Case Presentation Gloria consi

Case Presentation

 Gloria considers herself an expert nurse on her medical/surgical unit. She has been a registered nurse (RN) on this unit for 12 years and has seen some important changes in how care is provided. Keeping up with these changes is an important part of Gloria’s practice, and many RNs look to Gloria for guidance in understanding the latest evidence. Lately, Gloria has been concerned about the occurrence of decubitus ulcers on her unit. She knows that there are several strategies that must be employed to effectively address this deleterious patient outcome. When caring for Mr. Brown, a postoperative spinal stenosis patient, Gloria knows that at the individual practice level it is important that she establish a schedule of turning this patient every 2 h. Gloria is aware this nursing intervention at the individual clinician level is effective in preventing decubitus ulcers.

 As Gloria goes off shift after caring for Mr. Brown, she thinks about the importance of clear communication with the rest of the healthcare team about decubitus ulcer prevention for Mr. Brown. Therefore, to address safety at the healthcare team level, Gloria posts a reminder above his bed listing the turning schedule so that all healthcare team members follow the same protocol to turn Mr. Brown every 2 h. While Gloria cares for Mr. Brown for consecutive shifts, she thinks about the variety of ways that nurses can work with other members of the healthcare team to prevent decubitus ulcers. On his second postoperative day, Mr. Brown’s surgeon mentions to Gloria that because he has been prescribed steroids, he is at especially high risk for developing decubitus ulcers. Gloria decides to address this safety concern for Mr. Brown at the unit level, and she seeks input on his care from the physical therapist to learn about skin protection products and from the dietitian to address nutritional strategies to help prevent decubitus ulcers in Mr. Brown. When speaking with the physical therapist and dietitian about decubitus ulcer prevention for Mr. Brown, both colleagues mention the increase in occurrence of decubitus ulcers on this medical/surgical unit. Gloria works with her manager and the quality improvement department to track the decubitus ulcer rate on her medical/surgical unit for the previous 6 months, and plans to compare this rate with state and national quality benchmarks for decubitus ulcer prevention. She is also aware that many studies have been published by the Institute for Healthcare Improvement on best practices for decubitus ulcer prevention. Once Gloria has retrieved the data from her own unit to compare to other benchmarks, she will collaborate with her manager and RN colleagues to identify some systematic strategies that can be adopted on her unit. Gloria demonstrates that she understands how to address safety needs at the individual clinician level as well as at the systems level that improves patient outcomes.

Case Analysis Questions

 1. In what ways does Gloria exemplify the incorporation of safety into her clinical practice?

 2. Review Fig. 45.3. Which interrelated concepts are evident in this case? Are there other concepts representing in this book that also apply to this specific situation?