1.
|
Issue |
Priority |
Action and rationale |
|
An elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery. |
– I will attend her first -I will personally care for her because she is in a critical condition |
-I will move the patient to an open place in which there is free air circulation in order to get fresh air and with little or without any distraction. -I will ensure all tight clothing are loosened. -I will conduct ABCD. Open the Airway through chin tilt. Facilitate her Breathing in order to remove any obstructive objects. Circulation through applying chest compressions. Check for any Disability. -check for the vital signs, that is, the respiratory rate, the heart pulse rate, temperature and her blood pressure (Campbell, Gilbert, & Lausten, 2010). -I will give her intravenous fluid, normal saline water in order to maintain electrolyte balance. -will also administer oxygen since she has breathing difficulties. Then will check her oxygen saturation. -I will catheterize her to monitor her urine output and input (Siviter, 2013). |
|
Mr. Smith’s visitor has fainted. |
-will assign the patient to AIN since the patient may not be in a critical condition. |
-AIN should make sure that the patient rests in a flat position on his/her back. -put the patient at a recovery position by ensuring the patient’s legs are at an elevation angle in order to facilitate restoration of blood flowage to the brain and flow of any other fluids from the patient’s openings. -AIN to try alert calls by calling out the patient’s name while shaking her/him to check whether s/he is conscious or unconscious. -AIN to loosen all the tight clothing if there is. -AIN to assess the patient and conduct ABCD -Open the Airway by chin tilting to promote air flowage in and out. Breathing in order to push out any obstructive objects out of the breathing system. Do chest compressions on the patient to facilitate Circulation (Casey & Wallis, 2010). -monitor the clinical vital signs; temperature, oxygen saturation, the pulse rate, respiratory rate, blood pressure |
|
One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly. |
– I will delegate the duty to AIN. |
– AIN should arrange as fast as possible to have the situation put into control and the toilet repaired. -AIN to get in touch with the relevant people such as plumbers to come over immediately and have the problem rectified. Hospital cleaners to assist in the process. |
|
Mr. Esposito is scheduled to leave the ward now for his cardiac catheterization and he has still not received his preoperative medication. |
– I will assign the duty to the ward clerk |
– the ward clerk to prepare patient’s file and forward it to the relevant medical professional, who shall administer Mr. Esposito preoperative medication. -the clerk should also prepare the patient’s inter-ward transfer forms to facilitate movement of the patient to the theatre room for the cardiac catheterization. |
|
Mrs. Chew’s intravenous (IV) infusion has tissue, her IV fluids are running behind and she has missed her 14.00 hrs. IV antibiotic. |
-I will assign the role to the Enrolled Nurse and give her/him the guiding procedures. |
-I will direct the EN to assess patient and have the IV cannula fixed. -Enrolled nurse should make sure that the IV fluids are flowing well. -an enrolled nurse should also make sure that there is compensation for the missed IV antibiotic. |
|
One of the surgical consultants (VMO) is waiting to discuss a medication error that happened last week. |
-I will hold a thorough discussion with the surgical consultant. |
-I will find out from the consultant on which patient and medical staff(s) were involved and how the patient is still fairing on, how it happened, whether it was intentional, negligence or accidental (Wentworth, 2003). -I will further discuss with the consultant immediate effects of the error on the patient, the possible solutions and how such errors may get avoided in the future health care practices. |
2. a) The Multidisciplinary team
-the sick person’s status whether in critical condition or not
-the type of treatment required
– the geographical location of the health facility and the patient
-the medical professional objectives of the individual health and the community health care specialists available.
-the patient’s economical class; patients from rich families attracts most experienced healthcare professionals since they do visit big and private hospitals of their class
-the patient’s age
-the gender of the patient
-the availability and number of healthcare professionals
-health care teams lead by doctors are believed to work well and more effectively and also most patients prefer and feel satisfied to be treated by professional teams that are doctor-led.
