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nursing diagnosis for alcohol withdrawal

Alcohol Withdrawal Nursing Diagnosis and Nursing Care Plan

Last updated on January 26th, 2024 at 05:18 pm

Alcohol Withdrawal Nursing Care Plans Diagnosis and Interventions

Alcohol consumption is pervasive in society; often, it is seen as a standard beverage in celebrations, fiestas, or special occasions, but it is also evident in ceremonial and religious customs.

With that said, alcohol withdrawal is the sudden discontinuance of chronic alcohol consumption after years of dependence. When alcohol is put on rapid halt, the body elicits excitatory indications—whereas signs and symptoms suggesting alcohol withdrawal manifest as delirium tremens, seizures, and mood changes.

Causes of Alcohol Withdrawal

Signs and symptoms of alcohol withdrawal, related factors to alcohol withdrawal.

Alcohol withdrawal usually occurs in individuals with unhealthy drinking habits or who experience alcohol abuse. The risk factors include the following:

Diagnosis of Alcohol Withdrawal

Treatment of alcohol withdrawal.

Mild AWS may be treated with home care and nutritional supplements. For severe cases of alcohol withdrawal characterized by DT, these may be necessary for treatment:

Nursing Diagnosis for Alcohol Withdrawal

Nursing care plan for alcohol withdrawl 1.


Observe the patient’s ability to express and respond to stimuli. Assess his/her level of consciousness.	It is essential to recognize the patient’s ability to respond since it can signify judgment and muscle coordination problems. A garbled, slurred, or disorganized speech can indicate incapacity to respond to commands and concentrate.
Observe the patient’s behavioral reactions (e.g., disorientation, hyperactivity, irritability, sleeplessness, confusion, etc.) and the onset of hallucinations. Note these factors.	A person’s change in demeanor is often helpful in determining impending hallucinations. Hyperactivity may indicate disturbances from the CNS, whereas sleeplessness is most commonly attributed to a decline in the sedative effect offered by alcohol.
Ensure the patient’s environment is stress and tension-free. Keep the surroundings quiet and peaceful and maintain calmness when approaching the patient.	Hyperactivity can aggravate if the environment is raucous and disorderly. Changing the approach, such as modulating voice in a calmer tone, is one way to reduce the onset of hallucinations and a change in the sensory-perceptual abilities.
Encourage the patient’s family, significant other, guardians, or loved ones to remain with the patient whenever possible.	Having someone reliable, the patient can depend on or find comfort from limits the risk of developing and negative thoughts. This instills a calming effect and may significantly reorganize the patient’s life.
Guide the patient in grasping and comprehending reality.	The tendency of hallucination is always a given. The patient may try to harm himself/herself or potentially others surrounding him/her; thus, it is crucial to orient the patient from distinguishing reality and fallacies.

Nursing Care Plan for Alcohol Withdrawl 2

Nursing Diagnosis: Anxiety / Fear related to a perceived threat of harm or death, secondary to alcohol withdrawal as evidenced by helplessness, feelings of remorse, panic attacks, increased BP, and heart rate.


Assess the possible cause of anxiety or fear.	The patient may have trouble identifying and comprehending the events happening around him/her. Therefore, inquiries might be difficult considering the lack of awareness. Determining the cause is critical to ascertain whether environmental or physiologic factors cause anxiety.
Reexamine the patient’s anxiety level now and then.	To identify the stage of anxiety or fear and to mitigate it when alarming signs are observed.
Educate the patient on the consequences of alcohol withdrawal.	Perpetual alcohol intoxication can lead to anxiety and over apprehension, and this is made possible when the effect of alcohol slowly wears off. Educating the patient would lead to awareness of the situation, thereby giving him/her a sense of control.
Inform the patient of the nurse’s duties and responsibilities.	It builds a rapport of mutual trust between the patient and nurse.
During the planning process, ensure the patient’s inclusion and, if possible, provide options he/she can choose from.	Including the patient in the planning process will likely reduce his/her stress and anxiety level.
Establish a trusting bond with the patient by approaching him/her with a non-judgmental attitude and projecting acceptance instead.	To promote compassion and humanness. Accepting the patient despite the matter of alcoholism will reduce their sense of distrust and paranoia.
Frequently reinstruct and reorient the patient.	The patient may have occasional periods of confusion and hallucination; thus, reorientation whenever this instance alarmingly arises is equally essential as checking up the patient.
Monitor the patient for signs of depression.	The patient’s demeanor will likely show signs of depression, and recognizing these red flags should be pivotal to mitigate the patient’s tendencies.

Nursing Care Plan for Alcohol Withdrawl 3

Desired Outcome: The patient’s vital signs will normalize with a marked decrease of dysrhythmias.

	Rationales
During acute withdrawal, frequently monitor the patient’s vital signs.	In the acute withdrawal phase, a serious potentiating indication to observe is the development of hypertension. The increase in BP and heart rate is attributable to extreme hyperactivity. On another side, BP fluctuations may also arise due to disease progression. It is important to note that patients suffering from alcohol withdrawal are often compounded with another complication, an underlying cardiovascular disease; therefore, hypotension is induced.
Monitor the patient’s cardiac rhythm and cardiac rate, noting aberrations and irregularities in the heart rhythm.	When there is long-term alcohol abuse, it potentiates the risk of developing cardiomyopathy or heart failure. Other irregularities such as dysrhythmias arise from a shift in the electrolyte balance, therefore deterring cardiac function and heart output. Additionally, tachycardia may also occur due to a sympathetic output (e.g., hypoxia) and an increased catecholamine release.
Monitor the intake and output of the patient’s fluid and electrolytes—document the 24 hours fluid and electrolyte balance.	In an alcoholic patient, hydration is usually assessed (albeit unreliable) to determine an implicated cardiac function. Dehydration, diaphoresis, and fever are common markers indicating cardiac disease. Untreated overhydration is another risk to be wary of as it arises from electrolyte imbalance in the presence of a compromised cardiac output.
Administer the required fluids and electrolytes as prescribed.	Chronic alcohol abuse predisposes the patient to fluid loss and electrolyte imbalances (e.g., magnesium, potassium, glucose), as mandated by fever, vomiting, and cold sweats.
Evaluate and monitor the patient’s laboratory results, such as the electrolyte panel.	To monitor electrolyte imbalances (e.g., magnesium, potassium) that could translate to the patient’s risk of developing CNS hyperactivity and dysrhythmias.

Nursing Care Plan for Alcohol Withdrawl 4


Frequently assess the patient’s respiratory rate, depth, and pattern of inhalation.	Monitoring these vital signs and aspect is essential due to the shifting motion of toxicity levels. During the withdrawal phase, hyperventilation is one of the most typical signs in the acute withdrawal phase. Similarly, marked hypoventilation is associated with the depression effect of alcohol during acute intoxication. And to control alcohol withdrawal symptoms, the usage of drugs is synthesized.
Perform lung auscultation to monitor the patient’s breath sounds. Observe the presence of respiratory noises like rhonchi and wheezing.	Patients exemplifying withdrawal symptoms are at risk of developing atelectasis due to respiratory depression and pneumonia. Atelectasis is unilateral; therefore, lung collapse may set in. For alcohol debilitated patients, pneumonia in the right lower lobe is common and is attributable to chronic . Other lung diseases may also come about, such as and emphysema.
Encourage the patient to perform deep-breathing exercises and recurrent position changes; likewise, suggest coughing when necessary.	The patient may develop complications when there is limited lung expansion. And doing such exercises and position changes would promote lung expansion. Coughing is also one way to reduce the risk of atelectasis and pneumonia since this will mobilize secretions and improve ventilation.
Ensure that the patient’s head is elevated.	To decrease the risk of aspiration as it depresses the diaphragm, increasing the chance of lung inflation.
Always have a piece of available suction equipment, airway adjuncts, and supplemental oxygen.	Alcohol and drugs have sedative effects, and this adverse influence heightens the risk of hypoventilation, aspiration, and oropharyngeal muscle relaxation, all of which are grounds for intervention as they will potentiate respiratory arrest. Another risk is hypoxia as it simultaneously arises with CNS and hypoventilation; hence, supplemental oxygen may be necessary if the situation needs so.
Monitor the patient’s series of chest x-rays, pulse oximetry, and arterial blood gasses as indicated.	Reviewing and monitoring the patient’s serial test results can identify possible grounds or suspicions of secondary complications (e.g., pneumonia and atelectasis). It will also help evaluate respiratory effort effectiveness and denote therapy necessity.

Nursing Care Plan for Alcohol Withdrawl 5

Nursing Diagnosis: Risk for Injury related impaired motor and sensory function, secondary to alcohol withdrawal


Assess the patient’s stage of alcohol withdrawal syndrome (AWS); for instance: stage I is characterized by absence of signs and symptoms of hyperexcitability and hyperactivity (e.g., sleeplessness, vomiting, tremors, nausea, tachycardia, cold sweats, and vomiting), whereas stage II is characterized by signs and symptoms of delirium tremens, severe autonomic hyperactivity along with anxiety, sleeplessness, and anxiety.	It is essential to distinguish the stage of AWS as it recognizes the need for immediate intervention. Likewise, prevention improves prognosis and moderate the progression of the disease, thereby increasing the chance of recovery. It will also provide information on the possible relapse of the disease that could indicate the need for treatment modifications.
Monitor and record the patient’s seizure episodes. Ensure that the airway is free of obstructions and there are padded coverings in the bed’s side rails.	The most common type of seizure linked to elevated blood alcohol levels and decreased glucose and magnesium levels is generalized tonic-clonic seizures. Careful observation of the patient’s seizure activity, particularly grand mal seizures, and the use of protective covering or material would ensure the patient’s safety during such episodes. These seizures are usually self-limiting (as long as they are absent in the patient’s medical history), requiring only palliative or systematic treatment.
Support the patient during ambulatory and self-aid activities.	To assist and prevent the patient from falling or injuring himself/herself.
Ensure that the patient’s environment is secure and safe by promoting healthy and protective practices.	To promote the patient’s safety and wellness, especially if there is poor hand-eye coordination.

