eModule Prioritization of Care for Registered Nurse

eModule Prioritization of Care for Registered Nurse Order Instructions: Kindly view the attached file.

E-module 1:

1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate.

eModule Prioritization of Care for Registered Nurse

2: Document your rationales in detail.

Prioritization of care is one of the major responsibilities of registered nurses to ensure safe and quality care within the clinical setting (Parham, 2012) Care should be prioritized according to the patient’s condition and severity of illness. In order to prioritize care, nurses should have critical reasoning and decision making skills (Levvet-Jones, 2013). As per the scenario, my first priority would be an elderly woman who has collapsed on the floor post surgery. Parham (2012) states that an unconscious condition can lead to a life-threatening situation when there is a delay in the treatment process. I will use the primary survey approach DRABCDE to optimize the patient’s condition as soon as possible and initiate met call or code blue if needed (Thim et al, 2012). Post-operative patients are at risk of clinical deterioration and airway management would be my primary concern because effects of pain relief medications and anesthesia may lead to respiratory depression that can further deteriorate her condition (Farrell & Dempsey, 2014). In addition, I will be engaging with met call teams for medication and documentation. At the same time, I would delegate the task to enrolled nurses (EENs) and assistants in nursing (AINs) to assess and provide support to the visitor who fainted in the visiting room to minimize the potential risk. However, a delegation of work must be within their scope of practice and I will be supervising them frequently to increase patient safety and maintain legal requirements (Eager, Cowin, Gregory & Firtko, 2010).

Other priority would be Mr Esposito who has been scheduled to leave the ward for cardiac catheterization and he is due for perioperative medication. Thus, I will delegate EEN to administer preoperative medication to minimise postoperative risks and complications (Farrell & Dempsey, 2014). I will also double check the perioperative check list and consent that patient has provided for a procedure to avoid legal and ethical issues (Nursing and Midwifery Board of Australia, 2015). I would also ask AIN to help me to transfer patient for cardiac catheterization. After that, I would inform the ward clerk about toilet overflow, as it is code yellow criteria due to internal crisis and mechanical damage (Government of Western Australia, 2013). This condition may increase possibility of spreading infection and smell in the hospital environment. Thus appropriate action will be taken by the authorized memberas it is considered as health hazard that needs to be fixed as soon as possible (Government of Western Australia, 2013).

Next, I will check intravenous cannula site for any sign of inflammation or infiltration in the patient who is due for antibiotic. I would remove IV cannula if there is any sign of inflammation and will notify the doctor for recannulation. Then, I would also tell the EEN to prepare Mrs. Chew’s antibiotics and I will be closely supervising EEN during preparing antibiotic. Nursing and Midwifery Board of Australia (2015) explains that enrolled nurses are able to administer most medications but they are not competent to administer intravenous antibiotics without completing intravenous medication competency. Lastly, I may discuss with VMO regarding medication error which occurred last week and is the least priority in the current situation. However, I will relay information to the next shift staff to provide clarification of this discussion to prevent further risks to patient and health professionals.

eModule Prioritization of Care for Registered Nurse References

Eager, S. C., Cowin, L. S., Gregory, L., & Firtko, A. (2010). Scope of practice conflict in nursing: A new war or just the same battle? Contemporary Nurse: A Journal for the Australian Nursing Profession, 36(1/2), 86-95. Retrived from http://search.informit.com.au/browseJournalTitle;res=IELHEA;issn=1037-6178

Farrell, M., & Dempsey, J. (2014). Text book of medical surgical nursing (3rd ed.). Philadephia PA

Government of Western Australia, (2013). Emergency codes in hospitals and health care facilities. Retrieved from http://www.health.wa.gov.au/CircularsNew/pdfs/12974.pdf

Levvet-Jones, T. (2013). Clinical reasoning: Learning to thinking like a nurse. Pearson, Melbourne Australia,

Nursing and Midwifery Board of Australia. (2015). Enrolled nurses and Medication Administration Fact Sheet. Retrieved from:file:///C:/Users/Owner/Downloads/Nursing-and-Midwifery-Board—Fact-Sheet—Enrolled-nurses-and-medicine-administration.PDF.

