page 19professional standards in nursing practice workbook
Case Scenario #2:
Tom and a Client Experiencing
Multiple Trauma
2
In the two years Tom had been working in this rural hospital, most clients experiencing severe multi-
trauma had been stabilized in their small emergency room and transported to a tertiary health care
agency. This time, however, that was not the case. Josef, the client, had experienced thoracic trauma,
complex fractures in his pelvis and both legs, and extensive soft tissue injuries in a heavy equipment
accident. A severe winter storm meant that the rural hospital staff would need to provide care for Josef
until weather improved enough for an air ambulance to operate.
Tom’s experience with providing care for clients with severe multi-trauma was minimal, and he had been
very aware of that when he found that Josef was assigned to his care. The one other RN on the shift with
him had an equally challenging workload and Tom realized he would need to do his best with Josef. After
reviewing Josef’s chart, Tom went to his room to get a better sense of his condition.
Tom introduced himself to Josef and two family members who were also present and explained that
he needed to complete an assessment. After completing his assessment and determining that Josef was
stable and did not need any pain relief medication at that time, Tom returned to the nursing station to
document his assessment. Josef’s sister followed Tom out of the room and asked him several questions
about Josef’s condition and prognosis. Tom was not able to answer all of her questions but promised her
that he would get more information and get back to her.
After he had documented the assessment, Tom considered his need for more information related to Josef’s
condition and associated nursing care. As well as wanting to be able to answer Josef ’s sister’s questions,
Tom had some questions of his own about specific assessment and care related to Josef’s injuries. First, he
decided he would ask the ER physician to meet with Josef’s family when he was available. He felt that was
an efficient way to provide an answer for most, if not all, of their questions. He would make sure he was
present at the meeting so that he could follow up with Josef’s family as required.
To address his own needs for information, Tom planned three actions. First, he would look on the hospital
intranet, and see what he could find related to caring for multi-trauma clients. Second, when the other
RN on shift with him that day had completed her initial assessments, he would also talk with her. Third,
Tom decided to call the Trauma Nurse Educator at the Tertiary Health Care agency where they typically
transferred their clients.
Tom’s intranet search and the conversation with the other RN yielded some information, but he still had
questions. So, as planned, he phoned the Trauma Nurse Educator and explained the situation to her,
using information from the recent assessment to provide a clear ‘picture’ of Josef’s condition. She asked
Tom some questions regarding his previous experience with caring for multi-trauma clients, about what
other health care team members were working that day with Tom, and about Josef’s current condition.
Tom answered her questions and then listened carefully as she offered him specific information related to
providing care for Josef. She also told Tom she would fax him some current literature that would help him
in caring for Josef and answering Josef’s family’s questions. Finally, she asked Tom to summarize the key
points of the information she had given him. Once she was sure he had understood her advice, she also
told him to call her again if he needed any further assistance.
After Tom had finished the phone call with the Clinical Educator, he documented the event in the nursing
notes and updated the Care Kardex to reflect the information she had offered.
