Answers to the Mariotti Case Questions

CASE BACKGROUND

This week you met your new patient: Mrs Angela Mariotti is a 72 year old woman who has a terminal disease. She is living in a nursing home, as her husband can no longer care for her. As a result of her tumour she is no longer able to eat solid food without choking. Her food consistency has been downgraded to pureed, by the speech-language pathologist. Mrs Mariotti has been found to be competent to make her own decisions.

You come back from your lunch break and find her very upset, with her own lunch scattered across the floor of her room, shouting in her mother tongue. Her out-of-town daughter is visiting and has left the room, crying.

When you talk to Mrs Mariotti you find out that she is tired of pureed food and is demanding to eat pizza. You explain that solid food will likely cause her to choke and if she aspirates, will likely get pneumonia, and may even die as a result. Mrs Mariotti says she understands and is prepared to take the risk. She tells you, “This is no way to live. If I have no quality of life, what really is the point? I love my food…my real food, not this baby food you keep bringing me. I know the risk and I will take my chances.”

Progressing from last week’s information: Mrs Mariotti’s condition has worsened and she is now unable to swallow any food. Her disease has progressed quickly and she also cannot speak. She remains competent and now her husband visits every day. The health care team is considering placement of a feeding tube based upon the husband’s insistence. He agrees with the health care team that his wife will probably not live much longer, but wants the feeding tube in case the doctors are wrong.

Progressing from last week’s information: Mrs Mariotti’s general condition has remained the same since last week. She is comfortable and a decision has been made regarding the feeding tube.

The only difference is that now Mrs Mariotti has a urinary tract infection (UTI). An intravenous infusion has been inserted for antibiotic therapy and hydration purposes while she has the UTI. You overhear your colleague using a lot of jargon while informing Mrs Mariotti of this new diagnosis, and while providing teaching to her and her husband.

BELOW IS THE SAMPLE SCRIPT 

Script using own words and all related jargon to tell Mr. and Mrs. Mariotti about the urinary tract infection.

Nurse: 

Good morning, Mrs. Mariotti. I’m here today to discuss with you the results of your urinalysis. Your urine culture and sensitivity test came back positive for traces of Escherichia coli. Therefore, the doctor has diagnosed you with a urinary tract infection (UTI). A UTI means that you have an infection of the urinary system. In this case, the doctor believes that your catheter may have caused the infection. Catheter-induced UTI can occur due to long-term catheter use or backflow of the urine from the bag to your urethra. The most common symptoms are lower abdominal pain, dysuria, urgency and frequency of urination, and hematuria. The doctor has prescribed you intravenous Ceftriaxone 1G every 24 hours for 7 days. Do you know if you are allergic to Ceftriaxone or other similar Cephalosporin antibiotics? If you are, the doctor can prescribe you alternate antibiotics, such as Gentamicin or Ciprofloxacin. It is important that, while you are on this medication, you are aware of the signs and symptoms of anaphylaxis. These signs and symptoms can include fever, dyspnea, abdominal pain, urticaria or exanthem on your body. Please let me know if you experience any of these symptoms. Taking your full course of medication, hydration, and proper cleaning after a bowel movement is important and can help treat or prevent UTI. Given your condition, you will need hydration through IV therapy. Therefore, the doctor has prescribed a normal saline IV to ensure your fluid intake is adequate and to help excrete waste from the body for faster relief from the infection. Do you have questions or concerns for me at this time? Please do not hesitate to approach me should you have any questions later on. 

1. Simple script to explain the urinary tract infection to Mr. and Mrs. Mariotti.

Patient education is vital in improving patients' health through health promotion. One way to provide patient education is by using a picture board or a diagram. The nurse can deliver effective patient education using simple words and diagrams to explain urinary tract infections and other medical jargon to Mr. and Mrs. Mariotti. Therefore, the following script includes utilizing a picture board to ensure a clear understanding of urinary tract infection using effective communication and listening skills.

Nurse:

Good morning Mrs. Mariotti. How are you today?

Mr. and Mrs. Mariotti, I am here to explain to you the results of the urine sample I took from the tube connected to your bladder. The urine sample result showed the presence of a bacteria called E. Coli, which has caused an infection to your bladder or kidney. The doctor reported to me that you have what is known as a urinary tract infection. This means that you have an infection to your bladder or kidneys.

One of the ways you can get a bladder infection is by having this tube in your bladder that helps you pee. Sometimes, pee can go back up into the bladder if the tubing is not hanging properly below your hip level at the side of the bed. Another way is if some poop didn’t get properly cleansed after a bowel movement, which then can easily travel to your bladder.

Usually, this condition is treated with a pill form of antibiotics, but because we can’t give you anything by mouth, your doctor has you on a strong antibiotic that will be going through the tubing in your arm to help fight off these bacteria. You will be given this antibiotic once a day for seven days.