Parham, G. (2012). Recognition and response to the clinically deteriorating patient. Australian Medical Student Journal, 3(1), 18-22. Retrieved from: www.amsj.org/

Thim, T., Krarup, Grove, Rohde, & Lofgren,. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of General Medicine,117. http://dx.doi.org/10.2147/ijgm.s28478

Module 2 Collaborative and Therapeutic Practice

Identify factors that determine which healthcare professionals are required to be involved in a health care team?

Multidisciplinary team is composed of healthcare professionals from different healthcare fields with specialised knowledge, skills and expertise. These team members collaborate together to provide clients the best healthcare services and expected outcomes (RACGP, 2011).

The major components of an effective interdisciplinary team:

Identifies a team leader who establishes a clear direction for the team, and also listen and provides support and supervision to all team members (Nancarrow et al., 2013)
Demonstrates an interdisciplinary environment of trust where ideas and contributions are equally valued and consensus is fostered (Nancarrow et al., 2013)
Promotes effective and efficient communication within the team, and collaborative decision making (RACGP, 2011)
Ensures appropriate processes are in place to uphold the established goals (RACGP, 2011)
Provides promotes roles interdependence while respecting individual roles and autonomy (Nancarrow et al., 2013).
Facilitates personal development through adequate training, recognition and opportunities for career development (Nancarrow et al., 2013).
Provides quality patient-centered services with documented outcomes, utilizes feedbacks to enhance the care quality (RACGP, 2011).

Who should lead the team?

The case manager should play the important role for patient’s holistic health care. The responsibilities include maintaining regular contact with the patient, initiating effective and timely response when the patient needs change and liaising with other team members and services.

Who is the most important member of the health care team?

Every member within the health care team plays a vital role as they contribute their expertise skills and knowledge to provide a coordinated care for patients to ensure that the patients receive the best possible health outcomes. It is important to have a team leader, who takes responsibility to direct the team to achieve an efficient outcome for the patients. A team leader’s roles include contacting the patients, collecting relevant information from the patients, organizing group meeting and continuously updating the patients’ health and treatment progression (World Health Organisation, 2014). Moreover, it is also crucial to involve the patients into clinical decision-making, and it has been proven that active patient involvement often results in better health outcomes achieved (Politi, Wolin & Legare, 2013). The process involves healthcare workers and patients work together to make choices about the patients’ care, taking both the clinical evidence as well as patients’ preferences into consideration. Politi, Wolin & Legare (2013) also stated that patients and healthcare workers collaboratively work to identify and to clarify the patients’ values and preferences and select a decision.

eModule Prioritization of Care for Registered Nurse Case Study One

Question 1: key issues in the dilemma?

There are three different opinions as follow:

Firstly, the patient and the family wish to rehabilitate at home. The family has also modified their accommodation. The psychologist and social worker also believe that staying at home can be generally more beneficial for the patient. Secondly, the physiotherapist and the occupational therapist suggest the patient to stay inpatient for longer to receive more benefits from hospital services. Thirdly the treating doctor thinks that the patient may be able to go home however the patient will still require regular appointments with the physio and the occupational therapist.

The key issue is that whether discharge can be more beneficial for the patient or inpatient services can achieve better outcomes.

Question 2: best outcomes?

I think that patient’s treating doctor has the best option, as the doctor’s suggestion would meet every request from the patient, family and multidisciplinary team members. This suggestion also indicates the team members respecting patient’s right.

Question 3: how do we guide the group to make sure we can achieve this outcome?

As a RN, we should advocates for the patients and their rights. According to Nursing and Midwifery Board of Australia (2006), we need to practice in a way that acknowledges patient’s the dignity, values, beliefs and culture. Therefore, in this situation, we should discuss with the physiotherapist and the occupational therapist regarding patient’s rights and autonomy. For example, I would request the occupational therapist to help patient’s family regarding house modification to minimise the potential risks of injury. I would also educate the patient about the importance of physiotherapy and rehabilitation process and also make sure the patient will attend the appointment with the physiotherapist in order to achieve the maximums outcomes.

eModule Prioritization of Care for Registered Nurse References

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources For Health, 11(1), 1-11. doi:10.1186/1478-4491-11-19

Nursing and Midwifery Board of Australia. (2006). National competency standards for the registered nurse. Practises within a professional and ethical nursing framework.

