Summative Assessment: Critical Thinking Case Study 3 Assignment

Summative Assessment: Critical Thinking Case Study 3 Assignment

Summative Assessment: Critical Thinking Case Study 3 Assignment

            The case study assigned for this paper demonstrates a 75-year-old African American male patient with a history of coronary artery bypass graft (CABG) surgery that was performed four days ago. The patient has a past medical history of exacerbated COPD by smoking heavily. He is still under mechanical ventilation and in need of frequent suctioning by nurses in different shifts. The patient is currently being evaluated for ventilator-associated pneumonia (VAP). However, while still observing the patient in today’s shift, I observed an experienced RN suctioning the patient, with thick secretions. The nurse was instilling NS through the patient’s endotracheal tube while suctioning. The patient seemed to be in respiratory distress evidenced by the cough and turning red. The purpose of this paper is to present a summative assessment of the above case scenario and identify the theory-practice gap illustrating how it can affect nursing practice and the process of patient care.

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The Identified Theory-Practice Gap

            The nursing theory that applies to the above case scenario is Kolcaba’s Comfort theory. The theory of comfort was developed by Katharine Kolcaba in 1994, based on the care that was being provided to patients or observed (Lin et al., 2022). The theory emphasizes comfort as the frontline of patient care. According to the theory, comfort can be achieved based on their main concepts, ease, relief, and transcendence. The above three concepts can also be achieved in four main domains, sociocultural, psychospiritual, physical, and environmental. Relief can be achieved when the patient’s comfort needs are met (Puchi et al., 2018). Ease is achieved when the care process brings calm and contentment to the patient. And finally, transcendence is experienced when the care process enables the patient to rise above the pain and discomfort.

            There is a comfort gap in the case scenario described above. The patient in the ICU seems to experience vehemence of discomfort despite the experienced nurse trying to create relief by administering normal saline while suctioning. Despite the care that the patient has been receiving, RNs still find it difficult to wean him off the ventilator hence the need for frequent suctioning. This does not relieve his discomfort or give him the power to overcome his challenges (Lafond et al., 2019). The nurse can see that the patient is in distress, evident by his turning red and coughing. However, she proceeds with the procedure, due to its health benefit to the patient. Kolcaba, in her Comfort theory, argues that a state of comfortable cannot be achieved in a stressful care situation (Lin et al., 2022). As such, all three comfort needs of the patient have not been met.

Impact on Nursing Practice and Patient Care

            With the application of the Kolcaba taxonomic structure, the assessment of the patient’s comfort needs should be based on three main factors, ease, relief, and transcendence (Wachalovsky, 2020). The clinician should try and achieve the above needs while observing the patient’s sociocultural, psychospiritual, physical, and environmental factors. When planning for care, the clinician must choose to align the patients’ needs and comfort measures which may help promote positive outcomes. However, based on the identified theory-practice gap, the patient may be unable to communicate to the attending nurse about his discomfort, given the instilled endotracheal tube (Lafond et al., 2019). As such, the assessment of this patient may be majorly based on objective findings. Consequently, the nurse’s efforts to satisfy the patient’s health needs seem to be worsening his state of comfort.

            Assuming that the patient’s comfort needs cannot be fully satisfied, the clinicians will continue conducting routine procedures that might promote the health of the patient but with great suffering (Puchi et al., 2018). Failing to observe the patient comfort needs during the process of care delivery cannot achieve positive care outcomes. The patient satisfaction level will be very low. Consequently, poor patient experience can make the patient afraid of going through such a procedure in the future, or even losing trust in the healthcare facility. Patient-centered care emphasizes attending to all the patient care needs including spiritual, physical, and emotional (Lafond et al., 2019). Comfort needs are key in attaining complete satisfaction from the patient. As such, the patient care plan should focus on closing this gap, for positive care outcomes.

