Donabedian’s framework for measuring healthcare quality comprises a triad of domains: Structure, process, and outcomes. Pretend you have just moved to a new city and are seeing a new cardiologist for the first time and were not satisfied with the encounter. Discuss how the visit’s quality was on each domain and what is your overall assessment of the provider’s quality? What recommendations would you make to improve quality?

Irma is an 82-year-old widow who lives alone. She has a history of hypertension. At the age of 67, she had a mild stroke but recovered with no physical impairments. Lately, she has been complaining of dizziness and fatigue.

Irma used to be an avid fan of all the cooking shows and took pride in fixing gourmet meals for friends and her husband. Her husband died 6 years ago and since his death, she lost all interest in cooking. A year ago, her smoke alarm went off when she fell asleep and left the stove on.  Now Irma is afraid of using the stove for fear of starting a fire. Her meals consist of a boiled egg and toast with orange juice for breakfast and a cup of canned soup in the evening. She has no variety in her meals and eats little protein or vegetables.

Irma has no children and her younger siblings live in another state. She occasionally walks to the community center and participates in some of the activities for seniors.  Her physician reported that she is exhibiting signs of early dementia and may not be able to live alone much longer.

 

• What malnutrition indicators are prevalent with Irma?
• How is Irma’s aging impacting her nutrition?
• What are Irma’s nutritional needs as part of the older elderly population?
• Citing evidence-based resources, what health problems can we expect Irma to have as a result of being malnourished?
• What determinants of health are impacted in Irma’s malnutrition scenario?
• If Irma were living in your community/state, what resources would be available to her?
• The Community/state where student lives is Newport News, Virginia

What sections of the Nursing Practice Act and the Board Rules address documentation?

• The nurse cannot make more staff magically appear. What could the nurse have done, under these circumstances, to improve her documentation and perhaps avoid being reported to the Board? (NOTE: In the real case upon which this scenario is built, the nurse did testify that she felt that she had allowed herself to get lulled into the “that’s the way we do it” mentality for that unit!)
• What do you feel is the best way to handle narcotic wastage if another nurse is not readily available?

 

Prisha remembers her late grandfather who refused to take his medication and how her grandmother struggled to watch his health decline. She notices that Mr. Lang’s partner is very concerned, so Prisha provides reassurance by touching Mr. Lang’s partner’s hand. Which characteristic of the therapeutic relationship is Prisha displaying?​