Part I
A nurse at an acute care hospital is caring for a patient who is not doing well. The patient is a 65 year
old male who was originally admitted four months ago following a late diagnosis of lung cancer. The
patient underwent a thoracotomy and surgical removal of the left lower lobe. On this admission, the
patient is diagnosed with metastasis to the bone and liver and unrelieved pain in both the left side of
the chest and back. Using concepts from the readings in the assigned chapters and ISMP articles, as
well as the critical elements from the AACN Health Work Environment standards and “Skilled
Communication” article, answer the following question.
1. Collaboration is going to be needed to address this patient’s problems. What are the important
concepts related to collaboration and skilled communication that this nurse needs to understand?
Identify and briefly discuss 2 – 3 important concepts: Focus on the “need for”, “barriers to” and
negative outcomes that are possible.
Part II
The nurse calls the physician to discuss the patient’s current situation; pain of a 7 on a scale a (0 –
10) scale despite multiple doses of the ordered Percocet. The nurse suggests changing the patient’s
current pain management to a Morphine infusion or patient controlled analgesia (PCA) pump. The
physician is hurried on the phone and tells the nurse that he doesn’t really think the patient’s pain is
that bad and that he is doesn’t want to cause an addiction to the opiates. When the nurse
reemphasizes the patient’s pain experience and unlikely outcome of addiction in this type of patient,
the physician becomes aggravated and tells the nurse “not to try and practice medicine”. Use the
concepts from the information contained in the two ISMP newsletters, the chapter readings and the
required articles to answer the following questions.
2. Identify how this comment is a type of disrespectful behavior that will have negative
consequences on the patient’s care and why the negative outcomes occur.
3. Identify important steps for the nurse to consider in responding to the physician’s comment and
write out your actual response to the comment – not what you think, but you would actually
say