Analysis of Decision Making and Consent Guidelines

This assignment involves analyzing various guidelines related to decision making and consent in healthcare. It includes a critical evaluation of the NSW Government's Decision Making and Consent Guidelines and the Recognition and Management of Patients who are Clinically Deteriorating, as well as other relevant sources such as research articles and books. The analysis provides insights into the importance of informed consent and decision-making processes in healthcare, particularly for older adults and patients with complex medical conditions.

Nursing Project

Table of Contents
INTRODUCTION...........................................................................................................................1
PART1.............................................................................................................................................1
Airway.........................................................................................................................................1
Breathing.....................................................................................................................................2
Circulation...................................................................................................................................2
Disability.....................................................................................................................................3
Exposure......................................................................................................................................4
PART 11 .........................................................................................................................................4
Discharge planning......................................................................................................................4
Social and cultural elements: .....................................................................................................5
Environmental factors: ...............................................................................................................5
Psychological..............................................................................................................................6
Politico economic........................................................................................................................6
REFERENCES................................................................................................................................8

INTRODUCTION
PART1
The project presents essential precedence of nursing and it deal with a case where Janice
Kingsley is an old lady whose age is 71 year and caught in a road mishap and is a victim of
paramedics. The old lady was worked as a registered nurse in which records shows that she is
suffering from a heart disease named Arrhythmias and through Sotalol medication or Eliquis
there is a chances to reduce her heart problems. Even three days before, she was also admitted
into a hospital for pathology and denosuman therapy and during that time, ECG also completed
in an ambulance which shows that she has a Atrial Fibrillation and registered nurse get to know
that Janice lives alone and belongs to unknown background (NSW Government, Ministry of
Health 2013). There is a need to take a critical review because all the information are quite
necessary to determine in order to treat a lady as RN is provided to her. As the report helps to
determine nursing priorities as well as assessment for Janice's care that also includes her
discharge planning.
Airway
All the registered nurse has a responsibility to make sure that Kingsley is a patent airway.
When the primary survey has been undergo, registered nurses (RN) immediately takes action in
order to save life of Janice and provide some medication as the life of her is in threatening. It is
the duty of emergency care to keep focus on those patients whose health conditions are not up to
the mark and they should treat them first. The primary survey has been taken in which trauma
care has a priority to take care of patency of airways. As the old lady is also met with an accident
in which she is suffering from an cervical spine problem. Moreover, Janice medical histroy also
shows that she has osteoporosis and it can be cure or reduced by Denosumab (NSW
Government, Family & Community Services 2016). As the lady is 71 year old, her problem also
raise and it may convert as a fracture too. Therfore, it is quite necessary to protect a patient
suffering from spinal injury even if a doctor does not arrives.
Foremost, the registered nurses needs to tell Janice about the signs of structure which she
face during an accident so that she realizes what is the actual problem. As she met with an
accident, a facial injury has occurred (MIMS online 2017). To start her operation, RN must take
an initial steps such as they remove broken teeth, vomit and check on which part swelling occur.
Registered nurses must look after whether any other injury in a body, bone recession, movement
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of chest is properly and lungs work in proper way or not, blood, tracheal deviation etc. because
these are the sign of airway blockage. Moreover, RN also listen airways of Janice that this are
work properly or not by checking for ripple, breathing, noise of high pitched, as this are
necessary to check because this will allow to measure the consciousness and if found any that
immediate steps should be taken (Maclejuk-Ploriska and et.al., 201). After some time, RN
noticed that there is a trapped air in tissues and she feels some pain when she starts speaking in
full sentence, she feels some problem from her upper airway structure and it needs some urgent
treatment.
Breathing
Breathing is the next step which must be evaluated when patient have an injury. Having a
medical history of Atrial Fibrillation and she was involve in an motor car accident, registered
nurses are quite aware that she will definitely suffer from cardiovascular and respiratory
problems and even they also found some symptoms which shows that there could be another
symptoms of acid-base or infection which may lead to some changes in neurological system as
well as level of consciousness (Holland and et.al., 2008). So RN also assess Kingsley for
Cyanosis by using her accessory muscle and they all observe her breath which was passed out
from both lungs or not and also measure her pattern of speech in order to find out there is no
obstruction in her upper airway. And finally, nurses realize the problem of Janice that she has a
problem in her chest whose name is Pneumothorax. As the rate of respiratory system of Janice is
quite high so nurses check her anxiety and stress level and also look on monitor in order to know
her oxygen saturation. If oxygen level is above 95 percent then there there is no problem for
Janice breathing system (Platts-Mills and et.al.,2015).
