Yolanda is a 55-year-old married African American mother of two adult children who has a history of breast cancer. She was diagnosed with fibromyalgia 2 years ago, after years of unexplained muscle aches and what she thought was arthritis. The diagnosis was a relief for her; she was able to read about it and learn how to care for herself. Over the past 2 months, Yolanda stopped taking all of her medicine, because she was seeing a new primary care provider and wanted to start her care at “ground zero.” In addition to her family responsibilities, she is completing her degree as an English major. At the time of her clinic appointment, she told the nurse practitioner that she was having the worst pain possible.

Using Levine’s conservation model, the nurse practitioner completes a comprehensive assessment in preparation for developing a plan of care. A thorough assessment of characteristics of the internal and external environments is performed, with assessment of the adequacy of the adaptive fit that Yolanda has achieved in response to the changing environmental conditions produced by this health challenge. Nursing care is planned using the conservation principles. Yolanda’s diagnosis of fibromyalgia was based on the cluster of presenting symptoms (pain, fatigue, and sleeplessness) and the exclusion of other illnesses.

The assessment of the internal environment (physiological and pathophysiological processes) was performed by a thorough physical examination and various laboratory and diagnostic tests. Yolanda’s tests results were within normal limits.

The external environment includes perceptual, operational, and conceptual factors. Perceptual factors are perceived through sensory input. Yolanda reported a history of unexplained fatigue and sensations of pain for years. She recently stopped her medications “to clean my body out.” However, she reported that the pain became unbearable and was making it difficult for her to sleep. She noted that when she sleeps at least 6 hours a night, her pain is less intense. With the current insomnia, her pain is very intense.

Operational factors are threats within the environment that the patient cannot perceive through the senses. Yolanda reported severe pain in response to both the cold weather and changes in barometric pressure.

The conceptual environment includes cultural and personal values about health care, the meaning of health and illness, knowledge about health care, education, language use, and spiritual beliefs. In response to breast cancer, Yolanda developed her spirituality through prayer and reading the Bible. She believes this is how she is getting through the painful moments of her current illness.

Conservation of energy focuses on the balance of energy input and output to prevent excessive fatigue. Yolanda complains of a fatigue that just “comes over me.” She has difficulty doing housework. A day of work usually means 1 day in bed because of extreme fatigue. Her hemoglobin level and hematocrit are normal; her oxygen saturation is also within normal limits. These normal physiological assessments are typical in patients with fibromyalgia.

Conservation of structural integrity involves maintaining the structure of the body to promote normal functioning. Fibromyalgia treatment focuses on reducing symptoms. Yolanda’s symptoms could not be traced to any physical or structural alteration, yet she reports severe pain and fatigue. It is important to acknowledge the reality of the symptoms and work with the patient to determine whether activities of daily living result in changes in the pattern of illness. In addition, Yolanda thinks she is going through menopause (a normal physiological change in body structure), and she is having trouble determining whether her symptoms are menopause or fibromyalgia.

With continued questioning, Yolanda revealed that she was diagnosed with irritable bowel syndrome several years earlier. This condition presents further risks to structural integrity. She is not worried about constipation but is concerned about sudden diarrhea. She is afraid to go to school, fearing embarrassment because she might have an “accident.” Interventions to conserve structural integrity include interventions to promote normal bowel function and optimize Yolanda’s nutritional status.

Personal integrity involves the maintenance of one’s sense of personal worth and self-esteem. Yolanda reported that she “lost control” when she was diagnosed with breast cancer. A dear friend convinced her to go to church and encouraged her to use prayer. When feeling sorry for herself, she would go into her bedroom and read her Bible, cry by herself, and pray. She believes that prayer and Bible reading helped her heal. She continues to pray and read her Bible to gain the strength she needs to live with her illness. She also believes that she needs to be able to laugh at aspects of her situation; humor helps her feel better. She actively seeks health information, as indicated by her quest to learn about her diagnosis of fibromyalgia. She is most upset about not being able to walk as she used to walk. One of her favorite pastimes was shopping for shoes at the mall, which now is difficult for her.

