APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
1.How might the nurse respond to Mrs. Morita’s
remarks regarding her husband’s home care?
Mr. Morita has the right to a urinary assessment to
determine if there are any underlying causes either
physical or psychological for the incontinence. The
nurse should speak to the couple to assess their feel-
ings regarding the incidents. Nursing strategies
could be implemented to promote urinary
continence prior to inserting a urinary catheter. If
these measures fail, the nurse might suggest using a
condom catheter for Mr. Morita as a possible alter-
native, rather than an indwelling catheter, which
would increase his risk for infection. The nurse
could also look into home healthcare personnel for
the couple to assist with toileting and/or light
housekeeping.
2.What would be a successful outcome for this
patient?
By next visit, Mr. Morita states two methods to pro-
mote urinary continence.
By next visit, Mrs. Morita expresses satisfaction
with urinary strategies to promote continence and
receives outside help in the home.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the anatomy and physi-
ology of the urinary systems and developmental
variables that influence urination
Technical: ability to use the equipment and proto-
cols necessary to diagnose and treat urinary
problems
Ethical/Legal: strong sense of accountability for the
health and well-being of patients experiencing uri-
nary problems
4.What resources might be helpful for the Morita
family?
Home healthcare services, printed information on
urinary incontinence and care of urinary catheters
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Mr. Eisenberg, age 84, was admitted to a nursing
home when his wife of 62 years died. He has two
adult children, neither of whom feels prepared to
care for him the way his wife did. “We don’t know
how Mom did it year after year,”his son says.
“After he retired from his law practice, he was
terribly demanding, and it just seemed nothing
she did for him pleased him. His Parkinson’s dis-
ease does make it a bit difficult for him to get
around, but he’s able to do a whole lot more
than he is letting on. He’s always been this way.”
The aides have reported to you that Mr. Eisenberg is
frequently incontinent of both urine and stool dur-ing the day as well as during the night.He is alert
and appears capable of recognizing the need to void
or defecate and signaling for any assistance. His son
and daughter report that this was never a problem
at home and that he was able to go into the
bathroom with assistance. He has been depressed
about his admission to the home and seldom
speaks, even when directly approached. He has
refused to participate in any of the floor social
events since his arrival.
2.Nursing Process Worksheet
Health Problem: Toileting self-care deficit
Etiology:Depression on entering nursing home and
decreased will to live
Signs and Symptoms: Incontinent of both urine and
stool during the day and night (need to determine
the frequency); alert and capable of recognizing and
signaling the need to void/defecate; able to walk to
bathroom with assistance
Expected Outcome: Within 2 weeks (6/17/11), patient
will communicate the need to void/defecate appro-
priately, as evidenced by reduction in incontinent
episodes to one “accident” daily.
Nursing Interventions:
a.Initiate a regular toileting schedule with the
patient in which he is assisted to the bathroom;
use these interactions to reinforce the importance
of his maintaining his independence.
b.Refrain from using adult incontinent pads or in
any way communicating that incontinence is
“OK.”
c. Call an interdisciplinary conference to develop
a strategy to ease his transition to the home.
Evaluative Statement:6/17/11: Expected
outcome partially met—when assisted to the bath-
room, the patient voids/defecates; but if the staff
neglects to offer assistance, the patient will not
use his call light to request it, and incontinent
episodes recur (more than one a day on some days).
Revision: Continue to counsel regarding transition
to the home and importance of independence.
—P. Wu, RN
3.Patient strengths: Patient is alert and capable of
expressing his needs for assistance. Mobile with
assistance.
Personal strengths: Good knowledge of
gerontologic nursing and experience in caring for
the elderly; experienced counselor and teacher of
appropriate self-care measures
4.6/15/11: A review of the patient’s record reveals
three incontinent episodes in the past 24 hours
(two urine, one stool). When asked why he did not
ask for assistance to get to the bathroom, the
patient refused to answer. Generally, he cooperates
with the toileting regimen, and when taken to the
bathroom voids/defecates as needed. Will continue
to counsel regarding the importance of his
independently managing his toileting needs. Will
reevaluate his ability to recognize the need to
void/defecate and ask for assistance.—P. Wu, RNCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:400 ANSWER KEY
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