Nursing Practice

This study material covers various topics related to nursing practice, including sharing assessment data, collaborative and therapeutic practice, assessment problem solving, and scope of practice/delegation/advocacy. It provides insights into tasks undertaken personally, delegated tasks, documentation of rationale, identification of factors determining healthcare professionals, and more.

Running Head: NURSING PRACTICE
Nursing Practice

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NURSING PRACTICE
Table of contents
Answer 1: Sharing assessment data & putting clinical decisions into action..................................3
Tasks undertaken personally:..........................................................................................................3
Delegated tasks:...............................................................................................................................3
Documentation of rationale.............................................................................................................4
Answer 2: Collaborative and Therapeutic Practice.........................................................................6
2. a. 1. Identification of factors determining requirement of healthcare professionals in healthcare
team..................................................................................................................................................6
2. Leader of healthcare team............................................................................................................7
3. Most important member of healthcare team................................................................................7
2.b.1. Key issues of dilemma...........................................................................................................7
2. Best outcomes for Grant and his family......................................................................................8
3. Best guidance for the group.........................................................................................................8
Answer 3: Assessment problem solving..........................................................................................8
Answer 4: Scope of Practice/ Delegation/Advocacy.....................................................................12
Total patient care...........................................................................................................................12
Shared care models........................................................................................................................12
Task allocation...............................................................................................................................12
Team nursing.................................................................................................................................13
Individual patient allocation model...............................................................................................13
Task allocation...............................................................................................................................13
Rationale........................................................................................................................................14
Reference list.................................................................................................................................15

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NURSING PRACTICE
Answer 1: Sharing assessment data & putting clinical decisions into action
Tasks undertaken personally:
As per the provided scenario, I would undertake the tasks that involve direct encountering the
patient are listed below according to order.
Firstly: I will help the elderly patient to recover as I see the incident. In order to encounter the
post-operative patient, I will also seek help from the enrolled nurse and AIN .Before preceding
further encounter it is desired to go through the medical reports of the patient because very
recently she had undergone operation so it’s also important to consult clinician to examine her
from close.
Secondly: I will visit Mrs. Chew with a clinician who can help her to revive the fluids and
compensate the missed dose for antibiotic.
Thirdly: Among the 6 scenarios, I will personally encounter Mr. Esposito first as that is second
most emergency case now. Mr. Esposito is scheduled to leave for his catheterization so it is
utmost important to give him preoperative medications.
Fourthly: I will visit the surgical consultant to discuss the medication error.
Delegated tasks:
Rest of the tasks will be delegated by me. For instance fixing the blockage of the staff toilet
doesn’t require any medical actioners instead I will report to ward clerk who will call plumber
for fixation.
I would direct the AIN to encounter Smith’s visitor and helping his recovery since I myself
cannot attend so many patient and coulsultant in one time neither being a registered nurse, I can
neglect the importance of all the cases reported to me. So the most important issues as stated
above will be encountered by me while for others I will seek help of my nearby staffs. Since

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NURSING PRACTICE
recovering a patient from collapsing do not require any competency certification (Durand et al.
2016).
Documentation of rationale
Emerge
ncy
cause
Nam
e of
the
patie
nt
Observed
symptoms
Nursing
diagnosis
intervention Outcome
evaluation
Rationale
Collaps
e of
post-
operativ
e patient
-  Rapid
heart
rate
 Bluish
skin
color
 Taki
ng
her
to
her
bed
with
the
help
of
other
staffs
 Chec
k BP
and
pulse
rate
chec
k
 Lying
her in a
position
with
back
upright
position
leaned
against
bed
 Waiting
for few
minutes
after
giving
oxygen
mask
(William
s et al.
2016)
Patient got
back her
senses
Delivered
oxygen
reached the
cells on the
brain,
helping in
gaining
energy
IV Mrs.  Fatigu  chec  Assisting  Ne  Patie

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NURSING PRACTICE
fluids
running
behind
Chew e
 panick
ed
k the
chan
nels
of
veins
clinician
in IV
fluid
therapy
w
cha
nne
l
was
don
e
nt
rehy
drati
on
 Arre
st of
infec
tion
 Pain
mana
geme
nt
Patient
waiting
for
medicati
on
Mr.
Espos
ito
None none  Encounte
red to
know if
any
problem
is being
faced
 Medicine
s were
provided
none  Loca
te
redu
ction
in
bloc
kage
 Chec
k
cardi
ac
pum
ping
activ
ity
Delegated actions Purpose Intervention Rationale
Visiting surgical To revise the  Apologizing for  Every patient

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NURSING PRACTICE
consultant
schedule of
medication dose and
record
the medication
error caused
 Renewing the
medication
check list
receives
accurate
intervention and
treatment
 Rectification of
mistake that
involves patient
health
Visitor fainted Send nursing staffs
to encounter him
 Check BP,
pulse rate and
body
temperature
 Offering
electrolytic
fluid (Bastos et
al. 2019)
 Restoration of
hydration of the
patient (Eva et
al. 2016)
 Monitor
physical
parameter that
might interfere
with present
health status
Answer 2: Collaborative and Therapeutic Practice
2. a. 1. Identification of factors determining requirement of healthcare professionals in
healthcare team
 Healthcare professionals include actioners from multiple disciplines such as doctor,
nurses, dietician, MND advisors, physiotherapist, neurologist, psychologist, social worker
and so on.

