Please answer the questions below on regards of   

Inadequate Pain Management in Postoperative Patients

1. Regarding your presentation assignment, what did you learn about the research project?
2. Would you have approached the assignment differently? Why or why not?

 

Submission Instructions:

• Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

This week, you will complete Case Study Part 1:

SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM Eleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient care team. You complete patient care rounds and assess Eleanor’s vital signs, comfort level, intravenous (IV) site and wound dressing. Eleanor has an IV for fluid replacement and medication administration. She also has an indwelling urinary catheter. She tells you that her pain level is a 4 out of 10 and she is reluctant to move around because of the pain. You know that the patient’s pain control is a high priority and that the physician ordered the indwelling urinary catheter until the patient is able to get out of bed easily and tolerate fluids. The urinary catheter is convenient in that the patient will not experience pain getting up to the bathroom and it provides an accurate measurement of output. On the other hand, you know that the longer the indwelling urinary catheter is in place, the higher the risk of an infection. You ask a trusted senior nurse when is the right time to remove the catheter since Eleanor is now tolerating ice chips. The senior nurse tells you that the catheter is usually kept until the patient is able to get up and ambulate independently. You wonder if there are any contraindications or problems with removing Eleanor’s indwelling catheter now. You decide to follow the senior nurse’s advice, leaving the indwelling urinary catheter in place and reevaluate for removal in the morning. 

SECTION II BACKGROUND: INTERPROFESSIONAL TEAMS AND STAKEHOLDER ENGAGEMENT This section is focused on the identification of a clinical problem and the steps of forming an interprofessional team to work on fixing the problem. The intent is to understand who are the stakeholders for this problem and the importance of engaging stakeholders in the quality improvement (QI) project. Examine the problem of CAUTIs holistically to identify stakeholders. You return to work the next day to learn that Eleanor has a low-grade fever of 99.8° F that was reported to the physician. The physician ordered an immediate urine culture and removal of the catheter the previous afternoon. The urine culture was positive for Escherichia coli, representing the presence of catheter-associated urinary tract infection (CAUTI). During the bedside report, you find that although Eleanor states she is tired, she is able to get up to the bathroom with a walker independently. She is also tolerating oral fluids and foods. The presence of the CAUTI bothered you enough that you spoke to your Unit Director about looking into evidence-based interventions to reduce CAUTIs. The Unit Director tells you that the rate of CAUTIs for the medical–surgical unit has steadily risen over the past year and the monthly total is twice the number from 2 years ago. You volunteer to convene a committee to work on the problem. Your first step is to identify others who should be on your team. You know that the stakeholders are individuals who influence or are influenced by the clinical problem under investigation. Review the discussion on stakeholders in Chapter 15 for guidance on selecting appropriate stakeholders. 

SECTION III BACKGROUND: LEADING A QI TEAM This section is focused on power gradients and leadership styles within an interprofessional team. Consider how to lead a team consisting of various healthcare professionals. You identified a variety of interprofessionals to include on your committee including two direct care nurses from the medical–surgical unit, one nurse from the operating room, two certified nurse assistants, a nurse supervisor, a physician, the medical–surgical clinical nurse specialist, a pharmacist, a laboratory representative, and a dietician. You feel that these individuals clearly represent all aspects of patient care. Review the information on communicating within a team and with different power gradients in Chapter 8. By working closely with the clinical nurse specialist (CNS), you are able to convene a meeting of the team.

Download and complete Case Study Part I Worksheet Download Case Study Part I Worksheet. 

Submit your completed Case Study Part I worksheet and its attachments into the drop box as one attachment. 

Student Instructions for i-Human Virtual Simulation

NR325/NR330 Maggie Naganashe Scenario 2

PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Maggie Naganashe is a 62-year-old American Indian female with chronic renal failure. She also has a 15-year history of type II diabetes mellitus and a history of hypertension, and hyperlipidemia. She lives on an American Indian reservation and is a proud member of the Odawa tribe. Mrs. Naganashe reports that she was unable to go to her dialysis treatment this week because her husband had to use their only car for a job interview. She was admitted for shortness of breath, swelling, weight gain and fatigue.

LEARNER OBJECTIVES:

1. Utilize clinical reasoning skills to perform a health history and physical assessment on an adult patient. (CO 1, 2, 3, 4)

2. Construct a plan of care based by prioritizing assessment findings and nursing diagnoses (CO 4, 5, 6, 7)

3. Evaluate patient outcomes to determine the effectiveness of nursing interventions and need for ongoing care (CO 4, 8)

4. Communicate and collaborate with the patient, family, and interdisciplinary healthcare team members (CO 3, 6)

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive assessment. After completing your assessment, you are expected to document your findings as a nurse’s note in SBAR format.

KEY FEATURES OF i-HUMAN:

· As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Analyze, Actions, Nursing Notes, Summary

· There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.

· Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

DUE DATE:

The virtual simulation is assigned to be completed during

Week 4
prior to your scheduled debriefing with faculty/peers.

SIMULATION TIMING:

· Pre-simulation preparation: 30-60 minutes

· Pre-brief: 15 minutes

· Run Time: 2.75 hours

· Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Evaluation – What does my total score mean?

REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

In order to prepare for the simulation, you are
required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your responses in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will

not
be able to access or participate in the simulation.

1. Describe the fluid and electrolyte imbalance that occur with chronic renal failure.

2. What are key patient education concepts related to chronic kidney disease?

3. Explore the CDC Tribal Data, Information, and Resources at
www.cdc.gov/tribal/data-resources and read the following article.

Mitchell, F. (2012). Reframing diabetes in American Indian communities: A social determinants of health perspective.
Health & Social Work, 37(2):71–79.

[Note: This article can be located through the Chamberlain University Library.]

4. Describe risk factors and conditions that lead to health disparities for American Indians.

Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the link provided.

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 Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document .

Attached you can find both case study.