Post Operative Patient Case Study

Submitter Information

Author: Gerry Altmiller, MSN, APRN
Title: Assistant Professor
Institution: La Salle University
Email: Altmiller@lasalle.edu

Competency Category(s)
Patient-Centered Care, Safety

Learner Level(s)
Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s)
Classroom

Strategy Type
Case Studies

Learning Objectives

(K) Examine how the safety, quality, and cost-effectiveness of health care can be improved through the active involvement of patients and families. (K) Describe strategies to empower patients or families in all aspects of the health care process. (A) Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. (K) Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds and dangerous abbreviations). (S) Demonstrate effective use of strategies to reduce risk of harm to self or others. (S) Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists). (A) Value the contributions of standardization/reliability to safety. (A) Value own role in preventing errors. (K) Discuss potential and actual impact of national patient safety resources, initiatives, and regulations. (S) Use national patient safety resources for own professional development and to focus attention on safety in care settings. (A) Value relationship between national safety campaigns and implementation in local practices and practice settings.

Strategy Overview

A pdf for the publication “Protecting Patients From Harm: Improving Hospital Care for Surgical Patients” (Susan M Daniels, RN, MSN, in NURSING 2007, August, Vol 37 No 8) will be posted on Blackboard for students to read in preparation for the class. Students will also be assigned the chapter on peri-operative nursing care in their fundamentals textbook to read as preparation. The unfolding case study powerpoint presentation will be made in class. Students will be encouraged to brainstorm to answer the questions as the case study unfolds. Theory bursts are woven throughout the case study. Following the class session, the case study file will be posted for the class to retrieve so that theory content is available to them.

Submitted Materials

77.Nur307-Perioperative-unfolding-case.ppt

Additional Materials

Evaluation Description

Evaluation strategies related to student learning will include separate measurement of a cohort of questions on the final exam that focus on the decision making skills of the nurse caring for the peri-operative patient. Questions will include content related to implementation of national patient safety standards for the surgical patient, appropriate and effective strategies to use to reduce risk of harm, and recognition of the role of the patient as well as the role of the nurse in preventing errors.

Student satisfaction with this teaching strategy will be evaluated following the presentation of this unfolding case study using a questionnaire with the five following statements followed by a 5 point Likert scale: (1) This presentation provided the information needed to care for the peri-operative patient. (2) I found myself actively thinking about the patient’s care during this presentation. (3) I recognize the value of my role in preventing errors and promoting safety for the surgical patient. (4) I would like to have more course content presented as unfolding case studies. (5) I found my mind wandering during this presentation. In addition, an area for comments will be provided.

Mobilizing Patients Post-Op
Case Study: Mr. Spinuzzi

Mr. Spinuzzi entered the Medical Center of the Rockies for a gastric resection and an esophagojejunal anastomosis as part of his treatment to fight gastric cancer. His stay was complicated by a leak at the anastomosis, re-exploration and placement of a mediastinal tube, chest tube and feeding tube. He had to be in the ICU two times during his stay and he was often in bed. It took three to four people to ambulate him with the eleven devices to which he was attached. He often had to wait for multiple caregivers to show up to walk him to the bathroom, get him up to a chair or to walk in the hall. He felt like this was a burden on the staff.

Things changed for Mr. Spinuzzi on post-surgical floor when his devices were secured to the PACE. He was able to get up with the assistance of one nurse, and walk well over 200 feet around the unit. He was not at risk for falls and could now walk independently. His limitations had been removed! His experience was completely changed by being able to use the bathroom on his own, walk in the hall, and even visit with friends and family on the outside patio. The PACE empowered him through independence and he regained a sense of control and normalcy.

*Case Study and photographic images used with patient permission

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