Circulation
As Janice met with an accident and injured also that will cause bleeding and it is major
problem with circulation (Hassal & Butler-William, 2010). And it is a duty of registered nurses
to stop bleeding and they also be aware of central circulation and activities if heart. RN must also
determine all the functions of heart and should monitored neurological observations too. They
also must be look after if Janice complaining about her headache or chest pain. RN regularly
check Janice's heart, blood pressure and if they found her palm warm then they must provide
medication because it is a symptom of infection and if found cold hand which shows a sign of
depressed cardiac output. RN also check pulses of Janice in every 30 seconds because the nature
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of her pulses gives a warm sign. To assess the circulation of an old lady, notes must be taken in
order to know whether she is improving or deteriorating like hypotension or some irregular
pulse. If RN found that she has hypotension then they put her in an lateral position (Clinical
Excellence Commission 2013).
Moreover, when RN looking towards a capillary refill time then they come to know that
she has a poor peripheral perfusion because normal capillary refill takes two seconds to fill but in
the case of Janice, it takes a long time to refill that is a sign of poor peripheral perfusion (Platts-
Mills and et.al., 2016). As they all know that an old lady has a heart problem and she takes
Eliquis in order to reduce her disease, therefore, it is quite important for RN to stop Janice's
bleeding and ECG is also completed in an ambulance only. So the main aim of RN is to maintain
output of cardiac and tissue perfusion to make sure that Janice problem will not increases as a
thromboembolism. If patient's heart rate is rapid then a medical team should be notified as soon
as possible and if the heartbeat blood pressure is less than 90 mm (Australian Institute of Health
and Welfare 2016). While on the other side, if a person is suffer from Atrial Fibrillation then
they must be respond rapidly for treatment and on this time, nurses should do at much possible in
order to relieve patient's fears and anxieties and also provide them physical support.
Disability
As Janice met with an accident, so it is quite important for RN to keep monitoring old
lady's neurological status because this only helps to determine whether she has a head injury or
not and that time ambulance officers notified RN that the GCS scale is 14 which is a good sign
that she is not have any head injury and this is also used by RN in order to measure the degree of
eye opening such that if Janice's eye opened normally then the scale reach up to fifteen and if the
scale is less than eight which means that a person has a severe depletion of level of
consciousness (LOC) and its is a major problem of neurological disruption of another organ or in
metabolic process (Chin-Jung and et.al., 2012). Further, the officers of ambulance also advised
registered nurses that her pain score is proper in her right leg and even proper medication is also
provided. RN determine Janice level of pain by using scale of 0 to 10 method in order to evaluate
severe pain if she having. Pain scale is used by doctors to know any severe pain among patients
those who are serious ill, those who are returned from surgery or those who are also admitted in
emergency section. In the case, as Janice met with an motor vehicle accident then the pain in
neck, jaw, back, legs, hand or hips are immediately reported only in emergency department
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(Australian Government Department of Human Services 2012). For Janice case, her glucose
level is also stable and even nurses also gives a reason behind testing blood glucose and they
perform a test and takes a result into consideration, if blood glucose is high or low then they
provide necessary guidelines in order to make patients feel better and test frequently by
providing proper medicine related to blood glucose and takes care of them (Rebeiro, 2013).
Exposure
Further, registered nurses also proper examine Janice's whole body in order to determine
she may be bleeding or injured from any other part or is there any internal harm or injury such as
intra- abdominal hurt as she has her seatbelt or crash with other motor vehicle. This all are done
immediately and even they also take decision fast, RN must take correct assessment by analysing
her conditions and signs in order to save Janice's life so that they provide fluid replacement and
blood insertion. They must take proper assessment of Janice in order to maintain company's
dignity and respect (Australian Commission of Safety and Quality in Health Care Seminar 2009).
Moreover, RN should also check bleeding, wound sites or tube that may be hidden in her clothes
or bed which may be cause harm to her. The most important thing which RN must be in mind
that they are bound by physiological state by reducing how much her body is uncovered when
they examine her. Nurses must check central venous pressure, air leakage if any and bowel
sound must listened by RN. Proper assessment must be done in order to know about Janice
abdominal situation if she is declining. Further registered nurses must also examine all blood
vessels if there is a bleeding then they must provide proper medication and also makes sure that
there is no infection in any of her part (Resuscitation Council 2016).
