BNS 101 Nursing Assignment
Question:
Q.1 Order of tasks on the basis of priority:
Nursing is a noble profession that holds different roles for the nurses. Nurses acts as a care provider, liaison, advocate, educator and many more likewise, nurses also plays an important role as a leader in a medical team and the patients outcome depends upon their clinical judgement that is governed by their communication and delegation skills (Huber, 2014).
It is In the given scenario the first priority would be addressing the elderly patient who is unconscious as it is a medical emergency and if delayed could cost someone’s life having said that, there are other issues going around therefore, I would delegate other staffs according to their scope of practice. According to NMBA (2016) one of the standards of practice that is 6 is to provide safe and quality care that is possible by working as a team according to the scope of practice and delegating right task to the right person. Similarly, I would ask the NUM who is also a RN to get involved in the emergency and also ask the surgical consultant to help with the situation until the emergency team arrives.
Administering medication on time is also very vital for good patient’s outcome. As a student nurses we are taught to check the seven rights of the medication administration before giving the medicine in which the ‘right time’ is indispensable one and it is expected we follow this practice as a RN hence, I would then attend Mrs. Chew to re-site her cannula and give her fluids as soon as the emergency team arrives and ask the NUM to stay there.
With the IV antibiotic I would administer the antibiotic if it’s just late by 30 to 60 minutes of the prescribed time but it is the duty of the nurses to document and write the exact time of the administration which could prevent from overdosing as the antibiotics administration should have certain time in between the second one is administered (Australian Commission on Safety and Quality in Health Care, 2013) simultaneously, I would ask the enrolled nurse (EN) .
whom I am assuming that is a medication endorsed to give medication to Mr. Esposito and send him off for the procedure and then to attend Mr. Smith’s visitor. Likewise, I would ask the Assistant in Nursing (AIN) to attend the fainted visitor and start taking the vitals and to inform the doctor or the EN if there is an abnormal reading as they are able to do some simple tasks such as taking vitals (NSW Health, 2010). Furthermore, I would ask the ward clerk to solve the problem with the blocked staff toilet and to provide reassurance to Mr. Smith and the family members.
Lastly I would discuss the medication error with the surgeon as it can wait till later and also it does not have any negative effect on the patients at the very moment. The nurse faces this type of situation more often as the health of a person is dynamic in nature and it is hard to anticipate what might happen but it’s the responsibility of the nurses to be prepared therefore, nurses should have the knowledge of the five rights of delegation, scope of practice, prioritising tasks accordingly, good communication skills and critical thinking and judgement to bring out the positive outcome in the patient’s health.
References
Australian Commission on Safety and Quality in Health Care (2013). Literature Review: Medication Safety in Australia. Retrieved from
Huber, D. (2014). Leadership & nursing care management (5th ed.). St. Louis: Elsevier/Saunders. Retrieved from
NSW Health (2010). Assistants in Nursing working in the acute care environment. Retrieved .
Nursing and Midwifery Board of Australia (2016). Registered nurse standards for practice. Retrieved from
Module2
- Identify factors that determine which healthcare professionals are required to be involved in a health care team? The factors mostly depend upon the severity of the disease. MND usually affects the patient’s ability to breathe, talk, walk and swallow hence; respiratory specialist is needed to treat the respiratory problems, physiotherapist and occupational therapist to assist in their mobility and ADLs, case manager or a social worker to look after their social and financial issues, speech pathologists for swallowing and talking, neurologist to treat the neurological symptoms and finally a MND nurse specialist.
- Who should lead the health care team?
It could be the MND nurse specialist because she would be the one liaising all the other health team members to come together and solve the identified issues.
- Who is the most important member of the health care team?
Health care members have their own importance in the team and they are interconnected to each other having said that, the patient themselves are considered to be the most important member of the health care team because they provide a way for better, effective and improved methods of health care as it is lived experience by themselves, also its their right to be involved in their own health care furthermore this concept would change the paternalistic physician and health system regulation in future respecting the autonomy of the patient (Carmen et al., 2013).
