Assignment: NSGCB 416 Competency 3

Assignment: NSGCB 416 Competency 3

Assignment: NSGCB 416 Competency 3

Assessment Details

Read the following case study:

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old African American man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered several setbacks. Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.

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Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress.

Develop a plan to address nursing theory gaps in this scenario, including how theory, research, and practice interact to create positive patient outcomes.

Define the theory-practice gap and describe what impact this potential gap can have on nursing practice and patient care.

Format your assumptions and findings of the theory-practice gap in a concept map. Show alignment of nursing theory and its relation to the nursing process (including alignment with critical thinking and clinical decision-making) for an improved nursing care plan. Access the Technology Resources Library to locate visual presentation resources.

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Assignment: NSGCB 416 Competency 3 Sample

Case Study:

As an intensive care unit staff nurse, I was assigned to a 75-year-old African American man who underwent coronary artery bypass graft surgery four days before. The patient smokes heavily and has COPD. He had multiple setbacks postoperatively. Despite their best efforts, staff have been unable to wean him off the ventilator since surgery. During the shift, he needed repeated suctioning and is being investigated for ventilator-associated pneumonia. After lunch, I saw a skilled nurse suctioning the patient. The nurse was suctioning heavy secretions from the patient’s endotracheal tube with saline. The distressed patient grew scarlet and coughed.

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Theory Practice Gap: The theory-practice gap that has been identified in this particular case study pertains to the improper technique employed during the suctioning of the endotracheal tube (Mortell, 2019).

Concept Map

Summary

In nursing education, there are two essential components that one will encounter: the theoretical aspect and clinical learning. The theoretical component encompasses the rich tapestry of nursing history, the embodiment of professionalism, the intricate workings of the human body, the complexities of diseases, and the meticulousness of nursing procedures (Mortell, 2019). On the other hand, clinical learning serves as the transformative bridge where students have the opportunity to seamlessly integrate theory into the realm of practical application. Exposure to the clinical setting is crucial for nursing students as it allows them to develop the necessary skills and knowledge to deliver safe and efficient care. The theory-practice gap can occur when there is a discrepancy between the correct application of theory in practice. The theory-practice gap is often observed as a challenge in effectively applying the knowledge gained through academic studies and research into practical situations.

The theory gap that has been identified in the case study pertains to the improper suctioning technique employed for the endotracheal tube. The case study discusses a 75-year-old African American gentleman who underwent coronary artery bypass graft surgery. He is currently experiencing various complications, such as difficulty in being successfully removed from the ventilator. Additionally, he is currently being assessed for the possibility of ventilator-associated pneumonia. The patient needs frequent suctioning. During the suctioning procedure, the nurse gently introduces saline into the endotracheal tube, which may result in the patient experiencing a coughing reflex and a reddening of the complexion. Patients admitted to the Intensive Care Unit (ICU) commonly experience an elevation in airway secretions, necessitating frequent suctioning interventions. Endotracheal suctioning, if not executed using the proper technique, may result in various consequences and risks. These include potential respiratory and cardiac complications, trauma to the trachea’s endothelial lining, bleeding, elevated intracranial pressure, decreased oxygen levels in the blood (hypoxemia), and the development of cardiac arrhythmias (Kuniavsky et al., 2020).

There have been several studies conducted on the physiological effects of normal saline instillation in the endotracheal tube, dear. Based on research findings, it has been observed that the administration of normal saline has resulted in certain effects in older patients (Kuniavsky et al., 2020). These effects include decreased oxygenation levels, increased levels of perceived dyspnea, lower airway contamination, as well as increased mean arterial pressure (MAP) and intracranial pressure (ICP). Endotracheal suctioning should be conducted in accordance with the appropriate standards and protocols to minimize any potential adverse effects. It is advisable to have highly trained nurses perform the suctioning procedure, ensuring that the patient’s requirements are assessed beforehand. This approach yields more favorable outcomes and minimizes the occurrence of side effects.

According to nursing researchers, it has been observed that the theory-practice gap has the potential to undermine the credibility of nurses and may result in a decline in the quality of patient care (Shoghi et al., 2019). There have been various strategies implemented to address this gap in nursing, such as the utilization of internships, residencies, mentorships, and preceptorship programs. As a seasoned nurse, it can be challenging to carve out time for further education and skill development due to the demanding nature of our work responsibilities. It is imperative that their work setting prioritizes the provision of ongoing education and regular updates on policies and practices for those dedicated nurses. Other methods that were mentioned in addressing this gap include the implementation of culture-based theories, modification and restructuring of curriculum content, and reintroduction of clinical theories.

Theory-practice gaps continue to exist. Schools and healthcare organizations need to provide more nurse education to narrow the gap. Also needed is better clinical education. Since this gap starts at the beginning of the nursing career, clinical instructors should have more free time and fewer obligations so that they may spend more time with students (Ngozika Ugwu et al., 2023). Clinical practice should complement college lab sessions. Students would seek practical and theoretical teaching as a result of the analogies. The curriculum should begin integrating theory from the beginning. All of this will help nursing professors better grasp what clinical trainees need from them and how to bridge the gap between the classroom and the clinical setting.

References

Greenway, K., Butt, G., & Walthall, H. (2019). What is a theory-practice gap? An exploration of the concept. Nurse Education in Practice, 34(34), 1–6. https://doi.org/10.1016/j.nepr.2018.10.005

Kuniavsky, M., Vilenchik, E., & Lubanetz, A. (2020). Under (less) pressure – Facial pressure ulcer development in ventilated ICU patients: A prospective comparative study comparing two types of endotracheal tube fixations. Intensive and Critical Care Nursing, 58, 102804. https://doi.org/10.1016/j.iccn.2020.102804

Mortell, M. (2019). Is there a Theory – Practice – Ethics gap? A Patient Safety Case Study. International Journal of Africa Nursing Sciences, 10, 38–42. https://doi.org/10.1016/j.ijans.2018.12.002

Ngozika Ugwu, S., Ogbonnaya, N. P., Chijioke, V. C., & Esievo, J. N. (2023). Causes and effects of the theory-practice gap during clinical practice: the lived experiences of baccalaureate nursing students. International Journal of Qualitative Studies on Health and Well-Being, 18(1). https://doi.org/10.1080/17482631.2023.2164949

Shoghi, M., Sajadi, M., Oskuie, F., Dehnad, A., & Borimnejad, L. (2019). Strategies for bridging the theory-practice gap from the perspective of nursing experts. Heliyon, 5(9), e02503. https://doi.org/10.1016/j.heliyon.2019.e02503