Case Study to Promote Critical Reasoning
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Julio works at a large teaching hospital in a major metropolitan area. This institution services the entire geographical region, including indigent clients and, because of its reputation, administers care to international clients and individuals who reside in other states. Similar to all health-care institutions, this one has been attempting to cut costs by using more NAP. Nurses are often Aoated to other units. Lately, the number of indigent and foreign clients on Julio’s unit has increased. The acuity of these clients has been quite high, requiring a great deal of time from the nursing staff.
Julio arrived at work at 6:30 a.m., his usual time. He looked at the census board and discovered that the unit was filled, and Bed Control was calling all night to have clients discharged or transferred to make room for several clients who had been in the emergency department since the previous evening. He also discovered that the other RN assigned to his team called in sick His team consists of himself, two NAP, and an LPN who is shared by two teams. He has eight patients on his team:
•Two need to be readied for surgery, including preoperative and postoperative teaching, one of whom is a 35-year-old woman scheduled for a modified radical mastectomy for the treatment of breast cancer.
• Three are second-day postoperative clients, two of whom require extensive dressing changes, are receiving IV antibiotics, and need to be ambulated.
•One postoperative client is required to remain on total bedrest, has a nasogastric tube to suction as well as a chest tube, is on total parenteral nutrition and lipids, needs a central venous catheter line dressing change, has an IV, is taking multiple IV medications, and has a Foley catheter.
• One client is ready for discharge and needs discharge instruction.
• One client needs to be transferred to a subacute unit, and a report must be given to the RN of that unit.
Once the latter client is transferred and the other one is discharged, the emergency department will be sending two clients to the unit for admission.
1. How should Julio organize his day? Think about how you would set up an hourly schedule.
2. Make a priority list based on the ABC plus Maslow method.
3. What type of client management approach should Julio consider in assigning staff appropriately?
4. If you were Julio, which clients or tasks would you assign to your staff? List all of them.
Sample Solution
In order to effectively organize his day, Julio should set up an hourly schedule as it will help him structure his day in a more efficient manner. This can be done by focusing on the most pressing tasks first—such as any urgent care needs (e.g dressing changes) which must be attended to right away—and gradually working through the rest of the list with proper planning and delegation of duties whenever possible.
The ABC+Maslow method can then be used to prioritize tasks based on their importance and urgency; starting off with those that are both “A”s (critical & time sensitive) such as preoperative teaching/preparation for surgery followed by “B”s (important but not time-sensitive) like teaching about postoperative care or providing discharge instructions etc.. Lastly, any remaining non-emergent yet important tasks should be placed in the “C” category—such as transferring a client to another unit or attending regular rounds etc..
Keeping all this in mind an example hourly schedule for Julio could look something like this:
6:30–7:00am – Report & handoff from previous shift
7:00–8:00am – Preoperative preparation/teaching for mastectomy patient
8:00–9:00am – IV medication administration/assessment for 3 second-day postop patients
9:00–10:30am – Dressing change/IV antibiotics administration for 2nd day postop patients
10.30 – 11.00 am – Ambulate 2 postop clients
11.00 – 12 noon – Central venous catheter line dressing change + TPN monitoring & adjustement for bedrest patient
12 noon – 1pm Break
1pm –2 pm Prepare paperwork + give report to receiving RN prior to transfer of subacute patient
2 pm – 3 pm Discharge instruction + packing up belongings of discharged patient
3 pm onwards Attend regular rounds/address any other pending matters.
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