Case Studies (Questions and Answers )
Chapter 6: Historical Perspectives: Influences on the Present
Case Study 1
As a project for a course, a group of nursing students was asked to examine historical nursing influences and their effect on today’s nursing practice. They created a table to illustrate the similarities:
A. Review the table and the content in Chapter 6. Perform an Internet search on the history of nursing and influences on today’s nursing practice. Would you add anything to the content of the table?
B. Use the following table to identify influences from Florence Nightingale on today’s nursing practice. Add additional rows as needed to demonstrate how Florence Nightingale continues to affect nursing today.
Case Study 2
You volunteered to participate in a mock disaster drill as part of your orientation to the hospital. The drill involved an airplane crash into a field near the hospital with multiple wounded individuals. During the drill, you overhear two nurses complaining. “They had better conditions during the Civil War!” exclaimed the first nurse. The second nurse replied, “No, those nurses made the conditions better.” Referring to the management of the drill, the second nurse added, “I feel like I’m a nurse in the Victorian Age.”
A. Based on what you know about nursing conditions during the Civil War, what did the first nurse mean by the remark?
B. What did the second nurse imply by the statement about nursing in the Victorian Age?
Case Study 3
Laurie is graduating from nursing school next month. As she prepares for graduation, she reflects on her experiences during nursing school. She remembers her fundamentals class; she was so nervous during her first nursing assessment that she fumbled with the blood pressure cuff and had it upside down. Smiling, she remembers how her patient patted her arm and told her she was doing fine. Laurie recalls holding a family member’s hand while a patient passed away, feeling inadequate to handle the situation, but feeling powerful in that the family wanted her to stay with them. Then there was the pediatric rotation with that young boy who fell out of the tree and broke his arm. The babysitter heard him fall and called 911. During her assessment, Laurie found bruises all over his body and showed the nurse. She became sad as she recalled that when social services finished with the case, the babysitter was charged with abuse.
Laurie remembered how she ambulated dozens of patients miles and miles around the various nursing units. One patient asked questions about his newly diagnosed diabetes, and Laurie’s mind froze. She felt embarrassed and humiliated that she couldn’t respond to his inquiries quickly. Based on the interaction, Laurie created an educational plan for the patient, but when she arrived at the patient’s room she found his wife and sister at the bedside. Again, she froze, but the family was kind and wanted to participate in the teaching. When she discussed the event during post conference, her classmates agreed with her teaching plan and discussed their fears about their own knowledge base of nursing. Her classmates supported her, validating her feelings and suggesting methods to overcome the fear associated with teaching. Finally, Laurie remembered her final medical-surgical rotations. She laughed as she recalled her horror over an assignment of three patients during the clinical rotation. With guidance from her clinical instructor, she managed and coordinated the care of the patients.
A. Describe how Laurie demonstrated evidence of the following roles of the traditional nurse.
B. Reflect on your own experiences in nursing school. How did you demonstrate characteristics of the traditional nurse roles?
Case Study 4
Three nurses—Ann, Bob, and Carol—are enjoying their lunch break together. The discussion moves from their plans for the weekend to their plans to apply for graduate school. Ann graduated from a diploma program, explaining to the others that her education helped her transition into the role of the nurse. She describes the program as having a clinical focus, in which she learned the tasks involved in nursing care. Bob graduated from an associate degree program. He describes his program as having a general focus, a preparation for attending a graduate program in nursing. Bob explains how his educational preparation is historically considered the most technically advanced degree in nursing. Finally, Carol describes her baccalaureate degree program and explains how it once was considered the diploma degree plus 2 years of general education.
A. Identify the correct and incorrect descriptions of the three degrees in this scenario.
B. Bob goes on to describe how his nursing career would have been much different in the Victorian Age. He explains how he would probably not be a nurse—he would be something else instead, taking care of his frail and dainty wife. He laughingly tells Ann and Carol that they would be nurses and “old maids.” Explore his comments in relation to the Victorian-era nurse.
Next, Carol tells Bob that in earlier eras, both men and women were nurses and both genders took vows of purity and chastity. What did she mean by this statement?