Your doctor also started you on fluids to help flush these bacteria out of your body. Normally, your doctor would suggest you drink a lot of water, but instead the fluid will be going through the tubing in your arm.

You should feel relief from your discomforts in about 3 days. After 3 days, please let us know if you continue to feel a fever or pain in your lower back, you feel pee seeping out around the tube, you see blood in your pee, or your pee is darker than clear yellow. The other nurses and I will continue to monitor your infection and report anything to the doctor if we don’t see improvement to this infection.

This is a strong antibiotic medication, and you may experience side effects because of how your body reacts to it. We need to know if you are experiencing any burning at the site where the tubing goes into your arms, belly pain, any watery poop, or any red, and itchy rash spots on your body. Also, we need to know if you experience fever or difficulty breathing. It is important for me to know if you are having these side effects so we can call the doctor to see what other medication can help get rid of this infection without causing you further discomfort.

Our goal is to help you feel comfortable, so please let me know if you experience any pain or discomfort. We can give you some pain medication like Tylenol to help. Is there anything more that I can do for you now? Do you have questions for me before I leave the room? Please do not hesitate to approach me should you have questions later.

As nurses, we must fully inform our patients of their current health status by providing education. In the YouTube video, Keep it Simple for Safety (2013), the narrator states to keep explanations simple and maintain safety by not using jargon. We cannot assume that everyone has the same literacy level. Therefore, by utilizing effective communication and listening skills, we believe Mr. and Mrs. Mariotti will be fully informed by keeping it simple. We also might add that an interpreter may need to be involved for a clear understanding with a language barrier because of ethnicity. By having Mr. Mariotti involved in the teaching, he can also provide an extra set of eyes to prevent further issues with the catheter, which helps empower him as a caregiver.

When thinking about jargon, how can you role model effective communication when working with the interprofessional team?

Jargon means using words or terminologies that are specific to your profession. Utilization of jargon in healthcare means using a medical vocabulary that only the medical team can understand. The CNO professional relationships practice standards (2018) stated that nurses are responsible for "role-modeling and using a wide range of communication and interpersonal skills to establish and maintain an effective and positive collegial relationship (pg. 12)." When thinking about jargon, we can model effective communication in several ways while working with an interprofessional team. Medical jargon typically leads to a breakdown in the communication between doctors and patients, resulting in inadequate medical care (Müller et al., 2018). Jargon can be a barrier to efficient interprofessional care; hence, using a simple and easily understandable language for team communication would be appropriate. Nurses can achieve successful communication and set an example by increasing self-awareness and realizing that not everyone on the healthcare team understands the jargon. When sharing our knowledge or communicating with our colleagues, nurses must pay attention to how we use words and encourage others to ask freely for clarifications if there is an unfamiliar term. Clear communication helps avoid medical errors and helps foster successful communication and collaboration with other healthcare team members. Quality of patient care is achievable only when the healthcare team builds a system and practices that promote a seamless flow of communication. It is essential to understand that the quality of patient care improves when healthcare team members collaborate to offer their distinct patient-care viewpoints (DiazGranados et al., 2018).

 Nurses are responsible "to share knowledge and show knowledge of and respect for each other's roles, knowledge, expertise and unique contribution to the health care team (CNO, 2018, pg. 12)." Nurses can model effective communication by sharing knowledge and model mutual respect through mentorship. Mentoring new nurses enables the experienced nurse to pay attention, patiently train and share their expertise with the new nurse and be a role model for open communication in a healthcare setting. To become a skilled and competent healthcare provider, one must first become a good teacher (Harden and Laidlaw, 2020). A person must be able to deconstruct all medical science's complexity into something that even a third party can comprehend. Modifying one's explanation depending on the patient is also essential to master. Torring et al. (2019) suggested that teamwork and communication improves when members know each other's roles and coordinate using shared knowledge and mutual respect. Therefore, it is important that with effective communication between healthcare team and the patients that there is a common language understood by all in providing health care services.

TO DO

Provide feedback on the scripts and create your own script. Include questions with your answers. 

1. Create a script that includes all the related jargon you can think of, to tell Mrs and Mr Mariotti about the urinary tract infection and include the teaching you must give to help them in the treatment and recovery.

• For this question, use your own words – no reference needed – because you will create a script and provide teaching (in your own words)

2. Create a simple script to explain the above situation so that Mrs and Mr Mariotti can fully understand what you explain to them.

• For this question, create a simple script that you would use to speak with Mrs/Mr Mariotti – if you are responding – has Mrs/Mr Mariotti – would you understand the script – would you say anything different? Write your own script.
• Use a reference to support your explanation – how would you explain an infection to a family member so they understand? 
• How would the family respond? 

3. When thinking about jargon, how can you role model effective communication when working with the interprofessional team?

• Explain what jargon is your own words, and explain how you would model effective communication when working with the health care team in your words;  use a short/small reference to support statement
• If responding to the post – do you agree, and what would you do differently – explain in own words, only using a reference to support your statement

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