Clinical Integration Case Study

Case Study - Clinical Integration

Table of Contents
1. INTRODUCTION.......................................................................................................................1
2. CONTENT...................................................................................................................................1
a) Considering patients situation. ...............................................................................................1
b). Collection of information.......................................................................................................1
c) Process information.................................................................................................................2
d) Identify the problem................................................................................................................3
e) Establish goals.........................................................................................................................3
f) Take action..............................................................................................................................4
g) Evaluation and Reflection.......................................................................................................5
3. CONCLUSION............................................................................................................................5
4. REFERENCES............................................................................................................................6

1. INTRODUCTION
Clinical integration can be defined as a means of facilitating coordination of patients care
across the different conditions, settings, providers as well as time to achieve a care facilities
which are safe, effective equitable and efficient for a patient. It also includes the activities for
providing a safe and quality care to patients and developing a proactive plans in order to provide
effective treatment to patients. Clinical integration can be different for every patient and every
practice but the goal of clinical integration is same which is to improve the health of patient and
its experience. This report is based on the persons centred care which involves establishing of
realistic as well as relevant goals by using Clinical Reasoning Cycle. This paper discusses about
the maternity case of a women namely Jennie Picket aged 38 years and is suffering from
gestational hypertension.
2. CONTENT
a) Considering patients situation.
Jennie Picket is a 38 years old women which is going through a pregnancy which was
suffering form gestational hypertension. It was her first pregnancy and has been attending the
clinical for the third antenatal care of her 26 week gestation period. In her first antenatal visit she
was in her 12 weeks gestation and weighed 64 kg and had a blood pressure of 120/80 mmHg.
Also, in her visit she was also diagnosed that her Uterine size was normal and was felt just above
the symphysis pubis (Hunter and Arthur, 2016). Her urinalysis was normal and also her fetal
heart rate was 120 bpm and no other anomalies was detected. But in her third antenatal visit she
was in 26 weeks of gestation and weighed 66 kgs. Her blood pressure was higher which was
140/92 mmHg. Also, her uterus can be felt above her umbilicus level. Her fetal heart has also
increased up to 140 bpm. She also has mild swelling of feet and her hands. As, she it was her
first pregnancy and she was very nervous about her pregnancy and there has been rise in blood
pressure her and is in her 26 week of gestation and this gestational hypertension can worsen her
situation is not taken care.
b). Collection of information
Jennie Picket has been previously diagnosed with high blood pressure and has high fetal
heart rate also has mild swelling on her hands as well as on her feet. Her clinical observation has
represents that her Blood Pressure is 140/92 mmHg and her fetal heart rate is 140 bpm. Also, it
has also been diagnosed from her clinical examination that her uterus can be felt over umbilicus
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level. So, her clinical examination is implying that she is suffering from high blood pressure
which has resulted in the gestational hypertension (Koivisto and et.al., 2016.). This can be fetal
for both mother and child and it is really important for nurses to lower her blood pressure to
normal. In order to lower down the hypertension Jennie should be made rest by lying on her left
side in order to take the weight of the child away from her major blood vessels. She should be
given more water to drink and made to consume less salt which could help in decrease
hypertension. Also, she should be advised to increase her antenatal check ups. As it is her first
child so this risk is very much experted in her. If it is not treated on time it may result in severe
complications on the child and mother like it can prevent the placenta from getting enough blood
which may result in loss of oxygen and food to baby. This can have major consequences on the
baby like low birth weight (Liaw and et.al., 2018). As Jennie has been detected from
hypertension, she can be still give birth to a healthy baby is she is provided with effective
treatment. If gestational hypertension is not controlled on time it can result in sever complication
on mother and baby. As her placenta is moving her it if not treated in can result in the placental
abruption. Another complication can be that it could result in a poor fetal growth which is also
known as intrauterine growth restriction. Also, other complications can be stillbirth, seizure and
in worse situation it can lead to death of mother and baby. So, it is need to taken serious and
provide her effective treatment.