ACTIVITY 2: CASE STUDY 3
Robert Hughes is a 52 year old male who was injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long term care options for Robert.
- What are the key issues in this situation?
One of the main concerns in this case is the primary carer of Robert who is his 75 year old mother who is not capable enough to take care of her son. Secondly, Robert being intellectually flawed and his inability to take care of himself and his dependence on his mother is also a major issue similarly, socioeconomic factor could be another issue in this scenario as Robert being 52 year old and unable to earn his own living and depending on his old mother and also he could be looked down upon in the society being intellectually imperfect furthermore, it looks like the mother is unable to control and protect him as the case reveals that he had a bicycle accident and is verbally abusive to the staff and other patients. Additionally, another issue also could be the lack of information to Robert’s mother about the support system in the community to help Robert and her.
- Who would be included in the health care team and what role would they play?
First of all a neurologist or a clinical psychologist could be included to manage Robert’s neurological symptoms because of the fact that he is intellectually impaired. Secondly, an orthopaedic surgeon could play a vital role in managing his presenting physical problem alliancing with the pain team to address his pain because of the fracture.
Thirdly, physiotherapist could help him with his mobility and exercises that could strengthen his muscles and bones, also; occupational therapist could be placed as he might need some equipment to assist himself to do certain activities at home. Similarly, in this case a nurse specialist in the field of intellectual disability could be included to work as an advocate, educator and liaison between the other team members and also to help with the holistic assessment that includes biopsychosocial aspects of Robert.
Furthermore, a social worker and a case manager could be assigned so that Robert could get better place to live with the good medical, physical and psychological environment suited for him and also his mother could be relieved from the thought that Robert might hurt himself at home or unsuited environment; in addition, recreational therapist or vocational trainers in arts or music could be arranged so that Robert could do something practicable for himself (Clare et al., 2016). Lastly, speech pathologist and optometrist could be referred for Robert according to his symptoms (Carmeli & Imam, 2014).
References
Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-31. Retrieved from
armeli, E. & Imam, B. (2014). Health Promotion and Disease Prevention Strategies in Older Adults with Intellectual and Developmental Disabilities. Frontiers In Public Health, 2. doi: 10.3389/fpubh.2014.00031
Clare, I., Madden, E., Holland, A., Farrington, C., Whitson, S., & Broughton, S. et al. (2016). ‘What vision?’: experiences of Team members in a community service for adults with intellectual disabilities. Journal Of Intellectual Disability Research. doi
MODULE 3:
You are working on the morning shift on the ward, and receive a patient from ED. The ED nurse provides you with the following handover, using the ISOBAR format. Further information about the ISOBAR format can be found on page 7 of this module. Please click on the handover link in LEO within Module 3 section, titled: ‘Module 3 Activity 2 Verbal Handover’. Listen to this recording, and then please answer the following:
- What further questions will you need to ask the nurse?
The given handover is a satisfactory handover that covers all the aspects of the ISOBAR framework although it lacks few details. The questions that I would ask could be the exact vital signs so that I could determine if the patient has any signs of infection that is hyperthermia, tachypnoea, tachycardia and also increased blood pressure and decreased oxygen saturation as the handover affirms that pneumonia is suspected for this patient. Additionally, I would ask about the medication if the patient is taking any and the indications furthermore, any significant surgical history or allergies and also if the patient is suspected with pneumonia then does he/she needs to be kept for droplet precaution and lastly about the plan for his abdominal pain and weight loss.
- List specifically what further assessments you would complete when the patient arrives onto the ward 3. The assessments that I would perform when Joe arrives on the ward would be a comprehensive assessment that would include a head to toe systematic assessment such as orientation to time, place and person, temperature and pain assessment, then CVS assessment that includes vitals, capillary refill and perfusion followed by detail Respiratory and GI assessment that includes the inspection, auscultation, palpation and percussion as the presenting problem revolves around these systems.