Nursing References

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes . St. Louis, MO: Elsevier. Buy on Amazon

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Improving Nursing Knowledge of Alcohol Withdrawal

Second generation education strategies.

Berl, Kimberly MSN, RN, PCCN; Collins, Michelle L. MSN, RN-BC, ACNS-BC; Melson, Jo MSN, RN, FNP-BC; Mooney, Ruth PhD, MN, RN-BC; Muffley, Cheryl MSN, RN-BC; Wright-Glover, Angela MSN, RN-BC

Kimberly Berl, MSN, RN, PCCN, is a Staff Development Specialist for the Stepdown and Intensive Care Unit, Wilmington Hospital of Christiana Care Health System, Delaware.

Michelle L. Collins, MSN, RN-BC, ACNS-BC, is Director of Nursing Professional Development and Education, Christiana Hospital of Christiana Care Health System, Wilmington, Delaware.

Jo Melson, MSN, RN, FNP-BC, is a Nurse Practitioner, Wilmington Hospital of Christiana Care Health System, Delaware.

Ruth Mooney, PhD, MN, RN-BC, is a Nursing Research Facilitator, Christiana Care Health System, Wilmington, Delaware.

Cheryl Muffley, MSN, RN-BC, is a Staff Development Specialist for a Medical Stepdown Unit and the Express Admission Unit, Christiana Hospital of Christiana Care Health System, Wilmington, Delaware.

Angela Wright-Glover, MSN, RN-BC, is a Staff Development Specialist for two medical-telemetry units, Christiana Hospital of Christiana Care Health System, Wilmington, Delaware.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site ( www.jnpdonline.com ).

ADDRESS FOR CORRESPONDENCE: Kimberly Berl, MSN, RN, PCCN, Wilmington Hospital, 501 W. 14th Street, P.O. Box 1668, Wilmington, DE 19801 (e-mail: [email protected] ).

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0 .

Christiana Care Health System implemented a Care Management Guideline for Alcohol Withdrawal Symptom Management, which provided direction for inpatient screening for alcohol withdrawal risk, assessment, and treatment. Nurses educated on its use expressed confusion with the use of the assessment tools, pharmacokinetics, and pathophysiology of alcohol withdrawal and delirium tremens. Reeducation was provided by nursing professional development specialists. Pre- and postsurveys revealed that nurses were more confident in caring for patients with alcohol withdrawal.

The National Survey of Drug Use and Health, conducted from 2008 to 2012, reveals that 7.1% of Delawareans aged 12 or older describe themselves as dependent upon alcohol or abusive of alcohol in the previous year. In addition, 7.4% of these individuals considered themselves heavy users of alcohol, and yet only 3.8% received treatment—trends that are comparable to national averages ( Substance Abuse and Mental Health Services Administration, 2013 ). Throughout the nation, the number of adults admitted to a hospital with an alcohol use disorder increased significantly from 2006 to 2010 ( National Institute on Alcohol Abuse and Alcoholism, 2013 ), translating to approximately one in five admitted adult patients ( Elliott, Geyer, Lionetti, & Doty, 2013 ).

If untreated, up to 6% of patients with an alcohol use disorder will experience alcohol withdrawal when alcohol is withheld, with up to 10% of those progressing to delirium tremens (DT), a potentially life-threatening complication ( Melson, Kane, Mooney, McWilliams, & Horton, 2014 ). Screening and early management of alcohol withdrawal prevents progression of symptoms and further deterioration to DT ( Pecoraro et al., 2012 ). Before implementing the Care Management Guideline (CMG) for Alcohol Withdrawal Symptom Management, patients admitted to the largest healthcare system in Delaware were not evaluated for the potential of experiencing alcohol withdrawal, nor were they assessed or recognized until their behavior escalated to a crisis. The CMG for Alcohol Withdrawal Symptom Management is a hospital system tool developed by an interdisciplinary care team used to aid clinicians and providers in the management of this patient population. Prior to program implementation, severe symptoms arose before staff knew that patients were experiencing alcohol withdrawal. Delay in diagnosis and treatment resulted in suboptimal patient outcomes. Because of the absence of a protocol, patients experiencing escalating alcohol withdrawal were often transferred to an intensive care unit (ICU). Consequently, nurses and providers working outside of ICU were not prepared or educated to adequately manage the complexity of these patients.

The model of change that served as the framework of this process was Lewin’s change model. Kurt Lewin, a social psychologist, postulated a three-stage theory of change: unfreezing, change, and freezing or refreezing ( Lewin, 1947 ). For change to be successful, the driving forces for the change must be strengthened ( Shirey, 2013 ). For this project, such forces included safety considerations for nurses and patients, a desire on the part of the hospital to better manage patients with alcohol withdrawal, thus preventing DT and decreasing use of ICU and rapid response teams for this subset of patients. The nurses caring for patients experiencing alcohol withdrawal were unaware of the physiology of alcohol withdrawal and DT, and lacked confidence in caring for this patient population. They also felt that it would require more time to care for these patients, thus depriving other patients of their “share” of the nurse’s time. According to Lewin’s theory, these attitudes and beliefs are known as restraining forces, and these must be weakened in order for the change to occur successfully ( Shirey, 2013 ).

PHASE I: EDUCATION BEFORE IMPLEMENTATION OF THE CMG

Nursing professional development (NPD) specialists educated nurses and providers on the use of the new protocol before implementation. Education was provided by NPD specialists using small groups on individual patient care units, and larger groups of nurses from multiple units in a classroom setting.

There was much resistance to this initial education, both by NPD specialists and staff nurses. The short time frame designated for educating all of the nurses was challenging, and most NPD specialists had not previously used the Clinical Institutes Withdrawal Assessment-Alcohol revised (CIWA-Ar). The CIWA-Ar is a symptom-based assessment tool that quantifies the level of alcohol withdrawal symptoms, and helps determine appropriate Benzodiazepine dosing when the patient has a history of alcohol use. It is a freely distributed and widely used tool easily accessed via the Internet. The CIWA-Ar is widely used in both acute care and outpatient settings because of its high level of interrater reliability and ease of use. It is comprised of 10 questions and indicates the level of withdrawal the patient may be experiencing ( Sarff & Gold, 2010 ). Although relatively uncomplicated to administer, the CIWA-Ar does require instruction and a level of familiarity with its questions. Therefore, the NPD specialists needed instruction on how to properly perform the assessment and how to appropriately intervene. An educational slide presentation on risk assessment and the CIWA-Ar tool was reviewed with the NPD specialists by one of the advance practice nurses (APN) leading the project. Education included Nursing Grand Rounds and a No Harm Intended session. Nursing Grand Rounds is a presentation developed by nurses, and focuses on specific case studies and lessons learned. No Harm Intended sessions are presented by an interdisciplinary team for all healthcare team members, and cover actual or potential issues within the healthcare system. Providing education using an interdisciplinary approach allows a free exchange of ideas across fields, fosters an appreciation and understanding of others’ areas of expertise, and provides all those involved with an opportunity to learn from each other. Alcohol withdrawal served as a topic for both of these forums, and concentrated on situations where inpatients placed themselves or staff at high risk for injury. Nurses from inpatient units recounted difficult experiences with patients actively withdrawing from alcohol. Content experts provided information about the history of alcohol abuse management, basic pathophysiology of alcohol abuse, and current practice within our healthcare system. Key aspects of the new alcohol withdrawal CMG were introduced. The CMG included the Alcohol Withdrawal Risk Assessment (AWRA), the CIWA-Ar, order sheet, and algorithms. Completed on admission, the AWRA determines the risk for alcohol withdrawal. A score of 5 or greater prompts the nurse to complete the CIWA-Ar.

Many nurses felt the care of patients experiencing alcohol withdrawal was extremely difficult to manage and required increased nursing resources. Often times, these patients required high dosages of medication to alleviate their withdrawal symptoms, which many floor nurses were uncomfortable administering. In addition, there were several instances of patients attempting to harm themselves or harm others while withdrawing from alcohol, which contributed to nurses’ fear for patient and staff safety. Unfortunately, completing the AWRA and following the CMG were viewed as simply additional tasks for them to perform. The benefits of treating patients with alcohol withdrawal on the medical surgical units, rather than in the ICUs, were not clear to the nurses. These were some of the restraining forces that had to be addressed in order to successfully implement this new process.

INITIAL EVALUATION OF CMG IMPLEMENTATION

Documentation review.

Point prevalence assessment conducted via chart review hospital-wide one month after implementation helped to determine compliance. Nurses gathered data and were asked to determine if the AWRA was completed on admission. If the AWRA score was 5 or greater, nurses were instructed to complete a baseline CIWA-Ar. In addition, the provider was to be contacted to initiate the appropriate treatment plan and order set. In March of 2010, of the 184 charts that were reviewed, 96 (52%) had the AWRA completed. All of the patients who scored 5 or greater on the AWRA had the CIWA-Ar initiated. In April of 2010, charts for 224 patients were reviewed. Of those, 141 (63%) had the AWRA completed. Again, all of the patients who scored 5 or greater on the AWRA had the CIWA-Ar initiated. The results also showed that five patients scored 8 or greater on the CIWA-Ar; however, two of these patients did not have the CMG initiated. Moreover, these findings revealed opportunities for additional education regarding use of the AWRA and the CMG.

Focus Group

An APN involved in the alcohol withdrawal task force led a focus group to determine concerns or problems that staff nurses encountered related to implementation of the CMG. The format of the focus group included eight open-ended questions to solicit information and keep the discussion focused. Nurse managers sent staff from their units to provide representative opinions from their respective units. Two APNs with knowledge of the CMG and experience in leading focus groups facilitated, and two nurses not involved in the discussion documented the sessions.

