Therapeutic Communication, Safety, & Quality Care

SUBDOMAIN 725.1 – INTRODUCTION TO NURSING ARTS & SCIENCES
SUBDOMAIN 725.3 – CARING ARTS & SCIENCES ACROSS THE LIFE SPAN (CASAL) II

Competencies:
725.1.2: Therapeutic Communication, Safety, & Quality Care – The graduate involves the patient and family in decisions about care; recognizes need for communicating effectively; uses tools, including technology, to increase safety of patient care; acts to decrease risks of infection; acts with integrity, consistency, and respect for differing views; demonstrates effective use of strategies to reduce risk of harm to patients or self; and reports errors.
725.1.5: Culturally Competent Care of the Family – The graduate uses knowledge of cultural demographic patterns to plan culturally competent care; recognizes how cultural experiences affect health choices; integrates family characteristics of values, spirituality, and roles within the family structure into a plan of care; recognizes the influence of one’s own cultural affiliation, beliefs, and values on planning care for patients; and recognizes how to elicit family participation during patient teaching and determines the need for family support for the patient in healthcare decision making.
715.1.6: Health Perception/Health Management – The graduate recognizes positive and negative alterations in health status and how to assist patients to increase their movement toward optimal health; determines the impact of patient levels of development on health-promoting behavior; and assesses patient/family understanding of a therapeutic regime and patient’s desire to continue toward wellness.
725.3.3: Growth and Development Across the Life Span – The graduate recognizes human developmental differences across the life span in relation to health and illness; utilizes developmental milestones as an indicator of health and illness; assesses the physical and cognitive level of patients; assesses the emotional and social development of patients; recognizes how developmental levels affect nutrition; and integrates knowledge of growth and development into the care of patients across the life span.
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Introduction:

The nursing process is used as a problem-solving framework to plan and provide safe, patient-centered care to patients and their families. The incorporation of growth and development and cultural concepts in the planning and provision of care promotes patient safety and ensures quality care.

Scenario:

Jane Vuong is a Vietnamese 24 year-old single woman who is living in the United States on an academic visa. She has been attending the local university for two years, studying cellular biology as an undergraduate. She comes from an affluent Vietnamese family. Her parents are paying for her education and want her to come back to Vietnam with her doctorate and take over the research lab owned by her uncle. Jane is a straight “A” student and spends much of her time studying. She makes extra money by working part-time in the molecular biology laboratory in the university campus research center. She takes the subway or rides her bicycle to get around.

Jane enjoys working out doing Quan Khi Dao at the local martial arts school. One day while working out, she feels a severe tightness in her chest and says she is having difficulty breathing. Susan, a regular attendee in the class, brings Jane to the emergency department where you work. You note that Jane is having trouble speaking, appears anxious, and her lips are dusky. You are able to hear a wheezing sound when she breathes. She denies a history of asthma but says that she has some allergies which she generally treats with herbs. Susan takes you aside and tells you that she has noticed over the past month that Jane has seemed out of breath after taking the stairs up to the martial arts studio and that she no longer rides her bike to the studio.

Because of the severity of her symptoms, the doctor decides to admit her for evaluation and observation. The physician orders supplemental oxygen, a chest X-ray, blood tests, and a regular diet. Her anticipated stay is two days.

Once on supplemental oxygen, she is better able to communicate, and you begin to do a general assessment and take a history. Here are some of your findings:

Diet: Jane states that she is proud that she only eats a traditional Vietnamese diet of fresh vegetables, chicken, rice and noodles. Much of the food she eats is prepared with Nuoc mam (fish sauce), soy sauce, sour lemons, bean sprouts and scallions. She prefers to eat Banh Khuc (rice ball), Banh Cuon (rolled rice pancake), and Pho-bo (beef and noodle soup). You note that she is very slender, verging on being underweight.

Religion: Jane states she is a Mahayana Buddhist. She goes to the Buddhist temple early each morning for meditation and communion with her dead ancestors. She says her meditation brings blessings from her ancestors, and they watch over her and help her succeed and stay healthy.

Health history: Jane admits she has had a dry cough for several months which she attributes to allergies. She says her allergies have kept her from riding her bike to work. She continues to smoke 1 pack of cigarettes daily and says smoking doesn’t bother her. She laughs and says she could never quit because her roommate smokes too.

Six months earlier she tested positive for Hepatitis B. The diagnosis surprised her since she didn’t have any symptoms. She denies drug use but admits to being sexually active. She reports having 5 sexual partners in the past six months. She states: “I meet guys at the college bar and we have weekend flings. I like it this way, so I don’t have to be involved in any type of long-term relationship, which can make life really complicated.” When asked if she uses protection, she shrugs and says, “Sometimes.” She claims that no one told her that Hepatitis B was sexually transmitted, but she isn’t worried because she says she is over it now.

Exam: During her examination, red circular burns are found on Jane’s chest. On Jane’s back, there are reddened abrasions. When asked about these strange marks, Jane explains that she was having difficulty breathing earlier in the week, and went to a Vietnamese medicine man who treated her with “coining” on her back and “cupping” on her chest to remove the bad air. He also gave her an herbal mixture and told her to boil it and breathe the steam from the mixture three times daily. She says it really helped her.

Jane’s primary nursing diagnosis is “impaired gas exchange.”

Task:
A. Write an analysis paper with at least one reference (suggested length of 2 pages).

1. Summarize (suggested length of 1 paragraph) Jane’s history.

2. Explain how Jane’s history and behavior relate to each of the following theories:

• Erikson’s adult growth and development theory

• Freud’s adult growth and development theory

• Maslow’s needs theory

3. Explain how each theory in part A2 is relevant to Jane’s plan of care.

4. Discuss how the nurse will adapt care to meet Jane’s cultural needs.

a. Justify each adaptation.

5. Explain how the nursing process will assist the nurse in planning Jane’s care, including at least one specific example.
B. Given Jane’s history, select two additional nursing diagnoses from the below list. All of these diagnoses are reasonable diagnoses for Jane; you are not evaluated on which one you select.

• Knowledge Deficit

• Ineffective Denial

• Activity Intolerance

• Alterations in Health Maintenance

1. Using the attached Nurse Care Plan Templates, complete a nursing diagnoses chart for each of the two diagnoses you have chosen with the following information:

a. Subjective data that support the diagnosis

b. Objective data that support the diagnosis

c. Problem (nursing diagnosis)

d. Etiology

e. Signs and symptoms

f. Two short-term patient outcomes to be achieved before discharge

g. One long-term patient outcome to be achieved two weeks to six months after discharge

h. Nursing interventions that describe what the nurse will do to help the client meet each short-term and long-term outcome

Note: Interventions must be culturally and developmentally appropriate when applicable.
i. Rationale for each nursing intervention, including why this nursing intervention is relevant to helping the patient achieve the corresponding goal
C. If you use sources, include all in-text citations and references in APA format.
Note: Please save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

 
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