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NURSING PRACTICE
 Recovery of the patient depends on skills and experience by which the patient is
encountered by the healthcare professionals
 The professionals monitor patient health and take necessary action towards improving
health of the patient (Gergen, K. J., & Ness, 2016). They also keep in touch with patient’s
family members.
 The members’ response timely as per changing requirement of the patient (Kvarnström,
Jangland & Dahlgren, 2018).
 Consults with other team members to select the appropriate clinical practice for the
patient .
 The healthcare professionals organize medical conference and seminars to stay updated
with recent evidence based practices.
2. Leader of healthcare team
Key worker leads the MND healthcare team who is the team coordinator in the provided scenario
(Shin, Park & Kim, 2015). The team coordinator collects all the necessary information of patient
and allocates specific tasks to each member of the healthcare team (Gondek et al. 2016).
3. Most important member of healthcare team
The most important member of MND team is the MND association advisor and general
practioner collectively. After the clinical interventions by RN, main treatment guidelines are
outlined by any of the two professionals.
2.b.1. Key issues of dilemma
As per the given scenario, the issues of dilemma are
 Grant still needs care treatment but the team members are not sure about the effectiveness
of house modifications but cannot confess it in front of his wife.
 Looking through perspective of his family the treating doctor is ready to call Grant as an
outpatient but that would bring more physical stress on him during this vulnerable health
condition.

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 Grant can never drive truck as his bones got severely injured but the team is not able to
convey it to his wife since his family is dependent on him financially.
2. Best outcomes for Grant and his family
 Grant can be shifted to a separate cabin where her wife can accompany him for few more
days. Being into medical professional, clinical practices cannot be defeated by emotions;
Grant needs more attention and care for few more days (Bryant‐Lukosius et al. 2016).
The hospital has all the equipment and instruments that will lack in his residence. It is
better to get the dressing of wounds done by a professional in order to prevent secondary
infections.
 After he is discharged within a day or two, the psychologist and occupational therapists
would visit Grant and counsel him. He would also be given some exercises that would
help him to strengthen his mussels (Hacohen et al. 2017). His improvement will be
monitored by expert team members once per week. After he has recovered more, then he
can come down as outpatient.
3. Best guidance for the group
 In order to achieve outcomes, I would discuss about the present health condition of the
patient individually. In addition to I would suggest the psychologist to talk with Grant’s
wife so that she understands the necessity for inpatient treatment. I will encourage
effective communication among the team members so that after grant is discharged, the
members can communicate with each other regarding the post-operative treatment
(Santelli, 2018). Grant will be counseled through therapeutic communication to take up
some other earning profession after he recovers completely.
Answer 3: Assessment problem solving
As per the audio clip, a nursing professional portfolio is constructed for necessary
assessments based on the ISBAR format.

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NURSING PRACTICE
Patient
name
Patient details Questions Assessments after
patient’s arrival
Mr. Blogs
93 years
 Meningitis
pneumonia
with too much
cough
 Production
 Intra-
abdominal
problem
 Has history of
gastric ulcer,
chronic
venous
insufficiency
and
congestive
heart failure
 He is on
antibiotics
such as
ceftriaxone
and
gentamycin
 Urinate 15 ml/
hr
 The patient
also reported
to suffer from
oxygen
 What exact
medical
condition is
doctor
suspecting?
 What are the
diagnostic
procedures
that need to
perform
immediately?
 Is the patient
allergic to any
particular
group of
drugs?
 What was the
last time he
urinated?
 Does his
sputum spots
blood?
 Is the patient
fluctuates
blood
pressure?
 How is the
diet and water
 Registration:
admission to
emergency
department
requires
registration
within 5
minutes of
patient’s arrival.
However, if for
emergency
cases navigation
precedes
registration, the
records should
be linked to ED
notes.
 Navigation:
After navigation
completed Mr.
Blogs is sent for
clinical
assessment.
 Clinical
assessment:
initially the
physical
parameters are

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NURSING PRACTICE
tension in his
nephron for
which he is
susceptible to
hypoxia
 Patient
urinates 15 ml
per day and
urine
sometimes
shows
presence of
blood. All the
conditions can
be related to
urinary tract
infection or
any associated
medical
condition
regard to
kidney
infection
intake in a
day?
 Did he have
any surgery
or chronic
disease
before?
 What are the
medical tests
taken within
last 48 hours?
 Are there any
specific
recommendati
ons for the
treatment
process of the
patient?
 What is
patient’s
response after
administratio
n of the
antibiotics?
 Does the
patient take
any separate
medication
for cardiac
disorder?
checked such as
BP, weight and
pulse rate.
 Since the patient
is suffering
from meningitis
pneumonia, he
has to schedule
a chest x-ray
(Eboreime et al.
2019)
 Body
temperature is
recorded as the
person
experiences
symptoms of
urine infection.
People affected
with urinary
tract infection
experience
(Pearsall et al.
2015) fever. His
urine will be
taken for culture
as he admitted
in early morning
empty stomach.
 Since the patient