The following themes emerged as listed in Table 1 :

Reeducation needs,
Effective use of CIWA-Ar scores,
Increased burden of caring for patients on medical-surgical units,
Limitations of the form used for documentation, and
Ethical dilemmas.

An education subcommittee of the alcohol withdrawal team was formed in order to address knowledge gaps and assist in developing second-generation education for staff using information obtained from the focus group and other feedback. The purpose of this team was to facilitate understanding among nurses through reeducation. Units with the highest incidence of patients with the discharge diagnosis of alcohol withdrawal and/or DT were chosen to pilot this second generation of education.

PHASE II: EDUCATION FOLLOWING IMPLEMENTATION OF THE CMG

Focus group feedback, staff comments, and discussion with the interdisciplinary team revealed confusion around the correct meaning of the AWRA and CIWA-Ar scores. Furthermore, the scores were being reported to the providers interchangeably. It was clear that there was a need to remedy and clarify this misunderstanding quickly. A Safety First Alert , a rapid communication process to disseminate key safety practices and education across the organization, was used in December 2009 to provide timely communication to the appropriate staff, and focused on clarifying the difference between the two assessment tools: the AWRA score as an initial screening tool and the CIWA-Ar score as a symptom-based assessment and management tool.

According to Lewin’s Theory of Planned Change, driving forces must be identified and presented to all involved to ensure a successful transition ( Shirey, 2013 ). In this case, these forces included increased patient safety and a decrease in the incidence of DT, ICU transfers, and rapid response teams. NPD specialists were now actively involved in the alcohol withdrawal committee, and their expertise in nursing development and education was utilized to address targeted learning needs. The educators were better able to understand nursing’s various concerns and determine the focus for our educational methods in order to focus on the driving forces and bring about positive change. The goal was to educate nurses to recognize alcohol withdrawal symptoms before patients advanced to DT, and initiate treatment before the onset of severe symptoms. Therefore, education focused on increasing nurses’ depth of knowledge about the differences between Alcohol Withdrawal Syndrome versus DT. On the basis of focus group results, small group discussions occurred with the alcohol withdrawal team and staff. NPD specialists presented second-generation education using educational slides and included content in the following areas:

physiology of alcohol withdrawal and DT;
mechanism of action of benzodiazepines, dosing, and frequency of administration for effective management of alcohol withdrawal;
directions on how to complete the CIWA-Ar;
correct use of the newly implemented electronic AWRA and CIWA-Ar forms; and
mobilization of additional resources.

This second phase of education included greater sensitivity to environmental distraction, so educators used small group instruction in break rooms.

Electronic versions of the AWRA and the CIWA-Ar forms introduced a year after initial program implementation in October 2010 now sends an electronic reminder that alerts the nurse to complete the AWRA upon admission. This transformational change reminds nurses automatically to complete the CIWA-Ar and to intervene in a timely manner.

EVALUATION OF THE CMG IMPLEMENTATION AFTER PHASE II EDUCATION

For three consecutive quarters following completion of secondary education, charts of patients with a discharge diagnosis of alcohol withdrawal or DT were reviewed as delineated in Table 2 . Increases in the percentage of AWRA completed were seen (79% in the fourth quarter of 2010, 87% in the first quarter of 2011, and 90% in the second quarter of 2011). The CIWA-Ar was administered in 94%, 100%, and 98% of patients whose charts were reviewed. One reason more patients had a greater number of CIWA-Ar completed than AWRA is that AWRA is not always completed in critical care units. Often times in these units, patients are unable to communicate verbally during the admissions process, thereby preventing an accurate assessment. Families are requested to provide the information, but are often times unable to offer a thorough history. Patients may have been admitted to these units and then later transferred to noncritical care areas.

NPD specialists knew it was important to evaluate the effectiveness of the education. The survey instrument and education plan were developed by the NPD specialists and validated by the alcohol withdrawal team. The preeducation survey consisted of four questions with Likert scale responses from 1 to 4, with 1 being none and 4 being extensive . As shown in Table 3 , one additional question was added to the posteducation survey regarding the impact of the electronic version of the CIWA-Ar.

Surveys were conducted using Zoomerang and were distributed to approximately 250 nurses on five medical units. These units were selected based on the number of patients with a discharge diagnosis of alcohol withdrawal. Preeducation surveys were conducted in October 2010, and posteducation surveys were conducted in January 2011. Responses were obtained from 88 nurses in the preeducation survey and 92 in the posteducation survey.

As shown in Figure, Supplemental Digital Content 1, https://links.lww.com/JNPD/A6 , the preeducation survey revealed that many nurses rated their knowledge of the CIWA-Ar assessment tool as moderate, substantial, or extensive. This was unexpected based on the feedback from the focus group discussion, as we expected the ratings to be much lower. The posteducation survey showed that nurses’ ratings of their knowledge of the CIWA-Ar assessment tool increased. The greatest changes occurred in the moderate, substantial, and extensive categories with a decrease in the number of nurses rating their knowledge as moderate and an increase in the number of nurses rating their knowledge as either substantial or extensive. There were improvements in ratings for all questions despite the high preeducation ratings. The second-generation education was designed to overcome the lack of knowledge needed in order to adequately care for patients at risk for or experiencing alcohol withdrawal.

Nurses were asked to rate their comfort level in caring for alcohol withdrawal patients and in using the alcohol withdrawal algorithm before and after education. Nurses rated their comfort level as none, limited, moderate, substantial, or extensive. As shown in Figure, Supplemental Digital Content 2, https://links.lww.com/JNPD/A7 statistically significant differences were found in comfort level caring for alcohol withdrawal patients, with six nurses rating their comfort limited on the presurvey and choosing that rating on the postsurvey, a decrease in nurses rating their comfort level as moderate (45 pre; 32 post) and an increase in those rating their comfort level as substantial (38 pre; 47 post). There was no change in nurses rating their comfort level as extensive (11 pre and post). Mann–Whitney U test was performed, and differences from pre to post were statistically significant ( p = .051). Comfort level with the alcohol withdrawal algorithm showed a similar pattern of change; however, this was not statistically significant, with a Mann–Whitney U test of p = .073.

Additional analysis revealed the impact of electronic assessment on the nurses’ ability to manage patients experiencing alcohol withdrawal. Figure, Supplemental Digital Content 3, https://links.lww.com/JNPD/A8 illustrates the majority (68%) of nurses rated the electronic CIWA-Ar task as having substantially or extensively improved their ability to care for this patient population. Of the remaining nurses who responded to the survey, 24% indicated moderately, 7% limited, and only 1% rated the impact as none.

Several lessons were learned from this project related to implementing change across multiple patient care units. Initially, we did not emphasize the rationale for the practice change or the physiology of alcohol withdrawal and treatment modalities. Consequently, the initial education lacked several key components and was inhibited by hastened time line for implementation. In listening to staff, the need for additional education was noted. Recognizing the value of our nurse educators in the development and planning of learning content to address behavior change, their involvement was requested. Lastly, we failed to appreciate the benefit of conducting a pilot as a means of discovering the shortcomings of our practice change.

Lewin theorized that, in order to move through the stages of change successfully, there needs to be a comprehensive action plan to engage those experiencing the transition ( Shirey, 2013 ). Unfortunately because of the pressing nature of the issues at hand, this step was overlooked in the original education plan, and therefore, the project was set up to fail. When the second generation of education was implemented, the alcohol withdrawal team and NPD specialists made great efforts to ensure that frontline staff understood the necessity and benefit of the change. By utilizing the focus groups and surveys, nurses felt their voices had been heard and were now able to unfreeze their behaviors and successfully navigate the transition. Over the past year, members of the alcohol withdrawal task force and education committee have informally rounded with bedside nurses. The conversations they have had throughout the organization support these results. These discussions revealed that they now consider themselves experts in caring for patients with alcohol withdrawal. One nurse stated, “We are seasoned nurses and we know how to take care of patients with alcohol withdrawal.” These statements indicate that nurses have “refrozen” their beliefs and new behaviors. Because of these findings and our commitment to our change model, similar education was later provided to nurses throughout the health system.

Use of the CMG has changed the course for patients admitted to the hospital at risk for alcohol withdrawal and has also increased the confidence level of nurses caring for patients at risk for alcohol withdrawal. Successful education, planning, and proper execution of the CMG by nurses and providers had direct positive impact on this patient population.

PATH FORWARD

Results of the pre- and postsurveys revealed successful reeducation efforts, and education for the remainder of the medical, surgical, and stepdown units was based on these results. A simulation involving a standardized patient experiencing alcohol withdrawal and DT was part of a collaborative learning project for resident physicians and novice nurses. Currently, an additional alcohol withdrawal simulation scenario, coupled with didactic classroom content, is incorporated into nursing orientation. Future strategies will include incorporation of alcohol withdrawal into a Web-based education module for all nurses to complete on an annual basis, and development of a video about a patient experiencing alcohol withdrawal. Through the provision of nursing education regarding alcohol withdrawal, nurses’ comfort level in caring for alcohol withdrawal patients has improved. By increasing their knowledge, nurses are more confident in caring for patients suffering from alcohol withdrawal, potentially improving multidisciplinary communication and clinical outcomes.

Supplemental Digital Content

JNPD_36_1_2015_11_04_BERL_14-458_SDC1.pdf; [PDF] (121 KB)
JNPD_31_6_2015_11_04_BERL_14-458_SDC2.pdf; [PDF] (63 KB)
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Alcohol Dependence in Acute Withdrawal (Case Study)

{{ (moduleVm.actions && moduleVm.changeStatus) ? moduleVm.status : '' }} Alcohol Dependence in Acute Withdrawal (Case Study)

Activity steps, description, learning objectives.

