Case study - Cancer and coping: Nursing

Nurse Rebecca works at an oncology clinic and is caring for Patricia, a 53-year-old female who had a breast biopsy confirming the diagnosis of breast cancer. Nurse Rebecca goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Patricia’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Rebecca recognizes important cues, including Patricia’s vital signs, which include, temperature 98.6 F or 37 C, heart rate 105 beats per minute, respirations 21 breaths per minute, blood pressure 138/88 mmHg, and oxygen saturation 97% on room air. Nurse Rebecca also notes that Patricia is restless, crying, and shaking and states she just doesn’t know how to handle her diagnosis.

Next, Nurse Rebecca analyzes these cues. She reviews the electronic health record, or EHR, and notes that Patricia has a family history of breast cancer. Nurse Rebecca also sees that previous nursing assessments document Patricia’s report of fatigue and difficulty sleeping. Nurse Rebecca recognizes that Patricia is experiencing emotional distress related to her breast cancer diagnosis.

Now, using the information she's gathered, along with Patricia's medical history, Nurse Rebecca chooses a priority hypothesis of difficulty coping.

Then, she generates solutions to address Patricia’s coping difficulties that will include nonpharmacologic interventions, and she establishes the expected outcome that Patricia will demonstrate effective coping skills regarding her breast cancer diagnosis by her next follow-up visit.

Nurse Rebecca then takes action to implement these solutions. After the health care provider discusses the expected treatment plan with Patricia, the registered nurse provides Patricia with education on coping strategies. Later, Nurse Rebecca follows up to see how she’s feeling about the information she’s received and to reinforce any information.

Nurse Rebecca: How are you feeling after talking with your health care provider and the RN?

Patricia: Well, I’m feeling very overwhelmed and stressed. I don’t know how I can handle this.