NRSG355 - Nursing - Clinical Integration - Towards Professional Practice - Assessment Answer

NRSG355 Clinical Integration Towards Professional Practice Assessment Answer

Assessment Task:

Module 1 – Critical thinking, clinical decision making and professional development

Clinical decision making - problem-solving and prioritizing

In the Australian College of Critical Care Nurses (ACCCN) text on Critical Care Nursing, clinical decision making is described as integral to critical care nursing practice (Aitken, Marshall & Chaboyer 2015). This observation is not only true for Critical Care, but is pertinent for all nursing. Clinical decision making is a cognitive process used to understand the significance of patient data in order to identify and diagnose actual and potential patient problems before arriving at a clinical decision regarding
appropriate interventions to resolve the problem and ensure optimal patient outcomes. The foundation stones of clinical decision making are clinical information and theoretical knowledge (Aitken et al, 2015).

It might be tempting to see data collection as the simpler of the two foundations of clinical decision making; however, the complexity of some patients and the overwhelming amount of data available via various technologies brings its own challenges. In order to attend to this complexity, it is necessary
to draw on the basis of patient assessment and to be systematic in the collection and interpretation of data.

While monitoring and assessment of patients can include technology, you already have the basic skills required to assess your patients in any setting. It is important to remember that at the core of all clinical decision making is a full and thorough assessment of the patient. To this end, recording and interpreting basic vital signs is the first, crucial, foundation step in patient assessment. Alysia Coventry (ACU) and Malcolm Elliott (ex-ACU lecturer) have written an article on patient assessment in
critical care. Alysia and Malcolm propose that: “Nurses have traditionally relied on five vital signs to assess their patients: temperature, pulse, blood pressure, respiratory rate, and oxygen saturation. However, as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to
identify those who are clinically deteriorating” (Elliott & Coventry, 2012). Clinical decision making is a component of the clinical reasoning process that the average nurse
performs 2-3 times per minute (Aitken et al, 2015). It takes time, practice, and training to hone this skill. As mentioned already, there is an abundance of technology we can draw on to facilitate patient monitoring and assessment. You might be feeling overwhelmed at the prospect of patient assessment and data collection in the acute care environment. However, you have had plenty of opportunity to practice patient assessment during your course so far and will have ample opportunity on your up-
coming clinical placements. You will also get plenty of opportunity to observe and be involved in clinical decision-making processes. You already have the basics of clinical reasoning as part of your professional repertoire. During the intensives, you will develop skills that allow you to link your critical thinking using the framework of the Clinical Reasoning Cycle (Levett- Jones, 2018). Draw on these basics and learn from the clinicians you work with during your placements.

ACTIVITY 1

Reading:
Please read the article by Coventry and Elliott. While you read the article take particular note of how traditional vital signs can be used to assess the critically ill patient as well as the role of the additional three “vital signs”: level of pain, level of consciousness, and urine output.

The challenge

As mentioned above, a particular challenge associated with the multidisciplinary team is the nurse-physician relationship. The factors that contribute to this challenge are also relevant to other nurse/co-worker interactions. However, there is evidence that suggests a positive relationship between physicians and nurses contributes to improved patient outcomes It is important that you don’t get intimidated by physicians or other health care practitioners; but, that you recognize your limitations while ensuring appropriate, professional communication channels are maintained.

 

 

ACTIVITY 2

Reading:
Benner et. al., (2009) have dedicated a chapter to the nurse-physician relationship. Follow this link to “Expertise in practice; Caring clinical judgment, and ethics 2nd Ed” by Benner et al, and then click on Chapter 11: The nurse-physician relationship: negotiating clinical knowledge. The chapter is quite long and includes a number of clinical scenarios that are used to illustrate specific aspects of the nurse-physician relationship. There is specific reference to junior nurses in some of the scenarios.