c) Process information
As Jennie Picked is suffering from gestational hypertension which is often in first time
pregnant women, Observation of Jennie suggests that she is suffering from high blood pressure
and high breathing and her fetal heart rate has also increased up to 140 bpm. She has also a mild
swelling on her hands and feet, another major factor is that her uterus can be felt at a level of her
umbilicus (Mather, McKay and Allen, 2015). Also, from her urinalysis it was diagnosed that she
had no glycorsuria and proteinuria. But rise in blood pressure and increase in fetal heart rate can
cause sever complications mother and baby and if not treated well on time can worsen the
situations in rest of gestation period and at the time of delivery it can further make job difficult
for nurses and for the patient. In such conditions prime importance should be given to
rectification of her gestational hypertension by providing proper medical care and attention to
her. Also, she should given proper advice on how she can take care of herself and what are the
precautions to be taken which can help her in decreasing gestational hypertension.
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d) Identify the problem
Hypertensive disease of pregnancy also known as maternal hypertensive disorder. This
disorder in human body can cause of high blood pressure which is not good for the pregnancy
women. As according to statistics over 20.7 million women suffered from this issue. From that
about 10% of pregnancies globally are complicated by hypertensive disease. In other words, due
to high blood pressure can might cause problem during women pregnancy, pre-eclampsia and
premature birth (Côté-Arsenault and O’Leary, 2015). The major issue found in this process is
gestational hypertensive which is also known as induced hypertension (PIH) which might be
happened during 20 weeks of gestation. The major issue that cab be found with the Hennie
Pickett is Preeclampsia. It is severe issue which is caused by hypertension. This issue involves
several risk factor which can impact the situation. One of the risk factor is nulliparity due to
which pregnancy process never having completed even after 20 weeks. After having this issue
women can might be facing issues like Nausea or vomiting, decreased urine output, Impaired
liver function, decreased levels of platelets in your blood (Alfieri, 2016). As found in the case
study that in first antenatal visit Jennie having only 120Bpm which is very risky for her during
the pregnancy. Or in 26 week of gestation. Her fetal heart rate was 140bpm. Another issue
which has been found during this case is Eclampsia which is also known as seizures that occur
during the pregnancy due to hypertension. This is the another issue which found in the patient.
Due to which the risk of pregnancy more increased. As compare to Preeclampsia this issue is
treatable with medical professionals (Alhwiesh, 2015). Due to this issue Jennie can have
headache, upper abdominal pain, changes in mental status etc.
e) Establish goals
The issue of Maternal Mortality is becoming a very high. Around 800 women die in
pregnancy due to not getting proper care in the duration. Many of the cases are preventable if
they get the right direction on the right time. Nurses plays a very important role in this situation
where the possibilities of prevention is high. Being as a Nurse it is my responsibility to give
excellent care to Jennie during her pregnancy stage (Ghansah, 2016). My three aim towards my
goal is 1) Establishing a good relationship with the mother 2) Preparing her for the childbirth 3)
protect her from the harmful things and make her surrounding safe and secure.
First goal is to build a emotional attachment with the mother who will soon deliver a
baby because Emotional attachment is the best way to make her happy and secure. I also try to
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make Jennie relax and happy so that she feel relaxed during their weeks. My second goal is to
make her ready for the final stage of baby birth. For that, I will make her aware by offering
books and knowledge (Volkov and et.al., 2018). This possibilities will help to control her blood
pressure and hypertension. My third goals is to make her surroundings safe and secure so that I
can protect her from the uncertainties.
Issues I have been facing
During the whole duration I have facing some couple of issues with Jennie. Along with
that, certainly they facing issues with the context with high defining goals. I have facing issues
related to Ethical challenges, high rates of litigation in obstetrics and the challenge of practising
safe and evidence based nursing care (Kim and et.al., 2019). Besides, nurses are responsible to
manage and take care the needs and requirements of the pregnant lady. As I do in my session
with Jennie. I have faced ethical issues everyday in healthcare and everyone has role to play in
ensuring the ethical delivery of care. Apart from that, interaction with patients and clients in the
reproductive age groups. Being a Nurse I am responsible to take some kind of decisions which I
have to know the ethical circumstances. So this is the issue I am facing during the whole session.
Another issue that I am facing is Poor patient compliance this is the most critical pathway that
been taken by the people which needs to be measured by the effective working manner
(Robinson and et.al., 2019). Somehow poor compliance of the patient is the big reason of
ineffective treatment which is not good.
