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The nurse competencies also exist on a continuum and range from novice or competent to expert nurse. Each nurse may be stronger or weaker in certain areas. The key to the model is to assess the patients’ needs and match the nurse that’s strong in that particular competency to ensure optimal patient outcomes. The following are the eight nurse competencies (Mullen, 2002): · Clinical Judgment: Clinical reasoning and critical thinking skills · Caring Practices: Creating a therapeutic environment based on the unique needs of the patient and family · Advocacy and Moral Agency: Working on another’s behalf; resolving ethical concerns · Collaboration: Working with others in a way that encourages each person’s contribution toward patient goals · Systems Thinking: Recognizing and incorporating differences into care · Response to Diversity: Recognizing the interrelationships of healthcare systems · Clinical Inquiry: The ongoing questioning and evaluation of practice · Facilitator of Learning: Using self to facilitate patient and family learning The concepts of the Synergy Model and the current recommendations for recognition and treatment of sepsis will be applied to the following case study. The Case Study A.R. was a 39 year-old female married with two teenage boys. They lived in a rural community that didn’t have many healthcare resources, including a hospital. A.R. was a math teacher at the local high school and her husband worked in construction. Her past medical history includes hypertension, diverticulitis, acid reflux, and allergies. Past surgical history includes a hysterectomy and a colon resection for diverticulitis. Social history is negative for smoking, drinking, and drug abuse. Current medications include Lisinopril 10mg daily, Protonix 40mg daily, and Claritin 10mg daily. A.R. came to the nearest emergency room (ER) for severe abdominal pain. The ER physician diagnosed her with an acute colon due to ruptured diverticuli. The patient was admitted to a general surgeon and underwent a colectomy. After the operation, the patient was admitted to the surgical unit. Three days later, the patient was still recovering and was anticipating discharge to home in a couple more days. A.R. was ambulating in the hall, tolerating a full liquid diet, and reporting a pain of 2 while on a patient controlled analgesia (PCA) pump. Her incision was intact with staples and some redness and swelling was noted. On the third post-operative night, the nightshift nurse noticed the patient’s condition started to change. At 1 am, Nikki, the nightshift nurse, noted the patient’s oxygen level was at 93% on 2 liters nasal cannula. Previously, the oxygen saturation was 99%. A.R. complained of feeling a little short of breath but contributed that to her anxiety. She was worried about all the tasks waiting for her at home. Nikki increased her oxygen to 3 liters and A.R. stated she felt better. Her oxygen saturation came up to 98%. Her lungs were clear to auscultation. She maintained a heart rate of 98, a blood pressure of 115/55, and a respiratory rate of 19. At 2 am, Nikki went back to check on A.R. She stated she still felt a little short of breath, but she was doing okay. She maintained her oxygen saturation of 95% on 3 liters and a respiratory rate of 21. At 4 am, A.R. asked for assistance to the restroom. Upon ambulating to the restroom, A.R. became diaphoretic, pale, and very weak. Nikki put her back in the bed and asked her to use the bedpan. She called the physician with the patient’s latest vital signs and condition. Now her heart rate was 105, blood pressure 95/42, and respiratory rate 23, temperature 99.8 F. The physician attributed these findings to the Morphine PCA pump. He instructed Nikki to notify him for any further changes and to bolus her with one liter of normal saline. Nikki continued to check on the patient throughout the night. A.R. maintained her vital signs but still continued to have shortness of air. At 7am, Betty, the dayshift nurse, takes over A.R.’s care. Nikki tells her to watch her closely because she feels that something is wrong. She stated she wanted to call the surgeon back but didn’t because her vital signs remained the same. After Betty finished with report at 7:45 am, she went to check on A.R. Betty immediately called the rapid response team (RRT) and notified the surgeon. A.R. was confused, vomiting, pale, and diaphoretic. Her oxygen saturation was 89% on 3 liters, heart rate was 122, blood pressure was 75/30 manually, respiratory rate was 28, and temperature was 102.3 F. Her lungs were clear and her incision had begun to drain a small amount of brown drainage. The surgeon was in the middle of a case and stated he would check on the patient as soon as possible. Betty asked him for an order for a complete blood count (CBC) and basic metabolic panel (BMP) since no am labs were ordered. She also asked for a normal saline bolus.
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