NRSG355 Written Assessment

This written assessment covers prioritization and delegation, collaborative and therapeutic practice, provision and coordination of care, and time management and delegation. It includes a case study and questions for nurses.

Running head: NRSG355 WRITTEN ASSESSMENT 1
NRSG355 Written Assessment
Name
Institution
Date

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NRSG355 WRITTEN ASSESSMENT 2
Q1: Prioritization and delegation
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

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NRSG355 WRITTEN ASSESSMENT 3
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
(Weller, 2012).
-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

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NRSG355 WRITTEN ASSESSMENT 4
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

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NRSG355 WRITTEN ASSESSMENT 5
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.
Q2: Collaborative and Therapeutic practice
(a) The Multidisciplinary team
1. Identify factors that determine which healthcare professionals are required to
be involved in a health care team?
-the sick person’s status whether in critical condition or not

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NRSG355 WRITTEN ASSESSMENT 6
-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
2. Who should lead the health care team? Doctors.
-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.
3. Who is the most important member of the health care team?
-the patient is the most important member of the healthcare team
(b) Case study name: Case study 3
1. What are the key issues in this dilemma?
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.
2. Who would be included in the health care team and what role would they play?
The following professionals should be included in the healthcare team;
1. Medical officer
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.
2. Guidance and Counselling Professional
The professional helps to advise Robert to relax and avoid being aggressive such
that he can gain help from the health professional attending him.

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NRSG355 WRITTEN ASSESSMENT 7
3. Surgeon
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.
4. Clinical officer
Follow up the patient in order to see the progress.
Orders another test to be done which has not been done.
5. Physiotherapist
The healthcare professional specializes on guiding the patient on how to exercise
regularly in order to allow for ambulation.
6. Anesthetist
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.
7. Nurse in charge
Explains to the patients what is going to be done and how. S/he prepares the
patient for the operation
8. Radiologist
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.
Q3: Provision and coordination of care (module three)
1. 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?

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NRSG355 WRITTEN ASSESSMENT 8
-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, (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

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NRSG355 WRITTEN ASSESSMENT 9
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.
Q4: Time management and delegation (module four)
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

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NRSG355 WRITTEN ASSESSMENT 10
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.

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NRSG355 WRITTEN ASSESSMENT 11
Reference List (APA style)
Campbell, L., Gilbert, M. & Laustsen, G. (2010). Clinical coach for nursing excellence.
Retrieved from
http://ezproxy.acu.edu.au/login?url=http://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:
http://www.icn.ch/who-we-are/icn-definition-of-nursing/
Jacox, L. & Cole. A. (2012). ISOBAR: Standardising nursing handover. Retrieved 21 June,
2013, from: http://yhhiec.org.uk/wp-content/uploads/2012/07/34.pdf
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: http://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.
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.

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Siviter, B. (2013). Effective time management for nurses. Retrieved 21 June, 2013, from
http://nursingstandard.rcnpublishing.co.uk/students/from-student-to-qualified-
nurse/effective-time-management-for-nurses.
http://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?
direct=true&db=ccm &AN=2004200538&site=ehost-live.
Virtual Simulated Patient Resource (VSPR) (2013). Standards of effective communication.
Retrieved from:
https://www.vspr.net.au/joomla/index.php?option=com_joomdle&view=wrapper&moodle
_page_type=course&id=5&Itemid=
Wentworth, S. (2003). Time management strategies in nursing practice. Journal of Advanced
Nursing, 43(5), 432-440.