1. Five problems in the case study are:
a) Shortage of staff: The unit is understaffed with only one nurse manager, two RNs, an LPN, and one technician for approximately 40 patients. This inadequate staffing level puts a strain on the existing staff and compromises patient care.
b) Lack of family support: Most patients are severely debilitated and need assistance with their activities of daily living. However, family members and loved ones are unavailable during the day, leaving the patients with limited support.
c) Negative attitudes and burnout: The staff members, including Laverne, Lynn, and Sheila, exhibit negative attitudes and burnout symptoms, which can adversely affect the work environment and patient care.
d) Avoidance of nursing students: The other staff members seem to avoid the nursing students and respond to their questions with annoyance, which hinders the students’ learning experience and professional development.
e) Fear of speaking up: Shawna is afraid to ask for more help or express her concerns due to the fear of being considered incompetent or a complainer. This fear prevents her from advocating for herself and the patients.
2. These problems present the following dilemmas:
a) Shortage of staff: This problem presents a dilemma of balancing patient care needs with the available resources. The limited staff may struggle to meet the complex needs of the HIV-positive patients with multisystem failure.
b) Lack of family support: This problem presents a dilemma of finding alternative support systems or resources to assist patients with their activities of daily living. Without adequate support, patients may experience decreased quality of care and increased dependence on the limited staff.
c) Negative attitudes and burnout: These issues present a dilemma of addressing staff morale and well-being while maintaining quality patient care. Negative attitudes can affect teamwork, communication, and patient satisfaction. Addressing burnout is crucial to prevent turnover and maintain a positive work environment.
d) Avoidance of nursing students: This problem presents a dilemma of fostering a positive learning environment and promoting the professional development of nursing students. The avoidance and short responses from staff members hinder the students’ ability to learn and gain hands-on experience.
e) Fear of speaking up: This issue presents a dilemma of promoting open communication and a culture of safety within the healthcare team. Fear of speaking up can lead to unaddressed concerns, missed opportunities for improvement, and potential patient harm.
3. Additional information needed to develop solutions for the problems includes:
– Staffing requirements: Understanding the optimal staffing levels for a unit with patients requiring intensive care due to HIV and multisystem failure.
– Patient and family preferences: Identifying patients’ preferences for care, including whether they prefer family involvement and the extent of assistance they require with activities of daily living.
– Staff workload analysis: Analyzing the workload of staff members to determine if adjustments need to be made to the assignments or responsibilities.
– Staff satisfaction and burnout assessment: Assessing staff satisfaction levels, identifying factors contributing to burnout, and determining interventions to address these issues.
– Student feedback and support: Gathering feedback from nursing students about their experiences on the unit, assessing their educational needs, and implementing strategies to facilitate their integration and learning.
4. Biases that each person in the scenario might have which could affect the problems and solutions include:
– Tina (nurse manager): Bias towards administrative duties over direct patient care, potentially impacting her understanding of the workload and staffing needs.
– Laverne (other RN): Bias towards pediatrics, potentially influencing her negative attitude and motivation to transfer out of the unit.
– Lynn (LPN): Bias towards medication administration, leading to frustration with patient interactions and a lack of investment in providing holistic care.
– Sheila (technician): Bias towards exhaustion, possibly affecting her ability to effectively support patient and staff needs.
– Shawna (new staff member): Bias towards fear of being perceived as incompetent or a complainer, hindering her from advocating for necessary changes.
(Note: These biases are fictional and based on the information provided in the scenario.)
5. Four solutions to the problems are:
a) Increase staffing: Hire additional qualified staff members to ensure adequate coverage for patient care needs.
b) Implement flexible visiting hours: Create flexible visiting hours to accommodate family members and loved ones who work during the day, increasing patient support.
c) Provide staff support and development programs: Implement programs to address staff burnout, such as stress management workshops, team-building activities, and professional development opportunities.
d) Develop a nursing student mentorship program: Pair nursing students with experienced staff members to foster a positive learning environment and facilitate their integration into the unit.
6. Positive and negative outcomes for each solution:
a) Increase staffing:
Positive outcomes: Improved patient care and satisfaction, reduced staff workload, increased staff morale.
Negative outcomes: Increased cost for staffing, potential challenges with recruitment and retention.
b) Implement flexible visiting hours:
Positive outcomes: Increased patient support and involvement, improved patient well-being.
Negative outcomes: Potential challenges with coordinating visits and balancing privacy concerns.
c) Provide staff support and development programs:
Positive outcomes: Increased staff satisfaction, reduced burnout, improved teamwork and communication.
Negative outcomes: Potential time and resource constraints for implementing and maintaining the programs.
d) Develop a nursing student mentorship program:
Positive outcomes: Enhanced learning experience for students, improved staff-student relationships, increased professional development opportunities.
Negative outcomes: Potential challenges with time management for staff members mentoring students.
Note: The best possible FINAL solution will be determined in the next part.