Reflection: Metastructures of Nursing

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The metastructures of nursing are data, information and knowledge.  However, wisdom was added when the scope of nursing practice and nursing science was reviewed.  Wisdom expands the focus of the model from the technology and the processing of objects to include the interaction of the human with the technology and resultant outcome(s). (Graves and Corcoran, 1989).  Utilizing the metastructures of nursing informatics, I was able to make an astute clinical decision

According to Graves and Corcoran (1989), data are discrete entities that are described objectively without interpretation.

My data: My seven year old patient presented with abdominal pain.  He was triaged as medically stable, and was sent to the waiting area.  He had three episodes of emesis in the waiting area before he was called to a room.  He had no significant past medical history.  Recent past medical history included: constipation and no bowel movement for twelve days, emergency center visit with outside hospital the previous day, no fever, vomiting for twenty-four hours, distended abdomen, hypoactive bowel sounds, and his abdomen was tender to touch.  His visit to the outside hospital resulted in him receiving an enema which resulted in two pebble size stools.  His x-rays showed large amount of impacted stool in his large intestine and colon.  His mucous membranes were white and tacky, and he did not produce tears when crying.  

Information, according to Graves and Corcoran (1989), is data that are interpreted, organized or structured.

My information: My patient was in pain, he had no bowel movement for twelve days, and his abdomen was tender to touch.  He pointed to number 10, on the 0-10 faces pain scale.  He was also dehydrated as evidenced by his mucous membranes being white and tacky, having had had three episodes of emesis in the waiting area, vomiting for twenty-four hours and he did not produce tears when he was crying.   He was impacted, as his x-ray showed large quantity of stool in his large intestine and his colon.  Additionally, he also had no bowel movement for twelve days, with the exception of two pebble size stools the previous day.  Lastly, he also had hypoactive bowel sounds and a distended abdomen.

Graves and Corcoran (1989) stated that knowledge is information that is synthesized so that relationships are identified and formalized.

My knowledge: Based on his clinical condition, his previously unsuccessful enema and his increasing pain, I decided to start a peripheral IV, administer a normal saline fluid bolus, collect blood lab specimens, and place a nasogastric tube to relief pressure and to administer a continuous polyethylene glycol-electrolyte solution (Go-Lightly).  I also administered a phosphate enema.  [All orders were approved and signed by a licensed medical doctor].   Patient did not have any further emesis episodes, and stated that his pain was decreasing, from an original 10 on the faces scale (and objective scale as well) to a 5 on the faces and objective scale.  By the time he was transferred to the floor, he was sleeping. He did not have a bowel movement in the emergency department, but his pain was controlled, the vomiting had stopped and his hydration status was improved, as evidenced by his mucous membranes being pink and moist.

Per Nelson and Joos (1989), wisdom is defined as the appropriate use of knowledge to manage and solve human problems.

My Wisdom: I consulted with child life and had a child life specialist at bedside during the procedures, to minimize fear.  I also used buffered lidocaine for the IV placement.  To decrease stress, we explained the procedures to the parents and to the patient and answered all of their questions. I provided a print out to the parents on the nasogastric tube placement. I applied warm blankets for comfort, and borrowed patient's favorite movie from our in-house library.  I understood that my patient would be scared, but  by providing him with with proper instructions and by explaining the process to him and his parents, I felt that my patient was better prepared to cope with the situation.  I involved his parents in his treatment, so that my patient did not feel isolated and abandoned.



Graves, J., & Corcoran, S. (1989).  The study of nursing informatics. In McGonigle, D. & 
    Mastrian, K., Nursing Informatics and the Foundation of Knowledge.  Sudbury, MA:  Jones 
    and Bartlett Publishers.

McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge.
     Sudbury, MA: Jones and Bartlett Publishers.

Nelson, R., & Joos, I. (1989, fall).  On language in nursing: from data to wisdom. In D.
    McGonigle & K. Mastrian, Nursing Informatics and the Foundation of Knowledge. 
    Sudbury, MA:  Jones and Bartlett Publishers.


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This page contains a single entry by STEFANIE YUNAKOV published on October 17, 2008 6:14 PM.

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