NURSING ASSESSMENTS2 Nursing Assessments Module One: Prioritisation and Delegation IssuePriorityAction and rationale As you are taking this handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery. First Priority for the RNPatient-centered care is fundamental to nursing practice as a priority necessary to guarantee good patient experiences and health outcomes (Elliot, Aitken & Chaboyer, 2007). For a collapsed patient, like the elderly lady the nurse must take immediate action and activate the emergency procedure. Prior to the arrival of the emergency team, the RN in collaboration with the AIN should position the client well and check their vital signs (Elliott & Coventry, 2012). When the patient gains stability the RN then moves to the next nurse activity. It is worth highlighting that nursing tasks that require nursing professional skills, understanding and decision making cannot be delegated to others. Mr. Smith’s visitor has fainted. Delegated to the Enrolled Nurse as their first priority It is important to realize that one nurse may not attend to more than one
NURSING ASSESSMENTS3 situation at the same time. It is important to delegate to improve the health outcomes of patients (Casey & Wallis, 2011). Given that the patient data for Mr. Smith may not be available, the EN would be tasked to inform the doctor about the condition of the patient as they check for the vital signs while waiting for the emergency team to arrive. The emergency nurse has the freedom of handing over the case of the patient to the emergency team upon their arrival. An enrolled nurse is adequately qualified to provide both direct and indirect aspects of care to patients. Hence, the RN can delegate a role to them. Mr. Esposito is scheduled to leave the ward now for his cardiac catheterisation and he has still not received his preoperative medication. A delegated task to the Enrolled Nurse as their second priority. The operation procedure to Mr. Esposito relies on timely administration of the preoperative medication. However, response to the patients lacking consciousness is given priority first. The RN gives direction to the EN to administer the medication to Mr. Esposito after handing over their first patient to the emergency medical team. An EN has the capacity to
NURSING ASSESSMENTS4 administer medication and hence the EN is still practicing within the confines of Nurses and Midwifery provisions. Mrs. Chew’s intravenous (IV) infusion has tissued, her IV fluids are running behind and she has missed her 14.00 hrs. IV antibiotic. RN Second PriorityIt is the responsibility of the RN to provide evidence-based care that is timely and meets the health demands of a patient. Timely nursing interventions are one of the indicators of good practice and competence for RN. This role can be delegated to the EN, however, they are not IV certified to undertake the task (Elliot, Aitken & Chaboyer, 2007). Administration of the antibiotic would avert the late medication that would constitute to a medication error. One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly Ward Clerk, First PriorityA ward clerk should only be allowed roles that do not require clinical licensing. These are majorly administrative duties. The clerk should be tasked to call the environmental officers to inform them about the overflowing toilet. The toilet would be a major risk for infections and falls. It would also make the environment none- conducive for therapeutic
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NURSING ASSESSMENTS5 activities. One of the surgical consultants (VMO) is waiting to discuss a medication error that happened last week. RN third priorityThe discussion relates to a previous scenario and cannot be given priority over other urgent current medical matters. Any aspect of medication errors is within the scope of the RN to respond and remain accountable. The EN can be accountable when there are qualified to administer medications. Clinical decision making requires that nurses are responsible for the care they deliver to patients. It is always required that patient care is safe and of the right quality to ensure their satisfaction to confirm nursing competency (Patricia & Christine, 2009).
NURSING ASSESSMENTS6 References Casey, A., & Wallis, A. (2011). Effective communication: principle of nursing practice E.Nursing Standard,25(32), 35-38. Elliot, D., Aitken, L., & Chaboyer, W. (2007). Critical care nursing.Sydney: Mosby Elsevier, 448-53. Elliott, M., & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring.British Journal of Nursing,21(10), 621-625. Patricia Benner, R. N., & Christine Tanner, R. N. (Eds.). (2009).Expertise in nursing practice: Caring, clinical judgment, and ethics. Springer Publishing Company.
