Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.

Critical thinking activities

Based on this case study, consider the following questions.

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring 

  What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring 

Case Study 1 – Prenatal and Infant Population 

In this case study G.K is a nurse practitioner working in the health department of a large city caring for children and infants referred there after discharge from the local hospital. These children are considered high risk because they may be going home to a high-risk environment. G.K follows up with these children to ensure that they are in a safe environment, and that they are growing and developing adequately. Additionally, she provides support and education to their parents so they may be able to respond adequately to the challenges of raising children.  

Children’s health is often determined by a myriad of complex factors that impacts their growth and development. Biological factors include prenatal influences, genetic expressions, prior states of health, biological constraints, and possibilities created by their prenatal and post-natal influences (“Children’s health,” 2004). Behavioral factors include behaviors, attitudes, child’s emotional state, and cognitive abilities that influence the child’s health (“Children’s health,” 2004). Environmental factors include toxins such as air pollution and lead, socioeconomic resources within the family and their community, loving interactions with family members and their caregivers, culture, racism, segregation, the availability of quality services, and policies that directly or indirectly affect these and other interactive factors (“Children’s health,” 2004). 

The role of biological, environmental, and behavioral factors tends to change as the child grows and learns to adapt. An example of this is the attachment a child has to an adult during infancy, this changes as they grow into a toddler or adolescent when peer influence becomes more critical (“Children’s health,” 2004). Health influences can affect different children in various ways dependent upon their families and their cultural views (“Children’s health,” 2004). Therefore, developmental milestones should be applied to children based on their specific cultural background. As healthcare providers it is important that we understand a child’s health development is not based on a single influence or even a specific set of influences. Additional research is important to increasing our understanding of relative contribution of influences across a variety of social and cultural groups (“Children’s health,” 2004). 

A study done by WHO in 2016 revealed that over 644,855 children under the age of 15 were killed by an injury and between10 million and 30 million children suffered non-fatal injuries (Sleet, 2018). Childhood injuries can be categorized into two different subgroups of intentional and unintentional injury. Injuries such as traffic accidents, sports injuries, burns, poisonings, drowning, and suffocation are all examples of unintentional injuries (Sleet, 2018). Injuries resulting from assault, suicide, and self-inflicted injuries are classified as intentional injuries (Sleet, 2018).  

Since most injuries can be predicted, prevented, and even controlled as healthcare providers we must educate parents on various methods to prevent injury to their children. Parents must be taught that risk taking is an important part of children’s lives, therefore they should closely monitor their children to avoid both unintentional and intentional risks. Parents must also be taught how to child proof their homes. The use of safety gates and locks that prevent children from potentially interacting with hazardous chemicals is one way to prevent unintentional injury. Another example is the utilization of outlet covers to help prevent children from electric shock. The goal is not to eliminate all risk but to better control and manage them (Sleet, 2018). 

References 

Children’s health, the nation’s wealth: Assessing and improving child health. (2004). National Academies Press. 

Sleet D. A. (2018). The Global Challenge of Child Injury Prevention. International journal of environmental research and public health, 15(9), 1921. https://doi.org/10.3390/ijerph15091921 (Links to an external site.) 

Module 5 Discussion

Healthcare has been one of the most complicated and political issues in the United States of America. Nurses continue to play important roles in the healthcare system. Nurses were among healthcare providers that supported the affordable care act because it is very beneficial for the healthcare systems and patients who did not have health insurance. The United States is one of the greatest countries in the world and there are many opportunities in this country. Healthcare should not be an issue for the citizens of this country, but sadly people continue to suffer and die because of lack of health insurance. I believe that many advocacy actions need to be taken to improve healthcare through the state and federal level, but I will talk about one of the most important actions. The advocacy action I might take to improve health care through legislation at the federal level is to decrease the cost of prescription drugs. The reason I chose that action is because private prescription drug companies continue to increase drugs prices on patients who needs the prescription drugs but not able to afford them due to low incomes.

The healthcare industry is a money machine industry. It costs lots of money to cure diseases and to buy prescription drugs. Most prescription drugs companies care more about making money and competition than their patients. I believe that congress and the senate must pass a legislation or a law that prevents prescription drugs company from increasing drugs prices on consumers. Recently, President Donald Trump took an historic action to deliver lower prescription drug prices to American patients. The president signed four Executive Orders on drug pricing directing the Secretary of Health and Huma Services to take several steps to deliver for American patients lower costs on prescription drugs, including insulin and epinephrine, and ensure Americans are getting the lowest price possible for their drugs. As a registered independent leaning more toward Democrats, I think the Trump administration is on the right path to help decrease prescription drugs prices in this country. According to Socal and Anderson (2019), as congress considers various approaches to address rising costs, one of the options is to allow Medicare to negotiate prices directly with drug manufactures on behalf of Part D beneficiaries, the challenges of this policy is the potential need for Medicare to impose a restrictive formulary to negotiate effectively with drug companies. This showed that the Trump administration and congress are trying to come up with a solution to decrease prescription drugs prices, but the private drug companies will continue to fight because it will not be beneficial for them if their drug prices lowered.

According to Fein (2019), some prescription drugs company offer multiple discounts to patients, which gives them the opportunity to purchase their medications. The article also stated that the companies provided those discounts because they want their products or invention to get on the market for advertisement purposes. Prescription drug companies have lots of powers in the political system, which makes it difficult for congress and senate to pass laws that are beneficial to the patients or consumers rather than the big prescription drug companies.

References

Socal, M. P., & Anderson, G. F. (2020). Older Americans’ Preferences Between Lower Drug Prices and Prescription Drug Plan Choice, 2019. American Journal of Public Health, 110(3), 354-356. https://doi.org/10.2105/AJPH.2019.305483 (Links to an external site.)

Fein, A. J. (2019). Don’t Blame Drug Prices on Big Pharma. Journal of Oncology Navigation & Survivorship, 10(4), 161-162.

See attached outline