In: Nursing
STUDENT-Part-II-COVID-19-Family_Dilemma.pdf ( Please Read)
Novel Coronavirus Disease (COVID-19) Family Dilemma: Part II
Glenda Taylor, 67 years old (John’s spouse)
Scenario
History of Present Problem:
John Taylor is a 68-year-old African-American male who was admitted
to the MedSurg unit after testing positive for COVID-19 today. Four
hours later he got up to use the bathroom and went into acute
respiratory distress with increasing O2 needs and decreasing O2
sat. John is transferred emergently to the intensive care unit
(ICU). John’s spouse Glenda has not been allowed to visit her
husband because of current hospital policy that does not allow
visitors for COVID-19 patients.
1. What data from the history is RELEVANT and must be
NOTICED as clinically significant by the nurse?
(Reduction of Risk Potential)
2. RELEVANT Data from Present Problem: Clinical
Significance:
The Dilemma Begins
IMPORTANT CONSIDERATION: The essence of a clinical dilemma
is that there is no clear right or wrong answer or response. Using
principles of medical ethics and the American Nurses Association
code of ethics and one’s conscience are guidelines to successfully
resolve the dilemmas that nurses will experience in practice.
Current Concern:
Since Glenda has not been updated on John’s change of status, you
call Glenda and communicate his critical condition
and his need to be intubated and placed on a ventilator. Glenda is
clearly upset and states, “I need to see him! I need to be there!
We’ve been married for 48 years and nothing has separated us! He
needs me now more than ever!”
3. What data from the current concern is RELEVANT and
must be NOTICED as clinically significant by the nurse?
(Reduction of Risk Potential)
4. RELEVANT Data from Current Concern: Clinical
Significance:
Caring and the “Art” of Nursing
5. What is John’s spouse likely experiencing/feeling right
now in this situation? What would you specifically communicate to
his spouse under these circumstances? (NCLEX: Psychosocial
Integrity)
6. What Patient/Family is Experiencing: What to
Communicate:
Resolving the Dilemma
7. Interpreting RELEVANT clinical data, what is the essence
of this clinical dilemma? (Management of Care)
8. What additional information is needed by the nurse to
clarify the dilemma? (Management of Care)
9. What additional members of the healthcare team could be
used in this situation if Glenda was able to be in the hospital?
Why? (Management of Care)
10. What psychosocial/holistic care PRIORITIES need to be
addressed for this patient?
(Psychosocial Integrity/Basic Care and Comfort)
11. Psychosocial PRIORITIES:
PRIORITY Nursing Interventions: Rationale:
Expected Outcome:
12. How can you ensure that John’s spouse receives adequate communication about the plan of care despite her inability to be in the hospital?
13. What principles of therapeutic communication are
relevant and how can they be stated by the nurse to develop trust
and encourage dialogue between the nurse and family during this
phone call? (Psychosocial Integrity)
14. Principles Therapeutic Communication: HOW to
Communicate:
Evaluation: Six Hours Later…
15. EVALUATE your patient by INTERPRETING relevant
clinical data to determine if Glenda’s coping is improving,
declining, or reflects no change. (NCSBN: Step 6 Evaluate
outcomes/NCLEX: Management of Care)
16. RELEVANT Data: Clinical Significance:
Improving-Declining No Change:
17. What response by Glenda would indicate that a change
in the plan of care and nursing interventions are needed?
(Management of Care)
18. Reflect on Your Thinking to Develop Clinical
Judgment
To develop clinical judgment, reflect on your thinking that was
used to complete this case study by answering the following
questions:
19. What did you do well in this case study? What
weaknesses did this case study identify?
20. What is your plan to make any weakness a strength?
How will you apply what was learned to future patients?
John Taylor Covid Patient: Please read the current scenario with John.
What about his wife?
We are going to cover every aspect as noted in the scenario.
What is the relevant data with the current problem?
What is the relevant data with the current concern with John's wife Glenda?
What is the art of nursing with caring?
Resolving the Dilemma, and the psychosocial Properties and the nursing interventions.
And we will finish with block 6 and therapeutic communication.
STUDENT-Part-II-COVID-19-Family_Dilemma.pdf
Scenario 1
Glenda Taylor, 67 years old (John’s spouse)
Scenario
History of Present Problem:
John Taylor is a 68-year-old African-American male who was admitted
to the MedSurg unit after testing positive for COVID-19 today. Four
hours later he got up to use the bathroom and went into acute
respiratory distress with increasing O2 needs and decreasing O2
sat. John is transferred emergently to the intensive care unit
(ICU). John’s spouse Glenda has not been allowed to visit her
husband because of current hospital policy that does not allow
visitors for COVID-19 patients.
1. What data from the history is RELEVANT and must be
NOTICED as clinically significant by the nurse?
(Reduction of Risk Potential)
Relevant data from present problem |
Clinical significance |
Jhon Taylor – 68 year Old |
Most High Risk age for COVID -19 |
Tested positive for COVID-19 |
Active presence of virus after incubation period |
Goes into acute respiratory distress |
Complication of COVID-19 need for intubation |
Elative procedures needed (means life saving) |
To save life |
Strict no visitor policy for COVID-19 |
Disease is highly contagious |
the risk potential is spread of infection which is to be reduced by strict no visitor policy
Scenario 2
Since Glenda has not been updated on John’s change of status,
you call Glenda and communicate his critical condition
and his need to be intubated and placed on a ventilator. Glenda is
clearly upset and states, “I need to see him! I need to be there!