After completing this continuing education activity you will be able to:

outline a nursing care plan for an alcohol-dependent patient in acute alcohol withdrawal.
list nursing interventions that are designed specifically for working with a patient in acute withdrawal for alcohol dependence, including hourly monitoring with the Clinical Institute Withdrawal Assessment for Alcohol, Revised Edition (CIWA-Ar) instrument and symptom-based pharmacologic management of withdrawal based on CIWA-Ar scores.
identify discharge issues that can occur when working with a patient in acute withdrawal as well as interprofessional team members who can support the patient and family throughout the patient's recovery.

Learning Outcomes

Disclosures.

The authors and planners have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this learning activity.

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Case Study and Treatment Plan: Major Depressive Disorder and Alcohol Use

Info: 4892 words (20 pages) Nursing Case Study Published: 5th May 2020

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Tagged: mental health depression alcohol misuse

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Medical supervision for Alcohol Withdrawal (inpatient admission for detoxification)
Residential rehabilitation
Pharmacotherapy for post detoxification support and in an attempt to prevent relapse
AOD counselling weekly for support
AA Meetings weekly for peer support in relapse prevention
Personal counselling
Psychology sessions (ie Cognitive Behavioural Therapy (CBT))
Taking medication as prescribed
Attending weekly AOD counselling sessions
Attending weekly AA meetings
Attending regular counselling
Attending psychology (CBT) sessions
Able to indicate some positivity and hope for his future
Regular attendance at gardens with support worker
Regular conversations with family members and support people

Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.

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Brown, R. A., & Ramsey, S. E. (2000). Addressing comorbid depressive symptomatology in alcohol treatment. Professional Psychology: Research and Practice , 31 (4), 418.
Durie, M. (1998). Whaiora: Maori health development. Oxford University Press
Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B. Z., Keith, S.J., Judd, L. L., & Goodwin, F.K.(1990) Comorbidity of Mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. Journal of the American Medical Association, 264,2511-2518
Turner, R., & Wehl, C. (1984). Treatment of unipolar depression in problem drinkers. Advances in behavioural research and Therapy, 6, 115-125

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Improving Nursing Knowledge of Alcohol Withdrawal

Associated data.

(See CE Video, Supplemental Digital Content 1, http://links.lww.com/JNPD/A9 )

PHASE I: EDUCATION BEFORE IMPLEMENTATION OF THE CMG

INITIAL EVALUATION OF CMG IMPLEMENTATION

Documentation review.

Focus Group

The following themes emerged as listed in Table Table1 1 :

Focus Group Themes

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Reeducation needs,
Effective use of CIWA-Ar scores,
Increased burden of caring for patients on medical-surgical units,
Limitations of the form used for documentation, and
Ethical dilemmas.

PHASE II: EDUCATION FOLLOWING IMPLEMENTATION OF THE CMG

physiology of alcohol withdrawal and DT;
mechanism of action of benzodiazepines, dosing, and frequency of administration for effective management of alcohol withdrawal;
directions on how to complete the CIWA-Ar;
correct use of the newly implemented electronic AWRA and CIWA-Ar forms; and
mobilization of additional resources.

This second phase of education included greater sensitivity to environmental distraction, so educators used small group instruction in break rooms.

EVALUATION OF THE CMG IMPLEMENTATION AFTER PHASE II EDUCATION

For three consecutive quarters following completion of secondary education, charts of patients with a discharge diagnosis of alcohol withdrawal or DT were reviewed as delineated in Table Table2. 2 . Increases in the percentage of AWRA completed were seen (79% in the fourth quarter of 2010, 87% in the first quarter of 2011, and 90% in the second quarter of 2011). The CIWA-Ar was administered in 94%, 100%, and 98% of patients whose charts were reviewed. One reason more patients had a greater number of CIWA-Ar completed than AWRA is that AWRA is not always completed in critical care units. Often times in these units, patients are unable to communicate verbally during the admissions process, thereby preventing an accurate assessment. Families are requested to provide the information, but are often times unable to offer a thorough history. Patients may have been admitted to these units and then later transferred to noncritical care areas.

Alcohol Withdrawal Assessment From Chart Review

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NPD specialists knew it was important to evaluate the effectiveness of the education. The survey instrument and education plan were developed by the NPD specialists and validated by the alcohol withdrawal team. The preeducation survey consisted of four questions with Likert scale responses from 1 to 4, with 1 being none and 4 being extensive . As shown in Table Table3, 3 , one additional question was added to the posteducation survey regarding the impact of the electronic version of the CIWA-Ar.

Items on Pre- and Postsurvey

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As shown in Figure, Supplemental Digital Content 1, http://links.lww.com/JNPD/A6 , the preeducation survey revealed that many nurses rated their knowledge of the CIWA-Ar assessment tool as moderate, substantial, or extensive. This was unexpected based on the feedback from the focus group discussion, as we expected the ratings to be much lower. The posteducation survey showed that nurses’ ratings of their knowledge of the CIWA-Ar assessment tool increased. The greatest changes occurred in the moderate, substantial, and extensive categories with a decrease in the number of nurses rating their knowledge as moderate and an increase in the number of nurses rating their knowledge as either substantial or extensive. There were improvements in ratings for all questions despite the high preeducation ratings. The second-generation education was designed to overcome the lack of knowledge needed in order to adequately care for patients at risk for or experiencing alcohol withdrawal.

Nurses were asked to rate their comfort level in caring for alcohol withdrawal patients and in using the alcohol withdrawal algorithm before and after education. Nurses rated their comfort level as none, limited, moderate, substantial, or extensive. As shown in Figure, Supplemental Digital Content 2, http://links.lww.com/JNPD/A7 statistically significant differences were found in comfort level caring for alcohol withdrawal patients, with six nurses rating their comfort limited on the presurvey and choosing that rating on the postsurvey, a decrease in nurses rating their comfort level as moderate (45 pre; 32 post) and an increase in those rating their comfort level as substantial (38 pre; 47 post). There was no change in nurses rating their comfort level as extensive (11 pre and post). Mann–Whitney U test was performed, and differences from pre to post were statistically significant ( p = .051). Comfort level with the alcohol withdrawal algorithm showed a similar pattern of change; however, this was not statistically significant, with a Mann–Whitney U test of p = .073.

Additional analysis revealed the impact of electronic assessment on the nurses’ ability to manage patients experiencing alcohol withdrawal. Figure, Supplemental Digital Content 3, http://links.lww.com/JNPD/A8 illustrates the majority (68%) of nurses rated the electronic CIWA-Ar task as having substantially or extensively improved their ability to care for this patient population. Of the remaining nurses who responded to the survey, 24% indicated moderately, 7% limited, and only 1% rated the impact as none.

PATH FORWARD

Supplementary Material

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Elliott D. Y., Geyer C., Lionetti T., Doty L. (2013). Managing alcohol withdrawal in hospitalized patients . Nursing 2013 Critical Care , 8 ( 3 ), 36– 44. doi: 10.1097/01.CCN.0000429387.18097.a9 [ PubMed ] [ Google Scholar ]
Lewin K. (1947). Frontiers in group dynamics: Concept, method, and reality in social science; social equilibria and social change . Human Relations , 1 ( 5 ), 5– 41. doi: 10.1177/001872674700100103 [ Google Scholar ]
Melson J., Kane M., Mooney R., McWilliams J., Horton T. (2014) Improving alcohol withdrawal outcomes in acute care . The Permanente Journal , 18 ( 2 ), e141– e145. http://dx.doi.org/10.7812/TPP/13-099 [ PMC free article ] [ PubMed ] [ Google Scholar ]
National Institute on Alcohol Abuse and Alcoholism. (2013). Alcohol-related emergency department visits and hospitalizations and their co-occurring drug-related, mental health, and injury conditions in the United States: Findings from the 2006–2010 Nationwide Emergency Department Sample (NEDS) and Nationwide Inpatient Sample (NIS) (NIH Publication No. 13–8000) . Retrieved from http://pubs.niaaa.nih.gov/publications/NEDS&NIS-DRM0.pdf [ Google Scholar ]
Pecoraro A., Horton T., Ewen E., Becher J., Wright P. A., Silverman B., Woody G. E. (2012). Early data from Project Engage: A program to identify and transition medically hospitalized patients into addictions treatment . Addiction Science & Clinical Practice , 7 , 20 doi: 10.1186/1940-0640-7-20 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Sarff M., Gold J. A. (2010). Alcohol withdrawal syndromes in the intensive care unit . Critical Care Medicine , 38 ( 9 Suppl ), s494– s501. [ PubMed ] [ Google Scholar ]
Shirey M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource . The Journal of Nursing Administration , 43 ( 2 ), 69– 72. [ PubMed ] [ Google Scholar ]
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Alcohol Withdrawal Case Study (45 min)

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The patient is a 45-year-old male who is a “frequent flyer” in the emergency room for abdominal pain. The patient always has a high ETOH level and demands to be given 3 macaroni and cheese dishes, 2 chicken sandwiches and 2 whole milk cartons. Vital signs are as follows:

Temp 98.6°F orally

Given that he will be admitted to the hospital for a few days without access to alcohol, what protocol medication needs to be ordered for this patient?

Benzodiazepine (Librium, Ativan)

What question needs to be asked in regard to the patient’s alcohol intake?

When the last drink was.

The patient reports he drank 2 pints of liquor and a 6-pack of beer tonight. The patient is telling the nurse that he is serious this time and is going to quit drinking for the holidays so that his family will let him come over for Christmas. The patient is slurring his speech and has a history of trying to elope from the hospital.

What precautions does the nurse need to set up for this patient?

Seizure precautions, fall precautions and elopement precautions.
He should also be placed on CIWAA protocol

The patient has an IV line, labs are drawn and the patient has their meal. The blood alcohol level comes back 395 mg/dL. The nurse knows that the patient will metabolize 100 mg/dL every four hours and that the patient is no longer legally intoxicated once it falls to less than 80 mg/dL.

When will this patient likely be no longer legally intoxicated? What is the implication of this time period?

In 12.6 hours.
After this point, the patient is at risk for alcohol withdrawal symptoms

What medications will the doctor likely order for this patient to replace vitamins?

