Developing Care Plans: Clinical Reasoning And Prioritization In Nursing

Activity 1: Collecting Cues During Handover

The main purpose of the professional nursing practise is to direct and maintain safe and clinically competent environment for nursing practise. These nursing standards are important for the profession of nursing because they help to promote quality and safe clinical practise (Benner, Tanner & Chelsa, 2009).

Module 1

            Delegation can be considered as the multifaceted skill set which mainly begins with the proper understanding one’s state nurse practice act that in turn outlines the legal responsibilities of the nurse, authority as well as accountability of the patient care (De Vleigher et al., 2016). Registered nurses have the responsibility to conduct ongoing reviews of their practice along with special attention given to delegation.

Five important steps of delegation needs to be followed by every nursing professionals that include consideration of right task, right circumstances, right person, right directions and communication as well as right supervision and evaluation (Cagginello et al., 2014). In this case, several scenarios are provided where the registered nurses has to undertake proper delegation of the tasks so that patient safety and quality care can be ensured.

• The elderly postoperative patient would be my first priority. She had suffered a fall and had become unconscious. For this, I might need to make a met call as well as code blue for her mainly because she had facial surgery.
• The second priority would be to administer the antibiotics to the patient named Mrs. Chew. Her infusion had tissued as she had missed her antibiotics. I can also delegate the task to NUM as he can successfully handle the situation as well. Enrolled nurses cannot do this task, as they are not competent yet.
• I can delegate the task of providing preoperative medication to Mr Esposito. As it is not stated in the case about the medication that needs to be given to her, I can also delegate the task to Enrolled nurse.
• Smith’s visitor had fainted but since she is an outsider, professionals cannot treat her in the nursing ward. The AIN should stay with her where an ambulance can be called for her or she should be admitted to the ED where a doctor can attend her.
• I should not prioritize the block toilet scenario and should request the ward clerk to call for an emergency maintenance request.
• The medication error had occurred one-week age and it had not been addressed at that time. Therefore, since it is already late, therefore, I can handle this situation after i have attended all emergencies.

Module 2

1. The healthcare professionals who would be included in the team are the neurologist who is specialized in the neurological disorders. Occupational therapist would be required for helping the person with his mobility, function and independence. Social worker, psychologist as well as the counselor would be required. As his mobility is decreased he may suffer from social exclusion as well as depression and other mental issues. Therefore, the professionals can help him in these. A physiotherapist would be also helping to maintain physical activity as well as mobility.
2. The case manager would be leading the team. He would be interacting with all the members of the team and would assist people to access health and community services. He would be communicating important information in the team and ensure that there is proper bonding and smooth flow in the healthcare.
3. The role of the occupational therapist is mainly important. After the doctors and nurses have conducted their assessment and acre intervention, it becomes important for the patient to initiate and maintain the daily activities of living. Being independent empowers the patients ensuring better quality lives. The occupational therapists thereby help the patients to come back to normal life without whom the care would be half-hearted.

Case study 4:

1. A number of issues had been identified from the case study. The main issue was that there was improper teamwork among the members. These might be mainly because they had poor team working skills. Moreover, there were also high rates of absenteeism in the team that might be because the working environment of team was not appropriate for effective teamwork. Effective team working requires development of proper bonds among the members for which work pressures are shared (Kalisch et al., 2015). Moreover, it also requires trust among the members. Therefore, blame games and high absenteeism were taking place, as the mentioned attributes were not present.
2. It is extremely important for me to first develop a proper bonding among the members and make them feel that the organization cares for them (Kalsich et al., 2015). Therefore, meeting sessions would be arranged where they will reveal their grievances so that I can work on them. There would be also meetings where the members would give each other constructive feedbacks so that they can overcome any ego problems and thereby develop bonding and emotional attachments. This would reduce their work burden and when they feel that organization care for them, the turnover would be reduced (Yi, 2016). Moreover, training on team working skills and development of communication skills would be ensured. These would help to resolve issues in the physiotherapy department.

Module 3

Patient Needs

Bed 1
Priority	Time	Justification
Priority 1: A	1230 hours	Urine sample test in order to detect the reason for cloudy urine. It can either be arising for dehydration or due to infection arising from catheter or other bacterial mediated urinary tract infection. Results of the test will help to take further steps in treatment (Foxman 2013)
Priority 2: B	20 hours	Administration of prophylactic cephazolin
Priority 3: C	1230	Checking the condition of ICC inserted upon arrival
Priority 3: D	Next morning	Review of pain, preparation for CXR and physio-assessment

Bed 2
Priority	Time	Justification
Priority 1: A		Introduction of IV at a rate of 100ml/hr of NaCl 0.9% running in order to maintain the electrolyte balance (Aitken, Chaboyer & Elliot, 2102)
Priority 2: B		Administration of oral paracetamol and oxycodone for pain
Priority 3: C		Tabulation of the vital parameters like blood pressure, heart rate, pulse rate, body temperature
Priority 4: D		Ultrasonography in order to detect the exact condition of the gal-balder for further progress in the surgery