The solution = Communication
Central to the nurse’s role is the diagnosis, treatment, and evaluation of patient responses to actual &/or potential health problems (Campbell, Gilbert & Laustsen, 2010). However, as alluded to already, 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 on which effective teamwork 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). 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. In an investigation of nursing handover practices, Street, Eustace and Livingston et. al., (2011), report ineffective communication as the most frequently cited cause of sentinel
(adverse) events in the U.S and Australian hospitals. Handover will be explored in more detail later in this module.

ACTIVITY 3
Reading:
Please read Chapter 7: Communication-mastering collaboration, delegation and documentation from Campbell, L., Gilbert, M. & Laustsen, G. (2010) Clinical Coach for Nursing Excellence when you read the chapter you can skip over the general discussion of communication techniques if time is short; however, please focus on the key aspects of the rest of the chapter. In particular, pay close attention to the sections on ISBAR, delegation, and documentation.

On returning from your tea break you are met by several staff members who relate the following information to you concerning your patients.

i. Mrs. Chew’s intravenous (IV) infusion has tissued, her IV fluids are running behind and she has missed her 14.00 hrs. IV antibiotic.
ii. Mr. Smith’s visitor has fainted.
iii. One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly.
iv. Mr. Esposito is scheduled to leave the ward now for his cardiac catheterization and he has still not received his preoperative medication.
v. One of the surgical consultants (VMO) is waiting to discuss a medication error that happened last week.
vi. As you are taking this handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery. The other RN is busy with NUM role. Staff currently available on the ward to assist you in addressing these issues include the ward clerk, an Enrolled Nurse who is currently undertaking her IV
cannulation certificate but is not yet competent, and an AIN.

ACTIVITY
Using the above scenario:
1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate.
2: Document your rationales in detail.

 

Module 2 – Collaborative and Therapeutic Practice

Welcome to Module 2 for NRSG 355 Clinical Integration: Transition to Professional Practice. This is the second of the on-line modules and will focus on the areas of Collaborative Practice, the Multi-Disciplinary Health Care Team and Therapeutic Practice. This relates very closely to the three other modules: Critical Thinking, Professional Practice, and Provision and Coordination of Care. As you enter your final semester of your nursing degree the content within this unit and the modules
will not be new to you. Although, the real test of knowledge is in how we apply it. With that in mind, each of the theoretical concepts within this module are only briefly addressed. The bulk of the work is how you apply it to some hypothetical clinical scenarios. Collaborative Practice Collaboration is when several health professionals work together for a common goal. Collaboration is not unique to health care but is also part of business and community models for achieving success in
any project. In the case of health, success is defined in terms of patient outcomes. A successful outcome for the patient can only be achieved by implementing a coordinated series of interventions from a variety of health professionals and intrinsic to this is the involvement of the patient and their family. Collaboration is essential for such a group to keep the patient as the central focus, ensure the roles within the team are clear, ensure all aspects of the health issue and its impacts are accounted
for and the care plan is aimed at achieving common goals (Crisp, Douglas, Rebeiro & Waters, 2017, pp 217).

A collaborative approach to health care reflects the multidimensional nature of illness. For the individual, illness often impacts on several body systems as well as having effects on family and friends. The end result can be personal, social and occupational malfunction. This pathological complexity means that health care intervention requires a complex response. In the course of your studies you have been exposed to terms such as ‘holistic care’ to describe a series of interventions aimed at
treating physical, psychological, emotional and spiritual care to describe this complex response. Each member of the team contributes to the care but merely having the same goals does not guarantee a smooth process or successful outcomes. You will all have had experience working in groups within your studies, on clinical placements, at school and with other group projects you may have been involved with.

ACTIVITY 1

Reading:

1. What does tribalism refer to?
2. How do tribalism and power inequities impact on information-sharing?
3. What are the five key dimensions for a well-functioning health care team?

Please read this article and answer the following question:
1. What benefits does the author suggest are there to conflict within groups?

ACTIVITY 2: ASSESSMENT

Reading:

The “MND Australia Fact Sheet on Multidisciplinary Teams” outlines professional groups who could make up a multidisciplinary health care team for a patient with motor neuron disease (MND).