- Following this, I would assess the condition of the skin and look for the signs of pressure injuries, patency of the IV cannula and also ability to ambulate additionally; I would check the BGL and weight of the patient for baseline record. I would also take some subjective data related to the suspected pneumonia like the duration of the cough, swallowing difficulty as he is 92 years old that could possibly contribute in aspiration pneumonia or recent hospital stay that could cause hospital acquired pneumonia (Suarez & Ortega, 2011) .
- in addition, social history like living arrangements and primary carer and finally about the medication and allergies. During clinical placement choose a patient that is of interest to you. Perhaps a patient that you found challenging in terms of linking the theory together. Fill in the Clinical Reasoning Cycle Worksheet that can be found on the LEO page to assist with your understanding of that patient’s condition and how the Clinical Reasoning Cycle can be of benefit to you. References
Suarez, M. & Ortega, S. (2011). Pneumonia. New York: Nova Science Publishers. Retrieved from
MODULE 4:
You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) surgical ward. One other RN, an EN and three AINs are also on duty. The NUM is off sick and the other RN is acting as NUM as well as taking a patient load. The ward is full: there are 22 patients, 14 of whom went to surgery in the morning, and 8 are going on your shift. Half of these a patients have intravenous access and antibiotics at some time during your shift.
Using your knowledge and experience of various patient allocation models (e.g. total patient care, team nursing and task allocation), outline how you would allocate the staff to the patients. Include in your discussion your rationale for the model of allocation chosen and the scope of practice of the various staff.
There are various models of patient allocation and care such as total patient care, individual patient allocation, team nursing, functional nursing and primary nursing but it has still not been clear that which of these is most efficient in providing quality patient care although, most of the studies supports the team nursing to be effective and widely used (Fairbrother, Jones, & Rivas, 2010; Dubois et al., 2013). Choosing the model of allocation and patient care depends upon many factors such as organisational policies and its structure, complexity of the situation, funding, scope of practice, increase need of skilled health care members and skill mix (King, Long, & Lisy, 2014).
In this case I would follow the team nursing model as this approach is managed by a team leader who is a RN furthermore, the patient load is high and the nurses available have different level of education and competency skills; also this model helps to bring out the maximum potential of the nurses to deliver quality care to the patient (Tran, Johnson, Fernandez, & Jones, 2010). Similarly, team nursing holds the potential to promote and advance the role of a RN as a team leader and care coordinator but it is imperative to have good communication and delegation skill; in addition, knowledge of scope of practice of the other team members is crucial (Tran et al., 2010). Polis, Higgs, Manning, Netto and Fernandez (2015) asserts that team nursing exhibited good patient outcome and safety, reduction in mishaps and deaths furthermore;
it increased the job satisfaction and retention of staffs and also provided support and supervision to the less experienced staffs from more experienced and learnt members. The concept of team nursing is used when there is a mixture of skills for instance; the RNs have different level of competency then ENs and also with the AINs but they have to work together in the same setting (Ferguson & Cioffi, 2011) having said that, I would allocate each AINs to the RNs and EN. I would divide the patient load into 8 to the EN and the AIN similarly, 8 to me and the AIN partnered with me and 6 for one of the AIN and RN who is also working as the NUM because she will also have some other concerns in the ward to manage.
According to the NSW Health (2010) it states that the scope of AINs includes ability to perform simple tasks such as taking vitals that are allocated in acute settings hence, I would ask all the AINs to take vitals and also take care of the ADLs of their allocated patients. With the IV antibiotics I am assuming that the EN is medication endorsed and is also competent with IV medication because in given scenario I would presume that in the surgical ward of the hospital they would recruit medication and IV competent staff hence, I would delegate the EN to administer the IV if there is any in her lot and tell her to ask for assistance if needed. NMBA (2016) declares that the EN is able to do the IV medication if they have completed the intravenous medication administration education. Furthermore, I would focus on other IV antibiotics for my patient and also try to help the other RN as the main idea of team nursing is to help and supervise each other when in need.