IV fluids with folic acid, thiamine and magnesium sulfate added.
This is also called a banana bag or rally pack.

The patient has been in the hospital for 14 hours now and is no longer legally intoxicated. The vital signs have stabilized and the patient is alert and oriented x4. The patient remains hopeful to stop drinking and is asking for additional help to stay sober.

What medication could be ordered for this patient to help keep him sober?

What education does this patient need in order to be successful on this medication.

Avoiding mouthwash, cold medications, aftershaves or anything else that has alcohol in it to avoid having a reaction.
As well as the reaction (they become immediately ill N/V/D) if they consume alcohol while on Antabuse.

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This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.

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Tackling negative healthcare bias in addiction treatment

Researchers at the Monash Addiction Research Centre and Turning Point have uncovered multiple examples of stigma within Australia’s health system , as well as processes and procedures that act as barriers when people seek help as a result of harm from alcohol and other drugs (AOD).

The findings also suggest health professionals may not be aware that the everyday processes and language they use could perpetuate stigma and negatively affect the people they are treating.

“I remember the worst time when I presented to hospital,” explained a patient with substance use problems that developed after suffering a back injury from their time in the defence force.

“I asked if I could get a bottle to urinate in, and one of the nurses just sort of scoffed at me and said she’s got real patients to treat. Wouldn’t get me one.”

Read more: A mental disorder, not a personal failure: Why now is the time for Australia to rethink addiction

As a result of the research, a series of resources have been developed to help service providers and policymakers improve processes and competencies among health professionals.

“We know that one bad interaction with a healthcare provider can put people off asking for help, often for many years. By identifying opportunities to make healthcare more welcoming, we hope that people will be able to get help with their substance use earlier,” says Professor Suzanne Nielsen, lead researcher of the study.

Welcoming and inclusive processes

According to Professor Nielsen, hospital and primary care settings were chosen as the focus of their research because they’re well-placed to initiate effective care pathways for people experiencing alcohol and other drug harms.

“Our findings have shown multiple opportunities to improve existing processes in hospital and primary care settings so that people seeking help for substance dependence receive person-centred care,” Professor Nielsen says.

For example, more could be done to ensure primary care funding doesn’t create a barrier to the patient receiving ongoing treatment.

“We have a system that pays us to write scripts and do referrals, rather than sit down and talk and listen, which is what our patients really need,” a healthcare staff participant explained as part of the research.

The researchers recommend implementing and strengthening AOD screening and brief intervention capabilities across all service settings attended by people experiencing harm from AOD, including emergency departments, mental health providers, and family violence sectors.

“Integrating peer navigation support , where trained professionals with lived experience in AOD support new clients, would also improve experiences and mean that people who have begun treatment are more likely to continue,” Professor Nielsen says.

AOD support integrated within health services

Another key theme identified during interviews was that treatment for AOD use was seen as being outside the “medical model”, and separate from the role of health services.

For example, healthcare staff had experienced colleagues treating patients with AOD-related problems being perceived as not sick or deserving of care.

“This person with the heart attack, [this] is our sick patient,” a staff participant said. “[T]his [AOD patient] is just wasting our time.”

The researchers also found healthcare workers were sometimes reluctant when treating patients with substance dependence due to comments other staff had made in their clinical records.

“Oh my god, [after I read the notes I thought] I don’t want to see this patient. They sound like a nightmare, they sound really agitated.”

In this case, the healthcare worker observed that the patient was not how they’d been portrayed in the notes, but the language used by colleagues in the notes had created fear and negative expectations.

Since people who use alcohol and other drugs often have complex presentations, the researchers recommend training so healthcare staff learn to respond compassionately, using trauma-informed approaches.

Policies were also identified as barriers, with some patients being told they could not access housing or mental health services until they had been treated for their drug use.

“We also recommend implementing policies to ensure that people actively using AODs aren’t excluded from accessing other services,” says Professor Nielsen.

Increased workforce capabilities

The issues with existing procedures in healthcare settings may also affect health professionals’ attitudes, leading to biased beliefs and stigmatised language .

The researchers identified three themes where language communicated stigma.

Rather than focusing on the patient’s experiences, the use of language maintained a focus on the patient, and:

positioned a patient as undeserving
separated them from other patients
blamed a patient for being unwell.

For example: “… he’s just a scumbag.”

“ … a nightmare. They sound like such a nasty person.”

“We argue that the issues identified in our study, such as organisational expectations about how to treat AOD patients, or processes that position treatment of AOD patients as separate to mainstream healthcare, may contribute to staff being unaware of their own biases, which in turn could perpetuate stigma,” says Professor Nielsen.

Crucially, stigmatising language among healthcare staff can lead to patients not continuing with their treatment , and may even perpetuate risky or dependent use of alcohol or other drugs .

“It’s vital we build non-AOD workforce competency in treating people experiencing harms from AOD and better-understanding the challenges faced by people with a substance dependence,” says Professor Nielsen.

Read more: Your Language Matters: A clinician’s guide

A future with equitable access to healthcare

Overall, ensuring that people with experience of AOD harms are empowered to tell their stories , engaged as peer researchers and involved in the co-design of support services will be important steps towards resolving the multiple issues relating to stigma and service delivery processes within Australia’s health system.

However, due to the research team’s finding that the existing healthcare service processes may be contributing to staff’s stigma communication, they’re also calling for improvements at policy and system levels that remove the stigma and barriers faced every day by people experiencing harms from alcohol or other drugs.

“Everyone deserves access to equitable healthcare,” says Professor Nielsen.

Drug addiction
alcohol misuse
healthcare bias
substance dependence
Stigma in the healthcare system

Suzanne Nielsen

Deputy Director, Monash Addiction Research Centre

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The case for decriminalising personal drug use

The recent introduction of a private member’s bill to decriminalise drug use has started an important conversation about how our drug laws are harming people, and how we can improve them.

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Open access
Published: 28 June 2024

Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study

Basma Mohammed Al Yazeedi ORCID: orcid.org/0000-0003-2327-6918 1 ,
Lina Mohamed Wali Shakman 1 ,
Sheeba Elizabeth John Sunderraj ORCID: orcid.org/0000-0002-9171-7239 1 ,
Harshita Prabhakaran ORCID: orcid.org/0000-0002-5470-7066 1 ,
Judie Arulappan 1 ,
Erna Judith Roach ORCID: orcid.org/0000-0002-5817-8886 1 ,
Aysha Al Hashmi 1 , 2 &
Zeinab Al Azri ORCID: orcid.org/0000-0002-3376-9380 1

BMC Nursing volume 23 , Article number: 441 ( 2024 ) Cite this article

Metrics details

Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education.

This study aimed to explore nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education.

This study used a mixed methods design. Students filled out a 13-item study-advised questionnaire, and qualitative data from the four focus groups was collected. The setting of the study was the College of Nursing at Sultan Qaboos University, Oman. Descriptive and independent t-test analysis was used for the quantitative data, and the framework analysis method was used for the qualitative data.

The descriptive analysis of 67 participants showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred with the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58), and 80.3% assented its association with clinical competencies as reflected by knowledge and cognitive skills (m = 3.21, SD = 0.60). No significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p > 0.05) was identified Three qualitative findings were discerned: case analysis is a preferred assessment method for students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.

Conclusions

This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Peer Review reports

Introduction

Nurses play a critical role in preserving human health by upholding core competencies [ 1 ]. Clinical competence in nursing involves a constant process of acquiring knowledge, values, attitudes, and abilities to deliver safe and high-quality care [ 2 , 3 ]. Nurses possessing such competencies can analyze and judge complicated problems, including those involving crucial patient care, ethical decision-making, and nurse-patient disputes, meeting the constantly altering health needs [ 4 , 5 ]. To optimize the readiness of the new graduates for the challenging clinical work environment needs, nurse leaders call for integrating clinical competencies into the nursing curriculum [ 6 , 7 ] In 2021, the American Association of Colleges of Nursing (AACN) released updated core competencies for professional nursing education [ 8 ]. These competencies were classified into ten fundamental essentials, including knowledge of nursing practice and person-centered care (e.g. integrate assessment skills in practice, diagnose actual or potential health problems and needs, develop a plan of care), representing clinical core competencies.

Nursing programs emphasize clinical competencies through innovative and effective teaching strategies, including case-based teaching (CBT) [ 9 ]. CBT is a dynamic teaching method that enhances the focus on learning goals and increases the chances of the instructor and students actively participating in teaching and learning [ 10 , 11 ]. Additionally, it improves the students’ critical thinking and problem-solving skills and enriches their capacity for independent study, cooperation capacity, and communication skills [ 12 , 13 , 14 , 15 ]. It also broadens students’ perspectives and helps develop greater creativity in fusing theory and practice [ 16 , 17 , 18 , 19 , 20 ]. As the learning environment significantly impacts the students’ satisfaction, case analysis fosters a supportive learning atmosphere and encourages active participation in learning, ultimately improving their satisfaction [ 21 , 22 ].

In addition to proper teaching strategies for clinical competencies, programs are anticipated to evaluate the students’ attainment of such competencies through effective evaluation strategies [ 23 ]. However, deploying objective assessment methods for the competencies remains challenging for most educators [ 24 ]. The standard assessment methods used in clinical nursing courses, for instance, include clinical evaluations (direct observation), skills checklists, Objective Structured Clinical Examination (OSCE), and multiple-choice questions (MCQs) written exams [ 25 ]. MCQs tend to test the recall of factual information rather than the application of knowledge and cognitive skills, potentially leading to assessment inaccuracies [ 26 ].

