Question

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	17-23%	ü
Safety and Infection Control	9-15%
Health Promotion and Maintenance	6-12%
Psychosocial Integrity	6-12%	ü
Physiological Integrity
Basic Care and Comfort	6-12%	ü
Pharmacological and Parenteral Therapies	12-18%
Reduction of Risk Potential	9-15%	ü
Physiological Adaptation	11-17%

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

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

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

3.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)

4. 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:

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

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? (Psychosocial Integrity)

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

Principles Therapeutic Communication:	HOW to Communicate:

Answer 1

Scenario 1

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

Scenario 2

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

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

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 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