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NURSING PRACTICE
has medical
history of CVI,
he will be
diagnosed with
duplex
ultrasound test
in order to
check blood
circulation in
legs. Inaccurate
blood
circulation
might be cause
of infection of
kidneys.
 The antibiotics
will be stopped
for a while since
a person on
antibacterial
drugs cannot go
for urine culture
 Medical reports
claim the patient
to be affected
with hypoxia so
pulse oximetry
diagnostic
process helps
the clinician to

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NURSING PRACTICE
get insight.
As the patient enters the ward it is necessary to go through his all medical records and
conduct preliminary tests (Greve & Pedersen, 2016). For example the patient is
prescribed gentamycin for both respiratory tract and urinary tract infection so a blood
test can assure the reduction of pathogen load from the body (Berman, Snyder, &
Frandsen,, 2016). Moreover, seeing the symptoms, the concerned assessments as
mentioned above is better to be confirmed so that clinician may take necessary
treatment process as soon he encounters the patient (Graber, 2019).
Answer 4: Scope of Practice/ Delegation/Advocacy
Nursing management aims at delivering care to patients that meets standards of nursing practice
(O'Meara et al. 2015). Allocating staffs to respective patients requires skills and experience.
According to many scholars health practioners have adopted different form of nursing skills and
care settings in order to deliver personalized care that achieves the rationale (Kitney et al 2018).
Total patient care
In order to manage 22 patients, nursing experiences of healthcare professionals are evaluated to
allocate then to every patients. However, there are some issues arise during team management
when the team leader is absent for managing team through effective communication (Hill et al.
2017). In such circumstances, responsibility and duty of every members increase. Similar kind of
situation arises in case study where absence of NUM the RN is holding the responsibility to
allocate tasks to the team members. The two care model that would be applicable for the
provided scenario is:

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NURSING PRACTICE
Shared care models
Task allocation
The shared care model includes patients who are attended by two or multiple care professions.
The model is applicable for patients who require more attention than the others (Johnsonet et al.
2018). For instance the model provides holistic care chosen for the case study is of the following
categories.
Pre-operative patients: There are patients to whom a pre-operative medical care is mandatory
(8 patients in case study).
 I allocated a surgeon and geriatrician to manage 8 patients on the day before the surgery.
 Following that I sent Dietician to every admitted patient in the ward so that everyone
receives the appropriate diet plan. The patients referring to surgery requires very light
diet.
 I allocate the medical advisors visit 8 patients whose surgery was scheduled on the next
day to guide him for necessary risk prevention methods post-surgery.
 It has been observed that many patients with weak nerve suffers nervous breakdown or
panicked before operation, for encountering them I allocated a psychologist who
profoundly builds confidence for the surgery.
Complex health needs: There are 5 patients who require more comorbidity especially for the
elderly patients.
 For encountering them, I allocated an AIN and EN who collectively can provide care and
monitor health parameters.
 3 Patients of critical care such as organ transplant or ICU also requires multiple
encounters since they are kept in a susceptible environment. Therefore I advised the AIN
to take care of it.

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NURSING PRACTICE
Post-operative patients: There were 14 Post-operative patients in the ward who were equally
vulnerable since they require careful wound dressing and prevention of any sort of infection and
osteoporotic (Berman, Snyder, & Frandsen,, 2016). Hence I allocated the enrolled and registered
nurses are allocated to the 14 patients to note their timely need and help them in bathing and
feeding (14 as per case study).
Team nursing
 Collaboration with clinician and other members
 Transparent administrative formalities
 Knowledge of principles of advocacy and delegation
 effective communication among team members
Individual patient allocation model
Task allocation
This model involves caring in a patient centered approach. The model is applicable to newly
admitted patients (in the afternoon shift) where the professional team is sent to recognize patients
as individuals and shows respect to their values. The AIN are allocated every day to collect
feedback so that the healthcare team can take decisions accordingly. This approach is even
performed to patients facing psychological issues so that they don’t feel rush while encountered
by several professionals (Johnsonet et al. 2018). The psychiatrist focuses on the need of
particular person rather on service. Other RN also helps in therapeutic communication.
The members of team are:
 Compassionate
 Effective
 Values patient’s choice

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Rationale
When a person is affected with a health issue, it requires multiple professionals to help in
recovery process. It is a chain process for instance when an orthopedic has completed his role on
a postoperative patient in managing fracture, a geriatrician takes the next charge in managing
behavioral issues. Thus shared patient care model helps the patient of above listed categories to
recover.
In the person centered healthcare the team ensures patient safety, confidentiality and preferences.
This approach is used for patients suffering from dementia so that they feel the care professionals
to be a partner in their decision and open up their problems to care providers.

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