-the patient is the most important member of the healthcare team
b) Case study name: Casw study 3
Robert suffers from fractures on his right tibia/fibula and the right radius. He is intellectually impaired. He has an old parent who can no longer manage to take care of him. Her mother is the only parent alive who is aged 75 years old now. He is an aggressive man verbally towards his staff and other patients.
The following professionals should be included in the healthcare team;
The healthcare professional checks the patient by doing proper assessment to the patient to see whether the patient is affected in the other parts.
Sends the patient to the radiologist for the X-ray in order to show the severity.
The professional helps to advise Robert to relax and avoid being aggressive such that he can gain help from the health professional attending him.
Surgeon plays a role in making an incision through the patient’s skin and muscles of the leg. The surgeon further helps to bring the pieces of tibia and fibula back to alignment and then fixes them well. S/he further makes other repairs if necessary.
Follow up the patient in order to see the progress.
Orders another test to be done which has not been done.
The healthcare professional specializes on guiding the patient on how to exercise regularly in order to allow for ambulation.
The healthcare professional administers the general anesthesia drug in order to make the patient to fall asleep during ORIF (Open Reduction Internal Fixation) so as to reduce any pain or discomfort during surgery or operation.
Explains to the patients what is going to be done and how. S/he prepares the patient for the operation
The health professional helps in taking X-rays of the patients to produce digital images showing the areas of fractures on the body of the patient.
3. What further questions will you need to ask the nurse?
-what happened?
-at what time did it happen?
-where did it happen?
– what is the patient’s gender and age?
-at what time was the patient brought in?
-who brought the patient to the emergency department?
-have you contacted the patient’s family members or close relatives?
-did you conduct any test?
-did the patient undergo first aid?
-is the patient conscious?
-was the patient breathing rate affected?
-did you capture the patient’s pulse rate?
-has the patient received medication?
-at what time did he receive?
-does the patient require intensive care?
-how did the patient respond to the medication if it was offered?
-is there any positive patient progress after medication (services, 2006)?
In the article by Felton, M. (2012), I have noted that taking the patient’s vital signs accurately is of great importance. According to the article the following vital observations are key in the assessment of the patient in order to realize major impact on the patient’s prognosis. Such vital signs are shortened as DrABC, that’s Airways, Breathing and circulation (Schwartz, 2002). As a healthcare professional I shall monitor the patient’s respiratory rate, oxygen saturation level, the pulse rate, the blood pressure, the AVPU (Alert, Voice, pain, Unresponsive), the GCS (Glasgow Coma scale), body temperature and the urinal output. Accuracy in such assessments will enable me to monitor the patient’s progress and make necessary adjustments in medications where necessary. For newly admitted patients, such assessments will be necessary in collaboration with them responding to questions like how they are feeling? The AVPU scale will assist me to easily, rapidly and effectively make assessment on the patient’s consciousness. This method is important when handling acutely ill patients (Australia, 2013).
In cases where the oxygen delivery into the body drastically falls the required amount, the body tissues starts extracting a lot of oxygen from the red blood cells hemoglobin and as a result the saturation of blood drops. If this situation is rectified in time, it would result to organ dysfunction since all body cells are majorly dependent on the adequate stable supply of oxygen since they are not at a position of storing it. The patient’s circulatory should also be monitored such that any obstructing objects are removed through chest compressions (Jacox & Cole, 2012). Urinal output should be closely monitored since it indicates sensitively the hydration levels and status of the patient. Most medical studies indicate that it should be kept at 0.5ml/kg/hr. Further, it indicates the status of the cardiovascular since the patient kidneys got a high demand for the blood supply. The close assessment of the patient’s fluid balance should be done accurately based on the patient’s area of residence. Usually there is a chain for safety which is followed in handling deteriorating patients. Starting from making observations and taking biodata documentation of the patient. making recognition of the deterioration, offering interpersonal communication practice and making escalations where necessary (Pearce, 2006). Determining whether the patient is responding appropriately to the assessment, if not reassessment will be necessary. Final step will be documentation.