Chapter 7: Nursing Education
Case Study 1
Martha, Jean, and Ahmad are researching the educational paths for a nursing degree. Martha does not have a nursing background and thinks that a generic baccalaureate program at a local university suits her needs. She is a recent high school graduate, with aspirations of teaching nursing. Jean, a single mother of three, already has a bachelor’s degree in business management. She wants to increase her earning potential for her family and enter a profession that allows her to care for others. She selects an Associate of Science in Nursing program, with an ultimate career goal of earning a doctoral degree as a step toward obtaining a position in health care administration. Ahmad, a 25-year-old, is working two jobs as a baccalaureate registered nurse. He wants to further his career opportunities with a master’s degree and eventually earn a doctoral degree. He is unsure which advanced practice path would work best for him.
A. Describe the educational requirements for each of the different educational paths (ADN, BSN, MSN).
B. What should Martha expect from a traditional nursing program (BSN)?
C. What are the possible master’s educational paths for Ahmad?
D. Jean is considering an online RN-BSN program when she completes her associate’s degree. What are the advantages and disadvantages of this method?
E. In your opinion, based on their goals of earning a doctoral degree, which type of degree would best suit Martha, Jean, and Ahmed? Defend your answer.
F. What influence does the Institute of Medicine (IOM) report have on Martha, Jean and Ahmed’s future nursing education plans, specifically recommendations 4, 5 and 6?
Case Study 2
Heather started nursing as an LPN at a community college. After graduation, she transferred into an associate degree program at the same school. She is currently an RN and is looking into options for earning a baccalaureate degree in nursing. A nearby university has an articulation agreement with her community college.
A. Search the website at www.allnursingschools.com/find/. Which options are available to Heather?
B. Describe how Heather’s educational choice is an example of a multiple-exit program. How does this differ from a career ladder or bridge program?
C. Is an RN-MSN program possible for Heather, considering her educational preparation? Defend your answer.
D. Obtain your school’s (or nearby school’s) BSN completion program requirements and required courses. Compare these with the requirements and required courses for the University of Phoenix Online program. How are they different? How are they the same?
Case Study 3
Marianne is researching the various advanced practice nurse educational paths. She wants to further her education but is unsure about which type of degree would best suit her present nursing career goals. Her final educational goal is to obtain a doctoral degree. She understands that the nurse practitioner might offer the most autonomy in the clinical setting, allow her independence in patient care, and provide her with flexibility. She worries about possible employment because most physicians in her area do not use nurse practitioners. Marianne also considers the clinical nurse specialist option. She likes the idea of teaching and thinks that this option might provide her additional opportunities for leadership. The nurse-midwife option appeals to her because of her experience and background in obstetrics. She is currently employed in the obstetrics unit and enjoys working in the labor room. She also likes the nurse anesthetist path—it could provide her with stability in her schedule, but the closest program is 60 miles away.
Although each area appeals to Marianne, she says the final decision needs to rest on employment opportunities. She decides that her needs are flexibility in schedule, proximity to her residence, an opportunity for advancement to a leadership position, and autonomy. She does not want to pursue prescriptive authority in a nursing position and feels uncomfortable with the responsibility of delivering babies. She enjoys clinical practice but thinks that her ultimate goal includes teaching in higher education.
A. How would you help Marianne with her decision based on employment opportunities within each of the advanced practice options described?
B. Compare how the clinical nurse specialist and nurse practitioner educational preparation could help Marianne meet her career goals.
C. Marianne’s professional goals include earning a doctoral degree in nursing. Consider the DNP versus the PhD in relation to Marianne’s professional goals. Which doctoral path would provide the educational preparation she would need to achieve her goal? Defend your response.
D. Describe the differences between the DNP and the PhD.
Case Study 4
Your nursing school recently added a new Master’s of Science in Nursing program. The professors explain that the accrediting agency will be interviewing students as part of the accreditation process. In addition, they promote accreditation as important to those students currently enrolled in the program, claiming that it adds value to their degree by providing evidence that the program is solid. One of the students tells you that the accreditation certifies that the school meets state requirements for nursing education and that the state requires the program to pass accreditation.
A. Can the state require nursing programs to pass accreditation standards?
B. Can entry to graduate school be denied if the undergraduate degree is from a nonaccredited school? Explain your answer.
C. What is the benefit of accreditation to the students? To the school?
D. The student in the scenario stated that accreditation certifies that the school meets state requirements for nursing education. What’s wrong with this statement?
