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NSB502 Introduction to Evidence-based practice
Assessment 2: Proposal for Practice Change (50%)
Scenarios
Choose one of these scenarios to complete Assessment 2:
Protocol Scenario 1.
John Ryan is a 66 year old man, who has a thirty year history of cigarette
smoking. Over the past few months, he has noticed he has had a worsening
‘smokers cough’. He has recently retired from his work and lives with his wife.
His GP orders a chest X-ray which shows he has a 2cm apical lesion. A CT
guided needle biopsy was performed and revealed non-small cell lung cancer.
Mr Ryan has been judged to be a good candidate for surgery, and undergoes the
procedure without complication. Two years later Mr Ryan develops right hip
pain, and on questioning he states he is breathless on exertion. He has also lost
about 6 kg over the past 6 months. He has a bone scan which shows an
abnormal focal area of accumulation in the posterior aspect of the right iliac
crest. The health team explain that his disease has recurred and what this
means for his care. He is referred for palliative chemo-radiotherapy. Mr Ryan
doesn’t want any more treatment he just wants to go home. Once John leaves
the hospital, he will be followed up by the clinic outreach nurse. You want to
know the best strategies for helping Mr Ryan manage at home.
Clue: Thisscenario contains several pieces of assessment data from which you can
identify some of the patient’s actual or potential nursing
diagnoses/problems. What are some of those problems that would impact
on Mr Ryan at home? You can choose one of the problems and focus on
which to focus your question.
Protocol Scenario 2.
William is a 60 year old man who grew up in a large family in a regional area of
Australia. Over the years, like many of his generation, he has seen amazing
improvements in the quality of health care and life expectancy. This is due to
such things as the introduction of immunisation, antibiotics and new medical
technology. William has been diagnosed with a life-limiting illness and is being
visited by you, the community nurse. William is most concerned at the moment
with a change in his normal bowel habits and has read that this could be a long
term problem. You want to ensure continuity of William’s care in this area.
Clue: A patient-centred approach to care guides you toward focussing on
issues that are of most concern to the patient. What is William’s main
concern? Focus your question on the patient’s main concern.
Protocol Scenario 3.
Mrs Anthony is an 84 year old lady, who presents to the emergency department
at 3am, complaining of shortness of breath and a sensation of suffocating. Even
though she sat up using 3 pillows in bed, this did not relieve her dyspnoea.
Over the last few weeks she has noticed difficulty getting her shoes on because
of her swollen feet. She also states that she has felt more lethargic lately as
well. Investigations confirm Mrs Anthony is in cardiac failure. Mrs Anthony says
her neighbour told her if she did more regular exercise she would feel better
and not have to go back to hospital for the same thing. There is variability
between the healthcare staff on patient education related to post heart failure
management.
Clue: There is variability in health care professional viewsand possibly practice regarding patient education in this area. A patientcentred
approach to care guides you toward focussing on issues that are of
most concern to the patient. What is the patient’s main concern? Focus
your question on the patient’s main concern.
Protocol Scenario 4.
Mr Sheppard is a 68 year old male who is admitted to the high dependency unit
for ventilatory support and post operative care following, Abdominal Aortic
Aneurysm repair surgery. Day 2, post op, you are the graduate nurse caring for
Mr Sheppard and you note his cardiac monitor is alarming and that his rhythm
has changed to a “squiggly” line. Mr Sheppard’s distressed family is rushed
from the room as the arrest team arrives. Mr Sheppard does not survive. After
the event you wonder if it would have been better for the family if they had been
allowed to stay and you also wonder what others nurses and doctors think
about it.
Clue: You are unsure of best practice and unsure of theperceptions of other healthcare professionals in relation to a particular
issue. What is ‘your’ (the nurse’s) primary concern?
Protocol Scenario 5.
Kevin Lewis, 22 year old weighing 72 kgs, was involved in an industrial fire at
1130 hours. Kevin was welding a steel structure when a spark from his torch
ignited a barrel of flammable material that was inadvertently placed in his work
area. Kevin sustained full thickness burns over the upper half of his chest and
circumferential burns to both arms. He also sustained superficial partial
thickness burns to his face, neck and both hands. His entire abdomen, upper
half of his back and front of his upper legs sustained deep partial thickness
burns. The hospital just bought a new pressure garment for treating burns. In
the past, burns were treated with a variety of different interventions. Some staff
are still unsure of what is best.
Clue: There is uncertainty among staff aboutbest practice in treatment of a particular alteration in health. What is that
alteration in health? Focus your question on possible management
alternatives for this alteration in health, being sure to include at least the
one alternative discussed in the scenario?
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