References
Dubois, C., D’amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal For Quality In Health Care,
Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220. doi: 10.5172/conu.2010.35.2.202
Ferguson, L., & Cioffi, J. (2011). Team nursing: experiences of nurse managers in acute care settings. Australian Journal Of Advanced Nursing, 28(4), 5-11. Retrieved from
King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: a systematic review protocol. JBI Database Of Systematic Reviews And Implementation Reports, 12(1), 59-73. doi: 10.11124/jbisrir-2014-1533
NSW Health (2010). Assistants in Nursing working in the acute care environment. Retrieved from.
polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2015). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian. doi: 10.1016/j.colegn.2015.09.002
Nursing and Midwifery Board of Australia [NMBA] (2016). Enrolled nurses and medication administration. Retrieved from
Polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2015). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian. doi: 10.1016/j.colegn.2015.09.002
Tran, D., Johnson, M., Fernandez, R., & Jones, S. (2010). A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes.International Journal Of Nursing Practice, 16(2), 148-158. doi: 10.1111/j.1440-172x.2010.
Answer:
Q.1 Order of tasks on the basis of priority:
The noble profession of nursing plays different roles in the lives of all nurses. Nurses are entrusted with a variety of tasks, such as, acting as a care provider, advocating for patient rights, liaisoning, providing education, and many other responsibilities. Furthermore, nurses also play a crucial role by acting as leaders in interdisciplinary medical teams. The health outcomes and satisfaction of patients are greatly dependent on the role and clinical expertise of a nurse.
In addition, nurses display excellent clinical judgment skills that are governed by their communication capabilities and delegation skills (Huber, 2014). In the given context, the primary objective should be to prioritise addressing needs of the elderly patient, who has been found unconscious. This situation should be considered a medical emergency, which if not treated immediately, might result in potentially harmful and fatal health consequences.
Owing to the fact that there are a plethora of issues in this context, I would focus on delegating the nursing staff according to their expertise and scope of clinical practice. The NMBA standards of practice (standard 6) illustrates the importance of delivering high quality, and responsive healthcare services to all patients, which in turn is facilitated by effective delegation of enrolled nurses and other staff according to their scope of practice and clinical roles (NMBA, 2018). In a similar way, I would request the concerned NUM, also a registered nurse to collaborate with us, in this emergency situation.
I would also seek help from the surgical consultant until appropriate services are made available by the emergency team. A patient’s health outcomes are directly influenced by medication administration. During our nursing course, we were taught the importance of checking and confirming the 7 rights related to medication administration by nurses, before giving any medicine to a patient. We were taught that ‘right time’ of administering a medicine is imperative to improved health outcomes of a patient, and that a registered nurse is bound to adhere to these guidelines.
Thus, I would attend the patient Mrs. Chew, and would reposition the cannula placement. I would also administer her necessary fluids upon arrival of the emergency team, following which the NUM would be requested to stay. Although, it is an essential duty of all nurses to document and record the exact time of antibiotic and other therapeutic administration, I would try administering the intravenous (IV) antibiotic to the patient, even if there is a delay in its administration by 30-60 minutes.
Recording accurate time of medication administration helps in preventing adverse health effects due to overdose due to the fact that there should be considerable time between administration of the first and second antibiotic (Roughead, Semple & Rosenfeld, 2013). I would also request the concerned enrolled nurse to provide proper medications to the patient Mr. Esposito, before sending him off for the medical procedure. She would also be requested to attend the visitor who has come to see Mr. Smith. Furthermore, I would also place a request in front of the AIN (Assistant in Nursing) for attending the visitor.
This would be followed by measuring the vital signs of the patient and subsequently reporting the readings to the EN or the physician, upon encountering abnormalities in the ranges. Enrolled nurses also have the expertise of measuring vital signs of a patient (NSW Health, 2010). In addition, the ward clerk would also be requested to assist in solving the problem of blocked toilet for the staff. The clerk would also be asked to reassure the patient Mr. Smith, and his family members, regarding his recovery.
