When talking about putting BPGs in practice, we use the word implementation. Implementation means using the guidelines in your daily practice as a nurse.
Many of the BPG concepts and principles will already be incorporated into your organization’s policies and procedures. However, you may experience challenges as you implement other BPG recommendations. This is very common and will likely depend on organizational contexts and cultures, attitudes of other healthcare providers, patient and family needs, expertise, workload, and resources.
No matter what the challenge, it helps to work through a few example scenarios and explore how different contexts might impact BPG implementation. Scroll down to see how BPG recommendations can be applied to potential scenarios.
A 65-year-old male (Mr. X) was admitted to a trauma surgical floor for a right tibia open fracture, caused by a car accident. He has been on the surgical unit for 3 weeks, and has had 3 surgeries to:
Routine care for this patient population is to preform “flap checks” which involves assessing CSM (colour, sensation and movement) of the flap and peripheral digits Q1hour.
In Mr. X’s case, the medical team was struggling to “keep the flap alive” as the hourly CSM checks were inadequate. Mr. X’s pulse was weak, colour was pale and cool to touch, and he had limited movement of his lower extremities.
The team discussed below the knee amputation as the next line of treatment as the flap reconstruction was not successful.
Mr. X was very upset when he was given this information and adamantly refused to undergo below the knee amputation.
“I was told I just had a broken bone, and that I would be out of here in a few weeks! Now you’re telling me you want to amputate my leg! NO WAY!”
Let’s apply the BPGs to this case. We’ll focus on recommendations 2.1 and 2.2 from the Person- & Family Centred Care BPG.
Develop a plan of care in partnership with the person that is meaningful to the person within the context of their life.
Engage with the person in a participatory model of decision making, respecting the person’s right to choose the preferred interventions for their health, by:
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