Given the aforementioned outcomes of CBT, the deployment of case analysis as a clinical written exam is more closely aligned with the course’s expected competencies. A mixed methods study was conducted among forty nursing students at the University of Southern Taiwan study concluded that the unfolding case studies create a safe setting where nursing students can learn and apply their knowledge to safe patient care [ 6 ]. In a case analysis, the patient’s sickness emerges in stages including the signs and symptoms of the disease, urgent care to stabilize the patient, and bedside care to enhance recovery. Thus, unfolding the case with several scenarios helps educators track students’ attained competencies [ 27 ]. However, case analysis as an assessment method is sparsely researched [ 28 ]. A literature review over the past five years yielded no studies investigating case analysis as an assessment method, necessitating new evidence. There remains uncertainty regarding its efficacy as an assessment method, particularly from the students’ perspectives [ 29 ]. In this study, we explored the undergraduate nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies. Results from this study will elucidate the position of case analysis as an assessment method in nursing education. The potential benefits are improved standardization of clinical assessment and the ability to efficiently evaluate a broad range of competencies.

Research design

Mixed-method research with a convergent parallel design was adopted in the study. This approach intends to converge two data types (quantitative and qualitative) at the interpretation stage to ensure an inclusive research problem analysis [ 30 ]. The quantitative aspect of the study was implemented through a cross-sectional survey. The survey captured the perceived efficacy of using case analysis as an assessment method in clinical nursing education. The qualitative part of the study was carried out through a descriptive qualitative method using focus groups to provide an in-depth understanding of the perceived strengths experienced by the students.

Study setting

Data were collected in the College of Nursing at Sultan Qaboos University (SQU), Oman, during the Spring and Fall semesters of 2023. At the end of each clinical course, the students have a clinical written exam and a clinical practical exam, which constitute their final exam. Most clinical courses use multiple-choice questions (MCQs) in their written exam. However, the child health clinical course team initiated the case analysis as an assessment method in the clinical written exam, replacing the MCQs format.

Participants

For this study, the investigators invited undergraduate students enrolled in the child health nursing clinical course in the Spring and Fall semesters of 2023. Currently, the only course that uses case analysis is child health. Other courses use MCQs. A total enumeration sampling technique was adopted. All the students enrolled in child health nursing clinical courses in the Spring and Fall 2023 semesters were invited to participate in the study. In the Spring, 36 students registered for the course, while 55 students were enrolled in the Fall. We included students who completed the case analysis as a final clinical written exam on the scheduled exam time. Students who did not show up for the exam during the scheduled time and students not enrolled in the course during the Spring and Fall of 2023 were excluded. Although different cases were used each semester, both had the same structure and level of complexity. Further, both cases were peer-reviewed.

Case analysis format

The format presents open-ended questions related to a clinical case scenario. It comprises three main sections: Knowledge, Emergency Room, and Ward. The questions in the sections varied in difficulty based on Bloom’s cognitive taxonomy levels, as presented in Table 1 . An answer key was generated to ensure consistency among course team members when correcting the exam. Three experts in child health nursing peer-reviewed both the case analysis exam paper and the answer key paper. The students were allocated two hours to complete the exam.

Study instruments

Quantitative stage.

The researchers developed a study questionnaire to meet the study objectives. It included two parts. The first was about the demographic data, including age, gender, type of residence, year in the program, and cumulative grade point average (GPA). The second part comprised a 13-item questionnaire assessing the perceived efficacy of case analysis as an assessment method. The perceived efficacy was represented by the acceptability of case analysis as an assessment method (Items 1–5 and 13) and the association with clinical competencies (Items 6 to 12). Acceptability involved format organization and clarity, time adequacy, alignment with course objectives, appropriateness to students’ level, and recommendation for implementation in other clinical nursing courses. Clinical competencies-related items were relevant to knowledge (motivation to prepare well for the exam, active learning, interest in topics, collaboration while studying) and cognitive skills (critical thinking, decision-making, and problem-solving skills) (The questionnaire is attached as a supplementary document).

The questionnaire is answered on a 4-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree. Higher scores indicated better perceived efficacy and vice versa. The tool underwent content validity testing with five experts in nursing clinical education, resulting in an item-content validity index ranging from 0.7 to 1. The Cronbach alpha was 0.83 for acceptability and 0.90 for clinical competencies.

Qualitative stage

For the focus group interviews, the investigators created a semi-structured interview guide to obtain an in-depth understanding of the students’ perceived strengths of case analysis as an assessment method. See Table 2 .

Data collection

Data was collected from the students after they gave their written informed consent. Students were invited to fill out the study questionnaire after they completed the case analysis as a clinical written exam.

All students in the child health course were invited to participate in focus group discussions. Students who approached the PI to participate in the focus group discussion were offered to participate in four different time slots. So, the students chose their time preferences. Four focus groups were conducted in private rooms at the College of Nursing. Two trained and bilingual interviewers attended the focus groups, one as a moderator while the other took notes on the group dynamics and non-verbal communication. The discussion duration ranged between 30 and 60 min. After each discussion, the moderator transcribed the audio recording. The transcriptions were rechecked against the audio recording for accuracy. Later, the transcriptions were translated into English by bilingual researchers fluent in Arabic and English for the analysis.

Rigor and trustworthiness

The rigor and trustworthiness of the qualitative method were enhanced using multiple techniques. Firstly, quantitative data, literature reviews, and focus groups were triangulated. Participants validated the summary after each discussion using member checking to ensure the moderator’s understanding was accurate. Third, the principal investigator (PI) reflected on her assumptions, experiences, expectations, and feelings weekly. In addition, the PI maintained a detailed audit trail of study details and progress. The nursing faculty conducted the study with experience in qualitative research and nursing education. This report was prepared following the Standard for Reporting Qualitative Research (SRQR) protocol [ 31 ].

Data analysis

Quantitative data were entered in SPSS version 24 and analyzed using simple descriptive analysis using means, standard deviations, and percentages. After computing the means of each questionnaire item, an average of the means was calculated to identify the perceived efficacy rate. A similar technique was used to calculate the rate of acceptability and clinical competencies. The percentage was calculated based on the mean: gained score/total score* 100. In addition, the investigators carried out an independent t-test to determine the relationship between the perceived efficacy and students’ GPA.

The qualitative data were analyzed using the framework analysis method. In our analysis, we followed the seven interconnected stages of framework analysis: (1) transcription, (2) familiarization with the interview, (3) coding, (4) developing a working analytical framework, (5) applying the analytical framework, (6) charting data into framework matrix and (7) interpreting the data [ 32 ]. Two members of the team separately analyzed the transcriptions. Then, they discussed the coding, and discrepancies were solved with discussion.

Mixed method integration

In our study, the quantitative and qualitative data were analyzed separately, and integration occurred at the interpretation level by merging the data [ 33 ]. As a measure of integration between qualitative and quantitative data, findings were assessed through confirmation, expansion, and discordance. If both data sets confirmed each other’s findings, it was considered confirmation, and if they expanded each other’s insight, it was considered expansion. Discordance was determined if the findings were contradictory.

Ethical considerations

Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, SQU (CON/NF/2023/18). Informed consent was collected, and no identifiable information was reported. For the focus group interviews, students were reassured that their grades were finalized, and their participation would not affect their grades. Also, the interviewers were instructed to maintain a non-judgmental and non-biased position during the interview. Data were saved in a locked cabinet inside a locked office room. The electronic data were saved in a password-protected computer.

The results section will present findings from the study’s quantitative and qualitative components. The integration of the two data types is described after each qualitative finding.

Quantitative findings

We analyzed the data of 67 participants, representing a 73.6% response rate. The mean age was 21.0 years old (SD 0.73) and 36.4% were male students. See Table 3 for more details.

The descriptive analysis showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58) and 80.3% (m = 3.21, SD = 0.60) assented the clinical competencies associated with it.

For the items representing acceptability, 81.8% of the students agreed that the case analysis was written clearly, and 80.3% reported that it was well organized. As per the questions, 81% described they were appropriate to their level, and 79.8% agreed upon their alignment with the course objectives. Moreover, the time allocated was adequate for 74.5% of the students, and 73.5% recommend using case analysis as an evaluation strategy for other clinical written examinations.

Regarding the clinical competencies, 77.3% of students agreed that the case analysis motivated them to prepare well for the exam, 81.3% reported that it encouraged them to be active in learning, and 81.0% indicated that it stimulated their interest in the topics discussed in the course. Additionally, 76.5% of the students agreed that the case analysis encouraged them to collaborate with other students when studying for the exam. Among the students, 82.5% reported that the case analysis as an assessment method enhanced their critical thinking skills, 81.0% agreed that it helped them practice decision-making skills, and 81.8% indicated that it improved their problem-solving abilities. See Table 4 .

The independent t-test analysis revealed no significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p > 0.05). Further analysis showed that the means of acceptability and clinical competencies were not significantly different between the lower GPA group and higher GPA group, t [62] = 0.72, p > 0.05 and t [63] = -0.83, p > 0.05, respectively (Table 5 ).

Qualitative findings

A total of 22 had participated in four focus groups, each group had 5–6 students. The qualitative framework analysis revealed three main findings; case analysis is a preferred assessment method to students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.

Qualitative Finding 1: case analysis is a preferred assessment method to students when compared to MCQs

Most of the students’ statements about the case analysis as an assessment method were positive. One student stated, “Previously, we have MCQs in clinical exams, but they look as if they are theory exams. This exam makes me deal with cases like a patient, which is good for clinical courses.” . At the same time, many students conveyed optimism about obtaining better grades with this exam format. A student stated, “Our grades, with case analysis format, will be better, … may be because we can write more in open-ended questions, so we can get some marks, in contrast to MCQs where we may get it right or wrong” . On the other hand, a few students suggested adding multiple-choice questions, deleting the emergency department section, and lessening the number of care plans in the ward section to secure better grades.

Although the case analysis was generally acceptable to students, they have repeatedly expressed a need to allocate more time for this type of exam. A student stated, “The limited time with the type of questions was a problem, …” . When further discussion was prompted to understand this challenge, we figured that students are not used to handwriting, which has caused them to be exhausted during the exam. An example is “writing is time-consuming and energy consuming in contrast to MCQs …” . These statements elucidate that the students don’t necessarily mind writing but recommend more practice as one student stated, “More experience of this type of examination is required, more examples during clinical practice are needed.” Some even recommended adopting this format with other clinical course exams by saying “It’s better to start this method from the first year for the new cohort and to apply it in all other courses.”