Politi, M. C., Wolin, K. Y., & Legare, F. (2013). Implementing clinical practice guidelines about health promotion and disease prevention through shared decision making. Journal Of General Internal Medicine, 28(6), 838-844. doi:10.1007/s11606-012-2321-0

The Royal Australian College of General Practitioners. (2011). The RACGP Curriculum for Australian General Practice 2011. Multidisciplinary care. Retrieved on 5^th October, 2015. From http://curriculum.racgp.org.au/statements/multidisciplinary-care/

World Health Organisation. (2014). Leadership, team skills and management. Retrieved from http://www.steinergraphics.com/surgical/001_01.2.html

Module 3 Provision and Coordination of care

What further questions will you need to ask the nurse?

Handover is one of the most important for nurses communication patients events. Handover generally happens at the end or the beginning of each shift and its purpose is to formally hand responsibility and accountability for patient care to another nurse or a team of nurse. During a handover, patient information is passed from one nurse to another, it often includes patients’ name, age, past medical histories, diagnosis, tests, procedures, vital signs, significant changes during previous shifts and care plan. Berman et al. (2012), handover’s main purpose is to achieve the continuity of care and also is a key component of patient safety.

How is his abdominal pain now?
Are his vital signs within the normal ranges? How his temperature now due to his pneumonia?
Is there any intervention has been done for his abdominal pain such as analgesic medication administration in ED including time, dosage and route?
Which doctors and health care team are responsible for his treatment and management?
Does he have any blood test or tests ordered? Or if any bloods test have done already and result?
When was the IV cannula been inserted, where is it?
How is his current mobility status? Does he require assistance or supervision with his ADLs, if yes how many people are require?
Does he have any discharge plan? Where is he going to for his discharge? And how does he manage to get to his discharge place such as family pick up or patient transport?

List what further assessments you would complete when the patient arrives onto the ward.

Doing Patient assessment is an essential part of nursing role. It is an ongoing process which requires gathering and collecting baseline information, updating patient’s treatments and evaluating patients’ outcomes. An initial patient assessment is generally performed at the start of every shift as to obtain baseline of patients’ condition and nursing history in order to establish plan of care and assist in making clinical judgments (Berman et al., 2012).

An initial head to toe assessment needs to be conducted immediately after the handover
Vital signs observation – temperature, respiration rate, pulse rate, oxygen saturation and pain assessment (Jang, Chauhan, Cundiff, & Kaji, 2014).
Respiratory assessment as pneumonia is suspected – inspection for the work of breathing – any shortness of breath, use of accessory muscles and auscultation of the bilateral lung sounds to find any adventitious sounds (Berman et al., 2012)
Complete a neurological observation.
Pain assessment.
Check the patient fluid balance status such as oral intake, IV fluid and IV medication administration, urine output.
Complete falls risk assessment and pressure ulcer assessment.

eModule Prioritization of Care for Registered Nurse References

Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T. Hales, M., Harvey, N. … Stanley, D. (2012). Kozier and Erb’s fundamentals of nursing. Frenchs Forest, Australia: Pearson.

Jang, T., Chauhan, V., Cundiff, C., & Kaji, A. H. (2014). Assessment of emergency physician-performed ultrasound in evaluating nonspecific abdominal pain. The American Journal Of Emergency Medicine, 32(5), 457-460. doi:10.1016/j.ajem.201

