Running head: RELATIONSHIP-BASED PROJECT

Relationship-Based Care Project

Sarah Pollock
Dixie State University
Nursing 4040-Nursing Leadership and Management

Relationship-Based Care Project

My relationship-based care project is making a table of the different kinds of
neurovascular checks that need to be done on a patient that has different orthopedic surgeries.
Because I am a central staffing nurse, I go from floor to floor and there are a lot of different
things that I have to remember. For the new nurses, I wanted to make a chart of different
neurovascular checks for different surgeries, this way they will not forget and help make sure the
patient is safe after surgery. This is relationship-based care intervention because it is helping to
promote a caring and healing environment. This is a process improvement because these checks
were not being done like they were supposed to and so it is being pushed more. This is important
to help our patients to feel safe and respected (Kloroutis, 2004).
In the book Relationship-Based Care by Mary Kloroutis, it talks about how a nurse and
patient can have a relationship-based care (RBC) relationship. One of the key aspects is being a
team with everyone in your workplace. If a nurse is not doing her job by checking a patients
circulation like the doctor ordered, they are not being a team player. If the nurse is doing the
checks and working with the doctor to keep the patient safe, he/she is keeping a RBC attitude
(Kloroutis, 2004).
Importance of Circulation Assessments
Neurovascular assessments are very important for a person that has a total joint surgery
or a back surgery. The reasoning behind them is because of the risk of swelling after surgery,
circulation can be cut off and it can cause the foot or leg to lose the important circulation is
needed to keep that limb alive. This is called compartment syndrome (Wright, 2009). If a nurse is
doing circulation assessments every two hours, it can help catch any compartment syndrome that
might arise after surgery and save the extremity involved (Schreiber, 2016). By checking the

pulses in the extremity and having the patient move the extremity, the nurse can see what is
going on with it and make sure it is getting the blood that it needs. In a journal article by Mary
Schreiber it says, Subtle changes can be meaningful and warrant immediate intervention.
Delays in treatment can result in harmful patient outcomes (Schreiber, 2016, pp. 57). Watching
for the slightest changes can be very important.
Literature Review
When I researched about neurovascular assessments in patients with total joint
replacements, there was not as much out there as I thought I would find on sites like Ebsco host
and Science Direct. There are lots of books educating nurses on how to do a neurovascular check
and that it is important, but finding information on patients that had total joint replacement was a
little bit harder. I found two journals done on neurovascular checks and total joint replacements
that were very helpful. The first of the journal articles I found was by Mary L. Shreiber, it talked
about the importance of neurovascular checks and gave some examples of times to do the
checks, but stated that most hospitals had different times and some times are set by the doctor or
surgion. The most common default is every four hours if the patients condition has been stable
(Schreiber, 2016).
The second journal article I found was by Vanessa Blair discussing the importance of
neurovascular assessments in patients with nerve blocks. Because we see a lot of patients with
nerve blocks after total joint replacement, this was a very helpful article. It went through
checking for the six Ps: pain, pallor, peripheral pulses, paraesthesia, and paralysis. She stated,
To detect compartment syndrome the nurse should carry out regular neurovascular observations,
document any findings whilst acting to minimize further damage (Blair, 2013). Doing

circulation assessments is a very important tool when trying to keep our patients safe and helping
to have a nurturing and healing environment.
Project Implementation Plan
For my project, I would make a table that was one sheet of paper that had all the different
surgeries that we get on our orthopedic floor and what assessments go with those surgeries. By
doing this, nurses would be able to see what surgery that their patient had and know exactly what
assessments they need to be doing and for how long. Because central staffing nurses would
utilize this the most, I would get approval from my education manager to give it to the rest of the
nurses that work in central staffing. Then we would all have the same information and have
something to look back on when we have not been to that floor in a long period of time. I would
then get the approval of the orthopedic floor manager to put it on the floor of central staffers and
for the nurses who work the floor. This would keep all the cares uniform and help to make sure
that all patients are getting the best care. As protocols change, or if evidence based practice was
to change, we could update our papers and help nurses to know the up to date information.
Not only would this project provide a healing environment for our patients, but it would
help to keep care throughout the floor uniform. Helping patients feel safe, and nurses know what
they are required to do is very important. By giving the nurses this information, it can help them
be a team because they can help to keep the doctors informed about their patients even when
they are not there.
Conclusion
Neurovascular assessments in patients that have had a total joint replacement are very
important. They can help to save extremities and help reduce some unintentional costs of going
to the hospital. By keeping all nurses informed about the best times and how long for each

surgery, we are keeping the care for all patients universal. Being a team with the doctors and
being able to keep them informed on how their patients are doing is also very important in
relationship-based care nursing.

References
Blair, V. (2013, May). Neurovascular assessment post femoral block: Nursing (RN)
implications on fall prevention. Elsevier, 17(2), 99-105.
Kloroutis, M. (2004). Relationship-Based Care A Model for Transforming Practice.
Minnealapolis: Creative Health Managment.
Schreiber, M. (2016, Jan/Feb). Neurovascular assessment: An essential nursing focus.
MEDSURG Nursing, 25(1), 55-57.
Wright, E. (2009, April). Neurovascular impairment and compartment syndrome.
Paediatric Nursing, 21(3), 26-29.

References