NMIH308 Transition To Professional Practice


You have been asked to review a critical incident, as per the case study.

This assessment is in two parts:

Part 1

Examine the case study and provide a brief, systematic overview of the issues that contributed to the critical incident that occurred for the patient.

o You must use a named process or model (Nursing process or clinical reasoning cycle) to analyse the key issues in the case study.

o This part of your assessment is about identifying all contributing factors and considering the areas that require further enquiry.

Part 2

To support your review of this critical incident, you are expected to source thre Scholarly, peer- reviewed journal articles. The articles must directly relate to three different issues identified in part A.

Each article must address a different issue.

For each article:

.Provide a summary of the evidence presented within the article.

. Identify and analyse how the evidence in the article could be used to improve nursing practice related to the key issue

.Use additional literature to support this analysis

.Provide a summary of how the article has informed your future practice.

Case study

Mr Thomas is a 60 year old gentleman who presented to his local Emergency department on the morning of 10th March, 2018 with a 2/7hx of productive cough and signs of alcohol withdrawal (tremors and hallucinations). He has a known history of chronic alcohol misuse, alcoholic liver disease and COPD. Mr Thomas was admitted to the medical ward that afternoon for management of exacerbation of COPD and was placed on an alcohol withdrawal plan which involved 2nd hourly clinical observations and alcohol withdrawal scale (AWS).

He was also commenced on thiamine and fixed dose regime of Oxazepam as part of this plan.

On transfer to the ward at 1500hrs, Mr Thomas’s observations were charted as P 110, Resp Rate 24, BP 135/85, SaO2 95% and his AWS had increased as he had become increasingly agitated and diaphoretic. The afternoon nursing staff documented this change and that they had administered a PRN dose of Oxazepam in addition to his fixed regime as charted for AWS. At 1800hrs, Mr Thomas was visited by his wife who voiced concerns to the nursing staff. She was very worried that he appeared pale and drowsy and not ‘himself’. The afternoon shift RN caring for Mr Thomas reassured her despite her repeating her concerns to the RN again before she went home.

Ms Kelly was the RN working on the 15-bed medical ward with an Enrolled Nurse (EN) on 10th March. Ms Kelly had been a registered nurse for five years. As per hospital policy, Ms Kelly and the EN were the only two staff members rostered to the ward on night-shift that commenced at 2245 hours. The medical ward

was at capacity on the nightshift 10th March. Two of the other male patients admitted to the unit were distressed; one was admitted for acute exacerbation of his chronic back pain requesting regular analgesia and assistance with ADL’s whilst the other gentleman had an acute delirium secondary to a urinary tract infection.

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