Case Study 5
Lisa has been the Unit Director of a medical-surgical unit for the past year. She accepted the position after completing a master’s degree in nursing administration. Her past experience includes 3 years as an intensive care nurse and 4 years as a medical-surgical nurse. She enjoys her administrative position and aspires to become the Chief Nursing Officer in the future.
A. What certification would help Lisa achieve her long-term career goal? Hint—try using this website: https://www.nursecredentialing.org/Certification.aspx
B. Does Lisa meet the eligibility criteria for the certification exam that you selected?
C. Review the certifications available for nurses at https://www.nursecredentialing.org/Certification.aspx. Which of the available certifications align with your career goals?
Chapter 8: Nursing Theory
Case Study 1
Over a break between their classes, Angela and Becky were discussing why theory is important for nursing. Angela brought up Florence Nightingale and how her theory revolutionized nursing by proposing that it was separate from medicine. She described how Nightingale had a scientific background that reinforced the need for nursing to improve patient outcomes. Becky disagreed, stating that Nightingale only initiated what it meant to be a nurse. She thought that a true theorist was someone like Dorothea Orem, and that theories like hers truly reflected nursing.
A. Did Florence Nightingale create the first nursing theory? Defend your position.
B. What definition for the metaparadigm of nursing does Nightingale’s theory propose?
C. Compare and contrast the definitions of person, nurse, health, and environment in Nightingale’s and Orem’s theories.
D. Review the theorists’ definitions of the metaparadigm in Box 8-2. Which of the theorists’ definitions fit your own beliefs about nursing?
Case Study 2
Jared provides care based on his assessment of the following patients:
A. 431: A 68-year-old female with surgical repair of a hip fracture. Jared notes that the patient lives independently in her home and that her two sons live nearby in the same community. She will be discharged tomorrow, and Jared prepares to address her needs.
B. 432: A 32-year-old female posthysterectomy. The patient is upset and tired, having been up all night because of her roommate (a dementia patient who screamed throughout the night). Jared arranges to have the dementia patient moved into a single-bed room.
C. 433: A 66-year-old male with chronic congestive heart failure. Jared identifies the need for prevention of further disease-related problems and promoting optimal health. He initiates teaching the patient about diet, exercise, fluid restriction, medications, and signs/symptoms of disease progression.
D. 434: A 70-year-old male rehabilitating from a stroke and experiencing right-sided weakness. Jared rearranges the room to promote accessibility to certain items such as the phone, call light, and water cup. He also arranged the patient’s get-well cards on a bulletin board so that the patient could see the well wishes.
E. 435: A 40-year-old female with surgical repair for bladder cancer. Jared’s assessment identifies needs in the following systems: elimination, ingestion (pain), and sexuality. He focuses his care on each subsystem in order to restore balance.
A. Which nursing theory might drive the care for each of the patients described above? Demonstrate how the theory would apply.
B. What is the purpose for using a theory in the care of patients?
C. Jared assesses and sets goals for each patient. He plans interventions with outcome criteria for their care. Which nursing theory best describes these actions? Defend your response.
Case Study 3
Theresa is a nursing student who recently completed a nursing theory course. Her current course requires clinical rotations at a local hospital on an oncology unit. Her assigned patient is a 40-year-old Hispanic male with inoperable cancer lesions throughout his organs. During her care, she explores the patient’s feelings of faith and hope in relation to the medical diagnosis. She spends a lot of her time at the bedside holding the patient’s hand, establishing a relationship with him, and meeting his care needs. Theresa asks the patient about his cultural beliefs and how they affect his perception of nursing care.
A. Describe how Theresa applied aspects of Watson’s theory of human caring to her nursing care of her patient.
B. How would you apply Leininger’s culture care theory to the care of Theresa’s patient?
C. Compare Watson’s and Leininger’s theories in regard to their definitions of person, nurse, health, and environment. What is similar? What is different?
D. Which type of theory level (grand theory, middle range theory or abstract theory) is Watson’s theory? Which type of theory level is Leninger’s theory?
E. Compare and contrast Watson’s Theory and Leininger’s theory with QSEN competencies.
Case Study 4
You are on a committee charged with redesigning the unit including nursing stations and patient rooms. Suggestions were solicited from nurses to help inform the redesign project. The following proposals were received by the committee:
Proposal 1: Design the rooms with windows on the inside to help the patient feel connected.
