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NRSG355 Clinical Integration

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NRSG355 Clinical Integration

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Course Code: NRSG355
University: Australian Catholic University

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Country: Australia

Question: 
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 ward3. 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.
 
Answer: 

Module 1
Delegation can be explained as the multi-faceted skill sets that need to be harbored by every healthcare professional in the healthcare units. Delegation is a complex procedure in the professional healthcare practices that require sophisticated clinical judgments as well as final accountability of the patient’s care (Barrow & McMillan, 2018). Delegation is considered to be one of the most important skills in present day because of the growing nursing shortage, rising of the patient acuity and the new emphasis that is put on patient satisfaction and patient centered care. Registered nurses have the responsibility of conducting patient ongoing reviews about their practices along with specific attentions given to the delegation procedures (Kim & Gu, 2015). Five important aspects need to be followed by the professionals. These steps include consideration of the correct task followed by taking into account the right circumstances. They should be also considering the right person as well as the right directions as well as communication and even right supervision and evaluation. In the present scenario, different scenarios have been provided. The healthcare professionals need to undertake proper delegation of the tasks to make sure that patient safety as well as quality care can be provided.
The first priority would be the elderly postoperative patient. This is because she had suffered a fall and had become unconscious. Becoming unconscious raises the concern of facing injury in the head region that might become fatal if not taken care. Therefore, I would need to make a met call. A code blue should be also initiated as she had faced a facial injury.
The second priority in the situation would be administering the antibiotics to the patient named Mrs. Chew. She had already missed her antibiotics and her infusion had tissues. Therefore, I will be delegating the task to the NUM. the NUM would be able to handle the situation well. Enrolled nurses will not be able to complete this task as they are not competent and so, I will not delegate them this task.
The third priority would be providing medication to the patient named Mr. Esposito. It is not stated in the case study about the particular type of medication that needs to be administered. Therefore, I can delegate this responsibility to an enrolled nurse who would be able to handle the situation effectively.
The fourth priority would be handling the visitor of the patient named Mrs. Smith. The visitor had fainted but as she is an outsider, the nursing professionals cannot treat her in the healthcare wards. In this case, the delegation should be done to an AIN. She should stay with the outsider where an ambulance cab be called for her. Accordingly, she should be admitted to the emergency department and a doctor can attend her there.
The fifth priority would be delegating the work of the block toilet issue. I would be delegating the task to the ward clerk. He would be calling for the emergency maintenance request.
The medication error had already occurred one week ago. It had not been discussed and addressed at that time. Therefore, I should apply my reasoning skill. As it is already late, I should only focus on this issue after all the emergencies are tackled effectively.
Module 2
Activity 1:

Tribalism refers to the state of existed as the tribe or advocating for an association for a tribe. It implies the possession of a strong culture and ethnic identity that separate a bunch of people from the community (Southall, 2018).
 Power inequality and tribalism influence individuals by feeding certain lies about cultural beliefs and therefore it becomes a huge hindrance in the health care system since a majority of the individuals refuse to take the treatment and even feel offended to take it. Therefore, a series of holistic approaches remain unsuccessful (Weller, 2012).
five dimensions of the well-functioning health care system are including the improved health of individuals, defending the population from health disease, protecting from financial consequences of ill health, providing patient-centric care, providing effective care with emotional well being.  

Part 2:

The benefit of conflict suggested by the author is team uses effort to manage a conflict and conflict enhances the sense of collaboration, interpersonal interaction. Moreover, it has an effect on performance, creativity, innovation and potential positive outcome (Kalishman et al., 2012).

Activity 2

The multidisciplinary teams communicate with each other about the fact and diseases and the severity of the disease along with the health conditions of the patient determines the members of the multidisciplinary team (Brown & Sherman, 2015).
The specialist and the neuropsychologists lead the multidisciplinary team.
A multidisciplinary team usually care for people with the long-term motor neurological disease. Therefore, the main members of multidisciplinary disease are a general physician who identifies disease first then the specialist who identify the core of the disease in the specific clinical area. In this case, the main member will be the neurologist and occupational therapist.

Case study 4:

The key issue is exceptional confrontational.  On a busy rehabilitation unit, the physiotherapy representative was absent due to the lack of bonding within a team member. Moreover, that team member failed to deliver smooth care to the patient and update to the patient. Therefore, it has a huge effect on the multidisciplinary team and patient outcome (Pillay et al., 2015).
Here, a key issue is the lack of bonding between key members of the physiotherapist. Here, physiotherapist failed to make bonding in the team and therefore absent on busy days. As a team leader, the most powerful strategy will be building up the strong bonding between physiotherapist and other members of the team. Bonding can be made by interpersonal communication, informal outing, the frequent session where every member will point out their area of concern and share their personal experience with each other (Pillay et al., 2015).Since physiotherapist was failed to serve the patient properly by not giving the smooth update to a patient and patient-centric care. Therefore, providing information about the importance of patient and providing training about therapeutic communication and building proper feedback communication will help the physiotherapist to cope up with current stress without disrupting the quality of life (Pillay et al., 2015).

