NURSING ADMINISTRATION USING FOCUS AND PDCA CYCLES IN A
SCENARIO PROVIDED
Introduction: Psychiatric emergencies in medical settings
may be particularly challenging since the staff does not encounter them
frequently and may not have experience dealing with behavioral crisis
intervention.
The purpose of this exercise is to help staff improve
understanding and coping with nonmedical emergencies that occur in medical
settings using the PDCA cycle.
Mr. X is a
41-year-old male admitted to a medical unit with a diagnosis of possible
stroke.
The patient is ambulatory, 5’10’’, and 350 lbs. Mr. X
presented to the emergency department the day before after apparently losing
consciousness at home. The initial CAT scan of his head was negative. It is
suspected that Mr. X may be an IV drug user since his urine toxicology
screening came back positive for opiates. The medical staff thinks that Mr. X
had a seizure prior to admission, but he has shown no abnormal signs or
symptoms within the last 24 hours. Mr. X was moved to an acute care unit where
he sits in bed wearing only a pair of ill-fitting boxer shorts and no shirt. He
is able to communicate without any signs of aphasia. The medical staff is still
not sure what is wrong with Mr. X. As the nurse administrator of the day, you hear
a Rapid Response called overhead for this patient. As you enter the room, you
see Mr. X screaming and on all fours in his bed. He is saying “Help, help” and
“I don’t know” repeatedly. Respiratory staff, physicians, physician’s
assistants, an ICU nurse, and unit staff are all standing there watching Mr. X
scream for help.
They all seem paralyzed. Finally, one of the staff nurses
asks Mr. X to turn over so that respiratory staff can administer oxygen via a
facial mask.
He complies and at that time the ICU nurse hooks him up to
the cardiac monitor as per protocol in a Rapid Response.
Mr. X remains quiet and still for about 60 seconds and then
proceeds to rip off the oxygen mask and the EKG leads attached to his chest.
He climbs over the side rails and stands there in a daze,
saying “I don’t know, I don’t know.”
The staff reacts negatively to Mr. X’s behavior in front of
him. The respiratory therapist says, “If you think I’m going in to get an ABG
from him, you’re crazy.” Speaking to Mr. X, the ICU nurse repeats over and over
in a stern impatient voice, “What don’t you know?” Mr. X seems overwhelmed and
can’t answer. The physician looks through the chart and asks the nurses
questions about the patient. The other nurses stand there staring at Mr. X. The
ICU nurse leaves a few minutes later stating that the patient’s EKG is normal.
All at once, Mr. X bolts from the room towards the elevator, which has just
opened, and gets on. One of the nurses calls a security code, but it is too
late; Mr. X has disappeared. The county police are called and hours later they
find Mr. X at his nearby home. They try to encourage him to return to the
hospital, but since he has not been deemed a danger to himself or others, they
have no choice but to leave him alone. The next morning Mr. X returns to the
Emergency Department with “severe chest discomfort and a headache” and is
admitted back to the same unit. When the staff see him, they are apprehensive
and somewhat angry that he is back. After about three hours on the unit, Mr. X
starts yelling that his stomach is hurting. His nurse calls the physician about
his symptoms but she and the rest of the staff avoid extended contact with him
because of what happened the day before. Task: Write an essay (suggested length
of 5–10 pages) in which you develop a plan to help this staff become proficient
in handling behavioral emergencies on a non-psychiatric unit by doing the
following: A. Analyze the situation using the FOCUS and PDCA models by doing
the following: 1. Use the FOCUS model to identify possible causes of the
staff’s problem.
a. Find a Process to Improve (What needs to be improved
based on the incident in the scenario?)
b. Organize a Team That Knows the Process (Who is the
leader, the facilitator, the recorder, the time keeper, team member? Do you
need all these people? Do you need others?)
c. Clarify Current Knowledge of the Process (What is being
done now that might have added to or allowed the incident?)
d. Understand Causes of Process Variation (Use cause-effect
diagrams, concept maps or other diagrams to show how you would understand the
cause)
e. Select the Process Improvement (What would you do to
improve the situation so that you decrease the risk of it occurring again?)
2. Develop an improvement plan that will ensure appropriate
response times and appropriate clinical interventions in this situation, using
a modified version of the PDCA model (PDC).
a. Plan (develop a plan to address the situation and
possible risk in the future)
b. Do (You are not expected to actually do the plan but tell
how it would be done)
c. Check (How would you check if the plan worked?)
d. Act (Note: Act has been omitted in the modified version
since you are not expected to carry out this plan so you cannot periodically
review the change to ensure that it is successful.
B. Write a unit protocol containing at least five directives
for staff to follow in case of a behavioral emergency in a non-psychiatric
setting.
C. When you use sources, include all in-text citations and
references in APA format. Note: For definitions of terms commonly used in the
rubric, see the attached Rubric Terms. Note: When using sources to support
ideas and elements in a paper or project, the submission MUST include APA
formatted in-text citations with a corresponding reference list for any direct
quotes or paraphrasing. It is not necessary to list sources that were consulted
if they have not been quoted or paraphrased in the text of the paper or
project. Note: No more than a combined total of 30% of a submission can be
directly quoted or closely paraphrased from sources, even if cited correctly.
For tips on using APA style, please refer to the APA Handout web link included
in the General Instructions section. The school does use turnitin to check for
plagarism across the US in term papers so must be original and cited
appropriately.
