Post Op CABG with COPD Exacerbation Case Study

Endotracheal suctioning is a common procedure, which nurses are expected to perform among patients with artificial airways (Wang et al., 2017). It helps in the maintenance of a clear way and the optimization of respiratory function. Suctioning is one of the many skills registered nurses perform that may appear a simple task but fraught with inconsistencies. The procedures nurses perform during endotracheal suctioning have been at the center of discussions, as some opt for saline instillation. The paper examines a case involving a patient who has undergone coronary artery bypass graft surgery, which has required frequent suctioning during the postoperative course.

Nursing Theory Gaps

The case presents various nursing theory gaps. For instance, the reliance on saline during suctioning by an experienced nurse presents a gap in Benner’s novice to expert model. According to this theory, nurses develop skills and knowledge over time, and their progression is explained through five stages: novice, advanced beginner, competent, proficient, and expert (McKenna, Pankhihar, & Murphy, 2014).

Nurses in higher levels should possess advanced skills and be more knowledgeable in patient care. However, the experienced nurse in the case study opted for saline instillation during suctioning, a controversial procedure without sufficient evidence (Wang et al., 2017). As per Benner’s theory, the experienced nurse is expected to be more knowledgeable, which means she should be aware of the effects of saline instillation during suctioning. It demonstrates the existence of a gap in the nursing theory.

Also, the decision of the registered nurse to suction the patient and instill saline during the suctioning presents a gap in Virginia Henderson’s nature of nursing. According to this theory, nurses’ unique function is to assist individuals in performing activities contributing to their health and recovery (McKenna, Pankhihar, & Murphy, 2014). In this case study, the registered nurse was focused on helping the patient recover, which is why she suctioned him to help clear his airway.

However, the use of saline presents a gap in the nursing theory, as the nurse believes that it helps in clearing the airway, yet there is no empirical evidence supporting this (Wang et al., 2017). Her use of saline during suctioning was motivated by her need to help the patient recover, as per Henderson’s nature of nursing theory.

Another nursing theory gap present in the case study relates to Ida Jean Orlando’s deliberative nursing process, which calls for a deliberative nursing process initiated by patient behavior (McKenna, Pankhihar, & Murphy, 2014). In this case study, the experienced nurse failed to notice the patient’s behavior, as expected, as explained in Orlando’s theory.

Nurses should notice patients’ verbal and non-verbal behavior and take necessary and deliberate action (McKenna, Pankhihar, & Murphy, 2014). However, the nurse believed that saline instillation was ideal in helping clear the patient’s airway, so she did not bother to notice that the patient was distressed and then take deliberate action.

Positive Patient Outcomes

According to McKenna, Pankhihar, and Murphy (2014), nursing theory, research, and practice can interact to create positive patient outcomes. The consideration of these can be crucial in addressing the nursing needs present in the case study. For instance, it is important to understand that saline instillation during suctioning is not advisable. Nurses tasked with suctioning are expected to be well trained and should demonstrate competence under strict supervision.

Moreover, these nurses are supposed to be knowledgeable and highly skilled, which they are expected to rely on regular research to be up-to-date. In this case, the experienced nurse failed to rely upon up-to-date research on the use of saline instillation during suctioning, as it is linked to adverse effects on oxygenation (Wang et al., 2017). According to Benner’s novice to expert model, nursing with more experience are expected to have more knowledge and skills (McKenna, Pankhihar, & Murphy, 2014). Therefore, achieving positive patient outcomes, in this case, would encompass relying on up-to-date knowledge on the use of saline during suctioning.

As an experienced nurse, the knowledge and skills over the years would have guided her to understand the patient’s needs; particularly, when the patient turned red and started coughing. As an experienced nurse, she should rely on past experiences to guide her actions (McKenna, Pankhihar, & Murphy, 2014). Therefore, positive patient outcomes regarding the case study would involve reliance on up-to-date research on the use of saline instillation during suction, relying on past nursing experiences, and abiding by the provisions of Benner’s novice to expert theory.

Theory-Practice Gap

The theory-practice gap refers to the disconnect between what is considered best practice, which is the knowledge learnt in nursing, and actual practice, the application of knowledge in real-world clinical practice (McKenna, Pankhihar, & Murphy, 2014). The gap is usually due to evolving care standards from practices rooted in tradition and custom. Addressing the gap encompasses encouraging critical thinking and reflection, which allow nurses to keep their nursing knowledge up-to-date (Shoghi et al., 2019).

Nursing Practice and Patient Care

The gap can impact nursing practice and patient care in various ways. For instance, it can reduce nursing motivation, which can harm nursing practice and patient care (McKenna, Pankhihar, & Murphy, 2014). Such nurses will start questioning the knowledge they learnt due to the disconnect they encounter in real practice. The disconnect will likely be the source of reduced motivation. These nurses will start wondering whether the nursing knowledge they gained was worth it, considering that the actual nursing experience did not require the application of some of the knowledge.

Unmotivated nurses are highly likely to deviate from their theoretical knowledge, despite some clinical situations requiring this. Also, the theory-practice gap can be linked to medication errors among practicing nurses due to attitudes about the effectiveness of knowledge learnt. Some nurses can experience reduced physical assessment skills due to the theory-practice gap, affecting nursing care quality and patient outcomes (Shoghi et al., 2019). Such nurses will have problems determining what they should assess in their patients due to the disconnect between what they learn in nursing school and their experience with patients.

These nurses will likely be confused about what they should consider when undertaking physical assessments, which means they will likely rely on what is not considered best practice. Also, the theory-practice gap can encourage hesitation among nursing in clinical situations that require prompt action (McKenna, Pankhihar, & Murphy, 2014). Due to the theory-practice gap, some nurses may hesitate to rely on clinical knowledge in certain clinical situations that require urgent care provision, which can have a negative impact on patient care.

Concept Map

Post Op CABG with COPD Exacerbation Case Study

References

  • McKenna, H. P., Pankhihar, M., & Murphy, F. (2014). Fundamentals of nursing models, theories and practice. Chichester, West Sussex: John Wiley & Sons Inc.
  • Shoghi, M., Sajadi, M., Oskuie, F., Dehnad, A., & Borimnejad, L. (2019). Strategies for bridging the theory-practice gap from the perspective of nursing experts. Heliyon, 5(9), e02503. https://doi.org/10.1016/j.heliyon.2019.e02503
  • Wang, C., Tsai, J., Chen, S., Su, C., Chen, L., Lin, C., & Tam, K. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials. Australian Critical Care, 30(5), 260-265. https://doi.org/10.1016/j.aucc.2016.11.001