During my clinical rotation in the emergency department, Imet Grace Gilligan. She was a 28-year-old woman who cameto the emergency department with complaints of severeepisodes of nausea and vomiting over the last 48 hours. She has a past medical history of Crohn’s disease, a gastrointes-tinal (GI) problem for which she underwent bowel resection surgery 1 month ago. “I thought the surgery would help myproblems.” The patient was dehydrated and needed IV fluidtherapy.My co-assigned nurse attempted to start a peripheralvenous access not once, but six times. The patient was already upset by her recurrent abdominal symptoms, butnow had to deal with the continuous painful stick of aneedle. During the course of attempts to start the IV, thepatient stated that a nurse on the IV team always had to becalled to insert her IVs. Although my nurse acknowledgedthe information, she continued trying to start the IV. Finally,on the sixth try, as the patient was in tears, the nurse wassuccessful. It seemed as if the nurse was out to prove herabilities without caring for the patient. By the end, I haddifficulty even watching. How do you think you would respond in a similar situation? What does this tell you about yourself and about the ade-quacy of your skills for professional practice? Why? Do you agree with the criteria that the nursing student used to evalu-ate a successful outcome? Are there any other criteria that would be appropriate to use? Did the nursing student meetthe criteria? Why or why not? What knowledge, skills, andattitudes do you need to develop to continuously improve thequality and safety of care for patients like Ms. Gillian?Patient-Centered Care: How could you involve Ms. Gillianas a partner in coordinating her care to minimize frustrationon the part of the patient, student, and nurse? What mighthave prompted the emergency department nurse to actas she did? The nursing student? How could the nursingstudent have advocated for the patient? What other barriers (other than those listed) might have interfered with the nurs-ing student acting as an advocate? Teamwork and Collaboration/Quality Improvement:What communication skills do you need to improve toensure that you function as a member of the patient-care team? What skills do you need to implement effective strate-gies for communicating and resolving conflict? What skills do you need to assert your own position/perspective indiscussions about patient care? Safety/Evidence-based Practice: What evidence in nurs-ing literature provides guidance for decision making regard-ing professional practice and venipuncture? Informatics: Can you identify the essential informationthat must be available in Ms. Gillian’s electronic record tosupport safe patient care and coordination of care? Canyou think of other ways to respond to or approach thesituation?
During my clinical rotation in the emergency department, I
met Grace Gilligan. She was a 28-year-old woman who came
to the emergency department with complaints of severe
episodes of nausea and vomiting over the last 48 hours. She
has a past medical history of Crohn’s disease, a gastrointes-
tinal (GI) problem for which she underwent bowel resection
surgery 1 month ago. “I thought the surgery would help my
problems.” The patient was dehydrated and needed IV fluid
therapy.
My co-assigned nurse attempted to start a peripheral
venous access not once, but six times. The patient was
already upset by her recurrent abdominal symptoms, but
now had to deal with the continuous painful stick of a
needle. During the course of attempts to start the IV, the
patient stated that a nurse on the IV team always had to be
called to insert her IVs. Although my nurse acknowledged
the information, she continued trying to start the IV. Finally,
on the sixth try, as the patient was in tears, the nurse was
successful. It seemed as if the nurse was out to prove her
abilities without caring for the patient. By the end, I had
difficulty even watching.
How do you think you would respond in a similar situation?
What does this tell you about yourself and about the ade-
quacy of your skills for professional practice? Why? Do you
agree with the criteria that the nursing student used to evalu-
ate a successful outcome? Are there any other criteria that
would be appropriate to use? Did the nursing student meet
the criteria? Why or why not? What knowledge, skills, and
attitudes do you need to develop to continuously improve the
quality and safety of care for patients like Ms. Gillian?
Patient-Centered Care: How could you involve Ms. Gillian
as a partner in coordinating her care to minimize frustration
on the part of the patient, student, and nurse? What might
have prompted the emergency department nurse to act
as she did? The nursing student? How could the nursing
student have advocated for the patient? What other barriers
(other than those listed) might have interfered with the nurs-
ing student acting as an advocate?
Teamwork and Collaboration/Quality Improvement:
What communication skills do you need to improve to
ensure that you function as a member of the patient-care
team? What skills do you need to implement effective strate-
gies for communicating and resolving conflict? What skills
do you need to assert your own position/perspective in
discussions about patient care?
Safety/Evidence-based Practice: What evidence in nurs-
ing literature provides guidance for decision making regard-
ing professional practice and venipuncture?
Informatics: Can you identify the essential information
that must be available in Ms. Gillian’s electronic record to
support safe patient care and coordination of care? Can
you think of other ways to respond to or approach the
situation?
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