Social integrity acknowledges that the patient is a social being. Yolanda is a married mother of two grown children. She conceals many of her feelings from her children but does share with her husband, who is supportive. Among the ways that he cares for her are to take her places she needs to go (such as grocery shopping) and to make sure she gets to her health care appointments on time.

An initial plan of care for Yolanda includes interventions based on the four conservation principles:

• Conservation of energy: (1) Discuss strategies to balance rest and activity; (2) discuss strategies to help her achieve restful sleep; (3) discuss both nonpharmacological and pharmacological approaches to manage pain; and (4) assess her nutritional intake to ensure adequate energy stores.

• Conservation of structural integrity: (1) Discuss any needed modifications of activities to prevent injury; (2) assess diet to identify whether any foods exacerbate gastrointestinal symptoms; (3) discuss the normal physiological process of menopause, including associated symptoms; and (4) consider additional laboratory work or referrals to evaluate hormone levels and assess whether additional treatment is indicated to relieve menopause symptoms.

• Conservation of personal integrity: (1) Validate the illness experience; (2) encourage continued use of prayer, Bible reading, and humor to help her feel better; and (3) discuss strategies to help her manage her anxiety related to the irritable bowel syndrome, including both nonpharmacological and pharmacological approaches.

• Conservation of social integrity: (1) Praise Yolanda for the strong family relationships that she has built and encourage her to continue to work together with her family to optimize her health; (2) with Yolanda’s permission, talk with her husband to answer his questions about her condition and discuss how they can continue to work together to improve her health; and (3) praise Yolanda for continuing to seek achievement of her goal of completing her English degree and discuss strategies to manage the irritable bowel syndrome and manage problems to help her feel more confident about going to school.

In Yolanda’s follow-up care, these outcomes suggest effective adaptation that is conserving wholeness and integrity:

• Feels rested, with 6 hours of uninterrupted sleep

• Reduction in pain and fatigue

• Distinguishes symptoms of menopause from symptoms of fibromyalgia

• Collaborates with health care providers to manage symptoms of menopause

• Reports comfort as a result of prayer, Bible reading, and humor

• Minimal adverse bowel symptoms and adequate nutritional intake

• Healthy relationships with family and friends.

• Attends school and participates in other social activities with minimal limitations.

*This case study was developed from a fibromyalgia study (Schaefer, 2005). A fictitious name was used to protect privacy and anonymity.

Critical thinking activities

1. Are there any aspects of Yolanda’s care that you would add to the plan as you consider nursing care with the conservation principles?

2. Keep a reflective journal about a personal health or illness experience and apply the conservation model to that experience.

3. As you consider application of the conservation principles in question 2, what aspects of care are assessed that previously were not included in your plans of care?

4. Use the perspective of the conservation model to identify what may be missed in simulation experiences of nursing practice. What does it capture that other perspectives miss?

5. Suggest how you might begin to develop your style of nursing practice using the conservation model.

 

Competency

Select appropriate nursing interventions for clients with lower gastrointestinal disorders.

Scenario

Patient and family education is important in increasing adherence. To provide education to patient and families, you are going to create a poster about a gastrointestinal disorder that will be displayed in a physician’s office.

Instructions

Please be sure to include the following in your poster design.

• Overview of the disorder
• Causes of the disorder
• Diagnostic tests to diagnosis the disorder
• Assessment findings
• Multidimensional nursing care interventions for the disorder

Resources

For assistance with research, refer to the Nursing Research Guide.

Jill,

Consider the scenario above to address the following.

1. Do you recommend that the data analyst examine aggregate data, detailed data, or both, to investigate this quality issue? Please explain your rationale.

Aggregate data is a summary of the population being evaluated and does not consider individualized data. Detailed data evaluates individualized information, which can eliminate potential biases that may exist in aggregated data. Tierney et al. (2020) concluded that aggregate data were more likely to agree with detailed data when the information size was large. Since this is a quality issue and the information provided does not state the sample size, I recommend evaluating the aggregate and detailed data to ensure enough information is captured.

