Problem
Sheila is a new graduate Registered Nurse working on a medical rehabilitation unit. It is 0645hours and she is walking onto the unit to start her day shift. As she walks toward the nursing station for the morning shift report, Sheila notices that more patient call bells are alarming, than usual. When at the nursing station, she mentions this to one of the night shift nurses, who is frantically trying to finish charting. The night shift nurse explains that a patient had to be sent to acute care overnight. The night shift nurse expresses that this was difficult to do with just two nurses on unit during night shift. The patient was in critical condition, so one nurse had to stay with the patient at all times. The other nurse had to ready all of the transfer documentation and keep in communication with the doctor-on-call, the overnight manager, security and dispatch. Asa result, care for the other patients was delayed. Sheila listens and wonders how she might manage a similar situation. At 0700 hours, the nurses start reading the morning shift report. At 0720, the charge nurse, Monique, interrupts the report to announce that one of the day shift staff nurses has called in sick.
Monique has asked the clerk to call for a replacement, but until someone agrees to take the shift, each nurse will have an additional patient or two. Sheila starts to feel anxious because she is just becoming proficient at managing six patients per shift. She feels as though she might help managing extra responsibilities but can also see that the other nurses might not be able to support her, given their extra workloads. Sheila realizes that she has no choice but to start the day and provide care in the best way that she can. Prior to starting the morning assessments, Sheila takes a few extra minutes to read over her patients' Kardexes (charts). She finds that when morning report is interrupted, she needs to ensure that he hasn't missed any patient information. After completing the initial morning assessments, Sheila starts checking orders. She notices that one of her patients, requires an extensive wound (pressure ulcer) care dressing over the sacral area, and reads the detailed order and supplementary notes provided by the wound care nurse. Sheila gathers her supplies prior to entering the patient's room, such as normal saline, gauze and a hydrocolloid dressing. Sheila removes the old dressing, cleanses the wound with normal saline and assesses it. She notices the patient is whimpering and restless, and notes erythema and mild edema at the wound site. She asks the patient if there is any discomfort.
The patient states that she is concerned that the wound is healing very slowly and that it is very painful. Sheila takes note of this and completes the wound dressing as ordered, as efficiently and quickly as possible given her workload. Sheila continues providing care for her patients throughout the morning. She feels a little rushed, as she is still caring for seven patients instead of six. At 1100 hours, the physiotherapist, Jill, finds Sheila in the medication room and says that she has an appointment with the patient in Room 115, but he doesn't seem to be ready. Sheila clarifies that he is showered and dressed, but she hasn't had time to transfer him from the bed to his wheelchair via ceiling lift. Sheila explains that she couldn't find another nurse to assist her with the ceiling lift because they are short staffed. She offers that they transfer the patient together now.
Jill agrees, but tells Sheila that the patient should be ready next time because the transfer time is cutting into his therapy time. After transferring the patient with Jill, Sheila returns to the nursing station and expresses to Monique that she feels badly about not having the patient ready for therapy on time. Monique listens to her concerns and shares that she often has the same experience when staffing is limited. Monique counsels Sheila to 'let it go' and says that some of the physiotherapists and occupational therapists act as though their time is more important. Monique explains that it's just a part of the culture on this unit. Sheila continues her shift and finishes her charting. When providing shift report to the evening shift nurse, she expresses that it was difficult to provide care due to the sick call. The evening shift nurse quietly jokes that Sheila should get used to that. As Sheila commutes home from work, she feels uneasy. She has many questions that remain in her mind about work today.
A. Reflecting on what is most meaningful for the patient receiving wound care, discuss techniques that nurse Shelia could employ to transform the experience from what is, to what is possible.
B. Identify three examples of nurse Shelia's use of empirical knowledge in the case. Identify two additional sources of evidence that could be utilized to inform care.
C. Using each pattern of knowing, discuss how nurse Shelia could have approached her day differently (integrated expression in practice). Please make explicit how each pattern of knowing is reflected in your response