Activity 2: Clinical Reasoning Cycle Worksheet

Consider the patient situation		A 65-year-old male patient was admitted to Coronary Care Unit with the diagnosis of ST elevation myocardial infraction (STEMI). He had a complain of severe chest pain during my shift. History of hypertension, type two diabetes (T2DM), EX- smoker, high cholesterol, asthma, chronic cardiac failure (CCF) and arterial fibrillation. He was on four hourly blood glucose level, tolerating diabetic diet and lives alone as his wife passed away a year ago.
Collect cues/ information	Patient was alert and oriented, GCS 15/15, equal limbs strength, pain score- 7/10, centrally located on left chest and radiating in nature. Vital signs- BP 140/90mmhg, HR-90/m, Afebrile, RR- 26/m. Troponin I level 0.6ng/ml, creatinine kinase (CK) -179U/L, He was on cardiac medication, prn Salbutamol and two hourly vital signs and frequent observation of pain score. He was also on continuous cardiac monitoring and planned for angiogram.
Process information		A set of observation was taken immediately. His pain score was still 7/10, anxious, restlessness, agitated and increased shortness of breath, SPO2 94% on room air and crackles sound noted on both lungs (lower bases). Therefore, pain could be due to insufficient oxygen level associated with anxiety, asthma and CCF (Farrell & Dempsey, 2014). Pain might be due to blockage of coronary blood vessels as he had multiple risk factors such as obesity, smoker, history of heart disease and current diagnosis which is STEMI. It can lead to serious cardiac complication such as cardiac arrest (Farrell & Dempsey, 2014).
Identify problem / issue	Acute Chest pain or angina is related to cardiac problems.
Establish goals	To improve patient’s chest pain and keep patient with pain free and provide comfort to the patient.
Take action	I used the pain assessment PQRST method to identify severity, location and nature of pain (Berman et al, 2012). Patient was put in upright position which helps to promote ventilation thereby reducing pain (Farrell & Dempsey, 2014). Patient condition was notified to my buddy nurse and on duty doctor. I took another set of vital signs and administer four litres of oxygen via nasal prong under the supervision of my buddy nurse that may help to optimize the oxygen level and facilitate breathing pattern. I performed ECG to monitor his cardiac condition. Reassurance was given to reduce his anxiety (Farrell & Dempsey, 2014). GTN patch 5 mg was given as per ordered as it helps to reduce pain and his regular cardiac medication such as anticoagulant and anti-cholesterol was given as per charted to minimize further risks. Patient was encouraged for deep breathing and coughing exercise that help to promote ventilation and facilitate breathing pattern thereby reducing pain (Abbas, 2015).
Evaluate Outcomes	The patient was on close cardiac monitoring his vital signs were significantly improved. After implementation of above interventions, patients stated that his pain score was around 3/10 and he was comfortable.
Reflect on process and new learning	From this scenario, I have developed my critical reasoning and analysing skills. As patient had a chest pain, I was able to collect cues and information and was able to take quick action by utilizing my theoretical knowledge in the clinical setting. I have learnt about importance of pain assessment tool to identify the nature of pain. In his case, his chest pain could be due to acute exacerbation of asthma. However, I was able to differentiate his pain which might be cardiac related to pain because it was centrally located and radiating in nature. I was able to minimize pain level with above interventions by collaborating interdisciplinary teams.

eModule Prioritization of Care for Registered Nurse References

Abbas, A. (2015). Nurses’ knowledge Concerning chest pain management in emergency unit. (Farrell & Dempsey, 2014). Asian Journal of Nursing Education and Research, 5(1), 01-07. Doi:10.5958/2349-2996.2015-00001.4.

Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T. Hales, M., Harvey, N. … Stanley, D. (2012). Kozier and Erb’s fundamentals of nursing. Frenchs Forest, Australia: Pearson.

Farrell, M., & Dempsey, J. (2014). Text book of medical surgical nursing (3rd ed.). Philadephia PA.

Module 4:

I would allocate six patients to the registered nurse who acts as the nurse unit manager (NUM), 8 patients to the enrolled nurse and 8 patients to me who is another registered nurse. The NUM should take a less patient load because the NUM is accountable for all nursing staff on the ward as well as overall patient care. In addition, the NUM is the best person who would manage unresolved patient-related concerns on the ward (Carers Victoria, 2006). Moreover, I would allocate the same patient load as mine to an enrolled nurse because an EN is competent in providing patient-centred care, recognising abnormalities in nursing assessment, offering necessary nursing interventions, evaluating patients’ outcomes, and administering prescribed medicines or maintaining intravenous fluids based on their educational preparation as well as the hospital’s policy (Monash University, 2013). If an enrolled nurse without notations has completed the education of administrating intravenous medication, he or she can administer intravenous medicines (Nursing and Midwifery Board of Australia, 2016). However, working under the direction and supervision of the registered nurse is the stipulation of the Australian Health Practitioner Regulation Agency and is a core of EN practice (Monash University, 2013). Therefore, I would provide necessary support to the EN, prepare and administrate the intravenous antibiotics for the EN’s patients if the EN has not complete her IV medications certificate. Besides this, the extent of a nurse’s scope of practice depends on the person’s education, training and competence (NMBA, 2016). Therefore, a nurse should recognise own limitation and know when to ask for help.

