. The pain is not being controlled by the current medication regimen, and the description of the pain suggests a different origin, possibly neuropathic pain rather than standard tissue damage pain. The problem isn't just "uncontrolled pain"; it's a specific type of pain that the current treatment isn't designed to address effectively.
3. Planning: Developing a Solution
With a clear understanding of the problem, the nurse develops a new plan. This involves several potential solutions and requires collaboration with the healthcare team. The nurse’s plan includes:
- Notifying the physician of the patient's change in condition and the ineffectiveness of the current pain management strategy.
- Suggesting a medication that is more effective for nerve pain, such as gabapentin, which is a common adjuvant for this type of pain.
- Exploring non-pharmacological interventions, such as repositioning, using a cold compress, or distracting the patient with conversation or television.
- Setting a new pain management goal with the patient—to reduce her pain to a tolerable level (e.g., 3 out of 10).
4. Implementation: Putting the Plan into Action
The nurse implements the updated plan. After discussing the situation with the physician, a new order for gabapentin is received. The nurse administers the new medication and also tries a non-pharmacological approach by helping the patient adjust her position to a more comfortable one. The nurse explains the changes to the patient, providing reassurance and setting clear expectations for when the new medication might start to take effect.
5. Evaluation: Assessing the Outcome
Over the next few hours, the nurse monitors Ms. Jones's pain level and response to the new medication. During the next assessment, Ms. Jones reports her pain has decreased to a 3 out of 10 and she feels much more comfortable. The elevated heart rate and blood pressure have returned to baseline. The nurse continues to monitor the situation, adjusting the care plan as needed and confirming that the problem has been effectively resolved. This evaluation loop is critical for continuous quality improvement.
Comparison of Problem-Solving Approaches
In addition to the formal nursing process, nurses use various problem-solving methods. A comparison of these approaches highlights the depth of critical thinking required.
| Aspect | Nursing Process | Trial-and-Error | Scientific Method | Critical Thinking |
|---|---|---|---|---|
| Definition | A systematic, patient-centered approach with five steps: assessment, diagnosis, planning, implementation, and evaluation. | Involves testing various solutions until one that works is found. | A formal, research-based process with defined steps: observation, hypothesis, experiment, and conclusion. | Objective analysis of facts to form a sound judgment. |
| Strengths | Comprehensive, holistic, patient-centered, and evidence-based. | Simple and quick for less complex problems. | Rigorous and provides strong, repeatable evidence. | Adapts to unique patient situations, flexible. |
| Weaknesses | Can be time-consuming for very rapid, high-stakes decisions. | Inefficient, potentially unsafe if solutions aren't carefully chosen. | Can be too slow and formal for immediate patient care. | Relies heavily on the nurse's experience and expertise; prone to bias if not used with a structured method. |
| When to Use | Standard for most patient care situations. | Only for low-risk, simple issues (e.g., finding the best place for a blood pressure cuff). | For research projects and evidence-based practice changes. | Integrated into all steps of the nursing process for effective clinical judgment. |
Conclusion: The Broader Impact of Nursing Problem-Solving
The example of managing a patient’s postoperative pain demonstrates that problem solving in nursing is far more than a simple, linear process. It requires the integration of clinical judgment, critical thinking, and the systematic application of the nursing process. By accurately assessing a complex situation, identifying the precise problem, and collaborating on an effective solution, nurses not only alleviate a patient's immediate discomfort but also prevent potential complications and ensure a smoother, safer recovery. The continuous loop of evaluation ensures that nursing practice is constantly adapting and improving, leading to superior patient outcomes. It is this combination of scientific knowledge, clinical experience, and systematic methodology that makes problem solving a central pillar of nursing practice.
For more in-depth information on the strategies nurses use, visit the official website of the American Nurses Association.