(a) of Question 2. This forms part of your assessment for this unit.
1. Identify factors that determine which healthcare professionals are required to be involved in a health care team?
2. Who should lead the health care team?
3. Who is the most important member of the health care team?

CASE STUDY 1
Grant Thompson was a fit 37-year-old man, a father of two young children and married for 14 years to Georgina. Grant was a truck driver who was involved in an MVA 6 months ago and suffered extensive injuries to his leg and a mild head injury. His recovery has been slow and he relies heavily on the use of a wheelchair but can now walk for short distances with the aid of a walker. Georgina wants Grant to come home and rehabilitate there. She has made some modifications to their home, ramps put in, handrails in the bathroom and toilet. The health care team is meeting to discuss this option. The team consists of the treating doctor, physiotherapist, and occupational therapist, NUM of the rehabilitation unit, social worker and psychologist. There is disagreement among the team as to whether Grant would be better to
stay in hospital a bit longer or go home. The physiotherapist and the occupational therapist both feel that Grant still requires intensive treatment which can only be provided as an inpatient. The psychologist and the social worker have noted that Grant’s separation from his family and home environment has been having a negative effect on Grant, Georgina, and their children. The treating doctor feels that we could treat Grant as an outpatient but it would mean he has to attend regular physiotherapy and occupational therapy sessions. You are the team designated leader of the health
care team.
Discuss the following questions
1. What are the key issues in this dilemma?
2. What outcomes would be best for Grant and his family?
3. How would you guide the group in achieving this best outcome?

CASE STUDY 2
Norma Ellis is a 76-year-old widow who recently had a fall at the nursing home she has lived in for the past 7 years and fractured her hip. She has subsequently had a hip replacement and has been rehabilitating well and is now due for discharge back to the nursing home. Norma has an extensive medical history including postural hypotension, rheumatoid arthritis, and impaired mobility. She mobilized within the nursing home using a walker. Her son is demanding that his mother be kept in the ward as an inpatient as he feels the nursing home staff were negligent and wants his mother to be placed elsewhere but has not arranged this yet. The treating team consists
of the doctor, physiotherapist, NUM of the rehabilitation unit, social worker and NUM of Norma’s wing at the nursing home she was in prior to the fall. You are the designated team leader. The doctor feels there is no need to have Mrs Ellis on the ward as he feels that her rehabilitation has been maximised, this is an opinion shared by the physiotherapist. Norma wants to go back to the nursing home as she has made many friends there and feels at home there.
Discuss the following questions
1. What are the key issues in this dilemma?
2. How would you deal with Norma’s son? Are his objections warranted?

CASE STUDY 3
Robert Hughes is a 52-year-old male who was injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting
Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long term care options for Robert.
Discuss the following questions
1. What are the key issues in this situation?
2. Who would be included in the health care team and what role would they play?

CASE STUDY 4
You are working in a health care team in a busy rehabilitation unit. Team meetings and patient reviews are conducted weekly. There has recently been a turnover of staff in the physiotherapy department and a new representative from physiotherapy has joined the health care team. You notice although that this new member of the team members is often absent, fails to provide patient updates and when challenged on these issues is exceptional confrontational., This behavior is not only impacting on the effectiveness of the health care team but also on patient outcomes. You are the designated team leader and need to find a resolution.
Discuss the following questions
1. What are the key issues in this situation?
2. What strategies would you employ to address this situation?

CASE STUDY 5
You are the NUM of a Mental Health Unit where case reviews are conducted every 4 weeks. You are the designated team leader and the team members include the medical officer, resident psychiatrist, patient case manager, social worker, and employment officer. Several of the team members approach you after the meetings and voice concerns about how the meetings are being dominated by the medical staff. The general feeling was that the medical team dominated all
clinical care decisions and most of them felt they did not have a voice at the team meetings. As the designated team leader you are responsible for ensuring equity exists in decisions about ongoing care.
Discuss the following questions
1. What are the key issues in this situation?
2. What strategies would you employ to address this situation?

