Effective pain management is fundamental to quality care, good pain control speeds recovery. The next step outlined is IV fluid therapy to correct the hypotension cause by severe sepsis. From this ABCDE assessment it was clear to the nurse that the patient was hypotensive, tachycardic, had a reduced respiratory function and had neurological disturbances. In addition to the Gibbs (1998) models, there are the Johns’ model of reflection (1995); Kolb’s Learning Cycle (1984) and the Atkins and Murphy’s model of reflection (1994). Evidence Summary Though anti-emetics were prescribed to counter the effect of nausea and vomiting, their effect was not profound and this caused some delay in the operative process. The Resuscitation Council UK (2006) as recommending the use of the airway, breathing, circulation, disability and exposure approach when treating the acutely ill patient to ensure they are treated promptly and effectively. Mrs Smith’s conscious level was measured using the Glasgow Coma Scale. The nurse sat the patient in an upright position supported by pillows to ensure the patent airway was maintained, this was the only intervention used for airway management. All strong opioids require careful titration from an expert practitioner it is better to begin with a small dose and increase gradually in conjunction with careful assessment of its effectiveness (Hanks et al 2001). Another aspect of nursing care that helped was effective communication which is an essential prerequisite for effective nurse-patient relationship (Robinson 2002). In a study carried out by Matthewson at the elderly care unit at New Cross Hospital in Wolverhampton, she concluded that nursing is the art of caring and as such we must listen empathically to what patients and service users want so we can give them the care that they deserve (Matthewson 2002). Sepsis may be apparent by inflamed wounds or red swollen cannula sites. The literature serving as testimony to the care that nurses provide has been growing increasingly, however, there are still areas of nursing care where the evidence is deficient. The patient was wearing no excess clothing and was covered by a sheet to maintain dignity and she required no blankets because she complained of feeling hot. Though it has several advantages that are well suited for small intestinal obstruction management like its effect on slowing down the motility of the gut (Rodney 2010) which in the case of small intestinal obstruction is good, it causes nausea and vomiting as some of its side effect due to its direct action and stimulation of the chemoreceptor trigger zone of the brain (Daniels 2008). There are certain standards and guideline designed by the American Holistic Nursing Association in which establish the core values of holistic nursing (Frisch, 2001, p. 1). Conclusion is the sixth step and it is about what else I could have done and what could I not have done. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or …

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