Introduction: Welcome to Riverbend City
The Riverbend City mission in this unit illustrated the importance of effective communication.
For this assignment, describe two strategies that you use in your nursing practice to effectively communicate with other members of your team, and with your patients
Expository Text: To protect residents from the chemicals released by the train derailment, the Rondo community and later the Ruby Lake neighborhood are evacuated. Eventually over 1,000 residents will be temporarily relocated to the Red Cross emergency shelters at Beck University. In the general needs shelter, Pilar Mendez, a resident of Ruby Lake, begins to experience dizziness and a severe headache. She seeks out a public health nurse for assistance.
Instructional Text: In this mission, the emergency highlights the influence of social, ethnic, and cultural factors on the effectiveness of medical treatment plans. As you move through the mission, consider the role of cultural competence in improving patient outcomes.
Characters in this Mission:
Carole Bartlett, RN – Public Health Nurse
Edith Duff, RN – Caring Hand Clinic
Grace Fowler, RN – Public Health Nurse, Caring Hands Clinic
Kimberley Fuller – Student Nurse, Caring Hands Clinic
Martin Lewis – HIV/AIDs Counselor
Ronnie Maxwell, RN – Manager, Caring Hands Clinic
Pilar Mendez – Riverbend City Resident
Father Yuni – Catholic Priest
Scene 1: Temporary Shelter, General Needs Area
Expository Text: In the general needs shelter, Pilar Mendez, a resident of Ruby Lake, begins to experience dizziness and a severe headache. She seeks out a public health nurse for assistance.
Conversation 1: Ruby Lake resident Pilar Mendez seeks help from Grace Fowler.
PILAR:
Excuse me, but I need some help, please.
GRACE:
Of course. What seems to be the problem?
PILAR:
I don’t know… I feel no good. Like I might pass out or something.
GRACE:
Well, we don’t want that! Go ahead and sit down here.
PILAR:
Gracias
GRACE:
Your skin feels a little damp. Do you feel sweaty or warm?
PILAR:
Not warm, not. Chilly, but I’m all sweaty. It’s not right.
GRACE:
Okay… Mrs…
PILAR:
Mendez. My name is Pilar Mendez.
GRACE:
Okay, Mrs. Mendez. I’d like to check your blood pressure. Sue… Go find Carole for me and ask her to come give me a hand here. Alright, Mrs. Mendez, let’s see what we’ve got going on here. Okay… 142-over-94. That’s considered high blood pressure. Are you taking medication for high blood pressure?
PILAR:
Si, but I thought it was getting better.
GRACE:
Well, a day like today can certainly have an effect on your blood pressure, but I think we should let you rest here and we’ll check it again in a little while.
Carole… thanks. Carole, this is Mrs. Mendez. She has been experiencing dizziness, chills and sweating. I just checked her blood pressure and it’s 142-over-94. I’d like you to finish taking her history while I call over to the special needs shelter and see if they can help us get her straightened out.
Mrs. Mendez, this is Carole. She’s also a nurse and she’s going to finish checking you over to see what’s going on.
PILAR:
Okay… good.
Conversation 2: Carole continues taking Mrs. Mendez’s history and begins to realize that there is a larger problem than the immediate crisis.
CAROLE:
Alright, Mrs. Mendez, can you tell me what medications you take?
PILAR:
I don’t know the names … I take two pills and sometimes insulin.
CAROLE:
Sometimes..?
PILAR:
I don’t have a lot of money and insulin is expensive. The pills, they aren’t so expensive, so I make sure I take them like the doctor said.
CAROLE:
Can you tell me what the pills are?
PILAR:
I’m sorry… no. I think one is for the blood pressure and one is for the diabetes. Oh… wait. I have one of the bottles with me. Here it is.
CAROLE:
Okay … that’s a help. Where do you go for medical care?
PILAR:
The clinic on Newton Street.
CAROLE:
The walk-in clinic?
PILAR:
Si.
CAROLE:
I’ve worked there.So… you’d see Dr. Crighton?
PILAR:
Si, or the nurses.
CAROLE:
Can you tell me how long you’ve had diabetes?
PILAR:
I’m not really sure. They tell me for a long time I need to go on a diet, but what can I do? I cook for my family and I can’t make them eat little diet food dinners. My husband and my grandson like to eat. It’s too hard to make food just for me.
CAROLE:
I understand that it’s difficult. Let’s move on to today. Can you tell me how your symptoms started? The dizziness and the sweating?