Caseload is the another issue that has been faced by the organisation in order to complete
the case of the Jennie.
f) Take action
In order to get over from the ethical issue Nurse need to get more knowledge regarding
ethical principle that helps them to evaluate the issues related to the nursing. Such principle can
help Nurses to manage the conflicts and challenges. Like Autonomy ; this first principle define
that right to self determination. Second principle of ethical framework is respect for others
Nurses should need to give respect to their patients. Third is Beneficence which create
obligations to do good next principle is non maleficence which define to create no harm to
others (Decuzzi, 2016). Justice is the another principle which talked about the equal treatment of
others or that other to be tread fairly. Cure for Poor patient compliance Nurse should use
interventions like familiar communication, nurse can educated Jennie about their risk and
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benefits of adhering to the medication regime. In order to reduce the problem of Caseload. Nurse
can use some intervention to better understand the case and its significance. Nurse should study
the case prior before taking into action. This can help to cure the issues and challenges with the
best consideration.
g) Evaluation and Reflection
Throughout this study, it has been measuring the goals and opportunity work s effectively
proper and manageable (Decuzzi, 2016). From the above discussed intervention it helps to better
understand the opportunity to get the good outcomes from the study. Besides, it also helps to
define the outcomes and better understand the case of the patient. Above discussed intervention
could also help in nursing practices In order to focus on the person centric approach.
3. CONCLUSION
It can be concluded that gestational hypertension is common in women who are pregnant
for first time. It is really important for nurses to provide proper care to such patients and with the
help of clinical integration this issue can be addressed. A women suffering from gestational
hypertension can face sever complications which can have an adverse effects on baby and on
mother. So, proper medical precautions should be taken by nurses in order to handle such
patients. It is the duty of nurses to provide person centred care to such patients in order to
improve the health of patients.
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4. REFERENCES
Books & Journals
Hunter, S. and Arthur, C., 2016. Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice. 18. pp.73-79.
Koivisto, J. M and et.al., 2016. Learning by playing: A cross-sectional descriptive study of
nursing students' experiences of learning clinical reasoning. Nurse education today,. 45.
pp.22-28.
Liaw, S. Y and et.al., 2018. Development and psychometric testing of a Clinical Reasoning
Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to
recognize and respond to clinical deterioration. Nurse education today. 62. pp.74-79.
Mather, C. A., McKay, A. and Allen, P., 2015. Clinical supervisors' perspectives on delivering
work integrated learning: A survey study. Nurse education today. 35(4). pp.625-631.
Laxmi, L., Devi, R. and Kapoor, B., 2019. Effectiveness of Self learning material (SLM) on
knowledge of Auxiliary Nurses and Midwifes (ANMs) regarding Behaviour Change
Communication (BCC) related to Antenatal care.
Côté-Arsenault, D. and O’Leary, J., 2015. Understanding the experience of pregnancy
subsequent to a perinatal loss. Perinatal and Pediatric Bereavement, pp.159-181.
Alfieri, R., 2016. Acceptance and commitment therapy as a proposed treatment for tokophobia.
Widener University.
Alhwiesh, A., 2015. Pregnancy in peritoneal dialysis and an infant with a ventricular septal
defect. Saudi Journal of Kidney Diseases and Transplantation. 26(1). p.111.
Ghansah, G., 2016. Factors promoting and preventing the utilization and uptake of IPT among
pregnant women in the Mampong Municipality. Ghana (Doctoral dissertation).
Volkov, N. and et.al., 2018. . Gynaecological and obstetrical problems and management
dilemmas in women with Ehlers-Danlos syndrome. Ehlers-Danlos Syndrome: A
Multidisciplinary Approach, p.241.
Kim, D. and et.al., 2019. Informal Clinical Integration in Medicare Accountable Care
Organizations and Mortality Following Coronary Artery Bypass Graft Surgery. Medical
care, 57(3), pp.194-201.
Robinson, F. G. and et.al., 2019. Clinical Integration in a Dental School Clinic Through an
Enhanced Patient Intake Process. Journal of dental education, pp.JDE-019.
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Decuzzi, P., 2016. Facilitating the clinical integration of nanomedicines: the roles of theoretical
and computational scientists. ACS nano. 10(9). pp.8133-8138.
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