This would be followed by a discussion of the error that occurred due to a delay in administering the antibiotic, with the surgeon because it does not show any adverse effects on the patient’s health at present. Situations as such are often encountered in the nursing profession due to the fact that health of an individual is a dynamic state of the wellbeing and often makes it difficult to anticipate beforehand.
Thus, it is essential for all nurses to have an idea that such emergency situations might arise in a healthcare setting. Therefore, it is imperative for all nurses to have a sound understanding of the rights related to workforce delegation, task prioritization, scope of practice, critical thinking, effective communication, and clinical judgement, with the aim of improving the overall health, wellbeing and satisfaction of all patients.
References
Huber, D. (2014). Leadership & nursing care management (5th ed.). St. Louis: Elsevier/Saunders. Retrieved from
NSW Health. (2010). Assistants in Nursing working in the acute care environment. Retrieved from
Nursingmidwiferyboard.gov.au. (2018). Nursing and Midwifery Board of Australia – Registered nurse standards for practice. Retrieved 3 March 2018, from
Roughead. L., Semple. S., & Rosenfeld, E. (2013). Literature Review: Medication Safety in Australia. Retrieved from
Module2
Identify factors that determine which healthcare professionals are required to be involved in a health care team?
Major factors are associated with disease severity. Motor Neuron Diseases (MND) are most commonly found to affect the ability of a person to talk, walk, breath or swallow food. Therefore, it is essential to seek help from a respiratory specialist for addressing the respiratory distress, the patient is suffering from. An occupational therapist and physiotherapist will be called for assisting the patient in improving the motor skills, thereby facilitating mobility. Social workers and case managers will also play a crucial role in managing the financial and social issues faced by the patient. Furthermore, a speech pathologist will prove effective in treating the impairment associated with language comprehension and swallowing food. The neurological abnormalities will be treated by a neurologist and an MND nurse specialist.
Who should lead the health care team?
The MND nurse specialist shall be held responsible for leading the healthcare team due to the fact that she would be responsible for forming a liaison with other members who are a part of the multidisciplinary team, thereby facilitating solving of the medical issues that have been identified in this context.
Who is the most important member of the health care team?
All members of a healthcare team are equally important, as they are responsible for maintaining safety and optimal health outcomes for their clients. However, a patient is the most essential member of the team because the experiences, preferences and demands of a patient assist the healthcare professionals to deliver appropriate healthcare services. Moreover, it is the primary right of all patients to remain involved in their treatment. This concept of respecting the autonomy of a patient is therefore responsible for challenging the paternalistic duties of a physician (Carman et al., 2013).
ACTIVITY 2: CASE STUDY 3
Robert Hughes is a 52 year old male who was injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long term care options for Robert.
What are the key issues in this situation?
One major issue in this context refers to the incapability of the patient Robert’s mother, the primary carer, aged 75 years, to care for her son. Old age of his mother does not permit her to provide appropriate healthcare services to her son, thereby resulting in her impairment to improve Robert’s optimal health outcome. Another issue is associated with Robert’s intellectual flaws that restrict him from taking self-care.
This makes him dependent on his mother. Socio-economic factors might also have an influence in this context. This can be attributed to the fact that although Robert is 52 years old, he does not earn a living. This makes him being looked down upon by members of his community and society. Moreover, his mother also demonstrates a failure to control his unruly behaviour, as evident by his bicycle accident and verbally aggressive behavior towards the nursing staff and co-patients. Another issue could be poor literacy about role of the community support system in providing help, as demonstrated by his mother.
Who would be included in the health care team and what role would they play?
A clinical psychologist or a neurologist will be included in the multidisciplinary team for managing the neurological abnormalities that result in intellectual impairment in the patient. An orthopaedic surgeon will also play an essential role in addressing the physical problems that are presented by Robert, following his accident. This surgeon will be able to collaborate with the pain management team, in treating the fracture and associated pain. Moreover, a physiotherapist will also play a crucial role in making him show compliance to exercises that would improve his mobility, muscle and bone strength.