In addition, each nurse would be partnered with an assistant in nursing (AIN) so that both the nurses and the AINs have a focused patient group. According to the NSW Department of Health (2010), the key functions of an AIN is to provide support to the nursing team, assist with nursing interventions as directed, communicate effectively with patients and other health professionals, and deliver direct care activities to patients according to the nursing care plan and under the supervision of a RN. Furthermore, a RN or EN could delegate simple tasks such as personal hygiene, feeding, positioning and repositioning, pressure area care, toileting, assisting patient’s transfer and supporting a patient’s mobilisation as per plan of care to the AINs (NSW Department of Health, 2010). By delegating simple tasks to the AINs, the registered and enrolled nurses could perform more complex tasks, improving work efficiency. However, both RNs and ENs should assess the AINs’ competency and willingness to perform the tasks before delegating the task, and ensure good communication, instruction, supervision and support for the delegation (Weydt, 2010). What is more, an AIN is partnered with a nurse because teamwork is a significant aspect of nursing because it employs the practices of collaboration and improved communication, which is known to enhance patients’ outcomes (NSW Department of Health, 2010).

eModule Prioritization of Care for Registered Nurse REFERENCES

Carers Victoria. (2006, 03). Nursing and other staff in hospitals. Retrieved from Carers Victoria: http://www.survivingthemaze.org.au/bcfc/PDFS/NSW-02-04.pdf
Monash University. (2013, 03 19). The Enrolled Nurse (EN) Scope of Practice. Retrieved from Monash University:Medicine, Nursing and Health Sciences: http://www.med.monash.edu/nursing/competency-standards/scope.html
NSW Department of Health. (2010, 05). Assistants in Nursing working in the acute care environment: Health Service Implementation Package. Retrieved from NSW Department of Health: http://www.health.nsw.gov.au/workforce/Publications/ain-acute-care.pdf
Nursing and Midwifery Board of Australia. (2016, 10). Fact Sheet: Enrolled nurses and medication administration. Retrieved from Nursing and Midwifery Board of Australia: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ.aspx

SAMPLE ANSWER

E-module 1:

1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate.

2: Document your rationales in detail.

Parham, (2012) states that Registered Nurses (RNs) are charged with the key responsibility of prioritising care whereby they ensure that patients receive safe and quality care within clinical settings. Care prioritization should be based on the condition of a patient as well as the severity of the disease. Critical thinking and decision making skills are some of the important parameters that nurses need for them to prioritize care (Levvet-Jones, 2013). From the scenario, I would first give priority to the elderly woman who has collapsed on the floor. Usually, an unconscious condition can predispose an individual to situations that are life threatening when urgent medical interventions are not provided (Parham, 2012). I will employ the primary survey technique DRABCDE so that I can optimize the condition of the patient quickly and initiate met call or code blue if necessary (Thim et al, 2012). Usually, post-operative individuals are predisposed to the risk of clinical deterioration. In managing the elderly woman my primary concern would be to stabilize her airway. This is because the analgesic and anaesthetics used during the operation depress the respiratory system and this can worsen her condition if not well managed (Farrell & Dempsey, 2014). Moreover, I will maintain contact with the met call teams for documentation and medication. Similarly, I would assign tasks to the enrolled nurses (EEN) as well as assistants in nursing (AINs) to evaluate and offer support to the individual that fainted in the living room to reduce the potential risk. The delegation of these tasks will be done according to the scope of practice of an individual. I will frequently supervise them to ensure there is patient safety and legal requirements are observed (Eager, Cowin, Gregory & Firtko, 2010).

I would also give priority to Mr Esposito who is meant to leave the ward for cardiac catheterization and requires perioperative medication. I will therefore ask an EEN to administer the medication to reduce the risk and complications encountered after surgery (Farrell & Dempsey, 2014). Moreover, I will double check the patient’s perioperative check list and consent to avoid any legal or ethical issues (Nursing and Midwifery Board of Australia, 2015). I would then request the AIN to help in transferring Mr Esposito to have cardiac catheterization. Thereafter, I would call the ward clerk and inform him about the toilet overflow; this is a code yellow criteria due to crisis and mechanical damage (Government of Western Australia, 2013). The overflow may increase chances of infections spreading and smell in the hospital environment, and therefore, proper and timely intervention should be put in place by the members responsible (Government of Western Australia, 2013).

