Question

Case Study

Leon Rowen is a growing premature infant whose 32-year-old mother, Cassandra Rowen, is described by the nurses in the unit as “difficult.” The baby is nearing discharge, but Cassandra is reported to be “resistant” to learning about how to feed and care for her infant. She has other children at home, but none of them were premature. A nursing care priority for the day is parental teaching about safe feeding of her premature baby.

Ruth, the nurse assigned to care for Leon, has worked in this unit for 10 years. She observes the entire caregiving situation and sees that Leon’s condition is stable. Ruth meets Cassandra and notices she is quiet and sullen. Rather than beginning by explaining how to feed the baby, Ruth asks about Cassandra’s other children and shares a little bit about the challenges of parenting her own children who are of similar ages as Cassandra’s other children. Cassandra smiles and agrees. As time passes, Cassandra begins to talk about what a frightening experience having a premature baby has been. Ruth acknowledges those feelings. Cassandra smiles and begins to ask questions about how to care for Leon. Ruth answers those questions in a way that is tailored to what the mother has revealed about her family. Cassandra demonstrates feeding Leon in a developmentally appropriate way (side-lying position to prevent aspiration) based on Ruth’s teaching. At the end of the shift, Ruth believes Cassandra has made significant progress toward competence in meeting her baby’s unique needs. On the drive home, Ruth considers the experience. She realizes that prioritizing getting to know the mother and building a relationship by sharing a bit about herself as a parent helped to create emotional safety and trust so that Cassandra could talk about her apprehension as a first-time mother of a premature baby and then focus on learning infant care.

Case Analysis

In this case study, Ruth’s previous encounters with mothers of premature infants and her knowledge of the family experience inform her nursing actions. Experienced nurses incorporate much information simultaneously. Notice that Ruth determines that the baby’s physiologic condition is stable while she is beginning to interact with the mother. In this action, she is prioritizing patient safety. While she interacts with the mother, Ruth may interpret Cassandra’s behavior as a pattern sometimes displayed by mothers in the NICU. She understands how frightening it is to have a hospitalized newborn and knows from experience that fear can take on many faces. This may be evidence of Ruth’s intrapersonal characteristics that value empathy and consider the patient experience. Rather than focusing on Cassandra’s negative response to her, Ruth focuses on relationship building before moving on to teaching. This action opens the door to effective teaching. Notice that Ruth takes some time afterward to consider what went well in this challenging situation. This will inform future interactions with mothers of patients.

1.In what ways could reflection on action be encouraged as part of nurses’ professional lives?

2.How do the interpretivist and standards-based approaches to clinical judgment compare in relationship with the goal of patient-centered care?

Answer 1

1- Reflection-on-action is perhaps the most common form of reflection.It involves carefully re-running in your mind events that have occurred in the past. The aim is to value your strengths and to develop different, more effective ways of acting in the future.

2- Value and science based care are concepts that will require rethinking how information is . Nurses are the persons who spent a lot of time with patients. Creat a seamless progression through all levels of nursing that is based on consensus.