Larkin and Burton’s abstract preface the Joint Commission’s directive for effective communication among caregivers during handoff to ensure patient safety (Larkin & Burton, 2008, p. 360). The case study reviews the lack of handoff practice and its effect on continuum of care provided to “Ms. C, a 64-year-old woman, presented to the ambulatory surgery center for an open cholecystectomy” (p. 390), and the subsequent workshop utilizing Bloom’s Taxonomy of Education Objectives to educate and change clinical practice among the staff members.
From this reader’s vantage Ms. C’s respiratory de-compensation was a result of the nurses’ failure to communicate patients medical history and critical findings during unit-to-unit transfer and shift report, inadequate nurse to patient ratio along with incomplete charting, failure to recognize early signs and symptoms of respiratory compromise, and lack of critical thinking skills. Evidenced by the case study’s assertions, Ms. C required oxygen in the post anesthesia care unit (PACU) but was transferred without it.
Second, the PACU nurse did not communicate to the patient’s need for oxygen to the receiving nurse during handoff report.
It is unclear if the surgeon wrote vital sign parameters and pulmonary toilet orders, or if there were standard protocols for this post operative unit. Ms. C’s incomplete graphic record indicate she was placed on four liters of oxygen within two hours of her arrival to the unit at 1630; however, fail to adequately trend abnormal vital signs such as low grade temperature and tachycardia (Larkin & Burton, 2008, p. 392).
The record does not document any nurse-initiated interventions or call to the doctor requesting a chest x-ray or recommending a respiratory therapy consult for breathing treatment and incentive spirometer.
On post-op day two Ms. C’s respiratory status declined requiring a non-rebreather mask, rapid response team consult, and a transfer to the intensive care unit for a diagnosis of respiratory distress (p. 392). There were multiply factors that contributed to the above scenario; Larkin and Burton writes that “after this near-miss, failure to rescue incident” (p. 94) a task force consisting of management, clinical nurse specialist (CNS) and unit educator convened to discuss the event. The task force concluded that the nursing staff members were ineffectual in critically evaluating the patient’s signs and symptoms. The CNS chose a framework that utilized “Bloom’s Taxonomy of Educational Objectives”, that provided measurable outcomes to the educational activity and enabled the nursing team to optimize their critical skill levels. A workshop to assist staff to navigate through the case study in a realistic manner was implemented (Larkin & Burton, 2008, p. 95). The cognitive domain contains six intellectual skills that measure: knowledge, comprehension, application, analysis, synthesis, and evaluation of information received. The affective domain contains five emotional factors: receiving, responding, valuing, organizing, also conceptualizing and characterizing by value concept. It is during this phase that individual buy-in occurs or not. Finally, the psychomotor domain contains five motor skills functions of imitation, manipulation, precision, articulation, and naturalization.
The individual learn to adapt his or her movements intuitively to a given situation (Larkin & Burton, 2008, p. 395). The key component of continued nursing education is to advance and apply evidenced based practice at the bedside. The use of Bloom’s Taxonomy of Educational Objectives as the framework promote the transfer of evidence based information, in a setting that allow the nurse educators to evaluate and measure the learner’s: cognitive, affective and psychomotor processes. It allows the learner (nurse) to assess his or her level of application within each domain.
Both the educator and the nurse can reinforce successes and target learning opportunities to areas of inefficiency. References Blais, K. K. , & Hayes, J. S. (2011). Professional Nursing Practice Concepts and Perspective (6th ed. ). Upper Saddle River, NJ: Pearson. Bouchard, G. J. (2011, November). In Full Bloom: Helping Students Grow Using the Taxonomy of Educational Objectives. The Journal of Physican Assistance Education, 22(4), 44-46. Larkin, B. G. , & Burton, K. J. (2008, September). Evaluating a Case Study Using Blooms Taxonomy of Education. AORN, 88(3), 390-402.