Bed 3
Priority	Time	Justification
Priority 1: A		Preparation of the detailed discharge report via stating all the dosage and the time of administration of the antibiotics (Campbell, Gilbert & Laustsen, 2010)
Priority 2: B		Noting down the vital parameters before release
Priority 3: C		Explaining the parents the importance of the medication, the condition of their child and how they are going to care for their boy while at home
Priority 4: D		Educating patient about the requirement of the antibiotics and all other interventions prescribed by the doctors (Street et al., 2011; Scovell, 2010)

Bed 4
Priority	Time	Justification
Priority 1: A		Immediate cleaning of bed and maintenance of the hygiene (Jacox & Cole, 2012)
Priority 2: B		Preparing a team to address patients need 1. pain score 2. measurement of vital stats 3. additional requirement: electrolyte balance (Jacox & Cole, 2012)
Priority 3: C
Priority 4: D

Documentation: Reflection

During my role as a trainee in clinical practise setup, I came into an understanding that the effective documentation of the patient information in ordered manner (complete, concise, accurate, clear and timely) will help to assist the physicians at the time of emergency or when they visit the ward. This helps to prevent the necessary confusion. Once I had written patient vital parameters over a sheet of rough paper with no clear documentation. Then when my senior nurse came, I failed to give her proper brief as by the time she came I was lost and forgot what data is related to which parameter. It is my senior nurse who informed me about the importance of proper documentation and how it can be helpful. After that incident I always document the patient’s information on the basis of the desired documentation format (complete, concise, accurate, clear, and timely)

Module 4

The first thing that I will do is divide the duty of the NUM between two of the RN (me and the other nursing professional). This division of the duty of the NUM between two RN will help to decrease the workload on a single person and thereby helping to increase the quality of care and decrease medication errors (Keers et al., 2013).

The total number of patients is 22 of them 8 are going to during my shift hence the remaining will be 14. All these 14 patients went to surgery during the morning and hence will have intravenous access. Moreover, as per the case study half of the total number of patients will require antibiotics that is 11 patients. I am assuming that all the 14 patients who returned from the surgery will require antibiotics. According to Keers et al. (2013), the rate of medication administration and dosage errors are high among the assistant nurses are nurses who are interns and this rate of error increases with the increase in pressure load.

Activity 2: Incorporating the Clinical Reasoning Cycle

Hence I will divide 7 patients under me and 7 patients under another registered nurse and will assign 1 AIN to each of the group of 7 patients to assist RNs. This will reduce the overall work-load and thus helping to increase the quality of care (Schwartz, 2002). Another AIN will be asked to meets other requirements of the patients including checking of the vital statistics. However, the entire work of the AIN will be done under the supervision of RN.

As a RN I will also perform task like patient education, counselling, wound care and infection control. All these fall under the scope of practice of RN (Nursing and Midwifery Board of Australia (NMBA), 2013). In the domain of patient education I will help the patient to understand why intra venous fluid transfusion and administration of antibiotic is important for their fast recovery. I will also take good care of the wound management while taking protective measures to control the hospital acquired infection. The AIN nurse working under RN will be asked to follow the routine hand hygiene in order to prevent spread of infection.

References

Aitken, L., Chaboyer, W. & Elliot. (2102). Scope of Critical care Practice. In ACCCN’s Critical Care Nursing 2nd Ed.  Elsevier, Sydney.

Benner, P., Tanner, C. & Chelsa, C. (2009). Expertise in practice; Caring, clinical judgement, and ethics 2nd Ed.  New York: Springer.

Cagginello, J., Blackborow, M., Porter, J., Disney, J., Andresen, K., & Tuck, C. (2014). Nursing Delegation to Unlicensed Assistive Personnel in the School Setting. Position Statement. Revised. National Association of School Nurses (NASN).

Campbell, L., Gilbert, M. & Laustsen, G. (2010). Clinical coach for nursing excellence. Imprint: Philadelphia, Pa.  

De Vliegher, K., Declercq, A., Aertgeerts, B., & Moons, P. (2016). Health care assistants in home nursing: The Holy Grail or the emperor’s new clothes? A qualitative study. Home Health Care Management & Practice, 28(1), 51-56.

Foxman, B. (2013). Urinary tract infection. In Women and Health (Second Edition) (pp. 553-564).

Jacox, L. & Cole. A. (2012). ISOBAR: Standardising nursing handover.  Retrieved 21 June, 2013, from:

Kaiser, J. A., & Westers, J. B. (2018). Nursing teamwork in a health system: A multisite study. Journal of nursing management.

Kalisch, B. J., Aebersold, M., McLaughlin, M., Tschannen, D., & Lane, S. (2015). An intervention to improve nursing teamwork using virtual simulation. Western journal of nursing research, 37(2), 164-179.

Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), 1045-1067.

Nursing and Midwifery Board of Australia (NMBA). (2013). Professional boundaries for nurses Retrieved from: 

Schwartz, L. (2002). Is there an advocate in the house? The role of health care professionals in patient advocacy. Journal of Medical Ethics, 28(1), 37-40.

Scovell, S. (2010). Role of the nurse-to-nurse handover in patient care. Nursing Standard, 24(20), 3539.  

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. 

Yi, Y. J. (2016). Effects of team?building on communication and teamwork among nursing students. International nursing review, 63(1), 33-40.