Proposal 2: Include medication and supply cabinets in the room. Also bring computer charting to the bedside.
Proposal 3: Make the room feel more like a bedroom in a home with an area for patient families to sleep or relax.
Proposal 4: Apply feng shui to the room, making it a place that allows relaxation and positive energy.
Proposal 5: Use colors that encourage a relaxing environment, bringing nature into the room.
The committee is considering each of the proposals in terms of the patient’s needs and nursing care to optimize outcomes.
A. Considering the metaparadigm from Rogers, how does each of the proposals fit with the definitions?
B. Which of the definitions of the environment proposed by the theorists best meets the proposals? Defend your response.
C. Which of the definitions of nursing do the proposals best meet? Is there more than one?
D. Select a theorist and design a patient room that conforms to the definitions of the metaparadigm. Include consideration for nursing work flow
Chapter 9: Image of Nursing: Influences of the Present
Case Study 1
Jeri is a nurse on a medical-surgical unit. The unit director is encouraging all nurses to join a professional nursing organization. She recruits Jeri to create a display that describes the benefits of joining an organization, lists the organizations available, and explains social impacts on the perception of nursing.
A. How could Jeri describe how nursing organizations enhance the professional image of nursing?
B. Why might Jeri expect to meet resistance by the nurses on the unit?
C. Explain why it is important for nurses to understand the social impacts on the perception of the nursing profession.
D. How will the IOM recommendation of an 80% baccalaureate-prepared nursing workforce affect society’s perception of the nursing profession? Take a stance for positive or negative and defend your position.
E. What steps can the nurse take to promote professionalism in daily practice?
F. The IOM recommendation of an 80% baccalaureate-prepared nursing workforce has changed the landscape of nursing education. Will this recommendation affect the professionalism of nursing practice?
Case Study 2
A group of nursing students is sitting in the cafeteria between classes. Nearby, a group of education students discusses how the field of education is a true profession as opposed to nursing, which one of the students describes as a field in which “nurses think just because they say they’re professionals, they automatically become professionals.” One of the other students adds, “Nurses work shifts, they are paid on an hourly basis, they can’t decide on the level of education for entry, and they have an organization for everything. How does that make nursing a profession?” The nursing students discuss how to address the issue in a constructive manner. During the conversation, one of the nursing students questions the professionalism of nursing, asking, “Is that true? Is that how the public views nursing? Do they see us as a group that can’t make up our minds or that we are just fooling ourselves about being a profession?”
A. Create an argument for nursing as a profession based on Pavalko’s eight dimensions for describing a profession.
B. Why would having multiple types and areas of nursing organizations benefit the nursing profession? Does it help or hinder the profession?
C. How could the nursing students explain how nursing organizations further nursing as a profession?
D. Describe the benefits of obtaining credentials in a chosen specialty. How does this affect professionalism in nursing?
Case Study 3
During one of your clinical rotations, you are assigned to the emergency department. A 34-year-old man who was in a motor vehicle accident arrives by ambulance. The nurse you are assigned to relates her assessment information to the physician and makes recommendations for care. The physician asks for a chest tube insertion tray and for respiratory staff to stand by for possible intubation, leaving the room to attend to another patient. The patient’s wife asks you to put in the chest tube and help her husband breathe. She says she sees nurses do it all the time on television.
A. Is making recommendations for care of the patient by the nurse consistent with a professional role of nursing?
B. How would you respond to the wife’s inaccurate understanding of the nurse’s role?
C. Review the portrayal of nurses on television shows (e.g., “Grey’s Anatomy,” “Scrubs, ” “HawthoRNe, ” “Nurse Jackie”). You can access episodes online by Googling the title of the show and “free online episodes.” How does the media influence the public’s perception of the nurse’s role?
D. Compare and contrast the media portrayal of nurses 10 years ago in programs such as “ER” and “Scrubs” with current portrayals in “Mercy” (2010), “HawthoRNe,” and “Nurse Jackie” in terms of characteristics of a profession.
E. During your next clinical experience, ask nurses to define what professionalism in nursing means to them. What are the policies of the institution regarding professionalism in relation to nursing? Bring your findings to discuss with the rest of the class.
Then on a separate sheet of paper, short summary of Florence Nightingale history.
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