Integrate the use of communication skills, information systems, and standardized language in relation to clinical outcomes and continuous performance measures.

Mia is the oldest of six children from a two-parent family. She was diagnosed with osteosarcoma of the left leg and was experiencing intractable pain. She received her diagnosis at 15 years of age under the care of a pediatric oncologist at a local hospital. Mia underwent months of radiation and intensive chemotherapy. Mia’s community nursing team was struggling to meet her needs and referred her for palliative care services through a local home care agency.

Her parents had a complex history of substance abuse and domestic violence, and Mia had a difficult relationship with both, although recently she has become close to her mother who has attended most of her chemotherapy treatments.

During one episode of severe uncontrolled pain which required that Mia be transferred by ambulance to the emergency department, she noticed all of the nurses except for one being attentive and kind. Mia overheard the nurse saying:

“I don’t know why her parents bring her here… We can’t meet her needs and we are short-staffed…”

The conversation Mia overheard was incomplete, which left her to draw her own conclusions. The whispering nurse was actually the charge nurse who was in the midst of planning staffing for a pending snowstorm. Her complete statement is as follows:

“I don’t know why her parents bring her here. The home care nurses should be addressing pain management issues with her oncologist in a more timely manner so that Mia can remain in her home for treatment. If we had available resources to address Mia’s pain, we could plan to make her stays in the emergency room more comfortable. I wish that we could meet her needs better and in a timelier manner. I feel frustrated that once again we can’t meet her needs more effectively. We are short-staffed, and that shortchanges Mia.”

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