NRSG355 Clinical Integration


Activity 1

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 ISBAR format. Further information about the ISBAR format can be found on page 7 of this module.

1. What further questions will you need to ask the nurse?
2. List specifically what further assessments you would complete when the patient arrives onto the ward
3. Upload the above answers to your Professional Portfolio on LEO. This forms part of your assessment for this unit.
Activity 2

To understand more about the Clinical Reasoning Cycle please read chapter 1 of the prescribed text. Whilst reading this chapter identify ways that you can incorporate the Clinical Reasoning Cycle into your clinical placement.
Levett-Jones, T. (2013) Clinical Reasoning: Learning to think like a nurse, Frenchs Forests, NSW: Pearson.
Please read the article by Felton (2012). While you read the article take particular note of how important it is to take accurate vital obs, and how your thorough assessment can have a major impact on the patient’s prognosis.

Development, implementation and evaluation of planned care based on assessment findings Once you have completed all your assessments, it is then time to re-evaluate a plan of care for your patient. Most nurses will have a patient load of 4 or more patients, and it is essential you learn how to prioritise your time effectively in order to provide safe and quality care.

Things change quickly in healthcare environments, and you need to learn how to be flexible.
Therefore, the ability to prioritise and delegate are essential skills for nurses, and with time and experience you start to improve these skills. Student and graduate nurses can quickly feel overwhelmed and overloaded when they are required to care for a full patient load, and their time management may suffer as they learn how to juggle different tasks and responsibilities.

Wentworth (2003, p. 438) also speaks of the “personal inadequacy” one feels when they cannot manage their time – from personal experience, most nurses can tell you that they certainly felt incompetent when they started their graduate years; as most want to do everything for their patients but can not understand why it is not possible. Most graduate nurses think that no one else feels this way and often feel judged as inept when they hand over to the next shift nurse. It takes a while, but you will finally learn that nursing is a 24/7 job, and you are not expected to do EVERY thing for your patients. You can leave tasks for the next shift if it does not compromise the care you provide.

Activity 3

You have been allocated 4 patients this afternoon shift commencing at 1300hrs. You have received handover for the following patients:
Bed 1: A 45 year old female presented to ED with a haemothorax, and had an ICC inserted. She arrived on the ward at 1230hrs. She has an IVC in-situ in her left antecubital, and currently has 100ml/hr of NaCl 0.9% running. She has a morphine PCA which she is using appropriately, and it has kept her settled and pain-free. She is on 3 doses of prophylactic cephazolin 8 hourly, and she has received a dose in ED at 1200 hrs. There is an IDC in-situ, which is draining 35ml/hr, the urine appears cloudy. She will require a CXR in the morning, physio assessment, as well as a pain review by the medical team. Diet and fluids as tolerated.

Bed 2: A 23 year old male has been admitted with suspected cholecystectomy, and has been placed on the evening emergency theatre list. He is complaining of severe abdominal pain with a numerical pain score of 8/10. He has been fasting for 8 hours since he came to the ward this morning. He has no IV inserted, and has been prescribed PRN oral paracetamol and oxycodone for pain.

Bed 3: A 17 year old male who is Day 4 following a laparoscopic appendectomy with perforation, and is ready to be discharged home. He has been on PRN paracetamol and oxycodone, and has been prescribed amoxicillin and lactulose for use at home. His parents will pick him up at 1700hrs, once 5 Communication of assessment, planned care and evaluation of planned care – handover and documentation Central to the nurse’s role is the diagnosis, treatment, and evaluation of patient responses to actual &/or potential health problems (Campbell, Gilbert & Laustse, 2010). However, this is not done in isolation; but as a member of a team.
The ability to communicate a patient’s condition, response to therapy, and plan of action is a foundation stone on which effective team-work is built. This communication can be between the nurse and other nurses, the patient, the patient’s family, and other members of the multidisciplinary team (Campbell et al., 2010).

According to the Department of Human Services (2006), ineffective communication between staff is ranked as the second most common factor contributing to sentinel events in the Victorian healthcare setting. Therefore different strategies for communication are necessary in order to facilitate effective communication depending on the setting, the issue, and the participants.
The importance of effective clinical communication cannot be overstated, and if successful, can lead to:
• Improved safety.
• Improved quality of care and patient outcomes.
• Decreased length of patientstay.
• Improved patient and family satisfaction.
• Enhanced staff morale and job satisfaction
(The Joint Commission, as cited in Department of Health, 2010, p. 5)
This module will now explore two major forms of clinical communication – the verbal handover, and documentation of patient care. they have finished work.
Bed 4: Dirty bed. A new patient is to come up from ED in 1 hour with abdominal pain of unknown origin. She has no relevant past medical history, and has been booked in for an abdominal ultrasound at 1600 hrs. She is fasting and has not yet been prescribed any analgesia.

Activity 4

1. Scovell, S. (2010). Role of the nurse-to-nurse handover in patient care. Nursing Standard, 24(20), 35-39. Scovell (2010) identifies that handover assumes an almost religious significance in a nurse’s day before going on to describe the various roles that handover assumes in nursing culture. Therefore, apart from being a simple information sharing event, handover has a significant influence on the day-to-day, shiftto shift experience of nurses.
2. Street, M., Eustace, P., Livingston, P.M., Craike, M.J., Kent, B. & Patterson, D. (2011). Communication at the bedside to enhance patient care: A survey of nurses’ experience and perspective of handover. International Journal of Nursing Practice, 17, 133- 140. According to Street et al. (2011), the primary purpose of handover is “to provide accurate, up-to- date information about the patient’s care, treatment, use of services, current condition, and any anticipated changes in that condition” (p. 134). However dangers to effective handover include omission of vital information, inclusion of irrelevant &/or speculative information, and poor handover technique.
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