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The author(s) will discuss a model case as a part of the analysis. Based on author(s) concept analysis, construct your own model case. 

 

MODEL CASE

 

The following is a model case regarding a critical care nurse that contains all the attributes:

 

Nurse A works in a critical care unit of a medium volume clientele hospital. The critical care unit on average admits 5 to 6 patients a day and for the local area is known for the trauma care provided. Nurse A works as the weekend charge nurse and is currently working her sixth 12-hour shift due to a colleague who is currently out for medical leave and desperately needing to supplement her income. While the critical care is very busy, nurse A is attentive to her patients’ needs and serves each patient with her skills and attends to the emotional and physical needs of each. Three nights ago, during nurse A’s shift, a motor vehicle collision (MVC) with multiple trauma victims arrived. Nurse A, being the charge nurse, assisted in each of the unit rooms and provided additional support to the nursing staff. The victims included a mother and her 3 younger children ranging in ages from 13 to 19 years. The 2 older children were from out of town and home from college for a visit with their mother and younger sibling. The mother and the 2 older children died, and the youngest child was in critical condition and later sent by helicopter to an area trauma center. Nurse A listened to the younger child ask about the mother and about the 2 older siblings. Nurse A was empathetic to the questions and was feeling sadness and concern for the others involved in the MVC. Since that night, nurse A has had trouble sleeping, having nightmares, and replaying the night over in her head. Nurse A does not call her patients by name anymore, she refers to them as “belly pain in room 3” or as “drunk guy in room 4,” and she makes cynical remarks about her patients in the nurse’s station. Since that night, her work performance has been less than optimal. Nurse A has been making charting mistakes, writing on the wrong chart, and caught herself before making a critical medication error. When assessing a patient during the early morning, nurse A told a 35-year-old patient who was having a myocardial infarction that he probably had indigestion from food slipped in by a family member. When she is off work, she cares for her elderly mother and is currently raising her grandchildren after taking custody from their mother who cannot stop her current drug habit.

 

The attributes in the aforementioned model case evidenced by nurse A represent traits of experiencing depersonalization. She is no longer calling her patients by their name but by “belly pain in room 3 or drunk guy in room 4.” She is working her sixth 12-hour shift, so her endurance levels are subpar. Her work performance is no longer optimal, as evidenced by charting mistakes and a near miss on a medication error. Nurse A is making poor judgment skills by dismissing the chest pain as indigestion. 

 

The following is a borderline case, with an explanation to follow:

 

Nurse B also works in the same critical care unit as a relief charge nurse. Nurse B has worked for the past 4 nights and was working when the above- mentioned MVC case came in. Nurse B took care of the 13-year-old young teen who was flown to the area level 1 trauma center. Nurse B was very attentive in her care of the young patient and assisted the flight crew upon arrival. Nurse B has been off for 3 days now and is returning to work. Nurse B has stated that she is still tired and does not feel well and has a headache. She also states that she has not been sleeping well since the last night she worked. Upon arrival of her shift, she has taken re- port from the day shift nurse, and all her rooms are full. Nurse B’s charge nurse asks for report on her patients, and she just says, “all the same, just a different day.” Nurse B sticks her head in each room, not addressing the patient’s needs, and rolls her eyes when a family member wants to talk to her about her loved one. Nurse B then takes all her patients charts and finds a quiet area to review and evaluate what still needs to be done. Nurse B realized that some of her patients were missing laboratory work, and intravenous antibiotics have not been hung as of yet. Nurse B knows by hospital protocol that intravenous antibiotics must be hung within 4 hours of the doctor’s order, and she has less than 1 hour to get the medications hung. Nurse B settles in for the night and proceeds with her patient care. 

 

This is a borderline case in that nurse B is experiencing depersonalization, by not giving the report on each of her patient, just states ” all the same, just a different day.” Nurse B is performing at subpar work performance by not addressing her patients’ needs and by rolling her eyes at patient family members. Nurse B is not experiencing bad judgment skills or making mistakes in providing care. Not making mistakes is what defines this model as a borderline case.

 

The following is an example of a contrary case and will be discussed after the example:

 

Nurse C also works in the same critical care unit and works as a staff nurse. She has worked there for the past year after graduating from nursing school. Nurse C is exposed to the same working conditions but only works her three 12-hour shifts per week as scheduled. She is juggling the same workload and institutional requirements as nurse A but does not have the responsibilities of a charge nurse. Nurse C loves her job and feels tremendous satisfaction each day when she goes home. Nurse C feels a sense of rewardment, knowing that she has helped each of her patients improve in some way. Nurse C has a smile on her face; she calls each patient by his or her name and addresses him or her when she enters into the room. She does not mind spending extra time talking with family member present and writes down phone numbers and is willing to call family members if the need should arise. Nurse C has a connection with her patients, and she takes pride in sharing the pain that her patients have but sparks feelings of kindness, tenderness, and gentleness along with understanding of the patients’ direct needs. Nurse C feels an overwhelming sense of reward when a patient suffers less because of the selfless care she has provided during her shift. Nurse C feels that any negative experiences are far less than the positive experiences she has at work and feels a tremendous satisfaction with her job and looks forward to caring for the next patient.

 

While nurse C has the same repeated exposure as the model case, she is flourishing in the same environment. She is having meaningful experiences with her patients and family members and looks forward to assisting the next patient. In compassion fatigue, the nurses will gradually distance themselves; this is not the case in the contrary example provided.

 

Jenkins, B., & Warren, N. A. (2012). Concept analysis compassion fatigue and effects upon critical care nurses. Critical Care Nursing Quarterly, 35(4), 388-395. https://doi.org/10.1097/cnq.0b013e318268fe09 

SCIENCE
HEALTH SCIENCE
NURSING
NSG 606