Preparing for Clinical Practice
Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension.
1. Using the health belief model, identify the modifying factors impacting Ms. Thom’s likelihood of taking a preventive health action.
2. Which primary intervention activities are important for Ms. Thom?
3. Using the transtheoretical model of change, in which stage is Ms. Thom most likely related to her smoking? Explain your answer.
Caring in Nursing Practice
1. Mrs. Lowe is a 52-year-old patient being treated for lymphoma (cancer of the lymph nodes) that occurred 6 years after a lung transplant. Mrs. Lowe is discouraged about her current health status and has a lot of what she describes as muscle pain. The unit where Mrs. Lowe is receiving care has a number of very sick patients and is short staffed.
a. You enter her room to do a morning assessment and find Mrs. Lowe crying. How are you going to use caring practices to help her, knowing that your day has just begun and you have many nursing interventions to complete?
b. When you listen to Mrs. Lowe, she explains that her muscle pain is very bothersome and it was worse when she was alone. Both you and Mrs. Lowe determine that an injection for her pain would be beneficial. In what way can you show caring in the way you administer the injection to Mrs. Lowe?
c. Mrs. Lowe’s day is getting better. She seems more comfortable and is crying less. You find that your day is more controlled. What else can you do for Mrs. Lowe?
2. During your next clinical practicum, select a patient to talk with for at least 15 to 20 minutes. Ask the patient to tell you about his or her illness. Review the skills of listening in this chapter and in Chapter 24 (Links to an external site.)Links to an external site.. Immediately after your discussion, reflect on the discussion with the patient and determine if you have enough information about him or her to answer the following questions:
a. What do you believe the patient was trying to tell you about his or her illness?
b. Why was it important for the patient to share his or her story?
c. What did you do that made it easy or difficult for the patient to talk with you? What did you do well? What could you have done better?
d. Would you rate yourself a good listener? How can you listen better?
Caring for the Cancer Survivor
1. Do you have a friend or family member who has cancer and is willing to talk about it? If so, ask the individual to tell you what the experience has been like and what he or she would recommend to help you provide better care for survivors.
2. Ms. Ritter is a 32-year-old woman who visits the medical outpatient clinic to discuss her treatment options for breast cancer. She is married and has one child, a daughter, who is 6 years old. She and her husband hoped to have another child in the near future but now wonder if that will be possible. She shares with the nursing staff her concerns about the future and how cancer will affect her and her family. Identify two follow-up care plan components that would be important when considering Ms. Ritter’s role as a wife and parent.
3. Ms. Ritter tells her nurse, “This chemotherapy has made me feel so tired, and there are many nights when I can’t sleep very well. I’m looking forward to this ending.” What is an appropriate response the nurse might give Ms. Ritter?
Cultural Awareness
Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and is now insulin dependent. In 2012 the company she worked for downsized, and Ms. Jackson lost her job. As a result she was unable to pay her mortgage and became homeless. Since then she has been staying with various family members and friends because she has not been able to afford her own apartment. She has been working as an office temp from time to time but has not been able to find full-time work. She arrived at the emergency department (ED) with a blood sugar of 322 (normal range is 80 to 120) and a hemoglobin A1C of 11% (normal is approximately 5%).
Sam is a 23-year-old nursing student assigned to care for Ms. Jackson. After Sam reads Ms. Jackson’s chart, she notices that she has come to the ED on several occasions over the past 6 months with the same issue. She also notices that health care providers who took care of Ms. Jackson during the previous visits documented that she verbalized an understanding of how to manage her diabetes but has been nonadherent with her treatment plan.
After Sam conducts a cultural assessment using an explanatory model with questions, she learns that Ms. Jackson fears that she will eventually die because her mother died of diabetes. She also learns that Ms. Jackson cannot get her medications filled because she doesn’t have health insurance. After obtaining this information, Sam consults with a social worker, who tells Sam about a community health center within eight blocks of the place where Ms. Jackson is currently living. This health center has a diabetes management program and can offer ongoing support to Ms. Jackson. Sam spends time with Ms. Jackson explaining that people do not die from diabetes if they manage it effectively. Sam also discusses with Ms. Jackson some realistic ways to manage her diabetes given her challenging circumstances. In addition, she escorts Ms. Jackson to the social worker’s office so they can discuss possible housing and unemployment resources. Sam realizes that there is an opportunity for her to learn more about the social determinants of health that affect Ms. Jackson’s ability to manage her care. She also realizes that by gaining skills in cultural competence she will be more confident in providing culturally competent care to her patients.
1. List some of the social determinants of health that Sam most likely discovered while conducting a cultural assessment with Ms. Jackson.
2. On the basis of a cultural assessment, Sam discovers that Ms. Jackson believes that she may die. Select the C-LARA communication mnemonic listed in this chapter and plot a discussion that might help Ms. Jackson understand that diabetes is a manageable chronic illness that does not have to result in death.
3. Ms. Jackson is discharged and returns to the ED several months later because she is having difficulty managing her diabetes again. You are assigned to care for her. How will her weight, history of nonadherence, and past visits to the ED possibly affect your treatment? How could these factors trigger biases and assumptions that will get in the way of providing quality care? How could self-awareness help you reduce the effect of bias on the quality of care you provide?