PILAR:
Okay … let me think…
CAROLE:
Sometimes when your blood sugar gets too low, you can go into what’s called hypoglycemia. Certain medications that help you manage your diabetes can cause hypoglycemia – particularly if you didn’t eat a meal after taking them. (scene ends as they continue to take history).
Conversation 3: Grace calls the medical needs shelter to coordinate moving Pilar to their care.
GRACE:
Hey, Edith. I’ve got another person to send your way.
EDITH (On the Phone):
We’re in good shape over here, that shouldn’t be a problem. What are we looking at?
GRACE:
Older woman who is reporting dizziness and sweating and a headache.
EDITH (On the Phone):
Diabetic?
GRACE:
You got it on one guess. High blood pressure, too. I am getting the feeling that this woman isn’t managing either condition very well. Obviously, this isn’t the place to figure all that out, but I’d like to encourage her to see her doctor as soon as things settle down. She needs a better management plan.
EDITH (On the Phone):
It can be difficult. There are a lot of factors that can make it hard for our patients to do what they need to do to take care of their disease. Anyhow, I think I can spare someone to come over to collect your patient. Have you been able to check her blood sugar?
GRACE:
No, we don’t have blood sugar monitors. I’ve noted that for my after-action report but that doesn’t help us now.
EDITH (on the phone):
I’ll see if we have an extra that Kimberley can bring when she heads over there. I’d go ahead and try to stabilize her – do you have juice or glucose tablets?
GRACE:
Yes, we’ve got orange juice… Carole already gave her a half cup and is sitting with her.
EDITH:
All right. I’ll get Kimberley over there.
GRACE:
Thanks.
Scene 2: Temporary Shelter, Special Needs Area
Expository Text: Evacuees requiring basic medical care can be brought to the medical needs shelter. Located in the same sports complex at Beck University as the general population shelter, the medical needs shelter offers basic medical assistance and monitoring. It is staffed by qualified medical personnel and has essential medical equipment.
Conversation 1: Edith Duff, RN, a veteran public health nurse tells her staff about the incoming patient.
EDITH:
Alright – Ronnie and Kimberley, we’ve got a woman with diabetes over in the general population side who is having an episode of hypoglycemia. They’re going to stabilize her blood sugar, but we want to bring her over here for monitoring. I need you two to grab a wheelchair and a blood sugar monitor and head over to the general population shelter. Once you’re sure she’s stabilized, you can bring her back here.
RONNIE:
Sure thing.
EDITH:
From what Grace was able to find out, the woman took her morning dose of glyburide. She was planning to eat breakfast when she got into work, but the train crash happened and in all the excitement, she forgot. Then, she was evacuated and missed lunch, as well. That was accidental, but Grace thinks the woman also has some confusion about how her medications work.
KIMBERLEY:
Oh, I hate that. You spend so much time explaining it all to a patient, and it just seems to go in one ear and out the other.
RONNIE:
That’s the case sometimes, but it’s important to keep an open mind when you’re talking to patients about compliance with a given treatment plan. It’s too easy to forget that medicine doesn’t grow on trees… some people who come to my clinic have to choose between feeding the family or buying their meds.
EDITH:
It’s true. Also, there are cultural issues too. I’ve had patients who … when you start digging into their reasons for non-compliance – they stop taking their meds because they know someone who had a lower extremity amputation just after being put on insulin therapy, so they equate taking insulin with the diabetes getting worse or even with needing the amputation itself. Also, a lot of patients still tend to see meds as a cure and not necessarily a control mechanism.
KIMBERLEY:
I totally never thought of it that way. Thanks for explaining.
RONNIE:
No problem. It’s just another case where understanding the cultural and social issues goes a long way.
Conversation 2: Ronnie Maxwell, the nurse manager of Caring Hands clinic offers his perspective on treating patients with chronic disorders.
RONNIE:
You look perplexed.
KIMBERLEY:
Not so much perplexed; just processing what you and Edith were saying about diabetes in the Hispanic community.
RONNIE:
Got it. It’s important not to over-generalize, but when you’re dealing with a chronic condition and one that can be so devastating, you need to understand and respect the patient’s concerns. You need to start where they are.
KIMBERLEY:
I thought I knew that… I think what I’m realizing is that I’ve had an attitude toward patients that I need to think about.
RONNIE:
How so?
KIMBERLEY:
Well … this is hard to put into words, but it goes back to the word non-compliant itself. I mean, it’s what’s going on. Patients aren’t complying with the treatment plan and that’s a problem. It’s a problem for us, it’s a problem for the patient, and it’s a problem for public health. But … “non-compliant??” … it sounds like something you’d say about a teenager who’s acting out. Not a grown woman or man.
