What Should the Nurse Do?
Members of the nursing staff on the Rose Unit of Sunshine Hospital are concerned there have been more falls than usual on the unit over the last six months. They would like to determine if there are better interventions they can use as a group to prevent falls. They bring it up to their nurse manager during a staff meeting. The nurse manager agrees it is a good project idea and suggests they use the JHEBP model. Answer the following questions regarding this case study and the JHEBP model:
1
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What is the first step the nurses should take when beginning their project?
2
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Suppose the nurses determine there is not enough available evidence to make a full EBP project. What alternatives might they have to reduce falls on the unit?
3
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The nurses eventually determine there is sufficient available evidence, so they are moving forward with their project. However, when it is time to use the rating worksheets to evaluate the evidence, they note that a lot of it rates as low quality. What should they do?
4
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The nurses have identified several recommendations they would like to implement on the Rose Unit. How should they proceed?
5
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The action plan has been implemented for six months, and the outcome measures have been established. Not only did the number of falls decrease on the Rose Unit, but there is also a lower percentage of injuries from falls—and unexpectedly, the patients’ length of stay also decreased over the same time frame. What should the nurses do next?
6
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Nurse Rosen is caring for an older adult patient with pneumonia who wants their adult child to stay the night. While this is not technically against the unit’s rules, usually staff allow family to stay only if patients are expected to pass away soon. Otherwise, families are encouraged to leave at 9 p.m., when visiting hours end for the day. Nurse Rosen knows several other hospitals in the area allow visitors overnight. What should Nurse Rosen do?
Mr. Rodriguez has been admitted to the ICU with a five-day history of high fever and cough. His English is quite poor, and he is very anxious. The nurse is trying to perform the initial assessment and evaluate his needs, but there is a real communication barrier.
7
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Mr. Rodriguez takes a turn for the worse, and the physician is concerned for sepsis. What should the nurse expect to do?
8
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A decision is made to establish a central line for Mr. Rodriquez. What can the nurse do to prepare the supplies?
9
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Mr. Rodriquez does have sepsis and goes into respiratory failure. He is placed on a mechanical ventilator. What additional care should the nurse expect to provide?
Nurse Sa’ad has a patient requesting to go to the bathroom. The patient has not been out of bed for five days and has physician orders for bed rest, but they are insistent that they will be fine to walk and want to use the toilet. Nurse Sa’ad walks them to the bathroom and returns to the nursing station after asking the patient to pull the cord when they are ready to return to the bed. Ten minutes later, a nursing assistant finds the patient lying unconscious on the floor between the bathroom and their bed. Upon assessment, the patient has a head wound and a fractured hip but will recover fully. The nurse manager contacts the quality and safety department with an incident report.
10
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What type of event is this?
11
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When the quality nurse arrives, what kind of investigation can Nurse Sa’ad expect to be conducted?
12
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Scenario update: The root cause investigation determines that the patient was not wearing nonslip socks (a unit standard), had a broken call light in their bathroom, and had been taking narcotics for pain, which might have contributed to their fall. Given this update, how should Nurse Sa’ad act to prevent a similar event from happening again?
13
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Nurse Gomez has delegated a task to a member of her unit’s AP staff, Glenda. She has ensured Glenda has completed the necessary training. Glenda has a competency on file, and Nurse Gomez is comfortable with Glenda’s ability to perform the task. After Nurse Gomez finishes explaining what she needs Glenda to do, Glenda states that she does not feel comfortable accepting the delegation. What should the nurse do?
Consider again the scenario of Mr. Rosenburg, the 50-year-old with the diabetic foot ulcer who was discussed earlier in this chapter. Reread that conversation and answer the following questions.
14
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Name one strategy that Dr. Blalock used to engage Mr. Rosenburg initially.
15
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How did the team encourage Mr. Rosenburg to determine his goals?
16
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Nurse Rosa asks for the wound care nurse to be consulted for Mr. Rosenburg’s foot wound. Was this an appropriate request for her to make?