An occupational therapist might also be included in the team with the aim of providing necessary equipments that would assist Robert to perform daily activities, all by himself. Similarly, a nurse specialist having expertise in treating intellectual disabilities can also be asked to adorn the role of an educator, and advocate, in addition to liaising between all members of the interdisciplinary team. The nurse will also be imperative in conducting a holistic assessment of the patient that will include a thorough measurement of his bio-psychosocial aspects.
A case manager and social worker will be able to provide assistance to Robert, with regards to better living amenities, and an appropriate physical, psychological and medical environment. This in turn will relive his mother of her responsibilities, and of the fact that Robert might get hurt in a new environment. Furthermore, a vocational trainer or recreational therapist can also be contacted for arranging music or art classes that would engage Robert in an activity of his interest (Clare et al., 2017). Depending on his symptoms, assistance can also be taken from an optometrist or a speech pathologist (Carmeli & Imam, 2014).
References
Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-231.
Carmeli, E., & Imam, B. (2014). Health promotion and disease prevention strategies in older adults with intellectual and developmental disabilities. Frontiers in public health, 2, 31.
Clare, I. C. H., Madden, E. M., Holland, A. J., Farrington, C. J. T., Whitson, S., Broughton, S., … & Wagner, A. P. (2017). ‘What vision?’: experiences of Team members in a community service for adults with intellectual disabilities. Journal of Intellectual Disability Research, 61(3), 197-209. DOI: 10.1111/jir.12312
MODULE 3:
You are working on the morning shift on the ward, and receive a patient from ED. The ED nurse provides you with the following handover, using the ISOBAR format. Further information about the ISOBAR format can be found on page 7 of this module. Please click on the handover link in LEO within Module 3 section, titled: ‘Module 3 Activity 2 Verbal Handover’. Listen to this recording, and then please answer the following:
What further questions will you need to ask the nurse?
The handover in this context covers all essential aspects of the ISOBAR framework. Hence, it can be considered satisfactory. However, there are few details missing in the handover. I would like to ask few questions related to measurements of the patient’s vital signs for determining presence of any potentially threatening infections in the body. An analysis of the responses to the questions will help me evaluate presence of tachycardia, hyperthermia, tachypnoea, hypertension, and low oxygen saturation. Presence of pneumonia is confirmed by the current handover.
Moreover, I would also question on the medications that are currently being administered to the patient and would try to find out previous history of allergies or surgeries. Furthermore, positive diagnosis for pneumonia would also require maintaining adequate droplet precaution. I would also question the nurse on symptoms of weight loss and abdominal pain.
List specifically what further assessments you would complete when the patient arrives onto the ward 3.
On arrival of the patient to the ward, I would perform a comprehensive assessment of the physiological condition. My assessment would be based on a systematic examination from head to toe, such as, pain assessment, temperature sensation, CVS assessment which includes measurement of vital sign, perfusion, and capillary refill. I would also determine whether the patient demonstrates and accurate orientation to place time and person. This will be followed by conduction of a detailed GI and respiratory assessment, with procedures, such as auscultation, inspection, percussion and palpation. I would also assess his skin condition and evaluate presence of pressure injuries, or sores. This will be followed by determining placement of the IV cannula.
I would also evaluate conditions that require ambulation. Baseline measurements of the patient would include checking his weight and BGL. I would also record the patient’s subjective data that will provide information on presence of pneumonia like condition. This data would be based on measurements related to swallowing difficulty, and persistent cough. This can be attributed to the fact that since the patient is aged (92 years old), it can possibly result in aspiration pneumonia. His recent hospitalization can also contribute to hospital acquired pneumonia (Suarez & Ortega, 2011).
Furthermore, I will record information related to his social history such as the primary caregiver, his living conditions, current medications and previous history of hypersensitivity. During a clinical placement, it is essential to select a patient who presents symptoms that are off interest. Selecting a patient what difficulties faced while linking clinical theory to nursing practice would be helpful. The clinical reasoning cycle worksheet, present on the LEO page will be filled up for providing assistance in understanding the current physiological conditions of the patient.