 

Module 3 – Provision and Coordination of Care

Assessment and problem solving
From our work with the Clinical Reasoning Cycle during the intensives, you should now be recognizing that a large part of clinical reasoning is the gathering of patient data or clinical cues. As a result the information that you gather, whether it is subjective or objective, is significant in the overall provision
and coordination of care. You have learned through the past two and a half years how to obtain the required data. This can range from HLSC 110 where you learned to interview and communicate with a patient to NRSG 354 where you learned more advanced and complex patient assessment skills. You have also learnt the relevant disease processes so now is the time to develop skills to link this knowledge altogether. Every interaction you have with people allows you an opportunity to collect cues whether you formally acknowledge this or not. In the healthcare setting, the information can come from several different, areas. Your initial collection of cues commences from handover. During handover, a nurse will identify if the patient is independent and self-caring or if they are of higher acuity. This is similar to the simulation class you had during the intensives. When you were given the patient handover and then commenced the allocation of staff to patients you were using the cues you had collected from handover to determine what would be an appropriate patient allocation without even seeing the patients. This is some of the information a charge nurse will allocate patients each shift. During handover, nurses will often start to question the cues they are getting about their patient that might influence the provision and coordination of care. Eg you receive handover and collect the cue that your patient is mildly hypotensive with an epidural. This information guides your priority post-handover to complete a focused physical assessment of this patient first as opposed to the patient that is due for discharge in one hour who has been ambulant and self-caring.

This activity demonstrates how you have started collecting cues during handover. After handover as graduate nurses, you will most likely develop a care plan. The development of a care plan is a way of processing the information that you have collected during handover to ensure you adequately manage your time in relation to the care you think you will need to provide. It is important to acknowledge that this care plan can often change, as you need to reprioritize care, which is similar
to the second activity we undertook in the “ward for a day” simulation. Whilst you start to process information you will also start to think about cues that you are missing and where you can gather this information. Assessing the patient’s chart, communicating with the patient and their family or even increasing your patient assessment are some of the ways in which you will achieve this. During the phase of processing information, you are also starting to work out what is relevant information as opposed to information that is irrelevant to the situation. The Clinical Reasoning Cycle can provide a framework for you to structure your thought processes and
ensure you can link the knowledge that you have obtained during your undergraduate degree to the clinical context in which you will be working as a graduate nurse.

ACTIVITY 1
You are working on the morning shift on the ward, and receive a patient from ED. The ED nurse provides you with the following handover, using the ISBAR format. Further information about the ISBAR format can be found on page 7 of this module.

1. What further questions will you need to ask the nurse?
2. List specifically what further assessments you would complete when the patient arrives onto the ward & provide your rationale for each assessment.

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.

During clinical placement choose a patient that is of interest to you. Perhaps a patient that you found challenging in terms of linking the theory together. Fill in the Clinical Reasoning Cycle Worksheet that can be found on the LEO page to assist with your understanding of that patient’s condition and how the Clinical Reasoning Cycle can be of benefit to you.

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 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 (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, shift- to shift the experience of nurses.

2. 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.

 

Module 4 – Professional Practice: Time Management, delegation, scope of practice

Scope of Practice/ Delegation/Advocacy
 

Over the course of your undergraduate degree you have been taught about your scope of practice as a student and the scope of practice of registered nurses under many different frameworks – legal, ethical, practical and so on. It is now time to consider how the change in your roles will influence your scope of practice. Historically the scope of practice of nurses was clearly defined. In the current model of health practice, the professional boundaries between the health professions are becoming increasingly
blurred (Fedoruk & Hoffman, 2014). The issue is further compounded due to the scope of nursing practice expanding with roles such as advanced practice nurse, as well as the increase in semi-independent practitioners in community settings.

