Case Study To Promote Critical Reasoning: Julio Works At A L

Case Study To Promote Critical Reasoningjulio Works At A Large Teachin

Case Study to Promote Critical Reasoning 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 floated 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 CNAs, 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.

Paper For Above instruction

Managing a nursing unit under crisis situations requires a strategic approach to prioritize patient care, organize staff tasks efficiently, and ensure safety and quality care. Julio faces a myriad of challenges, including high patient acuity, staffing shortages, and imminent admissions. To navigate this effectively, Julio must employ meticulous planning, prioritize based on patient needs, and delegate appropriate tasks to his team members. This essay discusses how Julio can organize his day, develop a priority list based on ABC + Maslow's hierarchy, adopt a suitable client management approach in staff assignments, and determine task allocation among staff.

Organizing Julio’s Day: An Hourly Schedule

Effective organization starts with a clear hourly plan that accommodates urgent tasks while allowing flexibility for unforeseen emergencies. Julio should begin his shift at 6:30 a.m. by conducting a quick team huddle, assigning tasks, and reviewing patient statuses. Early priority should focus on clients with critical needs, such as those requiring preoperative preparation, dressing changes, or on complex treatments.

6:30–8:00 a.m.: Initial assessments, prioritizing clients scheduled for surgery, ensuring preoperative teaching is completed, and reviewing the condition of postoperative clients. Simultaneously, preparing the patient scheduled for discharge, administering medications, and verifying that equipment such as IV lines, chest tubes, and Foley catheters are functioning well.

8:00–10:00 a.m.: Focus on dressing changes for postoperative clients, particularly those requiring extensive wound care. Conduct dressing changes and IV medication administrations concurrently. Ensure that the patient on total bedrest receives necessary care, including NG suction and TPN management. The discharge client gets counseling and education to facilitate timely departure.

10:00–12:00 p.m.: Complete preoperative preparations for surgery patients, including surgical site education and final assessments. Coordinate the transfer of the patient to the OR. During this time, start preparing for incoming admissions, reviewing patient histories, and ensuring all documentation is up-to-date.

12:00–1:00 p.m.: Lunch and a brief team check-in to re-evaluate priorities based on ongoing patient needs, changes in patient conditions, and incoming admissions.

1:00–3:00 p.m.: Continue care for postoperative clients, especially those requiring complex dressing changes and IV therapies. Prepare clients for discharge or transfer, finalize documentation, and give report for clients moving to the subacute unit.

3:00–5:00 p.m.: Finalize preparations for new admissions, hand off ongoing care, and ensure that all team members are aware of their responsibilities. Conduct a quick patient review and prioritize any emergent needs before shift handoff.

Priority List Using ABC + Maslow’s Hierarchy

Julio’s priority list should be rooted in the ABC framework—airway, breathing, and circulation—combined with Maslow’s hierarchy of needs to address both physiological stability and psychological needs. The highest priorities are patients whose lives are at immediate risk, such as those with compromised airways, poor breathing, or unstable circulations.

First priority: Clients with airway or breathing issues, such as the postoperative client on total bedrest with chest tube and NG suction, and the patient with chest tube drainage. Monitoring and managing these clients are essential to prevent respiratory failure or hemodynamic instability.

Second priority: Clients with circulatory compromise, including those with ongoing IV therapy needs, those at risk for bleeding, or hypotensive clients. Care involves ensuring adequate perfusion, timely medication administration, and monitoring vital signs.

Third priority: Clients with less immediate life threats but requiring ongoing interventions, such as the discharge-ready patient, clients with complex wounds, or those scheduled for transfer or discharge. Meeting Maslow’s safety and physiological needs, like wound care and discharge instructions, is critical here.

Psychological and emotional needs, such as patient education and reassurance, follow as additional priorities once physiological stability is assured, aligning with Maslow's emphasis on safety and belonging needs.

Client Management Approach and Staff Assignment

Julio should adopt a client-centered management strategy, utilizing a combination of task-oriented and relationship-based approaches. The focus must be on matching client acuity with staff expertise, maximizing efficiency, and maintaining safety.

High-acuity clients—those with complex surgical needs, critical IV therapies, or respiratory issues—should be assigned to the most experienced staff, such as Julio himself and the LPN with more experience. Clients with stable or less complex needs can be assigned to CNAs or less experienced staff under supervision.

In particular, the client scheduled for discharge and the transfer patient should be assigned to staff with good teaching and communication skills to facilitate education and handoff. The postoperative clients needing dressing changes and IV management require careful matching to staff with wound care skills.

Furthermore, staff should be assigned in a manner that allows for flexibility. For example, the LPN can assist with dressing changes and medication administration, while CNAs focus on ambulation, hygiene, and basic needs. Temporary float pools and resource sharing should be leveraged to optimize staffing levels as needed.

Task Assignments to Staff

• Julio: Oversee all patient care, handle complex assessments, coordinate transfers and admissions, and perform high-acuity interventions.
• Shared LPN: Manage dressing changes for postoperative wounds, provide medication administration, and assist with stable clients’ routine needs.
• CNAs: Assist with patient hygiene, ambulation, vital signs, and basic patient comfort measures, especially for postoperative and discharged clients.
• Discharge Client: Assign to a staff member skilled in patient education, enabling effective discharge instructions.
• Transfer Client: Responsible staff should be briefed on the client’s needs and transfer process, likely Julio, given the complexity.

In conclusion, managing during a high-pressure shift demands strategic planning, prioritization rooted in physiological and psychological needs, and effective delegation. Julio’s success hinges on his ability to organize the day efficiently, manage urgent needs first, allocate staff effectively, and communicate clearly with his team. Applying these principles ensures safe, timely, and quality patient care despite staffing challenges and increased patient acuity.

References

• ANA. (2015). Nursing: Scope and Standards of Practice (3rd ed.). American Nurses Association.
• Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Prentice Hall.
• Gordon, M. (2016). Manual of Nursing Diagnosis (14th ed.). Jones & Bartlett Learning.
• Hamilton, D. K. (2014). Nursing Leadership & Management. Elsevier.
• Henderson, V. (1966). The nature of nursing. American Journal of Nursing, 66(9), 49-52.
• Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (4th ed.). Wolters Kluwer.
• Potter, P. A., & Perry, A. G. (2016). Fundamentals of Nursing (9th ed.). Elsevier.
• Taylor, C., Lillis, C., & LeMone, P. (2015). Fundamentals of Nursing: The Art and Science of Nursing Care (8th ed.). Pearson.
• Watson, J. (2008). Nursing: The philosophy and science of caring. University Press of Colorado.
• White, J., & Taylor, C. (2014). Essentials of Nursing Leadership & Management. Elsevier.