In the patient that is due for antibiotic, I will check the IV cannula site to determine whether there is any sign of infiltration or inflammation. Any sign of inflammation will prompt me to remove the cannula and I will inform the doctor on the need for the patient’s recannulation. I would also notify the EEN to prepare antibiotics for Mrs Chew and I will supervise the EEN closely when she is preparing the antibiotics. According to the Nursing and Midwifery Board of Australia (2015), enrolled nurses can administer most medications but they are not competent enough to administer IV antibiotics without completion of the IV medication competency. I will lastly discuss with the VMO about medication error that were recorded the previous week. I will then convey the information to the next shift staff to offer clarification of this discussion to avoid similar risks to patient and clinicians.

References

Farrell, M., & Dempsey, J. (2014). Text book of medical surgical nursing (3rd ed.). Philadephia PA

Government of Western Australia, (2013). Emergency codes in hospitals and health care facilities. Retrieved from http://www.health.wa.gov.au/CircularsNew/pdfs/12974.pdf

Levvet-Jones, T. (2013). Clinical reasoning: Learning to thinking like a nurse. Pearson, Melbourne Australia,

Parham, G. (2012). Recognition and response to the clinically deteriorating patient. Australian Medical Student Journal, 3(1), 18-22. Retrieved from: www.amsj.org/

Module 2 Collaborative and Therapeutic Practice

Identify factors that determine which healthcare professionals are required to be involved in a health care team?

A multidisciplinary team is made up of practitioners from various fields in the health sector who have specialized skills, knowledge, and expertise. The team members work collaboratively in providing patients with quality services and meet the patient outcomes (RACGP, 2011).

An interdisciplinary team requires the following components for it to be effective;

First, it should identify a team leader who has good command and directs others according. He/she should also listen and offer support as well as supervision to other members (Nancarrow et al., 2013)
The team should have an interdisciplinary environment of trust where suggestions and ideas are valued equally fostering consensus (Nancarrow et al., 2013).
Effective and efficient communication should also be promoted in the time coupled with collaborative decision making.
The members should make sure that there are appropriate process in place to achieve the set goals (RACGP, 2011).
The team should exercise interdependence and respect the roles and autonomy of the members (Nancarrow et al., 2013).
Personal development should be promotes through provision of adequate training, acknowledgement, and opportunities that enhance career development (Nancarrow et al., 2013)
The team should deliver quality patient-centered services, document the results, and use feedbacks in promoting the quality of care (RACGP, 2011).

Who should lead the team?

It is the role of the case manager to ensure that there is holistic care for patients. Some of the roles involved include ensuring that there is regular contact with the patients, establishing timely and effective responsibilities when a patient is in need of change and liaising with other colleagues.

Who is the most important member of the health care team?

In a health care team, every member is important because each contributes his/her expertise, skills, and knowledge with an aim of achieving coordinated care for patients. A multidisciplinary team should have a leader who directs others to attain a desirable outcome. The leader’s responsibilities include contacting patients, gathering important patient information, convening group meetings, and updating the health of a patient and progression of treatment (World Health Organisation, 2014). Additionally, it is essential to have patients involved in making clinical decisions since active patient involvement usually leads to better patient outcomes (Politi, Wolin & Legare, 2013). The choices regarding patient care are made by both the clinicians and the patient based on the evidence presented and the preferences of the patient. Politi, Wolin & Legare, (2013) point out that practitioners and patients work collaboratively to determine and clarify the values and preferences of patients and make decisions.

Case Study One

Question 1: key issues in the dilemma?

There are three different opinions as follow:

First, the family and the patient prefer who rehabilitation and the family has also modified their accommodation. Additionally, the social worker and psychologist weigh in and suggest that home rehabilitation is beneficial for the patient. The other dilemma is that the physiotherapist as well as the occupational therapist recommend that the patient should be admitted so that he can benefit more from the hospital. Lastly, the doctor in charge feels that the patient can be discharged although recommends that the patient should have regular appointments with the occupational therapist and the physio.

The major issue in this case is whether the patient would benefit more from the discharge or inpatient services.

Question 2: best outcomes?

Personally, I would go with the decision of the treating doctor who suggests that he will meet every request from the patient, the family as well as the multidisciplinary team members, a suggestion that shows how team members respect the patient’s decision.

Question 3: how do we guide the group to make sure we can achieve this outcome?