In this time of transition you must be careful that you understand the scope of practice of the role you aspire to, that of an experienced practicing Registered Nurse and the role you are about to undertake that of new registered nurse. Benner describes the new graduate as an advanced beginner one who is competent but relies on the rules they have been taught to guide them in their practice. Advanced beginners are seen as nurses who have a wide theory base of practice but are still developing the
ability to make content-dependent judgments (Benner, 1984 p 21-22). This means that you should
not set the bar too high for yourselves and realize that you are still learning and developing the clinical judgment skills that can only come from exposure to clinical situations, known as experiential learning. If we take Benner at her word then it takes at least 2-3 years of clinical experience following registration as a registered nurse to be deemed competent and even then she says the competent nurse will lack speed and efficiency (Benner, 1984 p26-27).

ACTIVITY 1
Access the following summary of Benner’s stage of clinical competence and consider these along with the NMBA competencies and decision-making tools. Then, consider what your priorities for your final semester are and consider what skills you need to consolidate that will assist in you making the
transition from student to registered nurse.

ACTIVITY 2:
While you are out on placement, observe how other staff delegate, who delegates and what forms of communication they use to effectively delegate. As basis for this observation please read:

Role of Advocacy Nursing as defined by the ICN: 

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and inpatient and health systems management, and education are also key nursing roles (ICN 2010).  The term advocacy presents the newly registered nurse with a number of conflicting issues. What is advocacy? Are we talking advocacy for individual patient’s rights, nurse’s rights, or advocacy for the wider community on issues of public health, advocacy for equity of health care access? You have looked at the term advocacy throughout your undergraduate education in both clinical and ethical context  Point 2.4 of the National competency standard for registered nurse (2006) states that nurses should “advocate for individuals/groups and their rights for nursing and health care within organizational and management structures”. This clearly states that the role of advocacy can take many forms and encompasses an individual’s right to advocacy as well as advocacy for the broader community. Further 2.4.3 goes on to express that nurses have a duty to advocate for individuals to ensure that individuals are given information that facilitates informed decisions (ANMC, 2006).  The next time you are out on clinical placement during your final semester consider how you advocate for your patients. Make a note of your interactions for a day and consider: did you advocate for your patients? Did you just allow them to rest for half hour by negotiating with other health care team members, did you intervene on their behalf with medical doctor to clarify point of care, did you encourage your patient to speak up and ask the important questions or did you just listen to them? Advocacy does not have to be all bells and whistles and you will be surprised on completion of this exercise how often you act as an advocate for your patients.

ACTIVITY 3: 

Readings: Read the following articles to further your understanding of advocacy

Choi, P. (2015). Patient advocacy: the role of the nurse, Nursing Standard, 29 (41) 52-58. 

While the following article is dated 2002, it still contains information that is relevant and pertinent to your role in understanding patient advocacy. 

 

SUGGESTED TEMPLATE: NRSG355 WRITTEN ASSESSMENT

Q1: Prioritisation and delegation (module one)
You may use a table here to address each of the competing priorities you need to manage, or you can write descriptively - either is acceptable
Ensure you justify all of your choices in-depth, using references to support your claims.
 

Q2: Collaborative and Therapeutic practice (module two)
(a) The Multidisciplinary team

(b) Case study name: choose one of the available in module two

 

Q3: Provision and coordination of care (module three)

 

Q4: Time management and delegation (module four)

