Class 6 Unit 3 Topic 1 Comment 2 (M)

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

To Comment:

Case Study 1: Yolanda Pinnelas

This very unfortunate case involves a 21-year-old woman, currently studying to become an orchestra conductor. At some point, she was diagnosed with cancer, requiring chemotherapy. Upon her admission to Caring Hospital for the chemotherapy (chemo) a number of situations occurred, ultimately leading to permanent damage to her hand and thigh. The damage to her hand, caused her inability to pursue the career for which she was studying.

According to the case documentation, the IV infiltrated, was not managed in a timely manner, thereby allowing tissue necrosis to occur.

It is noted that some of the possible factors that may have led to this occurrence were understaffing, overworking of staff, inattentiveness to the alarms, and failure to respond to the alarm in a timely manner. Not mentioned is whether or not the nurse was chemo certified which, in many states is required to administer chemotherapy drugs. This may have provided a better understanding of the risk of this medication and the damages possibly done by the infiltration, thereby increasing awareness and monitoring of the IV site. 

Nurses are among the most overworked, stressed, and ill workers. More than 8% of the nursing workforce is absent each week due to illness (Cummings, Olson, Hayduk, Bakker, Fitch, Green, & Conlon 2008). Staffing issues certainly seem to play a role in this case. Increased workload and lack of a systemic response to address the shortage of nurses are sources of intense concern and constraint on nursing care. These factors may put nurses in a compromised position as they make efforts to address the increased pace and complexity of work. Several authors (Bakker et al., 2013; Lemonde, 2008) have emphasized that oncology nurses need to more effectively demonstrate contemporary and advanced practice roles and to develop higher national and international standards of cancer care that reflect current practice context. Some workplaces addressed these concerns by giving nurses increased responsibility and autonomy without providing the additional support required to fulfill their roles (Cummings et al, 2008).

 Several studies have persistently and urgently called for immediate action to address nurses’ work environments and the shortage of nurses (Bakker et al, 2013; Berry & Curry, 2012; Cummings et al, 2008). These studies report that nurses perceive a loss of control over their personal lives, jobs, and career opportunities. These changes may lead to a compromised ability to provide effective care for patients. Moreover, patient acuity and complexity continue to increase at an unrelenting pace with little accommodation in staffing.

While several factors led to this case, I believe the primary problem was the staffing situation, and the inattentiveness of the staff in responding to the alarm.

Alarm fatigue is a national problem and the number one medical device technology hazard in

2012. The problem of alarm desensitization is multifaceted and related to a high false alarm rate,

poor positive predictive value, lack of alarm standardization, and the number of alarming

medical devices in hospitals today (Cvach,2011). She goes on to say, that nurses may be exposed to as many as 700 physiologic monitor alarms per patient per day.  According to this same study by Cvach (2011), device alarms are intended to alert clinicians of a hazardous condition and potential problems. However, when a caregiver is subjected to too many alarms, it disrupts his or her usual workflow and may result in errors due to omission, distraction, or inattention.

                                                        References

Bakker, D., Strickland, J., Macdonald, C., Butler, L, Fitch, M., Olson,K., & Cummings, G. (2013). The context of oncology nursing practice: An integrative review. Cancer Nursing, 36(1), 72-88. doi:io.io97/NCC.oboi3e3i824afadf

 Berry, L., & Curry, P. (2012). Nursing workload and patient care. The Canadian Federation of Nurses Unions. Retrieved from https:// nursesunions.ca/sites/default/files/cfnu_workload_paper_pdf.pdf

Cummings, G., Olson, K„ Hayduk, L., Bakker, D., Fitch, M., Green, E., & Conlon, M. (2008). The relationship between nursing leadership and nurses’ job satisfaction in Canadian oncology work environments. Journal of Nursing Management, 16/5/, 508-538.

doi:io.1111/j.1365-2834.2008.00897.x

Cvach M. The Johns Hopkins Hospital Quality Improvement Alarm Data. 2011. Lemonde, M. (2008). UOIT challenge innovates connect: Faculty of Health Sciences research practicum. Retrieved from http://research.uoit.ca/EN/main/abouLresearch/findanexpert.html