Question

Natalie Rodriguez is a clinical nurse on a 65-bed oncology unit in a large teaching hospital in Phoenix, Arizona. She is a new graduate from a baccalaureate nursing program and strives to provide the best possible care to each of her clients. Nurse Rodriguez checks in on a 90-year-old patient, Mrs. Marting, who has pancreatic cancer. She has only one granddaughter, Allie, to come visit and stay with her for long hours each day, and the two are very close. Mrs. Marting has said she does not want any resuscitation measures, but when Nurse Rodriguez offers her DNR forms to sign, she waves them away. “I’m too sick right now, dear,” she says. “Let me deal with paperwork some other time.” In the meantime, Nurse Rodriguez has other patients she must attend to, but even as she tries to perform other tasks, Mrs. Marting’s wishes are on her mind. However, before she can return to Mrs. Marting and Allie, Dr. Daly arrives on the unit with a list of demands. Dr. Daly has a reputation for wanting “what I want when I want it,” and he asks Nurse Rodriguez to complete a laundry list of tasks that are not particularly patient-centered. She is restocking a supply cabinet, at his request, when Allie calls for help. Dr. Daly gets to Mrs. Marting’s room first and by the time Nurse Rodriguez arrives, Allie is begging the doctor to “do whatever it takes to save my grandma!” Mrs. Marting has undergone cardiac arrest. Nurse Rodriguez explains Mrs. Marting’s wishes, but Allie says, “I know, but I don’t care now! Just save her!” and Dr. Daly starts resuscitation.

1. Nurse Rodriguez is devastated by Dr. Daly’s choice and wonders what she could have done to stop resuscitation, which has broken one of Mrs. Marting’s ribs. “I don’t ever want to see that happen to one of my patients if I have anything to say about it,” she says. What kind of stress is Nurse Rodriguez experiencing, and which category of obstacle created it?
2. Nurse Rodriguez has said that she does not want that to happen to any of her patients again, if she can do anything to prevent it. What stage or phase of the “change process” outlined by the AACN is she most strongly associating with, and what, if anything, should she do first before acting on it?

Answer 1

The nurse Natalie Rodriguez is experiencing MENTAL DISTRESS.A particular patient care situation in which one is asked to give the care that is not desired by the patient and lack of collaboration caused the mental distress of the nurse Rodriguez.

The "change process" outlined by AACN has 4 stages or phases.

• Ask
• Affirm
• Assess
• Act

​​​​​​The nurse Rodriguez is strongly associated with the third phase, ie; "Assess phase" of the change process outlined by AACN because she identified her mental distress in case of Mrs Marting, she does not want that to happen for any other patient and she is ready to do anything to prevent that. Nurse Rodriguez has lready determined and confirmed her readiness to act , which is a characteristic of Assess phase.

Before acting on it she should consider the benefits and risks ,strengthen the benefits and try to overcome the risks for making a change. She should also seek guidance and support from others and make an effective action plan on how to make a change.

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