NUR-300 Lincoln University – Case Study A: Bailey Bailey is the director of nursing (DON) at a long-term care facility. She has been a nurse for 10 years,
QUESTION
Case Study A: Bailey
Bailey is the director of nursing (DON) at a long-term care facility. She has been a nurse for 10 years, but has only worked in long-term care for two years. She was promoted to DON recently and she knows there are several areas of care that need improvement. Bailey has noticed there is an increase in the number of urinary tract infections (UTIs) within the last three months.
- What are three factors that may contribute to the increase in UTIs?
- What education should Bailey provide to the nursing staff at the next staff meeting about how they can help reduce the number of UTIs in the facility?
It is October and Bailey understands the importance of the residents getting annual influenza vaccinations. The nurses on the units must get consent from the resident or the family member if the resident is not able to make decisions for himself/herself. Several family members of residents do not sign the consent for their loved one to get the influenza vaccine. They explain that their loved one has never got influenza and they hear a lot of bad things about vaccinations in general.
- What education can Bailey provide to the family members about influenza to encourage them to sign the consent? How does living in a facility increase the risk of influenza?
- Identify 3 other interventions Bailey can implement in the facility to reduce the number of respiratory problems in residents.
- A family member asks if their loved one should get a pneumonia vaccine every year. What should the nurse’s response be?
Bailey is in charge of tracking the number of falls that occur in the long-term care facility. Two hours after lunch time, a charge nurse comes to Bailey to report that a resident just fell, but there was no injury. The nurse expresses that this resident has been getting dizzy every day after eating.
- What do you think is happening to the resident and what interventions can the nursing staff put in place to try to prevent another fall in this resident?
ANSWER
Preventing Falls in Long-Term Care: A Case Study Approach
Introduction
In this case study, we explore the challenges faced by Bailey, the Director of Nursing (DON) at a long-term care facility. Bailey has identified an increase in urinary tract infections (UTIs) among the residents and has concerns about the low influenza vaccination rates and falls. In this essay, we will discuss three factors contributing to the increase in UTIs, educational strategies for reducing UTIs, promoting influenza vaccinations among family members, interventions to minimize respiratory problems, and addressing falls prevention for a resident experiencing dizziness after eating.
Factors contributing to the increase in UTIs
Poor Hygiene Practices: Inadequate hygiene practices, such as improper cleansing techniques or infrequent diaper changes, can contribute to UTIs (Vyas et al., 2015). Staff may need education on proper hygiene protocols and the importance of maintaining cleanliness in residents’ urinary areas.
Catheter Usage: Overuse or improper management of urinary catheters can significantly increase the risk of UTIs (Vyas et al., 2015). Bailey should evaluate the catheterization practices at the facility, ensure appropriate usage, and encourage alternatives when feasible, such as intermittent catheterization or promoting regular toileting.
Inadequate Fluid Intake: Insufficient fluid intake can lead to concentrated urine, promoting bacterial growth and UTIs. Encouraging residents to maintain proper hydration levels and providing access to water throughout the day should be emphasized.
Education to reduce UTIs
At the next staff meeting, Bailey should provide the following educational points to the nursing staff:
Reinforce Hygiene Practices: Emphasize the significance of proper hygiene, including correct techniques for cleansing the perineal area and promoting regular bathing or showering.
Catheter Care and Management: Educate the staff on appropriate catheter insertion and maintenance procedures, stressing the importance of sterile techniques, regular catheter care, and prompt removal when no longer necessary (Ak & Özbaş, 2018).
Promote Hydration: Highlight the importance of maintaining adequate fluid intake to prevent concentrated urine and encourage staff to offer fluids regularly to residents.
Influenza vaccination education for family members
Bailey can address family members’ concerns about influenza vaccinations and encourage them to sign the consent by providing the following information:
Vaccine Safety: Educate family members about the safety and effectiveness of influenza vaccines. Explain that vaccines undergo rigorous testing and are recommended by healthcare experts to prevent the spread of the flu, particularly in a communal living environment like a long-term care facility.
Herd Immunity: Emphasize that when a significant portion of the population is vaccinated, it helps protect vulnerable individuals who are unable to receive the vaccine or have compromised immune systems. Highlight the importance of communal responsibility in preventing the spread of influenza.
Risk in Long-Term Care Facilities: Explain that living in a long-term care facility increases the risk of influenza due to the close proximity of residents, potential exposure to infected individuals, and the higher vulnerability of the elderly population to respiratory illnesses. Emphasize that vaccination can significantly reduce the risk of severe illness, hospitalization, and even death.
Interventions to reduce respiratory problems
Regular Hand Hygiene: Promote consistent hand hygiene among staff, residents, and visitors to reduce the transmission of respiratory infections. Provide training on proper handwashing techniques and ensure the availability of hand sanitizers throughout the facility.
Respiratory Etiquette: Educate staff and residents about respiratory etiquette, including covering coughs and sneezes with a tissue or elbow, proper disposal of used tissues, and regular cleaning of frequently touched surfaces.
Adequate Ventilation: Ensure proper ventilation systems and air circulation within the facility to minimize the risk of airborne respiratory infections. Regularly maintain and clean ventilation systems and promote fresh air circulation when weather conditions permit.
Response to pneumonia vaccine question
The nurse’s response to the family member’s question about the pneumonia vaccine should be as follows: “According to current medical guidelines, the pneumonia vaccine is generally recommended for adults over the age of 65 or those with certain medical conditions. However, it is not required to be administered annually. The effectiveness of the pneumonia vaccine can last for several years, but it may be necessary to receive a booster dose in certain cases. It would be best to consult with the resident’s primary care provider to determine if a vaccination is necessary and at what interval.”
Preventing falls in a resident experiencing postprandial dizziness
Based on the information provided, the resident’s dizziness after eating suggests postprandial hypotension, a drop in blood pressure following a meal. To prevent further falls, the nursing staff can implement the following interventions:
Assess and Monitor: Conduct a comprehensive assessment to determine the extent and frequency of the resident’s postprandial dizziness (Appeadu, 2023). Monitor vital signs, including blood pressure, before and after meals, and document any significant changes.
Encourage Positioning: Advise the resident to sit or lie down for a short period after meals to allow for gradual blood pressure stabilization. This can help minimize postprandial hypotension and reduce the risk of falls.
Dietary Modifications: Collaborate with the facility’s dietitian to adjust the resident’s meal plan (Appeadu, 2023). Smaller, more frequent meals and reducing the intake of carbohydrates and sugars may help prevent postprandial hypotension.
Medication Review: Review the resident’s medication regimen with the healthcare team to identify any medications that could contribute to postprandial dizziness. Adjustments or modifications to the medication schedule may be necessary.
Conclusion
In this case study, we explored the challenges faced by Bailey, the DON at a long-term care facility. Through education and targeted interventions, Bailey can address the increase in UTIs, promote influenza vaccinations among family members, reduce respiratory problems, and implement strategies to prevent falls in residents. By taking a proactive and comprehensive approach, Bailey can improve the overall quality of care and enhance the well-being of the residents in the long-term care facility.
References
Ak, E. S., & Özbaş, A. (2018). The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Journal of Clinical Nursing, 27(5–6), e1078–e1088. https://doi.org/10.1111/jocn.14160
Appeadu, M. K. (2023, February 20). Falls and Fall Prevention In The Elderly. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560761/
Vyas, S., Sharma, P., Srivastava, K., Nautiyal, V., & Shrotriya, V. P. (2015). Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students. Journal of Clinical and Diagnostic Research. https://doi.org/10.7860/jcdr/2015/10995.6547

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