NRSG355 Clinical Integration: Towards Professional Practice
Question:
Critical thinking, clinical decision making and professional development
As part of this module please undertake the following activity and upload your answer into your e-Portfolio.
On returning from your tea break you are met by several staff members who relate the following information to you concerning your patients.
- Mrs Chew’s intravenous (IV) infusion has tissued, her IV fluids are running behind and she has missed her 14.00 hrs IV antibiotic.
- Mr Smith’s visitor has fainted.
- One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly.
- Mr Esposito is scheduled to leave the ward now for his cardiac catheterisation and he has still not received his preoperative medication.
- One of the surgical consultants (VMO) is waiting to discuss a medication error that happened last week.
- As you are taking this handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery.
The other RN is busy with NUM role. Staff currently available on the ward to assist you in addressing these issues include: the ward clerk, an Enrolled Nurse who is currently undertaking her IV cannulation certificate but is not yet competent, and an AIN.
Answer:
The first priority of any nurse should be the wellbeing of the ailing people. In the above scenario, three of the patients need immediate care. One of the patients, Mrs. Chew has still not received her prescribed 14.00 hrs antibiotics and her IV fluids are behind (Campbell, Gilbert, Laustsen, 2010). There is another patient Mr Esposito who is scheduled to undergo a cardiac catheterisation surgery, but yet to receive his preoperative medication. An elderly post-operative patient has collapsed to the floor after being unconscious, and has nobody to attend. There are also many other tasks like toilet blockage and the mentioned RN has to attend a meeting with one of the surgical consultant about a problem like medication error (Casey, A., Wallis, 2011).
In this scenario, there are two RNs (Registered Nurse) present in the unit. One of them is busy, as she has to be the NUM for that shift. The other RN is free and has to be ready to take the control of many tasks of the unit. The other members of the unit are the ward clerk, one Enrolled Nurse (who is under training of the IV cannulation certificate) and one AIN (Assistant in Nursing). The RN has to take some of these responsibilities and has to delegate some of the tasks to other unit members (Aitken, Chaboyer, Elliot, 2102).
At first, the RN should take the case of Mrs Chew, as she needs her IV antibiotics as soon as possible. After giving her antibiotics, the RN should appoint the EN to nurse Mrs Chew as she needs to match up the prescribed fluid intake. After attending her, the EN also go attend the Mr. Smith’s visitor who has fainted inside the unit and if needed, the EN has to check for an appointment with the doctor for the visitor. The RN should appoint the AIN in the care of the post-operative patient who has collapsed to the floor and fainted and has to instruct her to get the appointment of her doctor. The RN should attend the pre-operative patient Mr. Esposito who needs his pre-surgery medication as he has a prior appointment to the doctor for his surgery. After giving the medication to Mr Esposito and appoint the ER to get him ready for the surgery. The RN should delegate the problem of the overflowing staff toilet to the ward clerk and ask the clerk to contact a plumber to solve the problem. The RN will have to attend the meeting with the physician about the problem, which occurred previous week (Benner, Tanner, Chelsa, 2009).
As the EN does not have the IV cannulation certificate, the RN should have to give Mrs Chew her antibiotics by herself as there was a medication error last week and the RN does not want the same problem to arise once again (Elliott, & Coventry, 2012). The RN appointed the AIN to give the primary care of the post-operative patient and tell the AIN to get an appointment with the doctor to attend her. As Mr. Esposito has scheduled surgery, the RN should give him the post-operative medication herself and give the task of attending the mentioned patient to the ER for getting him ready for the surgery (Chaboyer, Hewson-Conroy, 2012). As the EN has the knows how to take care of an unconscious person, she should attend the visitor. The ward clerk should go take care of the plumbing problem in the staff toilet. The RN herself has to attend the meeting with the physician.
References:
Aitken, L., Chaboyer, W., Elliot, D. (2102). Scope of Critical care Practice. In ACCCN’s Critical Care Nursing, 2nd Ed. Sydney: Elsevier.
Benner, P., Tanner, C., Chelsa, C. (2009). Expertise in practice; Caring, clinical judgement, and ethics 2nd Ed. Springer, NY.
Campbell, L., Gilbert, M., Laustsen, G. (2010). Clinical coach for nursing excellence. Retrieved from https://ezproxy.acu.edu.au/login?url=https://ACU.eblib.com/patron/FullRecord.aspx?p=474457
Casey, A., Wallis, A. (2011) Effective communication: Principle of nursing practice E. Nursing Standard 25(32), 35-37. Retrieved from https://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011015656&site=ehost-live
Chaboyer, W., Hewson-Conroy. (2012). Quality and safety. In ACCCN’s Critical Care Nursing, 2nd Ed. Elsevier, Sydney.
Elliott, M. & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10), 621-625. Retrieved from https://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011651321&site=ehost-live
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