Question

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)

Primary Concept     
Professionalism/Communication     
Interrelated Concepts (In order of emphasis)     
Clinical Judgment
Collaboration
Patient Education     
NCLEX Client Need Categories   Percentage of Items from Each Category/Subcategory   Covered in Case Study     
Safe and Effective Care Environment         
Management of Care  
Safety and Infection Control  
Health Promotion and Maintenance     
Psychosocial Integrity  
Physiological Integrity         
Basic Care and Comfort     
Pharmacological and Parenteral Therapies  
Reduction of Risk Potential     
Physiological Adaptation  

I. 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.

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:     
         

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!”

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 Current Concern:   Clinical Significance:     
         

Caring and the “Art” of Nursing
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)

What Patient/Family is Experiencing:   What to Communicate:     
         

Resolving the Dilemma
Interpreting RELEVANT clinical data, what is the essence of this clinical dilemma? (Management of Care)

What additional information is needed by the nurse to clarify the dilemma? (Management of Care)

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)

What psychosocial/holistic care PRIORITIES need to be addressed for this patient?
(Psychosocial Integrity/Basic Care and Comfort)

Psychosocial PRIORITIES:         
PRIORITY Nursing Interventions:   Rationale:   Expected Outcome:     
             

   How can you ensure that John’s spouse receives adequate communication about the plan of care despite her inability to be in the hospital?

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)

Principles Therapeutic Communication:   HOW to Communicate:     
         

Evaluation: Six Hours Later…

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)

RELEVANT Data:   Clinical Significance:   Improving-Declining No Change:     
             

What response by Glenda would indicate that a change in the plan of care and nursing interventions are needed?
(Management of Care)

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:

What did you do well in this case study?   What weaknesses did this case study identify?     
         
What is your plan to make any weakness a strength?   How will you apply what was learned to future patients?     

Answer 1

#. The data that he went into acute respiratory distress with increasing O2 needs and decreasing O2 sat is clinically significant for the nurse because it indicates the respiratory distress of the patient due to the disease

#. The data relevant from the point of view of medical ethics is to allow his wife to see him but due to the pandemic and the policy for it attendents are not allowed to see their patients because of the transmission of disease . This is the ethical dilemma here .

#. The wife is under stress and anxiety as she is not able to take care of her husband . The nurse must explain her the scenario ,why she is not being allowed to meet , provide her emotional and psychological support.

#. The dilemma is clear - should the wife be allowed to see her husband or not . From both the points i.e. pandemic policy and medical ethics ,it is correct but since the scenario is this the policy is given weight .

#. The additional members of the healthcare team to be used to help Glenda is the Medical social worker , adminstration , psychological team .