Acute Care Assignment
NURS 333 – Clinical Management of the Growing Family
Purpose of Assignment:
The purpose of this paper is for the student to conduct an in-depth assessment of a childbearing woman and her family in order to plan nursing care specific to that client, based on nursing research and AWHONN Standards of Care. The assessment will include the appropriate physiological, psychological, social, cultural, and environmental influences pertaining to the client and her family as it relates to preconception, conception, antepartum, intrapartum, postpartum and neonatal care.
Student Approach to Assignment:
To complete this assignment I used a patient case study assessment tool and interviewing. I personally interviewed a new mother 21 hours after the delivery of her son via cesarean section. I questioned her feelings surrounding her pregnancy, birth experience, social history, and culture. After, I performed a focused assessment, studied the medical records of her and her son, along with medications and laboratory findings. When all this information was collected, it was then synthesized and reviewed for pertinent information. This paper is in case study format and follows the mother, her newborn, and their most relevant nursing concerns along with accompanying research and evidence-based practice.
Rationale for Inclusion of this Assignment in the Student Portfolio:
This acute care assignment uses the nursing process to explore hyperbilirubinemia with ABO incompatibility with exacerbation by direct antibody test positivity. Within the body of paper I satisfy the following Old Dominion School of Nursing End-of-Program-Outcomes in accordance with their accrediting body:
Critical Thinking
Uses nursing and other appropriate theories and models to guide professional practice
Example: To effectively complete this assignment, trusting interpersonal communication had to be established. While it is not explicitly discussed within the body of the paper, I used Peplau’s Theory of Interpersonal Relations and her systematic approach of orientation, identification, exploitation, and resolution.
Nursing Practice
Applies appropriate knowledge of major health problems to guide nursing practice
Example: While not necessarily a health problem, I applied my knowledge of a postpartum woman to complete the physical assessment as well as guide my questioning in the inventory phase. After identifying her son’s reason for being in the special care nursery, I made sure the mother was up-to-date on information and knew what she could expect, and steps to take to possibly improve his condition, like breastfeeding.
Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques.
Example: When performing the physical assessment of the mother, she revealed she had not experienced flatus since her caesarean. To stimulate gastric motility and provide comfort, I encouraged her to splint her incision site with a pillow and turn from side to side, or ambulate to the special care nursery to visit her son approximately 30 minutes after her pain medication is administered.
Implements traditional nursing care practices as appropriate to provide holistic health care to diverse populations across the lifespan
Example: I was able to encourage this mother to breastfeed through teaching her the benefits of oxytocin production for uterine contractions, and to lower the bilirubin levels in her newborn.
Communication
Uses therapeutic communication within the nurse-patient relationship
Example: As stated above, I used Hildegard Peplau’s Theory of Interpersonal Communication and her systematic steps of interviewing with this patient. We began by talking about her assessment, moved to her feelings about her hospital stay, and finally her feelings surrounding her birth. Once rapport was established, I was able to ask deeper questions about her past and implement the steps of interviewing.
Accesses and utilizes data and information from a wide range of sources to enhance patient and professional communication
Example: To communicate with this patient and establish a rapport that allowed her to open up to me, I not only used Peplau’s theory, but I also drew on psychology courses that emphasized motivational interviewing, empathy, and trauma-informed care. Because of this patient’s prior experiences, empathy and trauma-informed care were very important to the nurse-patient milieu.
Teaching
Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions
Example: For this patient I provided guidance on how to care for her surgical incision by teaching her to allow soap and water to run over it in the shower, keep it dry, and follow up with her OB if it starts to bleed, has an abnormal discharge, or she notices a foul odor prior to her follow-up appointment. I also provided teaching about the phototherapy lights she would see in the nursery, and how it will allow her son to excrete bilirubin.
Uses information technologies and other appropriate methods to enhance one’s own knowledge base
Example: I used nursing and medical journals during this case study to understand ABO incompatibility, and identification of this via a Coombs test. Through this research I learned the pathophysiology behind ABO incompatibility and how it is linked to hyperbilirubinemia through erythrocyte hemolysis.
Research
Evaluates research that focuses on the efficacy and effectiveness of nursing interventions
Example: While writing this paper I discovered that although hyperbilirubinemia is very common among Neonatal Intensive Care Unit patients, not much research has been done regarding clinical indicators to test for bilirubin level in infants. When the skin is jaundicing, the disease has already progressed. It was recently decided that the sclera provide the most effective evaluation because the color does not vary across race, and it is in the area first affected by hyperbilirubinemia – the head.
Professionalism
Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care
Example: To complete this assignment I used the AWHONN Standards of Care, a specialty-specific standard of practice. I evaluated my patient’s nurse and modeled my future behavior after hers regarding teaching and assessment. When exploring WAVENET, the hospital’s system of standards of care and protocols, I was unable to locate a standard of care that specifically addressed role-modeling behavior in preceptor nurses.
Culture
Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age
Example: Much of this new mother’s behavior was dictated by her status as a mother. Throughout her interview she reminisced about the hospital stay with her oldest son in comparison to her newborn. When asked questions about self-care or concerns, she was open in explaining that the needs of her children come first, but understood she needed to take care of herself to be an optimal caregiver. Culture also played a role during her interview, as she grew up in an abusive home – therefore, questions regarding abuse and trauma were triggering for her, sometimes causing tears and confusion.