Mixed Methods Inference 1: Confirmation and Expansion

The abovementioned qualitative impression supports the high acceptability rate in quantitative analysis. In fact, there is a general agreement that the case analysis format surpasses the MCQs when it comes to the proper evaluation strategies for clinical courses. Expressions in the qualitative data revealed more details, such as the limited opportunities to practice handwriting, which negatively impacted the perceived adequacy of exam time.

Qualitative Finding 2: case analysis assesses students’ knowledge

Students conferred that they were reading more about the disease pathophysiology, lab values, and nursing care plans, which they did not usually do with traditional means of examination. Examples of statements include “… before we were not paying attention to the normal lab results but …in this exam, we went back and studied them which was good for our knowledge” and “we cared about the care plan. In previous exams, we were not bothered by these care plans”. Regarding the burden that could be perceived with this type of preparation, the students expressed that this has helped them prepare for the theory course exam; as one student said, “We also focus on theory lectures to prepare for this exam …. this was very helpful to prepare us for the theory final exam as well.” However, others have highlighted the risks of limiting the exam’s content to one case analysis. The argument was that some students may have not studied the case completely or been adequately exposed to the case in the clinical setting. To solve this risk, the students themselves advocated for frequent case group discussions in the clinical setting as stated by one student: “There could be some differences in the cases that we see during our clinical posting, for that I recommend that instructors allocate some time to gather all the students and discuss different cases.” Also, the participants advocated for more paper-based case analysis exercises as it is helpful to prepare them for the exams and enhance their knowledge and skills.

Mixed Methods Inferences 2: Confirmation and Expansion

The qualitative finding supports the quantitative data relevant to items 6, 7, and 8. Students’ expressions revealed more insights, including the acquisition of deeper knowledge, practicing concept mapping, and readiness for other course-related exams. At the same time, students recommended that faculty ensure all students’ exposure to common cases in the clinical setting for fair exam preparation.

Qualitative Finding 3. case analysis assesses students’ cognitive skills

Several statements conveyed how the case analysis format helped the students use their critical thinking and analysis skills. One student stated, “It, the case analysis format, enhanced our critical thinking skills as there is a case with given data and we analyze the case….” . Therefore, the case analysis format as an exam is potentially a valid means to assess the student’s critical thinking skills. Students also conveyed that the case analysis format helped them link theory to practice and provided them with the platform to think like real nurses and be professional. Examples of statements are: “…we connect our knowledge gained from theory with the clinical experience to get the answers…” and “The questions were about managing a case, which is what actual nurses are doing daily.” Another interesting cognitive benefit to case analysis described by the students was holistic thinking. For example, one student said, “Case analysis format helped us to see the case as a whole and not only from one perspective.”

Mixed Methods Inferences 3: Confirmation

The quantitative data indicated mutual agreement among the students that the case analysis enhanced their critical thinking, decision-making, and problem-solving skills. The students’ statements from the interviews, including critical thinking, linking theory to practice, and holistic thinking, further supported these presumptions.

This research presents the findings from a mixed methods study that explored undergraduate nursing students’ perceived efficacy of using case analysis as an assessment method. The perceived efficacy was reflected through acceptability and association with two core competencies: knowledge and cognitive skills. The study findings showed a high rate of perceived efficacy of case analysis as an assessment method among nursing students. Additionally, three findings were extracted from the qualitative data that further confirmed the perceived efficacy: (1) case analysis is a preferred assessment method to students compared to MCQs, (2) case analysis assesses students’ knowledge, and (3) case analysis assesses students’ cognitive skills. Moreover, the qualitative findings revealed details that expanded the understanding of the perceived efficacy among nursing students.

Previous literature reported students’ preference for case analysis as a teaching method. A randomized controlled study investigated student’s satisfaction levels with case-based teaching, in addition to comparing certain outcomes between a traditional teaching group and a case-based teaching group. They reported that most students favored the use of case-based teaching, whom at the same time had significantly better OSCE scores compared to the other group [ 34 ]. As noted, this favorable teaching method ultimately resulted in better learning outcomes and academic performance. Although it may be challenging since no answer options are provided, students appreciate the use of case analysis format in their exams because it aligns better with the course objectives and expected clinical competencies. The reason behind students’ preference for case analysis is that it allows them to interact with the teaching content and visualize the problem, leading to a better understanding. When case analysis is used as an assessment method, students can connect the case scenario presented in the exam to their clinical training, making it more relevant.

In this study, students recognized the incorporation of nursing knowledge in the case analysis exam. They also acknowledged improved knowledge and learning abilities similar to those observed in case-based teaching. Boney et al. (2015) reported that students perceived increased learning gains and a better ability to identify links between different concepts and other aspects of life through case-based teaching [ 35 ]. Additionally, case analysis as an exam promotes students’ in-depth acquirement of knowledge through the type of preparation it entails. Literature suggested that case-based teaching promotes self-directed learning with high autonomous learning ability [ 34 , 36 ]. Thus, better achievement in the case analysis exam could be linked with a higher level of knowledge, making it a suitable assessment method for knowledge integration in nursing care.

The findings of this study suggest that case analysis can be a useful tool for evaluating students’ cognitive skills, such as critical thinking, decision-making, and problem-solving. A randomized controlled study implied better problem-solving abilities among the students in the case-based learning group compared to those in the traditional teaching methods group [ 12 ]. Moreover, students in our study conveyed that case analysis as an exam was an opportunity for them to think like real nurses. Similar to our findings, a qualitative study on undergraduate nutrition students found that case-based learning helped students develop professional competencies for their future practice, in addition to higher-level cognitive skills [ 37 ]. Therefore, testing students through case analysis allows educators to assess the student’s readiness for entry-level professional competencies, including the thinking process. Also, to evaluate students’ high-level cognitive skills according to Bloom’s taxonomy (analysis, synthesis, and evaluation), which educators often find challenging.

Case analysis as an assessment method for clinical courses is partially integrated in case presentation or OSCE evaluation methods. However, the written format is considered to be more beneficial for both assessment and learning processes. A qualitative study was conducted to examine the impact of paper-based case learning versus video-based case learning on clinical decision-making skills among midwifery students. The study revealed that students paid more attention and were able to focus better on the details when the case was presented in a paper format [ 38 ]. Concurrently, the students in our study recommended more paper-based exercises, which they believed would improve their academic performance.

This study has possible limitations. The sample size was small due to the limited experience of case analysis as a clinical written exam in the program. Future studies with larger sample sizes and diverse nursing courses are needed for better generalizability.

Implications

Little evidence relates to the efficacy of case analysis as an evaluation method, suggesting the novelty of this study. Despite the scarcity of case-based assessment studies, a reader can speculate from this study’s findings that there is a potential efficacy of case analysis as an assessment method in nursing education. Future research is warranted to validate the effectiveness of case-analysis assessment methods and investigate the effects of case-analysis exams on academic and clinical performance.

Overall, our findings are in accordance with the evidence suggesting students’ perceived efficacy of case analysis as a teaching method. This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Data availability

The datasets used and/or analyzed during the current study are available fromthe Principal Investigator (BAY) upon reasonable request.

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Acknowledgements

The authors wish to thank the nursing students at SQU who voluntarily participated in this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Basma Mohammed Al Yazeedi, Lina Mohamed Wali Shakman, Sheeba Elizabeth John Sunderraj, Harshita Prabhakaran, Judie Arulappan, Erna Judith Roach, Aysha Al Hashmi & Zeinab Al Azri

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Contributions

Dr. Basma Mohammed Al Yazeedi contributed to conceptualization, methods, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Lina Mohamed Wali Shakman contributed to conceptualization, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Sheeba Elizabeth John Sunderraj contributed to conceptualization, methods, data collection, writing the draft, and reviewing the final draft.Ms. Harshita Prabhakaran contributed to conceptualization, data collection, writing the draft, and reviewing the final draft.Dr. Judie Arulappan contributed to conceptualization and reviewing the final draft.Dr. Erna Roach contributed to conceptualization writing the draft and reviewing the final draft.Ms. Aysha Al Hashmi contributed to the conceptualization and reviewing the final draft. Dr. Zeinab Al Azri contributed to data collection, data analysis, writing the draft, and reviewing the final draft.All auhors reviewed and approved the final version of the manuscirpt.

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The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, Sultan Qaboos University SQU (CON/NF/2023/18). All data was held and stored following the SQU data policy retention. Informed consent to participate was obtained from all of the participants in the study.

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Yazeedi, B.M.A., Shakman, L.M.W., Sunderraj, S.E.J. et al. Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study. BMC Nurs 23 , 441 (2024). https://doi.org/10.1186/s12912-024-02102-9

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Women's History Month: Get to know 3 women in nursing

Since its establishment in the 1980s, Women’s History Month has taken place each March to encourage the study, observance and celebration of women’s vital impacts on American history.

Such impacts are evident throughout Case Western Reserve’s past and present, from the university’s origins as the Flora Stone Mather College for Women, to the efforts of today’s Flora Stone Mather Center for Women and student groups such as those in the Women’s Coalition .

All can celebrate this month with resources and events from Kelvin Smith Library, and stay tuned to The Daily each Wednesday to get to know some of the many women from across fields who help CWRU excel.

Megan Foradori

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For more than two decades, Megan Foradori’s pursuit of a PhD in nursing has taken her across the county, from Johns Hopkins University in Maryland to North Carolina, Texas and Pennsylvania. Throughout the journey, she’s been focused on identification and treatment of developmental delays in children.

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Read more about her work in Forefront magazine.