As Registered Nurses (RNs), we should protect the patients and their rights. The Midwifery Board of Australia (2006) reports that RNs ought to work in manner that acknowledges patients’ dignity, beliefs, values, and culture. As a result, in the situation, we should have a discussion with the occupational therapists and the physio about the rights and autonomy of the patient. For instance, I would ask the occupational therapist to help the family of the patient on house modification in order to reduce the probability of potential risks of injury. In addition, I would enlighten the patient about the significance of physiotherapy and rehabilitation process and ascertain that the patient will attend all appointments with the physio so that maximum patient outcomes can be attained.

References

Nursing and Midwifery Board of Australia. (2006). National competency standards for the registered nurse. Practises within a professional and ethical nursing framework.

World Health Organisation. (2014). Leadership, team skills and management. Retrieved from http://www.steinergraphics.com/surgical/001_01.2.html

Module 3 Provision and Coordination of care

What further questions will you need to ask the nurse?

Handover is one of the most significant events during shifting in clinical practice. Generally, it is done at the beginning or at the end of a shift with an aim of formally handing responsibility as well as accountability to another practitioner. Normally, patient information is handed from one nurse to the other during handover. The information ranges from the name of the patient, past medical histories, age, diagnosis and tests, vital sins, procedures, critical changes in previous shifts, and the patient’s care plan. The primary goal of handovers is to ensure that there is continuity of care which is an essential aspect in maintaining patient safety (Berman et al., 2012).

What is the severity of his abdominal pain?
Are the vital signs within the physiological range? How is his body temperature due to pneumonia?
Is there any intervention has been done for his abdominal pain such as analgesic medication administration in ED including time, dosage and route?
Which practitioners are in charge of the patient?
Has any blood test been done or is there an order for the same? If tests have been done what were the results?
For how long has he been having the IV cannula?
What is the status of morbidity in the patient? Does he need any supervision with his ADLs, and if so, how many practitioners are required?
Is there any discharge plan for the patient? Where will he go after the discharge? And how will he get to his discharge place?

List what further assessments you would complete when the patient arrives onto the ward.

One of the essential roles in nursing practice is conducting patient assessments. This process requires a clinician to collect baseline information, updating the treatments of the patient, and assessing the outcomes of the patient. At the start of every shift, an initial patient assessment is conducted to acquire baseline of information on the condition of the patient and nursing history so as to implement a plan of care and help in making clinical decisions (Berman et al., 2012).

Activity 2: Clinical Reasoning Cycle Worksheet

Consider the patient situation		A 65-year-old male patient was diagnosed with ST-elevation myocardial infarction (STEMI) and admitted to Coronary Care Unit. He complained of severe chest pain and had a history of type II diabetes, high blood pressure, cholesterolemia, smoking, asthma, arterial fibrillation and chronic cardiac failure. He was on tolerating diabetic diet, four hourly blood glucose level, and lives alone. His wife passed away a year ago.
Collect cues/ information	The patient was alert and oriented, having a GCS of 15/15, pain score- 7/10, centrally located on left chest and radiating in nature, and equal limbs strength. For the vital signs, his blood pressure was 140/90mmHg, heart rate of 90beats per min, afebrile, RR- 26/m. The troponin I level was 0.6ng/ml, and creatinine kinase-179U/L. Currently received cardiac medication with parenteral salbutamol and two hourly vital signs examination including constant observation of pain score. He was also on continuous cardiac monitoring and planned for an angiogram.
Process information		The pain score remained 7/10, being anxious, restless, agitated and pronounced dyspnoea. The saturated partial pressure of oxygen was 94% on room air. Crackles were evident on the lower bases of both lungs. The pain could, therefore, be due to insufficient oxygen level associated with asthma, anxiety and CCF (Farrell & Dempsey, 2014). The pain could also be as a result of coronary blood vessels blockage because of the evidence of multiple risk factors such as obesity, smoking, and past heart disease and current diagnosis of STEMI. All these could lead to serious cardiac complication such as cardiac arrest (Farrell & Dempsey, 2014).
Identify problem / issue	Angina or acute chest pain associated with cardiac problems.
Establish goals	To relieve the patient’s chest pain and make him comfortable.
Take action	The PQRST method for pain assessment was used to identify the location, severity, and nature of pain (Berman et al., 2012). The patient was put in an upright position to encourage ventilation which reduces hypoxia, thereby reducing pain (Farrell & Dempsey, 2014). The patient’s information was handed over to both my buddy nurse and the doctor on duty. I took another set of vital signs and administered four litres of oxygen via a nasal prong under the supervision of my fellow nurse to help facilitate the breathing pattern. An ECG monitored his cardiac condition. Constant reassurances reduced his anxiety (Farrell & Dempsey, 2014). GTN patch 5 mg was given to reduce pain. Anticoagulants and anti-cholesterols were given as per charted to minimize further risks. The patient was encouraged to perform deep breathing and coughing exercises in a bid to promote ventilation and facilitate breathing pattern consequently reducing the pain (Abbas, 2015).
Evaluate Outcomes	Close cardiac monitoring was done and his vital signs were significantly improved. The patient stated that his pain score had reduced to 3/10 and was comfortable.
Reflect on process and new learning	As a medical practitioner, my critical thinking and analysis skills were significantly improved. Collection of clues and information helped in taking a quick action by utilizing theoretical knowledge in the clinical setting to manage the patient’s pain. The pain assessment tool is significant in the identity of the nature of pain. The patient’s chest pain could have been due to acute exacerbation of asthma. However, I was able to differentiate his pain which was cardiac-related because it was centrally located and radiating in nature. I was able to minimize pain level with above interventions by collaborating with other practitioners.