RONNIE:
Yeah. That’s a really good point. In a perfect world, we’d have the time to talk with our patients, really find out what’s going on with them, and help them find solutions. In the real world, you do your best.
KIMBERLEY:
And on that note, here we are!
Scene 3: San Lorenzo Church Meeting Room
Expository Text: Several weeks have passed since the train derailment. For several of the nurses involved with caring for Mrs. Mendez when she had an episode of hypoglycemia, the event raised questions about how to improve diabetes self-management in the Latino community. One idea—offering diabetes education classes in Spanish—is taking off.
Conversation 1: Martin discusses the upcoming training session with Carole.
MARTIN:
Ready for primetime?
CAROLE:
I’m looking forward to this. I think the reason I went into public health nursing rather than working in a hospital was that I like the education part of it.
MARTIN:
Well, their loss is our gain.
CAROLE:
Do you know how many people we’re expecting?
MARTIN:
I’m really not sure. I’ve been telling people at the clinic and I know Father Yuni has been getting the word out as well.
CAROLE:
Great.
Conversation 2: Carole Bartlett, a public health nurse in the community, mulls over the importance of the evening’s outreach efforts.
CAROLE:
Father Yuni … we’re almost done setting up.
FATHER YUNI:
Great. I am looking forward to the presentation. I like to learn something new as much as anyone. I am interested to see what kind of changes a person has to make when he or she is diagnosed with diabetes.
MARTIN:
I’d say the biggest thing we’re trying to do tonight is help people understand how diabetes works and how to manage it. How to make healthy choices. A lot of the patients I see in the clinic don’t know where to start. And many of the women don’t want to impose their health problems on their families, so they’re reluctant to make changes in meals.
FATHER YUNI:
For many Latina women, preparing the family meal is an important part of their identity. They don’t want to put themselves and their needs ahead of the family.
MARTIN:
I’ve seen that. It also can be a factor in spending money on medications and making time to exercise.
CAROLE:
That’s why I like to teach this class from the perspective that the whole family benefits when the person who has diabetes manages it well.
FATHER YUNI:
What’s sad is that traditional for many of my parishioners is a very healthy diet. Lots of fruits and vegetables. Unfortunately, those things are more expensive in this country, and in this neighborhood it’s also hard to find, since we don’t have a big grocery store in Ruby Lake. The food that’s cheap isn’t so healthy.
CAROLE:
Those are some of the things we need to talk about. Sometimes there are ways to solve these problems.
FATHER YUNI:
Tonight will be interesting, that’s for certain. Can I get either of you something before people start arriving? Coffee or tea?
CAROLE:
Coffee would be great.
MARTIN:
Yes, that does sound good. I’ll help you get it.
Instructions
Describe two strategies that are used in your nursing practice to effectively communicate with members of your team and with your patients.
Explain how the communication strategies reflect your knowledge of pharmacology policies and procedures, protocol, practice standards, and regulatory guidelines.
Explain how the communication strategies demonstrate respect for others and cultural competence.
Explain how the communication strategies ensure patient safety with regard to the delivery of pharmacological agents
Additional Requirements
Length of paper: No more than 3 full pages, not including the title page and reference page.
References: At least two scholarly references, including this week’s reading assignment.
Formatting: Follow proper APA style and formatting.
Read Pattison’s 2013 article, "Religion, Spirituality, and Health Care: Confusions, Tensions, Opportunities," from Health Care Analysis: HCA, volume 21, issue 3, pages 193–207.
Read Hunter and Tilley’s 2015 article, "A Grounded Theory Study of the Process Used to Negotiate Condom Use Among African-American Women: Review of the Literature," from the Journal of Cultural Diversity, volume 22, issue 1, pages 23–29.
Read Steenfeldt and Hughes’s 2012 article, "An Evidence-Based Course in Complementary Medicines," from the American Journal of Pharmaceutical Education, volume 76, issue 10, pages 1–10.
Read Drake’s 2013 article, "A Mental Health Clinician’s View of Cultural Competence Training," from Culture, Medicine and Psychiatry, volume 37, issue 2, pages 385–389.
Read Nahin, Dahlhamer, and Stussman’s 2010 article, "Health Need and the Use of Alternative Medicine Among Adults Who Do Not Use Conventional Medicine," from BMC Health Services Research, volume 10, pages 220–230.
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