NURSING ASSESSMENTS7 Module Two: Activity Two Caring for patients requires adequate and careful consideration of their needs through the patient-centered care approach. As such, the factor determining the healthcare professionals required for an interprofessional team is largely the needs of the patient. In most cases, the patient outlines their care needs to a medical professional. The care needs are then communicated to an interprofessionals team for activity. The interprofessional meeting decides on the care planning process to delegate duties according to each individual’s competency, scope of activity and needs of the patient. The action developed is a highly collaborative and integrative process that guarantees positive health outcomes to the patient (Berman et al., 2018). An interprofessional team may compromise of many medical professionals that may include physiotherapists, general practitioners, dieticians, and social workers. The leading member of the team is the coordinator of the team effort. The roles of the care coordinator would be to sustain a frequent and regular contact with the patient, initiate timely changes according to the needs of the patient, liaising with other team members and organizing for the team meetings. Hence, the care coordinator is supposed to be the leader of the professional team to create the link between the patient and the interprofessional team (Crisp et al., 2017). It is worth highlighting that there is no member of the team who is more important than the others. This is because; all the members are adequately trained and competent in their various capacities. The collaboration is just a matter of convenience given the patients demands and the different specializations of the medical professionals.
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NURSING ASSESSMENTS8 Case Study 4 The key issues in the case study are turnover of staff in the Physiotherapy department, lack of collaboration from a team member, inefficiency of the interprofessional team and adverse effects on patient outcomes. As a team leader, I would undertake conduct a research on the Physiotherapy department to understand the underlying course for staff turnover. Further, I would present data during the weekly meeting about the significance of team collaboration to patient outcomes and team efficacy. I would also seek to understand the case of the non-cooperative member by summoning him before the interprofessional team to account for their actions. During the meeting it would be important to review with them their responsibilities to the whole team and the risks they expose patients to when they fail to provide their specific updates. As a leader I would emphasize on the significance of teamwork and professionalism as competences necessary for medical professionals while referring to the codes of conduct of medical professionals (Kalishman, Stoddard & O’Sullivan, 2012).
NURSING ASSESSMENTS9 References Berman, A., Snyder, S., Levett-Jones, T. Dwyer, Hales, M.....Stanley, D. (2018).Kozier and Erb’s fundamentals of nursing, (4th Australian Ed.).Frenchs Forest, NSW: Pearson. Crisp, J., Douglas, C., Rebeiro, G. & Waters, D. (2017).Potter and Perry’s fundamentals of nursing, 5th Ed. Chatswood. NSW: Elsevier. Kalishman, S., Stoddard, H. & O’Sullivan, P. (2012). Don’t manage the conflict: transform it through collaboration.Medical Education, 46, 926-934.
NURSING ASSESSMENTS10 Module 4: Professional Portfolio Based on the give scenario, I would propose the use of a task allocation model to direct the healthcare service delivery. I believe that all nurses must work and operate within their scope of practice. Scope of practice defines the specific roles, responsibilities, functions and the decision making capability of an individual in professional practice (Pearce, 2006). The scenario provided entails 22 patients, ten of whom have undergone surgery and others yet to be operated on. Notably, each of the patients has their own complex needs that would have to be managed by the available health professionals. In all healthcare services, there is demand for high quality services and patient satisfaction. These parameters can only be achievable through the use of highly competent and skilled workforce (Benner, 1984). According to the task allocation model, nursing and patient related activities are divided into small tasks. The tasks the get assigned to nursing personnel based on their complexity and technical ability requirements. Less-skilled nurses get assigned less complex tasks that are routine while the more qualified nurses are assigned complex and supervisory positions (Schwartz, 2002). Importantly, task allocation model demands that the competencies of all the RNs, EN, and AINs are critically assessed and matched to the needs of the patients. Given that the information provided does not indicate any aspect of qualification reservations for all the nurses, it would be important to divide tasks to the RNs on a 50% basis. It is indicated that the RN who stands in for the NUM is taking patient loads. Due to their leadership role, they would be assigned together with the EN for adequate backup as well as one AIN. On the other hand, I would be assigned two AINs.
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NURSING ASSESSMENTS11 The division of labor into smaller portions would help to improve the quality of healthcare services. The nurses are apportioned fair shares of responsibilities according to their abilities. The allocation aims at meeting all the care needs of the patients satisfactorily. The allocation will also ensure appropriate communication structure is in place for the nursing professionals and the patients. Aspects of delegation would also be incorporated into the practice after allocation of tasks. For instance, in the group, the responsibilities of the RN standing as a NUM would be increased (Nursing and Midwifery Board of Australia, 2013). Hence, some of their roles would be delegated to the ENs as a way of maintaining quality service delivery to improve the outcomes of patients. The allocation clearly demarcates the roles of each nurse to avoid conflict of interest (National Council of State Boards, 2014).
NURSING ASSESSMENTS12 References Benner, P. (1984).From novice to expert: excellence and power in clinical nursing practice. Menlo Park, Ca: Addison-Wesley. 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 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.