Case Study 2
Mary Jones, a new nurse graduate, applies for a position at a pediatric home care agency. During her interview with the agency’s clinical manager, Mary states that she has extensive experience with tracheostomy management having helped care for
her ventilator-dependent sister for many years, and that she would like to care for a child with a racheostomy. The clinical manager administers a written test to Mary. Mary receives a high score on the tracheostomy and LTV ventilator manage-ment sections. The manager accompanies Mary to the agency’s simulation lab to assess Mary’s tra-
cheostomy and ventilator skills on a mannequin. Mary performs well. There is a schedule opening for 2-year-old Jack Bell, a child with bronchopul-monary dysplasia (BPD). The clinical manager calls Jack’s mother to schedule an orientation day for Mary with one of Jack’s regular nurses, Susan, on a day that a routine tracheostomy change is
planned for Jack. During Mary’s orientation in the home, Susan shows Mary where the emergency and standard equipment and medications are located, and Mrs. Bell explains her expectations for Jack’s care. Mrs. Bell states that a primary ex-pectation is that the nurses who care for Jack are competent and vigilant and never sleep on the job.
Mary and Susan review Jack’s prescribed plan of care. The clinical manager arrives at the Bell home in time to observe Jack’s scheduled tracheostomy tube change by Susan and Mary. The tube change is completed without complication. Mary and
Susan verify correct tube placement, perform a thorough respiratory assessment, and documenhe procedures in Jack’s chart. Susan observes Mary providing independent care for the rest of the shift and quizzes her on proper response to “what-if” emergency scenarios. With Mrs. Bell’s approval, Mary is scheduled to work the following
Saturday when Mrs. Bell will be home during the shift. The clinical manager schedules her monthly supervisory visit to the Bell home to coincide with Mary’s work schedule so that she can validate Mary’s successful integration into Jack’s home care