1. Do you recommend that the data analyst use a retrospective data warehouse, clinical data store, or both, to investigate the mortality rate? Please explain your rationale.

To investigate the mortality rate, the analyst should evaluate the retrospective data warehouse. The retrospective data warehouse provides aggregate and detail-level data, whereas the clinical data store manages operational and clinical data to assist clinicians at the point of care. Aggregate data in the retrospective data warehouse may contain a mortality rate, risk-adjusted mortality rate, and risk of mortality for specific patient populations (McBride, 2019).

1. What type of tools or analytic approaches is relevant for use by this analyst? Please explain your rationale.

First, this analyst will need a spreadsheet, such as Microsoft Excel, that allows the data to be organized and sorted into various charts and graphics. BI tools are software applications that assist in the multidimensional analysis of clinical data in organizations (McBride, 2019). Statistical packages assist the analyst in organizing the data, performing data cleaning, and validating the data. Statistical tests such as t-test, correlations, and regression are often used.

Now, conduct a search for evidence. Select three scholarly sources of information describing the challenges of utilizing data in the clinical setting.

Data utilization in the healthcare industry presents many challenges. One challenge is proprietary or determining who owns the data, the facility, or the patient (Kruse et al., 2016). The patient’s ability and ease of accessing their information is another concern. Patient security is a significant challenge in data management (Galetsi et al., 2019; Kruse et al., 2016; Ristevski & Chen, 2018). According to Galetsi et al. (2019), future research is directed towards the standardization of data systems to allow for the safe extraction of patient data from all relevant organizations. Advanced encryption algorithms and pseudo-anonymization of personal data should be used to avoid patient security and privacy issues (Ristevski & Chin, 2018; Galetsi et al., 2019).

References

Galetsi, P., Katsaliaki, K., & Kumar, S. (2019). Values, challenges and future directions of big data analytics in healthcare: A systematic review. Social Science & Medicine, 241, 112533. https://doi.org/10.1016/j.socscimed.2019.112533 (Links to an external site.)

Kruse, C., Goswamy, R., Raval, Y., & Marawi, S. (2016). Challenges and opportunities of big data in health care: A systematic review. JMIR Medical Informatics, 4(4), e38. https://doi.org/10.2196/medinform.5359 (Links to an external site.)

McBride, S. (2019). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (2nd ed.). Springer Publishing Company.

Ristevski, B., & Chen, M. (2018). Big data analytics in medicine and healthcare. Journal of Integrative Bioinformatics, 15(3). https://doi.org/10.1515/jib-2017-0030 (Links to an external site.)

Tierney, J. F., Fisher, D. J., Burdett, S., Stewart, L. A., & Parmar, M. B. (2020). Comparison of aggregate and individual participant data approaches to meta-analysis of randomised trials: An observational study. PLOS Medicine, 17(1), e1003019. https://doi.org/10.1371/journal.pmed.1003019

  

Health Privacy Breach

breaches are serious offenses that negatively affect the trust between nurses and patients. To maintain this trust, nurses must maintain the privacy and security of patient information. Read the scenarios below related to the protection of health information.

Scenario 1

 A nurse posted the following comment on her social media page: “Can this shift be any longer? It started out with a waiting room full of nagging people that don’t seem to know what “emergency” means. Then I had to deal with the drama of trying to transfer a 400 lbs. (no joke) intubated COPD patient down the hall to the ICU, those ICU nurses are such divas and I wasn’t in the mood for their whining. Someone help!

• Describe the privacy and security issues related to this social media posting.

Scenario 2

 A nurse educator is preparing a presentation poster for an infectious disease conference. She includes pictures of varying stages of a client’s lesions in the poster.

• Describe the privacy and security issues related to the inclusion of patient information on the poster.

Scenario 3

• Marcus was admitted to the hospital from a long-term care facility. He was diagnosed with dehydration and delirium. He is expected to return to the facility. The charge nurse at the facility calls for an update regarding his status.
• Describe the privacy and security issues related to sharing this information with the long-term care facility.

Instructions:

Use an APA 7 style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. Citation and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

 Consider your own experiences as well as the literature.  

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used.