PART 11
Discharge planning
This planning must be in accordance of family and person centred approach. For ensuring
the stable health even after discharge from hospital registered nurse include the participation of
interdisciplinary teams (Holland et.al 2008, p. 185). This team consist of psychological
assistance, therapists, dieticians and social workers. This team will assess the care needs of
Janice so that pre-discharge objectives of care can be achieved (Chin et al. 2012, p.66). The
adequate support of RN in guiding the interdisciplinary team will help patient to recover quickly
and effectively. In order to avoid complications in nursing care RN reassesses the Janice so that
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if she is having any medical requirement or require any immediate medical assistance (Riemen
and Hutchinson, 2016, p.114).
The mobility of Janice will be affected by several other factors such as age related
factors, osteoporosis as well as hip fracture. She may face difficulty in bending, walking or
lifting weights. It will influence her independence on performing these routine activities. She
may require support in her routine life. Thus, physiotherapy will be effective for improving her
health status (Riemen, Anna, Hutchison 2016). The physiotherapists are also part of the
interdisciplinary team of nursing care. They will monitor her activities so that they can guide her
to strengthen her abilities (Riemen and Hutchison, 2016, p.118). These therapists will perform
the tasks such as guiding Janice to maintain balance, to regain strength for movement through
exercises and care plan (Clinical Excellence Commission, 2013).
The hip surgery can lead to severe pain. She must be provided with proper guidance so
that she can manage the pain level and can achieve her health objectives. She must have
interaction with the nurse and interdisciplinary team so that she can know that which life style or
diet she had to follow and which precautions she had to take so that recovery can be quick and
does not cause any adverse effects (Holland et al, 2008, p.185). The health service providers will
also require reviewing her health status and response towards treatment so that her safety and
well being can be ensured.
Social and cultural elements:
The discharge team also make efforts so that Janice can accomplish her routine tasks
easily. The team provides the occupational therapists which can help her for this purpose. The
assistance from these therapists can support the patient by providing them high quality
community services and support from independent living centres (NSW Government, Ministry
of Health 2009). If patient is facing any difficulty in relation with cultural or social beliefs then
these therapists provides them help and motivation. They also make some changes in the house if
it is required.
Environmental factors:
The surrounding environment of Janice must be developed in a way that it minimises the
fall risks. For example the proper lighting facilities can enhance visibility and accidental fall due
to darkness can be avoided. Further the wheelchair must be easily accessible to Janice and railing
support must be given in toilet so that she can safely move.
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Psychological
Moreover, from last so many years Janice lives alone such that its family and career are
only its primary support as analysed by RN. After met with an accident, Janice lose up her
confidence such that she has a hip fractured and now she is not able to do work as normally she
done before an accident so that is why she feel herself so depressed. As a result she called up an
psychologist who help her to overcome her problem which she is faces. There is another problem
which generally older people faces is that neck fractures and for this, it is quite important for
those people at a time of rehabilitation, treatment should be done after permitting with their
family members (MIMS online 2017). And this is a reason on which the process mostly focus on
psychological state and this is done to motivate patient and reducing their anxiety level. As
Janice is also suffer from this problem so psychologist suggest her to change her sleeping pattern
which help to protect them form many micro factors that may disrupt her sleeping problem.
Moreover, registered nurses also suggest Janice for a dietician as she has a poor
nutritional value that may lead to spoil its digestive system and also decreases its muscle mass
that is directly related to its risk of complication. However it has been realized that those person
who have hip fractured does not completed all nutritional requirement which directly creates
impact upon their body and as a result the wound may not be heal (Thim and et.al., 2012). As per
dietician, Janice is recommended to take proper nutritional food that help her to recover fast. As
she has already take denosumab which is a drug used to reduce her pathology so dietician
suggest her to follow a balance diet chart and take those products which are rich in Vitamin D as
well as Calcium which help to prevent bone loss and also aid to recover her soon. As she has met
with an accident then there Is a chances of broken up her teeth that enable her to eat proper and
when she give all the information to her dietician then RN will further assess that she has poor
craving and find difficulties in swallowing the food.
Politico economic
At last, Janice met with a social worker who support her by providing counselling,
provide help related to finance and also set up guardian for Janice. As per the act of
Guardianship, 1987 it states that if a person is suffering from any problem or he is disable then
they have a right to directly hire an advocate through custodial. Before discharging, registered
nurses contact with family members and also arrange transportation for Janice as she is a
pensioner an has limited resources that will influence the availability to use its services and this
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is known as Politicoeconomic. It also includes many services such as NSW senior card and
Home and Community program which help to provide concessions, transportation facility and
also sup[ports financially (Wells, Pasero, McCaffery, 2008). Moreover, Aged Care Assessment
Services is another program that are organized by Australian government which support older to
recognize their needs. Therefore, these teams have a power to support elder people in order to
provide them relaxation and get them free from their stress by providing best support.
