Reflections on the Analysis of The Lewis Blackman Story
Part 1: The Lewis Blackman Story
1. Why does Helen Haskell start her story by talking about Lewis?
2. What are indications, side effects, normal dosages, risks and benefits for Ketoralac when administered to a 15-year-old?
3. What was the significance of lack of urine output (to underlying problem, amount of Ketorolac, and need for fluids)?
4. What are possible reasons why health care providers dismissed implications of undetectable blood pressure? Why would they think it was equipment failure?
5. What was significant about Lewis’s crises development occurring on the weekend?
6. Describe the process of how Lewis developed septic shock.
Part 2: A Mother’s View of “Lessons Learned”
1. Create a list of the characteristics Helen Haskell ascribes to a “good” or professional nurse/physician. How does that compare to how you would describe “good” or professional nurse / physician?
2. When Helen Haskell says, “patients need to be empowered and nurses need to embrace it”, how does that make you feel?
3. What does Helen Haskell mean by “misplaced professionalism”?
4. Define professionalism in your own words.
5. What is your reaction to Helen Haskell’s view that nurses need policy-level help to be empowered with respect to communications with physicians?
Part 3: Patient-centered Care and Teamwork / Collaboration
1. Are patients and families in your facility considered to be part of the healthcare team? Explain your response.
2. Could the outcome have been different if Lewis’s parents were considered part of the health care team?
3. When Helen Haskell says she saw almost no evidence of teamwork, would you agree or not? Explain your response.
4. How does the culture in hospitals in which you’ve worked compare to the culture described in Helen Haskell’s story?
5. What can health care professionals do to create a hospital culture that supports effective teamwork and patient-centered care?
Part 4: Disclosing Error and Accountability
1. What does professional accountability mean to you?
2. How do health professionals demonstrate the following:
1. A feeling of accountability for the reliability of the system in which they work
2. Lack of accountability for the reliability of the system in which they work
3. Helen Haskell describes nurses focused on task completion (including documentation of a plan of care) rather than on accurate assessment, application of knowledge, listening to patient and family, and action on the patient’s behalf. How accurate is her depiction of nursing care you have observed? In instances where you have made similar observations, what contributes to this “misplaced” work focus?
4. Describe what happens in your current health care setting if someone is involved in an error?
5. Describe the “system” errors in Lewis’s story.
6. Describe the individual errors in Lewis’s story.
7. Did the “system” errors and individual errors contribute to each other?
8. What laws governed Lewis’s care?
9. If you were a patient or family member in Helen Haskell’s situation, what would you have wanted to say to or hear from the “frontline” nurses and residents who provided Lewis’s care?
Part 5: Transparency and Courage
1. What traits should a learner possess to help prevent errors and adverse events?
2. What factors can increase the risk of errors/adverse events for patients?
3. What policies or safeguards could help protect patients and families from a health care team’s inability to recognize a developing problem?
4. Patients enter hospitals assuming that health professionals are watching for complications so that they can properly care for patients. What factors detract from our ability to recognize complications in patients?
5. What are your ideas about patient empowerment and nurse empowerment in terms of the overall safety of our health care systems? When are the interests of patients and nurses in alignment? When are they not in alignment?
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