CASE STUDY # 2 (Ray’s Theory) CASE STUDY # 2 (Ray’s theory) Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had

CASE STUDY # 2 (Ray’s Theory) CASE STUDY # 2 (Ray’s theory)

Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had

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CASE STUDY # 2 (Ray’s Theory) CASE STUDY # 2 (Ray’s theory)

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, as 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 as 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, 2010). Over the next few hours, the Clinical Nurse Leader as well as a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The Clinical Nurse Leader asked the Nurse Manager to see if 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 ex[1]pressed 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, & 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[1]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, as well as nursing staff in partnership with the Vice President for Nursing. Nursing administration, Clinical Nurse Leaders, and staff’s actions 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. 

1. 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 CNL fit into the Theory of Bureaucratic Caring for implementation of a caring practice? CASE STUDY #1 (Nightingale’s theory)
You are caring for an 82-year-old woman who has been hospitalized for several weeks for burns that she sustained on her lower legs during a cooking accident. Before the time of her admission, she lived alone in a small apartment. The patient reported on admission that she has no surviving family. Her support system appears to be other elders who live in her neighbourhood. Because of transportation difficulties, most of them are unable to visit frequently. One of her neighbors has reported that she is caring for the patient’s dog, a Yorkshire terrier. As you care for this woman, she begs you to let her friend bring her dog to the hospital. She says that none of the other nurses have listened to her about such a visit. As she asks you about this, she begins to cry and tells you that they have never been separated. You recall that the staff discussed their concern about this woman’s well-being during report that morning. They said that she has been eating very little and seems to be depressed.
Based on Nightingale’s work, describe what action, if any, you would take regarding the patient’s request to see her dog. Discuss the theoretical basis of your decision and action based on your understanding of Nightingale’s work.

CASE STUDY # 2 (Ray’s theory)

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, as 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 as 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, 2010). Over the next few hours, the Clinical Nurse Leader as well as a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The Clinical Nurse Leader asked the Nurse Manager to see if 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, & 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, wellbeing, 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, as well as nursing staff in partnership with the Vice President for Nursing. Nursing administration, Clinical Nurse Leaders, and staff’s actions 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.
1. 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 CNL fit into the Theory of Bureaucratic Caring for implementation of a caring practice?

CASE STUDY #3 (Martinson’s theory)

As nurses, we meet patients and their family members in many different life situations. Patients may be of all age groups, acutely or chronically ill, might return to life and health, or are coming to the end of their lives and must face death as a reality. Nurses meet patients and family members in their homes, the hospital, the nursing home, the school health service, at the local clinic, and so forth. Some meetings with patients and family members make a greater impression on us than others, and all meetings represent situations of learning.
1. From the starting point of the situation in the first item, discuss what is meant by
person oriented professionalism and moral practice.

Critical Thinking Activities:

On Watson’s theory:
1. Review the values and beliefs in your own philosophy of person, environment, health, and nursing to discover if your beliefs fit with Watson’s 10 carative/caritas assumptions.
On Benner’s theory:
1. Using Benner’s approach, describe what is meant by the statement that caring practices, intervention skills, clinical judgment, and collaboration skills increase the visibility of nursing practice in the following three senses: (1) to the individual nurse, (2) to nursing colleagues, and (3) to the health care system.
On Erikson’s theory:
1. Suffering as a consequence of lack of caritative caring is a violation of a human being’s dignity. Think about a situation in which you saw this occur, and consider what can be done to prevent suffering related to care. (you may cite a persona experience or something that you’ve watched).

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