4. Total patient care refers to the healthcare services rendered by a band of health professionals to the patient. Team nursing is that model which utilizes a healthcare professional team methodology to offer healthcare service for the patients in the involving care environment. Team nursing bring nurses together thereby making health care services delivery more effective and efficient. Task allocation refers to delegation of duties, for instance, in healthcare setting in the activity involves the seniors assigning their juniors or equals roles to play in taking care of patients (Choi, 2015). In this activity there are 22 patients out of which 14 patients have undergone in the morning shift before handover was done. As a registered nurse I took over in the afternoon shift in which the remaining 8 patients are meant to undergo surgery. As a registered nurse on duty, am supposed to delegate duties and allocate these patients to the healthcare professionals present such that the patients get assisted and cared effectively. Out of the 8 patients half of them have intravenous access and require antibiotics at sometime within my shift. Healthcare professionals present on duty with me on the afternoon includes; a registered nurse who is acting as the NUM who is on sick off, an enrolled nurse and three assistants in nursing (Nurses, 2014).
I shall allocate the 14 patients who had undergone surgery in the morning hours to the enrolled nurse. The enrolled nurse will help in assessing the progress of the patients, offer patient care planning and making an evaluation of the patient outcomes under my supervision. Further, the enrolled nurse will implement the care for the patient. Due to the high number of patients, the enrolled nurse will gather and coordinate the two AINS to take care for the patients who have undergone surgery (Boards, 2014). For the remaining 8 patients meant to undergo surgery, I will take over and work in a team with one of the AINs and the registered nurse to ensure proper and smooth care for the patients. Together as a team, we will make observations and record the patients’ behaviour, coordinate with the physicians with an aim of conducting patient plan care evaluation. As a team we will also offer emotional and the necessary psychological support to both the patients and their caregivers and families. By doing so we assist in promoting a harmonious environment (Resource, 2013).
We shall also as a team diagnose the patients’ current conditions and take the necessary actions, like providing antibiotics to the patients when necessary (NMBA, 2013). As a registered I shall prepare and keep the patients’ medical reports and check any changes in their current situation. I will direct the assistant nurse to assist the patients with their daily activities such as eating and taking a bath. Also, the assistant nurses will assist in ensuring that the patient’s treatment areas are kept clean and transport logistics put in place where necessary.
Reference List (APA style)
Campbell, L., Gilbert, M. & Laustsen, G. (2010). Clinical coach for nursing excellence. Retrieved from https://ezproxy.acu.edu.au/login?url=https://ACU.eblib.com/patron/FullRecord.aspx?p=474457
Casey, A. & Wallis, A. (2011). Effective communication: Principle of nursing practice. Nursing Standard 25(32), 35-37.
Choi, P. (2015). Patient advocacy: the role of the nurse, Nursing Standard, 29 (41) 52-58.
Department of Human Services (2006). Sentinel event program: Annual report 2005-06. Department of Human Services, State of Victoria: Victorian Government of Human Services, Melbourne.
Felton, M. (2012). Recognising signs and symptoms of patient deterioration. Emergency Nurse, 20(8), 23-27.
International Council of Nurses (2014). Definition of nursing. Retrieved from: https://www.icn.ch/who-we-are/icn-definition-of-nursing/
Jacox, L. & Cole. A. (2012). ISOBAR: Standardising nursing handover.
National Council of State Boards (2014) A nurse’s guide to professional boundaries. Retrieved from: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf
Nursing and Midwifery Board of Australia (NMBA). (2013). Professional boundaries for nurses Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes- Guidelines Statements/Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2013). A national framework for the development of decision-making tools for nursing and midwifery practice.
Pearce, C. (2006). Leadership resources. Ten steps to effective delegation. Nursing Management, UK, 13(8), 19.
Pearce, C. (2006). Leadership resources. Ten steps to effective delegation. Nursing Management UK,13(8), 19.
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.
Siviter, B. (2013). Effective time management for nurses.
Virtual Simulated Patient Resource (VSPR) (2013). Standards of effective communication.
Weller, J. (2012). Shedding new light on tribalism in health care. Medical Education, 46, 132-142.
Wentworth, S. (2003). Time management strategies in nursing practice. Journal of Advanced Nursing, 43(5), 432-440.
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