Module 4:

I would assign 6 patients to the RN who serves as the nurse unit manager (NUM0, I will also allocate eight patients to the enrolled nurse and I will manage the other 8. The nurse unit manager should have a less patient load because she is in charge of all nursing practitioners on the ward and the overall care of the patient. Moreover, the NUM is well suited in addressing patient concerns that are unresolved in the wards (Carers Victoria, 2006). Additionally, I would assign similar patient load to the enrolled as mine because the EN has enough skills for offering patient-centred care, identifying abnormalities, providing appropriate medical interventions, assessing the outcomes of the patients, and administering drugs that have been prescribed and maintaining the flow of IV fluids according to the hospital policy and educational preparedness (Monash University, 2013). If an EN has completed the education of IV administration of medication, he/she can administer medications through the IV route (Nursing and Midwifery Board of Australia, 2016). However, the Australian Health Practitioner Regulation Agency recommends that the EN should work under the supervision of the RN. As a result, I will offer adequate support to the EN in preparing and administering the IV antibiotics where necessary. Apart from this, the extent of the scope of a nurse relies on the education of the nurse, training, and competence (NMBA, 2016). Consequently, a nurse should be aware of his/her own shortcomings and seek help.

A focused patient group will be established by partnering each nurse with an assistant in nursing (AIN).The NSW Department of Health (2010), points out that the primary responsibility of an AIN is to offer support to the nursing team, help in conducting nursing interventions as stipulated, effectively communicate with patients and other practitioners, and provide care activities that are direct and in line with the nursing care plan and direction by a registered nurse. Additionally, an EN or RN can delegate basic duties such as feeding, positioning and repositioning, personal hygiene, supporting the mobilisation of the patient, and toileting according to the AINs plan (NSW Department of Health, 2010). By assigning simple duties to the AINs, the RN and EN could do tasks that are more complex hence enhancing work efficiency. Nonetheless, both the ENs and the RNs should evaluate the willingness and competencies of the AINs to conduct tasks before assigning the task. They should also make sure that the delegation is accompanied with proper communication, instruction, monitoring, and support (Weydt, 2010). Since teamwork is a vital aspect in nursing care, AINs will be partnered with RNs to enhance collaboration practices and foster communication that has been proven to promote patient outcomes (NSW Department of Health, 2010).

References

Carers Victoria. (2006, 03). Nursing and other staff in hospitals. Retrieved from Carers Victoria: http://www.survivingthemaze.org.au/bcfc/PDFS/NSW-02-04.pdf

Monash University. (2013, 03 19). The Enrolled Nurse (EN) Scope of Practice. Retrieved from Monash University:Medicine, Nursing and Health Sciences: http://www.med.monash.edu/nursing/competency-standards/scope.html

NSW Department of Health. (2010, 05). Assistants in Nursing working in the acute care environment: Health Service Implementation Package. Retrieved from NSW Department of Health: http://www.health.nsw.gov.au/workforce/Publications/ain-acute-care.pdf

Nursing and Midwifery Board of Australia. (2016, 10). Fact Sheet: Enrolled nurses and medication administration. Retrieved from Nursing and Midwifery Board of Australia: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ.aspx

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