References
Suarez, M. & Ortega, S. (2011). Pneumonia. New York: Nova Science Publishers. Retrieved from
MODULE 4:
You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) surgical ward. One other RN, an EN and three AINs are also on duty. The NUM is off sick and the other RN is acting as NUM as well as taking a patient load. The ward is full: there are 22 patients, 14 of whom went to surgery in the morning, and 8 are going on your shift. Half of these a patients have intravenous access and antibiotics at some time during your shift.
Using your knowledge and experience of various patient allocation models (e.g. total patient care, team nursing and task allocation), outline how you would allocate the staff to the patients. Include in your discussion your rationale for the model of allocation chosen and the scope of practice of the various staff.
A plethora of models exist related to patient care and allocation such as, team nursing, indivisible patient allocation, primary nursing, total patient care, and functional nursing. However, there is lack of evidence regarding the model that is most effective in enhancing patient health outcomes, through delivery of optimal health care services. Most research studies have been found to establish the effectiveness of team nursing as the commonly preferred patient allocation model (Fairbrother, Jones & Rivas, 2010; Dubois et al., 2013).
Several factors, such as, complexity of the current clinical situation, structure, and organizational policies, availability of adequate funding, nursing scope of practice, skill mix, and an increase in demand of experience of healthcare professionals play a major role in determining the allocation and care model that should be applied while treating a patient (King, Long & Lisy, 2014). In the current case scenario, I would implement team nursing model for treating the patient. This model will be selected due to the fact that it focuses on management of the entire multidisciplinary team by a registered nurse, who functions as a team leader. In such cases, there is enormous workload on the nursing staff.
Moreover, all healthcare professionals demonstrate differences in their clinical competencies and level of nursing education, thereby collaborating together, with the primary objective of improving health outcome of the patient. Furthermore, this model will also assist nursing stuff in realizing their maximum potential, while delivering optimal health care services to the patient (Tran, Johnson, Fernandez & Jones, 2010). Further benefits of the team nursing model are associated with its potential in advancing and promoting role of RNs as effective care coordinators and team leaders. However, it is crucial for the team leaders to display appropriate delegation skills and interpersonal communication skills, in addition to adequate knowledge on the scope of practice of their colleagues (Tran, Johnson, Fernandez & Jones, 2010).
According to Polis, Higgs, Manning, Netto and Fernandez (2017) the team nursing model have been proved successful in improving optimal patient outcomes, enhancing patient safety, and reducing adverse events such as death. Moreover, the model has also been effective in staff retention and enhancing job satisfaction among healthcare professionals. It has also proved beneficial in supervising staff with less experience and providing them adequate support. Thus, this team nursing model is most commonly used in instances where there is an amalgamation of wide variety of nursing skills.
This can be elucidated by the fact that enrolled nurses display different levels of nursing expertise, upon comparison with registered nurse, and AINs. However, all of them are required to work in collaboration in healthcare settings while caring for a patient (Ferguson & Cioffi, 2011). Therefore, I would follow this model and allocate AINs to experience EN and RNs. The patient load will be divided accordingly, such as, 8 to myself and the AIN with whom I form a partnership, 8 to another AIN in partnership with an EN, and 6 to the partnership of an RN (working as NUM) and an AIN.
The registered nurse will work as NUM because she will be responsible for managing the entire word as well. The NSW health standard state that AINs are entrusted with the responsibility of performing simple clinical tasks related to measuring vital signs of patients admitted in acute health care ward (NSW Health, 2010). Hence, I would request all the AINs to measure vital signs of their corresponding patients. I would also presume that the EN has relevant knowledge in medication and is competent with administration of intravenous drugs.