Module 1
The purpose of this professional portfolio is to show my delegation skills, prioritizing care, critical thinking, and decision making during several incidents in the ward. The scenario is on returning to the ward from my break, numerous staff members approached me to inform me of the incidents related to my patients. The first situation is Mrs Chew’s intravenous infusion has tissued her IV fluids are running behind and she has missed her 14:00hrs IV antibiotics. The second situation is a visitor
fainted. The third is one of the staff toilets has blocked and is flooding and waste is pouring out quickly. The fourth situation is Mr Esposito is scheduled to leave the ward now for his cardiac catheterization and he has still not received his preoperative medication yet. The fifth situation is one of the surgical consultant is waiting to discuss a medication error that happened last week. And lastly, as I am taking handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery. I am the only registered nurse on the floor, with one enrolled nurse, one assistant, and a ward clerk. As a registered, I will have to be responsible for my
actions. The delegation will be done in accordance with the scope of practice and competency of registered nurses. A clinical reasoning cycle will be used to identify which situation requires immediate care and which situation can be dealt with later or earlier by recognising the situations and take the appropriate steps for a positive outcome (Levett-jones, 2013). At first, I will gather around all available staff and assess all situations and take necessary actions by allocating the available staff to deal with other issues at hand. Before I allocate staff, I will have to ensure that each of them will be working within their scope of practice, have the required skills to deal with their assigned situations. It is vital for me as a registered nurse to understand the enrolled nurse, nurse assistant and the ward clerk’s scope of practice before I even start my shift for the safety of my patients. My first priority is the elderly female patient who has collapsed to the floor and is unconscious. She is my first priority because she is unconscious and it could be an after-effect from the surgery she had (Ball et al., 2017). I would go to the patient and take the nurse assistant with me to assist me and tell her to press the MET call. I would start by taking the necessary actions to assess the patients and have the nurse assistant by my side if I require anything as I cannot leave the patient.
The second priority is the visitor who has fainted because he or she might have an injury and still needs a qualified nurse for assistance. So, I would send the enrolled nurse to assist the visitor as the nurse is competent and will be working within her scope of practice. However, after I will be free
later, I will have to double-check on the visitor to ensure appropriate care was provided as I am a registered nurse and it is my duty. The third priority is Mr Esposito who is due to leave the ward and has not has his preoperative medication. It is very important to ensure that the patient has his required medication for him to have a safe operation later on. I would allocate this task to the enrolled nurse, as she is competent in giving medication. The fourth priority is Mrs Chew because of
the tissued iv which is serious and could cause swelling of the skin and pain and also her antibiotic was not given as soon as possible to prevent further infections (Garger et al., 2017). However, the enrolled nurse is not qualified to deal with any cannulation. So I would have to assess Mrs Chew and provide appropriate care to her and ensure she has her IV antibiotics. However, before giving her antibiotic, I have to ensure there is enough time in between the next dose of the antibiotic (Nute, 2014).

The fifth priority is the over flooding toilet because if it’s not taken care of quickly it might flood the whole ward which might cause panic in the ward and also lead to contamination. I would delegate this job to the wards clerk and give him specific instructions to follow. And his last priority is the surgical consultant who is waiting to discuss a medication error. I have left this last because it is not an emergency situation, but it still is important to address to prevent further medication errors in the
future for patient safety. I delegated this task to myself and contacted the consultant to reschedule the meeting and explained the issues that happened in the ward.
To conclude, I would gather all the staff that helped me through these situations and we would discuss the outcomes of each situation. To think about what we did right and what we can improve from. It is very important for all of us to reflect on these situations to improve future practice and to get better guide our understanding for a positive outcome.
 

Module 2
Activity 2
1. Identify factors that determine which healthcare professionals are required to be involved in a healthcare team.
1. General practitioner is important to guide the patient to appropriate multidisciplinary team

2. Inability to breathe properly will require the patient to see a respiratory specialist 

Case study

1. What are the issues in this dilemma?
The key issues are:

 The case study is that Grants wife Georgina wants him to therapy at home.
 The team is not approving with each other’s decisions, whether Grant should be an outpatient or an inpatient.

 Grant's separation from his family is impacting the whole family emotionally.

2. What outcomes would be best for Grant and his family?
The best outcome for the grant and his family would be to send grant home because according to the scenario, grant could be an outpatient as long as he visits the physiotherapist and occupational therapist frequently and when needed. It is very important to involve the whole family when treating grant as it is impacting on them too and this could lead the whole family towards depression. Moreover, the children’s performances could be affected at school because of the separation from their father. As Georgina, she might also need support of her husband emotionally and it could be that she wants her whole family to go through the rehabilitation process together to
encourage grant for a fast recovery. In addition, by separating grant from his family could cause him to experience depression and other health problems. And to prevent this from happening, he has to be together with his family (Weisser et al., 2015). To promote a healthy lifestyle for the whole family, it would be better for the grant to be an outpatient. the issue, creating an objective, taking action by making grant an outpatient and continue assessing his progress along the way is important (Levett-Jones, 2013).

