NRSG355 Written Assessment Guide

SUGGESTED TEMPLATE: NRSG355 WRITTEN ASSESSMENT
This is a guide only – you may write this as a long form essay as long as you provide
headings for each question.
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.
Issue Priority Action and rationale
The first priority would be the issue of the elderly female post-operative patient who
collapses to the floor and becomes unconscious. Additionally, the patient has had
facial surgery. I would take an immediate action to wake up the patient and initiate
first aid interventions. The patient could have collapsed due to excessive bleeding
which following the facial surgical intervention. The main rationale for prioritizing this
issue is to save her life. The facial surgical procedure and the anesthetics used
impairs patient’s normal body metabolism. Excessive bleeding can cause
hypovolemic shock to the patient leading to death. Therefore, it is very essential to
intervene and initiate immediate actions such as fluid therapy and oxygen therapy to
resuscitate her hence saving life (Reay, Rankin, & Then, 2016).
The second priority issue would be Mr. Smith’s visitor who has just fainted. This
issue would require immediate action because fainting commonly occurs when the
patient’s brain temporarily does not get sufficient supply of blood and he ends up
losing his consciousness but for a short period. I would offer first aid measures such
as positioning him on his back, loosening any tight or constrictive clothing, checking
for breathing, placing the visitor in a well-ventilated area for him to get sufficient
oxygen. I can delegate this issue to the Assistant In Nursing (AIN) to provide the fist
aid measures to the visitor (Wong, 2015).
The third priority issue is the one of Mrs. Chew’s tissued Intravenous (IV) infusion
and her IV fluids are behind the schedules and she has also missed her IV
antibiotics for 14.00 Hours. Patient’s medications are very essential in the treatment
and healing of the patient’s condition. I would make it a third priority since it is not an
emergency but at the same the IV fluids were running behind time. I would do this to
prevent the patient from missing another dose of the IV medications which can
reduce the efficacy and effectiveness of IV antibiotics. This may cause relapse of the
patient’s medical condition. I would not delegate since the Enrolled nurse
undertaking intravenous cannulation certificate is not competent enough to handle it.
I would handle this issue by removing the tissued intravenous infusion and fix a new
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one in another place to ensure its patent enough for an effective flow of the IV
antibiotics and other significant fluids given to the patient. I would work with the
enrolled nurse who is undertaking a certificate in intravenous cannulation but not
competent enough. This would help her improve her level of expertise and
competence in IV cannulation (Papathanasiou, Kleisiaris, Fradelos, Kakou, &
Kourkouta, 2014).
The fourth priority issue would be the case of Mr. Esposito who is scheduled for
cardiac catheterization now and has not been given his preoperative medications.
Based on the issue, the degree of urgency is low. Regarding the primary vital signs
namely temperature, oxygen saturation, respiratory rate, pulse, and blood pressure,
the patient is stable. He has no signs of emergency which might immediate attention.
Therefore, I would make this a fourth priority compared to the first and second
scenarios whose vital signs were deteriorating and they required immediate
intervention to save their lives. I would take an action of delegating this task to the
Assistant In Nursing who would prepare and escort the patient for cardiac
catherization. I would also advice the AIN to give the preoperative medications
(Shaw, Davidson, Smilde, Sondoozi, & Agan, 2014).
The fifth priority issue would be the staff toilet which has blocked and waste is
pouring and overflowing rapidly. It is an essential issue in the ward because it is of
hygienic concern. I would delegate this issue to the ward clerk to handle it and
ensure the toilet has been unblocked. I would also advice the ward clerk to notify the
other staff members not to use the toilet until its ready for use
I would give the last priority to the issue of the surgical consultant (VMO) who wants
us to have a discussion regarding a medication error that had occurred the previous
week. This is because its degree of urgency is low when compared to other
incidences. Additionally, the discussion regarding a medical error requires and
humble time and a conducive environment to find out the primary cause of the error,
its impacts, the implemented measures of combating, and the most effective
approaches or strategies that can be used to prevent further occurrence of
medication errors in the future (Nemeth, 2017).
Q2: Collaborative and Therapeutic practice (module two)
(a) The Multidisciplinary team
A multidisciplinary team is a group of various professionals in healthcare who
collaborate in the provision of holistic care to the patient. The team consists
of a doctor, allied healthcare professionals such as occupational therapist,
dietitian, social worker, speech pathologist, physiotherapist. It also includes
the community and local palliative care workers (Choi, P. (2015). Some of
the factors that are used in the determination of the healthcare professionals
needed to be engaged in a healthcare team include patient’s healthcare
needs and requirements, specialization and level of expertise of an individual,
personal training, and development, team leadership. The healthcare team
should be led by a physician. The most important member of the team is the
patient who forms the integral part of the team. The patient is the source of
information to the entire team. The information provided by the patient helps
in the establishment of a diagnosis hence dictating the role of every member
of the team in the provision of patient care (Hartgerink et al., 2014).
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(b) Case study name: CASE STUDY 4
The key issues presented in the case study include a recent turnover of staff
members in the physiotherapy department, and a new physiotherapy
representative who has recently joined the healthcare team. The new
member is often absent from work and he does not provide updates on
patients and he is exceptional confrontational once he is challenged
regarding the issues. The behavior is affecting both the patient outcomes and
the effectiveness of the team. As the designated team leader, I would employ
various strategies to resolve the problem (Levett-Jones, 2013). I would first
conduct an employee assessment to determine the ability of the candidate to
carry out specific duties and reveal particular personality traits which can help
me in resolving the problem. In the assessment, I would also be able to find
out any possible factors that could be the contributors to the new employee’s
behaviour and actions (Weaver, Dy, & Rosen, 2014). This would help me in
identifying the most appropriate actions and strategies to employ. Other
strategies that I would employ in the case include keeping an open ear and
open door, taking the bull by its own horns, specificity about the problem,
discussing the problem, providing actionable and clear direction, setting
consequences if no change of the employee’s behaviour (Papastavrou,
Andreou, & Efstathiou, 2014).
Q3: Provision and coordination of care (module three)
Q4: Time management and delegation (module four)
My allocation would be based or determined by task allocation, total patient care,
and team nursing. I in the ward, there are two RNs, three AINS, and one EN. Having
in mind that there is a total of 22 patients in ward, with 14 intraoperative and 8 of
them would be joining my shift, I would allocate of the RNs to care for 11 patients
with the assistance of one EN and one AIN (Bratzke et al., 2015). On the other
hand, I would allocate the myself, as an RN 11 patients with the assistance of two
AINs. The rationale for this would be the level of expertise and competency of the
individual staff members. The fact 14 patients went for surgical does not mean they
will all come back at the same. I would accordingly prioritize as the patients come
back to the ward from theatre. It would be unfair if one RN was allocated 15 patients
and the other one 7 patients. I would split the number evenly to ensure fairness. My
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