Activity 1

The other questions that are required to be asked to the nurse during the clinical handover apart from the patient details that has been already presented includes the presenting the complaint of the patient. There should be a presentation of the any relevant details that needs to be conveyed. The information needs to be clear and succinct and should be sufficient to answer the questions of the other nurses who are oncoming to provide care. This should include details like what was the condition of the patient before he was handed over from the Emergency Department. Apart from the medication list, other treatments also needs to be mentioned like what diagnostic tests have been conducted on him like any X rays or USG or anything of this sort. There should also be a mention of the results which are awaiting and needs to be assessed. Mention of allergies, family dynamics or phobias all needs to be mentioned. A proper handover should also mention the plans for the future related to the health condition of the patient. This needs to include the direction the treatment procedure is heading towards. Additionally this should mention the task that needs to be handed on to the next nurse, without which provision of care to the patient will not be efficient and effective (Anderson et al., 2015).
On arriving to the ward, the nurse in charge might conduct a PQRST in order to access the rate of pain that the patient is suffering from. The PQRST mnemonic for a complete pain history is as follows:

P3 – Positional, palliating, and provoking factors
Q – Quality
R3 – Region, radiation, referral
S – Severity
T3 – Temporal factors (time and mode of onset, progression, previous episodes) (Naidu & Pham, 2015)

This assessment helps to understand and ensure the thorough patient history through following the steps of the above plan properly. This framework allows the healthcare professionals to ask the patient to feel the pain that is where it is located, to understand the character of the pain like what kind of pain it is, when and how it began like the onset of the pain. It also involves the understanding that how bad the pain is that is the intensity of the pain. This is where else they feel it, what makes it worse or better, how it has changed over time, and whether they have ever had it before.
Module 4:
Activity 1:
Nursing competency and decision making is one of the important nursing skill that allows a nurse to critically analyze a clinical problem and make effective decision in order to address the problem in an effective manner. Hence, it is important for a nurse to understand the way of developing competency and decision making skill in order to transit from student to registered nurse (Ingham-Broomfield, 2015). In this regards different Benner’s stage of clinical competence and NMBA competencies and decision making tools are effective to evaluate my competency and decision making skill. According to the NMBA decision making tool the primary motivation of decision of a registered nurse to involve in care activity should be to identify the health requirements of the client, in this regards I would like to develop my nursing care and diagnosis skill and as it is important to be accountable for making decision I would like to partnership with the client to select the person that is most appropriate to perform the care activities (nursingmidwiferyboard.gov.au, 2018). In addition I would like to involve in collaborative or interprofessional skill as it helps to made most effective decisions. In this regards I would like to develop my communication skill so that I could communicate with the other team members to access collaboration (Matziou et al., 2014). Further, I would like to evaluate my competency level by using Benner’s stage of clinical competence and rate my skills to evaluate how much improve I need to become an expert (Ingham-Broomfield, 2015). Such skill development would help my transition to registered nurse from student nurse.
Activity 4:
The give scenario is associated with 22 patients from which 14 patients have undergone surgery. 8 patients are under regular care and out of them 4 patients have intravenous access. Except me there are another register nurse who is also playing the role of nurse unit manager and 1 enrolled nurse and 3 AINs. I this regards I would like to use the team nursing approach to provide adequate care to the patients and achieve positive health outcomes (Dang & Dearholt, 2017). Being a NUM it is the responsibility of that registered nurse should be to supervise the care process of 22 patients. In this case the surgical patients need more critical care as compared to other 8 patients and a registered nurse poses the ability to take care of such patients and they trained in an effective manner to provide sufficient care to post-operative patients. Thus, being a registered nurse I would like to take care of 14 nurse with the help of another registered nurse who is playing the role of NUM (Smolowitz et al., 2015). Enrolled nurse will be appointed to take care of the patients that have intravenous access for antibiotics as an enrolled nurse is competent enough to take care of such patients. Further, I would like to appoint the AINs to assist the enrolled nurse and take care of the patients that are under usual care and do not need special care ((Swan et al., 2015)). Such team nursing would help to provide adequate care to each patients in the ward and achieve a successful team outcome.
References:
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-6), 662-671.
Barrow, J. M., & McMillan, J. (2018). Nursing, Five Rights of Delegation. In StatPearls [Internet]. StatPearls Publishing.
Brown, J., & Sherman, M. (2015). Successful Gastrostomy Tube Weaning Program Using an Intensive Multidisciplinary Team Approach. Medical Journal of Islamic World Academy of Sciences, 23(1), 1-4.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau. 3rd edition. pp. 24-56
Ingham-Broomfield, R. (2015). A nurses’ guide to qualitative research. Australian Journal of Advanced Nursing, The, 32(3), 34.
Kalishman, S., Stoddard, H., & O’sullivan, P. (2012). Don’t manage the conflict: transform it through collaboration. Medical education, 46(10), 930-932.
Kim, E. J., & Gu, M. O. (2015). Recognition for nursing competency importance, nursing competency level, and their influencing factors of nurses in the long-term care
Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014). Physician and nursing perceptions concerning interprofessional communication and collaboration. Journal of interprofessional care, 28(6), 526-533.
Naidu, R. K., & Pham, T. M. (2015). Pain Management. In Basic Clinical Anesthesia (pp. 265-296). Springer, New York, NY.
nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia – Search. Retrieved from https://www.nursingmidwiferyboard.gov.au/search.aspx?q=a+national+framework+for+the+development+of+decision-making+tools+for+nursing+and+midwifery+practice+?
Pillay, B., Wootten, A. C., Crowe, H., Corcoran, N., Tran, B., Bowden, P., … & Costello, A. J. (2016). The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer treatment reviews, 42, 56-72.
Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.
Swan, M., Ferguson, S., Chang, A., Larson, E., & Smaldone, A. (2015). Quality of primary care by advanced practice nurses: a systematic review. International Journal for Quality in Health Care, 27(5), 396-404.
Weller, J. (2012). Shedding new light on tribalism in health care. Medical Education, 46, 132-142. Please read this article and answer the following

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