Case Study: Intervening During a Dangerous Situation
Julia Marsh, a certified nursing assistant (CNA) in a long-term care setting, enters a resident’s room and sees that Mark, one of the nursing students on the unit, is struggling to help Mr. Lu move from the chair to the bathroom. Mr. Lu is a resident who has several oozing wounds on his arms and legs. The CNA observes that Mark is not using proper wound and skin infection control precautions, nor proper body mechanics, in transferring Mr. Lu. Julia’s immediate concern is that either Mr. Lu or the student will be injured if she does not intervene immediately.
Discussion Questions
- Describe how you would provide sensitive and instructive feedback to this student in a timely manner.
- Would you address both the lack of infection control and the poor body mechanics at the same time? Why or why not?
- Demonstrate respect for both the patient and the student.
- Did you consider any issues of experience level, power, or hierarchy between the CNA and healthcare professional student in planning your approach? If so, explain any impact that had on your planned approach.
- Providing Sensitive and Instructive Feedback:
a. It is important to address both the lack of infection control and poor body mechanics, but in a considerate and constructive manner. Here’s how I would provide feedback to the student:
i. Privacy and Respect: First, I would ensure that the feedback conversation takes place in a private and discreet location to respect the privacy of the student and Mr. Lu.
ii. Begin Positively: I would start by acknowledging the student’s willingness to assist Mr. Lu. This helps create a positive and non-confrontational atmosphere.
iii. Specific Feedback: I would then address each issue separately. For infection control, I might say something like, “I noticed that when assisting Mr. Lu, we should be using proper infection control precautions such as gloves and maintaining a clean environment. This is crucial to prevent any infections.” For poor body mechanics, I might add, “Additionally, it’s important to use proper body mechanics to avoid any injuries to yourself or the resident.”
iv. Provide Rationale: I would explain why these practices are important, emphasizing patient safety and the prevention of healthcare-associated infections.
v. Offer Solutions: Suggest practical solutions or alternatives. For instance, recommend the correct use of personal protective equipment (PPE) and demonstrate proper body mechanics for safe patient transfers.
vi. Encourage Questions: Allow the student to ask questions and clarify any doubts they may have.
vii. Support and Encouragement: Conclude the conversation by expressing confidence in the student’s ability to improve and reassure them that learning from mistakes is a normal part of the educational process.
b. Demonstrating Respect:
It’s essential to maintain respect for both the patient and the student throughout the feedback process:
- Use a non-judgmental tone and avoid blaming or shaming language.
- Actively listen to the student’s perspective and concerns.
- Be empathetic to the challenges they might be facing.
- Reinforce the importance of providing high-quality care to the patient, ensuring their comfort and safety.
- Consideration of Experience Level, Power, and Hierarchy:
Yes, it is crucial to consider the issues of experience level, power dynamics, and hierarchy when planning the approach to providing feedback to a healthcare professional student. The impact of these factors on the planned approach includes:
- Experience Level: Recognizing that the student may not have the same level of experience as a certified nursing assistant, it’s important to offer guidance and support rather than expecting them to have all the knowledge and skills already.
- Power Dynamics: Acknowledging that there is a power dynamic between a CNA and a student, it’s crucial to maintain a respectful and collaborative approach. Avoiding any authoritarian or condescending behavior is important to ensure open communication.
- Hierarchy: In healthcare settings, there is often a hierarchical structure. However, when providing feedback, it’s essential to create an environment where the student feels comfortable discussing their actions and learning from mistakes. This approach encourages a culture of continuous improvement and patient safety.
In summary, addressing the issues of infection control and poor body mechanics separately and sensitively, while considering the experience level and power dynamics, is essential to ensure the effective delivery of feedback that promotes learning and patient safety.