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Roberts Case Study Maria Robert is from a colostomy surgery, with comorbidities of diabetic type 2, hypotension post-surgery, hearing loss, and osteoarthritis, and she is 84 years old, living with her son with down syndrome. In this lesson, we will look more closely at Maria Roberts and her associated health issues. At the end of the shift, Maria asks Samantha, the nurse, for a heating pad as her shoulder and back hurt due to her osteoarthritis. Despite already giving report to Nancy, the oncoming nurse, Samantha checks the chart and notes that there is no order for a heating pad. As Nancy is admitting another patient, she decides to make a heat pack using washcloths and water from the coffee pot. While unknown at the time, later assessment revealed the temperature of the water from the coffee pot was 174°F. The washcloths are placed in two plastic bags and a pillowcase and placed between Maria’s shoulder and her lower back. As she leaves the unit, Samantha reports the heat pack to Nancy, who was a traveling RN. However, she is in a rush to pick up her children, so she doesn’t chart the heat pack in the Electronic Health Record (EHR). Nancy performs a skin assessment but does not see a heat pack as she was looking for an aqua K-pad, which is the only sort of heat pack she even knew existed. She saw no machine; therefore, she didn’t give this another thought. Because Maria can turn herself, no request was made, or effort initiated to reposition her every 2 hours. In addition, no further skin assessments were done beyond the one at the beginning of the shift. The following day (Friday), the nurse, Sean, performed a skin assessment as part of his head-to-toe assessment. Sean stated the patient sat up so the epidural site could be assessed. “Part of a blister” was noticed on the patient’s lower back; there were no blisters in the shoulder area, but no further assessment of the area (lower back) was performed. The Wound Care Nurse arrived on the unit later in the day to perform an admission skin assessment and ostomy referral. The Wound Care Nurse rolled Maria to assess the skin on the back and noted an area on the patient’s buttocks had blisters present. Sean was notified by the Wound Care Nurse of the blisters and told to call the physician. When the Wound Care Nurse returned on Monday, she observed that the physician was never called, so she called the physician Monday morning and obtained orders to treat the burn. QUESTIONS 1. Describe all instances of communication failure in the situation above. For each failure described, identify communication strategies that 1) are expected of all health professionals and 2) communication options that, while not required, would improve communication and understanding of the patient situation. Sources to support. 2. List and defend your choice for the top 3 most critical time points during which there was an opportunity to avoid the negative outcomes for this patient. Back with sources. 3. What are the implications of Maria’s current situation? Be sure to think holistically! 4. What solutions would you propose to avoid having patients in this situation in the future? Support your solutions with a discussion of the process you would use to make the necessary changes in the institution. cite sources. 5. Considering Maria’s health and sensory concerns, describe the strategies nursing should consider to prevent further negative health outcomes. back up with supporting data 6. Cite sources within 5 years old, citations on every question, in-text citations, and reference pages.
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