The Role of the Patient Care Assistant in Transforming Nursing

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NURSING SCIENCE

Leveraging digital technology in nursing

Cooperation Not Competition: Why Nurse-Technology Partnerships Are Necessary for the Future of Patient Care

Houston Methodist Special Edition of the Journal of Nursing Education and Practice

EDUCATION

Houston Methodist Willowbrook: Transforming Nursing Education Through Innovative Methods

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PRACTICE

Transforming Patient Satisfaction Scores with Nurse-Physician Bedside Rounding

PROFESSIONAL DEVELOPMENT

Transitional Residency to Acute Care (TRAC) Program

FROM OUR TEAMS

The Role of the Patient Care Assistant in Transforming Nursing at the Bedside

Utilizing Technology to Transform Your Workflow

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

pH

7.26

(7.35-7.45)

PaO₂

83

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

pH

7.32

(7.35-7.45)

PaCO₂

40

(35-45)

HCO₃

20

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

pH

7.49

(7.35-7.45)

PaO₂

94

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

BE

+2

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

pH

7.51

(7.35-7.45)

PaO₂

95

(80-100)

PaCO₂

42

(35-45)

HCO₃

30

(22 – 26)

BE

+3

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

The Role of the Patient Care Assistant in Transforming Nursing at the Bedside

By Latoya Clower, MSN, RN, CVRN-BC

Transformational leadership is a management style that inspires and motivates others to maintain accountability for their roles while encouraging individuals to perform beyond minimum expectations. As leaders display the example through enhanced visibility and modeling behaviors, employees can also reflect this leadership (Mennella, H. et al., 2018). As a magnet organization, transformational nursing is one of the critical components of nursing practice, and many Patient Care Assistants (PCAs) are currently modeling this on nursing units throughout the organization.

Marjorie Bernard, who has worked on Main 8 as a PCA Specialist for six years, is a great example. Throughout her journey at Houston Methodist, and after working closely with leadership, Marjorie has initiated 20 educational programs at the unit-based level. One of the most effective programs is “Grounding Day,” a new-hire training and onboarding program. The program includes a welcome binder, learning activities to promote staff engagement, clinical shadowing expectations, and a general unit orientation guide related to safety measures and available clinical resources. The program fosters connections between new hires and current staff members, provides an exceptional orientation process, and integrates hospital culture. Overall, the program has been very successful. New hires have provided encouraging feedback, including the welcoming nature of the program and unit, increased confidence levels, boosted morale, and enhanced comfort levels within their new position. Throughout the years, the program has improved staff retention rates and stimulated active professional development within the unit. Most importantly, patients report increased comfort levels and develop a heightened trust with staff members based on competent patient care experiences.

Alexia Martinez is another PCA Specialist who has worked on Dunn 8 West for the past two years. One of the unit-based educational programs she is most excited about is the Central Line-Associated Blood Stream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) bundles and audit process. Having previously worked with spinal cord injury patients for 12 years, Alexia knows how infections can impact patient conditions, especially when coupled with multiple comorbidities. The bundle and audit process remains influential within Alexia’s unit and continues to lead practice guidelines for patients with central lines and indwelling urinary catheters. It also serves as the driving force for the reduction of infection rates. Ultimately, as staff compliance and practice guidelines are maintained, patient risks are identified, and patient outcomes are enhanced.

Marjorie and Alexia show us the fantastic ways PCAs can create transformational nursing at the bedside. How have you made transformational changes in your units? We would love to hear about the incredible work that’s being done!

Reference:

Mennella, H., Balderrama, D. Pravikoff, D. (2018). Transformational Leadership in Nursing. CINAHL Nursing Guide. (p. 1-8).