Module 3
Activity 1

`1. What further questions will you need to ask the nurse?

It is very important to ask the nurse whether Mr Joe has any allergies because sometimes there is no mention about in the medication chart and no one has bothered to inquire about it. It is crucial for the nurse to know whether the patient is allergic to anything because a medication error could happen and the patient could have a severe allergic reaction (Smith, 2013). Furthermore, as a nurse, it is vital to ask about Joe’s airway, whether his airway is patent and what his respiration rate is. Besides, asking about his breathing pattern and also, about his air entry is important. Especially, because the patient has a chest cough, frothy sputum and suspected pneumonia.

 

3. How would you guide the group in achieving this best outcome?

As the team designated leader, I would remind them to look at the holistic side and also remind them that it is vital to involve the whole family in the treatment of grant. Furthermore, I would ask the team to think themselves in grants and his family’s place. It is very important to remind the team
about compassion, which a lot of health care professionals forget about as they are on autopilot
mode. If there is an option, I will tell the team that we should at least try the outpatient option. Also, we should provide support to the family such as social workers
and carers if Georgina needs help. Thus, assessing the situation, gathering information, identifying

Module 4
For this activity, I have to allocate staff to the patients. However, I need to assign each of them according to their scope of practice. I also need to discuss why I have chosen this type of allocation. There are two registered nurses myself and another nurse. There is one enrolled nurse and three nurse assistants. However, the other registered nurse is doing her job as well as taking the responsibilities of the NUM. It is vital to allocate each staff according to their skills and their scope of practice because I need to ensure the patients will be in a safe environment. As the registered nurse is taking patients loads and the NUM responsibilities, I would allocate then registered nurse/NUM to six patients and assign one AIN with her. This is because it is not fair for the nurse to take equal patient load as me and the other enrolled nurse. I would allocate the enrolled nurse to eight patients and also allocate one AIN. Without AIN’s taking care of so many patients it would have been a struggle. AIN’s are very
important to have because they can help the registered nurses and enrolled nurses with so many tasks. The scope of practice for an AIN is to ensure they work under the supervision of an RN at all times. AIN’s can do bed making, showering the patients, repositioning with the supervision of the RN. Also help with the mobility of patients, comprehending simple terminologies is also important as they are providing care to the patients and need to have an understanding. In addition, having good communication skills ability to work as a team is crucial for a positive outcome of patients. Maintaining patient’s privacy, dignity and respecting cultures are important. And AIN’s should know what to do in case of an emergency and report the problems accordingly and not work outside the scope of practice.

 The scope of practice for the enrolled nurse is working within the skills that were deemed competent. The enrolled nurse should be able to perform assessments according to the hospital’s policies. Furthermore, the enrolled nurse must be aware of the patient’s treatment plans and stay updated by working with the multidisciplinary team that is involved. The enrolled nurse must stay within a professional relationship with patients at all times and also respect the patient’s cultural background. Accurate documentation must be done at all times when there is a change in patients and also to show evidence of the care that was provided (Nursing and Midwifery Board of Australia, 2016). The scope of practice for registered nurses is to ensure that the enrolled nurses and AIN’s are performing their tasks properly. Moreover, building rapport with patients is important to understand their conditions and to promote trust between the patient and the nurse. Registered nurses should ensure they abide by the hospitals' policies and guidelines during their shifts. Registered nurses should promote positive patients outcomes at all times (Nursing and Midwifery Board of Australia, 2016). Lastly, both registered nurses and enrolled nurses should know how to collect patients' data analyze it, recognize the issue, have a targeted objective, and be active with the process and asses the consequences.

 

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