Plan to Close the Identified Theory-Practice Gap

            The patient admitted to the ICU is deprived of a functioning mind, body, and integrity. By closing the comfort gap, the patient will be able to attain positive care outcomes. The comfort gap can be closed by changing the focus of the care plan beyond pain, towards promoting the patient’s experience at the highest level possible while still in the ICU. Based on the Comfort Theory, expanding the focus of care will help the nurses identify the patient’s distress and discontinue the current process (Lin et al., 2022). They will then utilize research to promote evidence-based practice by identifying a more pleasant intervention that can help relieve the patient physical symptoms with minimal or no distress to the patient (Puchi et al., 2018). Nursing is an innovative practice, which requires letting go of old procedures and adopting updated evidence-based practice interventions that are more effective in managing the patient’s condition but still pleasant in improving patients’ experience.

Conclusion

            The patient in the provided case study was admitted to the ICU due to exacerbating symptoms of COPD. During the process of care delivery, the patient displayed signs of respiratory distress and pain. Based on Kolcaba’s Comfort theory, the patient’s comfort needs including ease, relief, and transcendence have been ignored. To improve the patient’s experience, the nurse will have to expand the focus of care for this patient toward his experience in the ICU. This will help the nurse utilize research to identify more pleasant interventions that are equally or more effective in alleviating the patient’s symptoms, at minimal or no distress.

References

Lafond, D. A., Bowling, S., Fortkiewicz, J. M., Reggio, C., & Hinds, P. S. (2019). Integrating the Comfort Theory^TM Into Pediatric Primary Palliative Care to Improve Access to Care. Journal of Hospice & Palliative Nursing, 21(5), 382–389. https://doi.org/10.1097/njh.0000000000000538

Lin, Y., Zhou, Y., & Chen, C. (2022). Interventions and practices using Comfort Theory of Kolcaba to promote adults’ comfort: an evidence and gap map protocol of international effectiveness studies. https://doi.org/10.21203/rs.3.rs-1589710/v1

Puchi, C., Paravic-Klijn, T., & Salazar, A. (2018). The Comfort Theory as a Theoretical Framework Applied to a Clinical Case of Hospital at Home. Holistic Nursing Practice, 32(5), 228–239. https://doi.org/10.1097/hnp.0000000000000275

Suparman Rustam, J., Kongsuwan, W., & Kitrungrote, L. (2018). Comfort in Patients Receiving Mechanical Ventilation: A Literature. Journal of Critical Care Nursing, 11(2), 1–7. http://jccnursing.com/article-1-415-en.html

Wachalovsky, M. (2020). Respiratory Distress Observation Scale Implementation for Comfort Care Patients in the Acute Care Setting. Doctoral Projects. https://doi.org/10.31979/etd.86uc-v9jk

Appendix

Concept Map

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Week 5 – Summative Assessment: Critical Thinking Case Study 3 [due Mon]
Exam Content
1.
Case Study
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 a number of 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.

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.

Assignment
Identify the theory-practice gap in the case study above and describe how this potential gap can impact nursing practice and patient care.

Create a concept map that depicts your assumptions and findings of the theory-practice gap. 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.

Write an 875- to 1,050-word summary explaining how the concepts in nursing theory align to the nursing process, including alignment with critical thinking and clinical decision-making for an improved nursing care plan.

Include the following in the summary:
o The theory-practice gap that you identified in the case study and how this potential gap can impact nursing practice and patient care
o A plan to close the gaps in this scenario which will consist of how theory, research, and practice interact to create positive patient outcomes

Use visual presentation software from the College of Education Technology Resource Library to create your concept map. To review your options, do the following:
o Select Web Tools in the Table of Contents.
o Select Collaboration & Productivity from the list of tools.

Include at least 2 scholarly resources from the University Library to support you work.

Cite and format your sources according to APA guidelines.

Use grading rubric located on the right side of the assignment to self-grade assignment and ensure all grading criteria are met.
You may select a content map tool like Bubbl.Us
Submit your concept map and summary as an attachment to the same attempt for grading.

Review SafeAssign results after submitting your assignment. The result should be without large areas of text highlighted as matching words of others. Here is some SafeAssign Information