Clinical Question: A 30-year-old male patient presents to the hospital recurrent furunculosis, a condition which causes his skin to boil, for the past eight months. These recurrent episodes have previously been treated with various antibiotics and drainage but they instead, keep on recurring. With this in mind, the clinical question asks whether this kind of recurrence can be prevented.
Condition: Furunculosis is a deep skin condition that causes bumps with pus to form on the skin surface. These lumps that form on the skin as a result of this infection are known as furuncles which form when the skin together with a surrounding hair follicle become infected leading to abscess formation of a necrotic tissue that has pus.
Being a deep skin condition furunculosis has its unique symptoms which appear on the skin surface. Initially, a furuncle appears on the skin surface in the form of a bump or a pimple. With time the infection begins to worsen, and the furuncle becomes hard and painful. Due to the build-up of bacteria and dead skin, pus begins to form in the bump leading to the formation of red, swollen and tender nodules on any hair-bearing parts of the body.
Additionally, carbuncle, which appears when several adjacent follicles become infected, are also common symptoms of this infection. Furunculosis also, have a propensity of recurring and many at times they can spread among family members.
Due to the boils recurring, the doctor requests that the patient takes several lab tests which are necessary for determining any underlying conditions. For instance, a blood test may be required to determine whether the patient has a poor immune system. For this particular patient, attempted treatments were such as administering oral antibiotics and nasal antibiotic creams which are intended to clear the staphylococcal bacteria in case the patient is a carrier. Additionally, administering both topical and oral antibiotics is expected to reduce the chances of furuncles from recurring.
Arguably, Data, Information, Knowledge, and Wisdom (D-I-K) are the most fundamental aspects in a clinical arena. Many at times the DIK framework works in a bottom-up approach. This means that the framework begins with the most basic concepts that are usually embodied in raw data, then to a more integrated view of information and finally on the synthesis power of knowledge. Besides, the top-down approach is also applicable. Thus, in this case, knowledge of the clinical problem begins as the primary goal, then explains how information about the condition at hand can be acquired to support the knowledge and finally, the data as the crucial observation that controls the entire condition (ANA, 2015).
In this particular clinical question, knowledge can be referred to as the central aspect to the issue of professional accountability concerning the control of the recurrence of the furunculosis infection. In this regard, the knowledge required relates to the causes and symptoms of the recurring furunculosis condition. One of the principal causes of the recurring condition on a patient who has no underlying infections would be the fact that the patient has a family member who is a carrier of the staphylococcal bacteria. For this reason, the patient is considered to have a considerable number of the staphylococcal bacteria that live harmlessly on their skin. However, a patient who is a carrier of this bacteria is more prone to recurrence of boils and other related skin conditions which quickly invade and rapidly spread following a minor injury or cut.
Sources of Knowledge
Concerning this clinical question, the most frequently used sources of knowledge were evidence based. Thus, these sources of knowledge relied on social interactions and other nurses individual experiences based on the treatment of a recurring furunculosis condition. Additionally, external sources of knowledge such as evidence-based nursing journals were the least frequently used sources of knowledge and research evidence. There are various reasons why nurses own experiences, treating the furunculosis condition were used in this case. For example, owing to the fact that the patient had previously been treated with other correct forms of treatment, social interaction by the nurses as well as the application of their own knowledge attained from past experiences was necessary. This is because the use of this particular source of knowledge gave the nurses the chance to use critically appraised as well as their own scientifically proven evidence for determining whether the recurrent condition in this patient was treatable.
Level of Evidence
The use of nurses individual experiences as the primary source of knowledge is in Level VII of evidence since it is based on the opinions and reports of the expert nurses and authorities.
According to Matney et.al. (2011), information is the meaningful picture that is formed by combining different data points with meaning. Thus, in this particular case, certain information is needed concerning the recurrence of the furunculosis infection in the patient. For instance, below are some examples of information that will be necessary in this case;
How long the patient has had the recurring furunculosis condition (Eg. 8 months).
Previously attempted treatment and their impact.
Any possible family history of the furunculosis condition among family members.
Being the smallest component of the DIKW framework, data is defined as the discrete factors that describe a particular patient or their environment. Additionally, data is a product of observation, with little or no interpretation, and is hence, presented as discrete facts (Matney et al., 2011).
How Data is represented in this case
In this case, the kind of data representation applied is visual. This is because the furuncles on the patients skin surface are visible and any possible underlying condition is evidenced by the results of the required lab tests. Some examples of data, in this case, are such as;
The patients previous medical diagnosis
Recurrent episodes of the skin boils on the skin
The age of the patient and their family background which relates to being a carrier of the staphylococcal bacteria.
In a clinical arena, wisdom is defined as the appropriate use of knowledge so as to manage, solve or treat a condition. In this regard, wisdom makes an implication of a form of ethics which guides in knowing why various things should or should not be implemented in the healthcare practice (ANA, 2008). Additionally, according to Benner (2000) wisdom can be defined as the clinical judgment that integrates intuition, senses, and emotions.
The Appropriate Use of Wisdom
In this case, wisdom is appropriately displayed through recognizing and understanding the situation at hand, the recurrence of the furunculosis condition, based on both the patients medical history and the healthcare knowledge. Additionally, understanding that this patient may be a carrier of the staphylococcal bacteria, or may have a family member who may be a carrier of the same bacteria is also an appropriate use of wisdom. For this reason, a clinical nurse will consider administering strong antibiotics for an immediate intervention so as to prevent any chances of recurrence.
ANA. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: nursesbooks.org.
Benner, P. (2000). The Wisdom of Our Practice. The American Journal of Nursing, 100(10), 99. doi:10.2307/3522335
Harrington, L. (2015). American Nurses Association Releases New Scope and Standards of Nursing Informatics Practice. AACN Advanced Critical Care, 26(2), 93-96. doi:10.1097/nci.0000000000000065
Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical Approaches to the Nursing Informatics Data-Information-Knowledge-Wisdom Framework. Advances in Nursing Science, 34(1), 6-18. doi:10.1097/ans.0b013e3182071813
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