Shanina Knighton (GRS ’17, nursing)

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At the height of the COVID-19 pandemic, Knighton and her nurse research colleagues were on the front lines of the healthcare crisis. Educating patients about the benefits of washing their hands, using hand sanitizer and wearing face masks has become her driving passion.

“Nurse scientists bring an important aspect to research and policy in that, while interventions and solutions are being created, our training allows us to see tangible solutions that are often overlooked or undervalued,” she told the Friends of the National Institute of Nursing Research. “While leaders around the world are encouraging the public to clean their hands to prevent germ transmission, my science provides evidence that patients and long-term care residents have germs on their hands, but lack adequate hand hygiene products and are rarely told to practice.”

Knighton was named a Veale Faculty Fellow in August 2023 and hopes to explore entrepreneurial goals of nursing research.

Read more about Knighton’s hand hygiene research in this article.

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Melissa Kline has spent most of her career in nursing identifying ways to better the health of communities around the country. As the recently named Joann Zlotnick Glick Endowed Professor in Community Health Nursing, as well as her capacity as senior vice president and system chief nurse executive at The MetroHealth System, Kline knows the impact nurses can make in the community.

During the COVID-19 pandemic, Kline spearheaded novel ways to help nurses identify Cleveland residents with COVID symptoms before they entered the hospital system. Now, as a member of the nursing school faculty, she’s teaching student nurses new ways of thinking about caring not just for patients, but the community as a whole.

“A commitment to community health—to meeting people where they are—became so much more important coming out of COVID,” said Kline. “I am hopeful our work here will not only help us respond to underserved populations but also to advance our efforts from being reactive to proactive. The partnership between MetroHealth and the School of Nursing will aid in changing nursing education to take on a more preventative approach to improve the health of our community.”

Learn more about Kline in the endowment announcement.

This article was originally published in The Daily as part of Women's history Month 2024.

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Study with Quizlet and memorize flashcards containing terms like Meet the client:, One of the simplest tools that a nurse can use to screen for alcoholism is the CAGE questionnaire. CAGE is an acronym that represents the four questions it contains. What is the first question that the nurse should ask Nick?, Nick answers "yes" to two of the four questions on the CAGE questionnaire.
Case Study and Treatment Plan: Major Depressive Disorder and Alcohol Use
Part 1 - Case study and treatment plan. Summary. Jacob is a 63 year old man with a history of Major depressive disorder and Alcohol use disorder. He lives alone and has had many failed relationships, leaving him feeling isolated and worthless for the last 10 years or so. He has cycles of binge drinking and his physical health has deteriorated ...
HESI- Alcoholism Case Study Flashcards
HESI- Alcoholism Case Study. Nick Davis, a 42-year-old, is accompanied to the emergency room by the police who found him standing on a bridge and threatening to jump. He planned to jump off the bridge because his girlfriend moved out on him and he lost his job as a cook several days ago. Vital signs upon admission are BP 146/94, P 92, R 20, and ...
Improving Nursing Knowledge of Alcohol Withdrawal
Nursing Grand Rounds is a presentation developed by nurses, and focuses on specific case studies and lessons learned. ... Through the provision of nursing education regarding alcohol withdrawal, nurses' comfort level in caring for alcohol withdrawal patients has improved. By increasing their knowledge, nurses are more confident in caring for ...
CASE Study 5
Alcohol wihdrawal case study alcohol withdrawal karen trevino, danielle ceniza, alexis gregory, heather escobar, ariani harisman, serena gonzalez, marissa. Skip to document. ... Galen College of Nursing. 131 Documents. Go to course. 221. MedSurg ATI Practice Questions. Adult Health III 100% (11) 60. Med Surg 3 Exam 3 - exam 3.
Case Study #4- Alcohol Withdrawal credits to Nursing.docx
Case Study #4- Alcohol Withdrawal (credits to Nursing.com) The patient is a 45-year old male who is a frequent flyer in the emergency room for abdominal pain. The patient always has a high ETOH level and demands to be given 3 macaroni and cheese dishes, 2 chicken sandwiches, and 2 whole milk cartons. Vitals are as follows: HR 103 RR 20 BP 125/67 Temp 98.6 degrees Fahrenheit SpO2 98% 1.
HESI case study [ADN240] "ALCOHOLISM" Flashcards
Risk for injury. Risk for injury related to Matt's thoughts of wanting to jump off a bridge is a priority nursing diagnosis and the rationale for admission to the crisis unit Altered nutrition. Nutrition is very important because a client with alcohol dependency drinks alcohol instead of eating nourishing food, causing malabsorption of essential vitamins.
Alcohol Withdrawal Case Study (45 min)
Alcohol Withdrawal Case Study (45 min) Join NURSING.com to watch the full lesson now. Start Trial. Take Quiz. Previous lesson. Next lesson. Included In This Lesson. Study Tools; Outline; Study Tools. Outline. The patient is a 45-year-old male who is a "frequent flyer" in the emergency room for abdominal pain. The patient always has a high ...
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By evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses' attitudes and behaviors regarding narcotic drug safety ...
Case Study
NUR1700 Midterm Study Guide; MED 2061 Nursing Fundamentals II (VNPT057) ... Case Study - Alcohol Withdrawal - Kasey Washburn. 1.. Which data from your assessment of J. are of concern to you? It is most concerning that the patient seems to be dishonest about having an alcohol addiction. It is clear he is in denial about his problem and is unable ...
Tackling negative healthcare bias in addiction treatment
A future with equitable access to healthcare. Overall, ensuring that people with experience of AOD harms are empowered to tell their stories, engaged as peer researchers and involved in the co-design of support services will be important steps towards resolving the multiple issues relating to stigma and service delivery processes within Australia's health system.
Perceived efficacy of case analysis as an assessment method for
Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education. This study aimed to explore nursing students' perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education.
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Substance Abuse Case Study. Arizona College of Nursing Nur 356. Substance Abuse Case Study. On admission, the hospital protocol is to screen the patient for potential alcohol abuse and/or dependence. List two (2) screening techniques for alcohol abuse/dependence.
Women's History Month: Get to know 3 women in nursing
Since its establishment in the 1980s, Women's History Month has taken place each March to encourage the study, observance and celebration of women's vital impacts on American history. Such impacts are evident throughout Case Western Reserve's past and present, from the university's origins as the Flora Stone Mather College for Women, to the efforts of today's Flora Stone Mather ...
Case Study Form Alcohol
Alcohol Case Study/Nursing. Course. Introduction to Nursing (NUR 110) 13 Documents. Students shared 13 documents in this course. University Montgomery County Community College. Academic year: 2022/2023. Uploaded by: Tiffany Nicholson. Montgomery County Community College. 0 followers. 1 Uploads. 0 upvotes.

Alcohol Withdrawal Nursing Diagnosis and Nursing Care Plan

Alcohol Withdrawal Nursing Care Plans Diagnosis and Interventions

Causes of Alcohol Withdrawal

Diagnosis of Alcohol Withdrawal

Nursing Diagnosis for Alcohol Withdrawal

Nursing Care Plan for Alcohol Withdrawl 2

Nursing Care Plan for Alcohol Withdrawl 3

Nursing Care Plan for Alcohol Withdrawl 4

Nursing Care Plan for Alcohol Withdrawl 5

Nursing References

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Improving Nursing Knowledge of Alcohol Withdrawal

PHASE I: EDUCATION BEFORE IMPLEMENTATION OF THE CMG

INITIAL EVALUATION OF CMG IMPLEMENTATION

Focus Group

PHASE II: EDUCATION FOLLOWING IMPLEMENTATION OF THE CMG

EVALUATION OF THE CMG IMPLEMENTATION AFTER PHASE II EDUCATION

PATH FORWARD

Supplemental Digital Content

CE Connection

{{ (moduleVm.actions && moduleVm.changeStatus) ? moduleVm.status : '' }} Alcohol Dependence in Acute Withdrawal (Case Study)

Learning Outcomes

Case Study and Treatment Plan: Major Depressive Disorder and Alcohol Use

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Improving Nursing Knowledge of Alcohol Withdrawal

PHASE I: EDUCATION BEFORE IMPLEMENTATION OF THE CMG

INITIAL EVALUATION OF CMG IMPLEMENTATION

Focus Group

PHASE II: EDUCATION FOLLOWING IMPLEMENTATION OF THE CMG

EVALUATION OF THE CMG IMPLEMENTATION AFTER PHASE II EDUCATION

PATH FORWARD

Supplementary Material

Alcohol Withdrawal Case Study (45 min)

Included In This Lesson

Given that he will be admitted to the hospital for a few days without access to alcohol, what protocol medication needs to be ordered for this patient?

What question needs to be asked in regard to the patient’s alcohol intake?

What precautions does the nurse need to set up for this patient?

When will this patient likely be no longer legally intoxicated? What is the implication of this time period?

What medications will the doctor likely order for this patient to replace vitamins?

What medication could be ordered for this patient to help keep him sober?

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Nursing Case Studies

Nursing Case Studies Introduction

GI/GU Nursing Case Studies

Obstetrics Nursing Case Studies

Pediatrics Nursing Case Studies

Neuro Nursing Case Studies

Metabolic/Endocrine Nursing Case Studies

Tackling negative healthcare bias in addiction treatment

Welcoming and inclusive processes

AOD support integrated within health services

Increased workforce capabilities

A future with equitable access to healthcare

Suzanne Nielsen

Getting ahead of the fentanyl threat to avoid a public health disaster

Australia’s changing opioid prescription landscape

Delving deeper into the social health of people who use methamphetamine

The case for decriminalising personal drug use

Republishing Guidelines

Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study

Conclusions

Introduction

Research design

Study setting

Participants

Case analysis format

Study instruments

Qualitative stage

Data collection

Rigor and trustworthiness

Data analysis

Mixed method integration

Ethical considerations

Quantitative findings

Qualitative findings

Qualitative Finding 1: case analysis is a preferred assessment method to students when compared to MCQs

Mixed Methods Inference 1: Confirmation and Expansion