By summing up above report it has been concluded that primary survey is a process
which is used by professionals of health in order provide their patients best facilities. It also
determine the importance of adapting new techniques in order to provide clear cut information to
their patients and also aware them related to any injury and decreases the involvement of many
other diseases. Further, registered nurses must have proper knowledge related to medication and
it is their duty to provide them primary care so that at least there bleeding may be stop. As per
Janice case, it is concluded that with proper team support and planning, Janice can easily
discharge from hospital and planning must be done in order to meet out all patient's needs.
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REFERENCES
Books and Journals
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Recognising Clinical Deterioration, Australian Commission of Safety and Quality in
Health Care, viewed 22 September 2017,
<https://safetyandquality.gov.au/wp-content/uploads/2012/11/MCS-Edu-Reece.pdf>.
Australian Government Department of Human Services 2012, Age Pension, Australian
Government Department of Human Services, viewed 22 September 2017,
<https://www.humanservices.gov.au/individuals/services/centrelink/age-pension>.
Australian Institute of Health and Welfare 2016, Osteoporosis, Australian Institute of Health and
Welfare, viewed 20 September 2017, < https://www.aihw.gov.au/reports/arthritis-other-
musculoskeletal-conditions/osteoporosis/contents/what-is-osteoporosis>.
Chin-Jung, L and et.al., 2012, ‘Discharge Planning’, International Journal of Gerontology, vol.
6, p. 237-240.
Clinical Excellence Commission 2013, Falls Prevention Strategies 2013, Clinical Excellence
Commission, viewed 20 September, 2017,
<http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/258468/hosp-falls-
prevent-strategies-june-2013.pdf>.
Hassal, S & Butler-William, C 2010, ‘Assessment of airway and breathing in adults’, British
Journal of Neuroscience Nursing, vol. 6, p. 288-291.
Holland, K and et.al., 2008, Applying the Roper-Logan-Tierney Model in Practice, 2nd edn,
Churchill Livingstone, Elsevier, Edinburgh.
Maclejuk-Ploriska A and et.al., 2012, ‘Psychological aspects of rehabilitation of the elderly
people after femoral neck fracture’, US National Library of Medicine: National Institutes
of Health, vol. 32, no. 187, p.79-81.
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Guidelines, NSW Government, Family & Community Services, viewed 22 September
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and-Consent-Guidelines.pdf>.
NSW Government, Ministry of Health 2013, Recognition and Management of Patients who are
Clinically Deteriorating, NSW Government, Ministry of Health, viewed 22 September
2017, < http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_049.pdf>.
Platts-Mills T F, and et.al.,2015, ‘Persistent Pain Among Older Adults Discharged Home From
the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study’,
American College of Emergency Physicians, vol. 1, p. 11.
Platts-Mills T F and et.al., 2016, ‘Persistent Pain Among Older Adults Discharged Home From
the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study’, US
National Library of Medicine: National Institutes of Health, vol. 67, no. 2, p. 166-167.
Rebeiro, G 2013, ‘Sleep’ in Crisp, J, Taylor, C, Douglas, C & Rebeiro, G (eds), Potter and
Perry’s Fundamentals of Nursing, 4th edn, Mosby Elsevier, Sydney, p. 1037-1063.
Resuscitation Council 2016, Guidelines and Guidance, Resuscitation Council, viewed 22
September 2017, < https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/>.
Riemen H. K. Anna, Hutchison D. James 2016, ‘The Multidisciplinary Management of hip
fractures in older patients’, US National Library of Medicine: National Institutes of
Health, vol. 30, vol. 2, p. 117-122.
Tennille, R, Deirdre, C & Louise, G 2008. ‘Role of occupational therapy after stroke’, Annals of
Indian Academy of Neurology; vol. 1, no. 11, p.1-5.
Thim, T and et.al., 2012, ‘Initial assessment and treatment with the Airway, Breathing,
Circulation, Disability, Exposure (ABCDE) approach’, International Journal of General
Medicine, vol. 5, p.117-121.
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Wells, N, Pasero, C, McCaffery, 2008, Improving the Quality of Care Through Pain Assessment
and Management, National Center for Biotechnology Information, viewed 22 September
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