Thus, I would expect them to appropriately administer medication two patients present in the surgical ward. I would also delegate the EN for administering intravenous drugs when required, and would ask her to seek assistance if needed. According to the NMBA (2018), enrolled nurses should be capable of administering drugs intravenously, provided they have completed their education on IV medication administration. Moreover, I would also focus on using other intravenous antibiotics for the concerned patient, and would provide assistance to other registered nurses, because the core idea of team nursing model is focused on supervising and helping each member of the team.
References
Dubois, C. A., D’amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal for Quality in Health Care, 25(2), 110-117.
Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220.
Ferguson, L., & Cioffi, J. (2011). Team nursing: experiences of nurse managers in acute care settings. Australian Journal of Advanced Nursing, 28(4), 5-11. Retrieved from-
King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: a systematic review protocol. JBI Database of Systematic Reviews and implementation reports, 12(1), 59-73. doi: 10.11124/jbisrir-2014-1533
NSW Health. (2010). Assistants in Nursing working in the acute care environment. Retrieved from
Nursingmidwiferyboard.gov.au. (2018). Nursing and Midwifery Board of Australia – Fact sheet: Enrolled nurses and medicine administration. Retrieved 3 March 2018, from
Polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2017). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian, 24(1), 19-25.
Tran, D. T., Johnson, M., Fernandez, R., & Jones, S. (2010). A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes. International Journal of Nursing Practice, 16(2), 148-158. DOI: 10.1111/j.1440-172X.2010.01823.x
Consider the patient situation
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The handover of the patient, Mrs. X, admitted to the palliative care was send to me. She reported impaired mobility and decreased appetite. She demonstrated a healthy skin turgour and was tachypnoeic. The RR was 28 rpm. |
Collect Cues/Information
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Patient history- Pelvic mass, adenocarcinoma (probability of having ovarian cancer with metastasis in the bones), left lung pulmonary embolism, right leg deep venous thrombosis. In addition to skin turgidity, the pulse rate of the patient should also be recorded (Wise, 2014). The patient also reported severe pain in her body. Her weight was 74.8 kgs. |
Process Information
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RR- 28 rpm. Respiratory changes are of significance for a patient since it is much above the normal range of 14-20 RPM (Jacox& Cole, 2012). The physiological changes and vital signs of the patient indicate a deterioration of her health. If these changes persist for a prolonged period of time, they can result in adverse health outcomes. |
Identify Problems/issues
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Upon comparison, I found that the patient manifested signs and symptoms of tachypnoea. I also found an elevation in her RR, beyond the normal ranges. This indicated adverse health condition (Schwartz, 2012). I would request presence of the physician for a discussion. I would also communicate the current health abnormalities with the family members of the patient. |
Establish Goals
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There should be a precise documentation of the physiological signs, followed by adequate supervision and monitoring of the patient’s condition (Felton, 2012). An effective collaboration should be developed between the healthcare professionals such as, physicians, nursing staff and cardiologists. This collaboration would bring about an enhancement in the overall health and wellbeing of the patient and would significantly improve health outcomes. |
Take Action
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The vital signs of the patient will be recorded, followed by a precise documentation. My nursing priority would focus on continuously monitoring the patient and regularly the vital signs. I will also administer oxygen and inform about it to the concerned medical officer. |
Evaluate Outcomes
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I expect to observe a reduction in the patient’s respiratory rate, in addition to stabilization of other vital signs. I also expect a reduction in bodily pain manifested by the patient. A PQRST assessment would be conducted. I would also ask the patient if she requires any pain breakthrough. I would try all possible efforts to make her comfortable during mobilizing or while she is in bed. |
Reflect on Process and new learning
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I understood the significance of appropriate documentation and supervision of patients. Helping mobility and giving pain medication prior will be my reminders. Respiratory team R/V. This exercise helped me learn importance of appropriate supervision and documentation of a patient. I learnt that it should be my utmost priority to assist all patients while moving. I also realized that careful administration of pain medications is essential. I also learnt that providing reassurance to a patient through effective communication is imperative for nursing duty. Furthermore, a patient should also be questioned for pain assessment and current medications. |
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