We’ve been married for 48 years and nothing has separated us! He
needs me now more than ever!”
What data from the current concern is RELEVANT and must
be NOTICED as clinically significant by the nurse?
(Reduction of Risk Potential)
Relevant data from present problem |
Clinical significance |
calling Glenda to communicate Jhon Taylor’s critical condition |
Patients’ and relatives / guardians’ rights to information is achieved |
need to be intubated and placed on a ventilator |
Informed consent is obtained |
Glenda is clearly upset |
Fear and anxiety are observed |
Nurses role |
Compassionate assure that best would be done |
Scenario 3
Caring and the “Art” of Nursing
5. What is John’s spouse likely experiencing/feeling right now in
this situation? What would you specifically communicate to his
spouse under these circumstances? (NCLEX: Psychosocial
Integrity)
6. What Patient/Family is Experiencing: What to
Communicate:
What Patient/Family is Experiencing: |
What to Communicate: |
John’s spouse likely experiencing/feeling right now |
Fear and anxiety |
communication to his spouse under these circumstances |
· ensure that Mr Jhon is being protected from being isolated, · steps are taken to prevent stigmatized, · care is provided and he is not left in a position of increased vulnerability · he is able to access basic · making sure he receives provisions and social care by keeping family in the loop of treatment |
Scenario 4
Resolving the Dilemma
7. Interpreting RELEVANT clinical data, what is the essence of this
clinical dilemma? (Management of Care)
8. What additional information is needed by the nurse to clarify
the dilemma? (Management of Care)
9. What additional members of the healthcare team could be used in
this situation if Glenda was able to be in the hospital? Why?
(Management of Care)
10. What psychosocial/holistic care PRIORITIES need to be addressed
for this patient?
(Psychosocial Integrity/Basic Care and Comfort)
11. Psychosocial PRIORITIES:
PRIORITY Nursing Interventions: Rationale:
Expected Outcome:
Psychosocial PRIORITIES: priority nursing interventions: |
Rationale: |
Expected Outcome: |
a. essence of clinical dilemma (management of care) |
1. The nurse practices with compassion and respect for the inherent dignity of the patient 2. She works on worth, and unique attributes of patient care 3. Nurse is responsible for nursing practice, that makes decisions better towards the patient care and 4. Nurse takes action consistent with the obligation to provide optimal patient care |
Patient receives best possible care |
b. What additional information is needed by the nurse to clarify the dilemma? |
5. Patients past history / medications / underlying diseases 6. Patients history of abuse /substance abuse 7. Occupation and other details of family history |
Assessment of vulnerability and best possible care is planned and given |
c. What additional members of the healthcare team could be used in this situation if Glenda was able to be in the hospital? Why? (Management of Care) |
8. Additional health care team would involve councillors, respiratory assistants, consultants, and nursing in charges |
To better communicate with Ms Glenda at hospital |
d. What psychosocial / holistic care priorities need to be addressed for this patient? |
9. Fear of dying 10. Fear of separation 11. Stress of uncertainty |
Make a note of the background of patient and help him get attention in required area |
Scenario 5
12. How can you ensure that John’s spouse receives adequate communication about the plan of care despite her inability to be in the hospital?
13. What principles of therapeutic communication are relevant
and how can they be stated by the nurse to develop trust and
encourage dialogue between the nurse and family during this phone
call? (Psychosocial Integrity)
Clinical Significance: |
Improving-Declining No Change: |
How can you ensure that John’s spouse receives adequate communication about the plan of care despite her inability to be in the hospital? |
Communicate and inform the updated status regularly and inform them about the need of care. |
What principles of therapeutic communication are relevant and how can they be stated by the nurse to develop trust and encourage dialogue between the nurse and family during this phone call? (Psychosocial Integrity) |
The principles of therapeutic communication are. a. Patient centred communication b. Professionalism and professional attributes followed c. Self – disclosure used cautiously d. Avoidance of social relationship e. Confidentiality norm f. Communicate based on intellectual competency g. Theoretical based h. Communication should be non-judgemental i. Avoid giving advice j. Share rational experience |
Scenario 6
What principles of therapeutic communication are relevant and how can they be stated by the nurse to develop trust and encourage dialogue between the nurse and family during this phone call? What about his wife? We are going to cover every aspect as noted in the scenario. What is the relevant data with the current problem? What is the relevant data with the current concern with John's wife Glenda? What is the art of nursing with caring? |
|
Principles Therapeutic Communication: |
How to Communicate: |
· Utilitarianism · Autonomy · Nonmaleficence · Beneficence · Justice · Veracity |
a. focus on the wife’s feelings b. honest and direct answers matter the most c. involve in active listening d. Encouraging clients to talk through verbal and nonverbal communication e. indicate acceptance of the client’s apprehensions f. maintain a goal-focused interaction g. encourage to share their view points and help them communicate better h. share the necessary data i. relevant data need to be updated frequently j. care compassionately and answer their queries k. repeat as many times they ask l. have patience |