NRSG355 Clinical Integration: Professional Practice Assessment

This assignment solution addresses key aspects of clinical integration and professional practice in nursing, covering four modules. Module one focuses on prioritization and delegation, detailing a nurse's actions in managing multiple patient cases, including an unconscious patient requiring immediate medical attention, and assigning tasks to different healthcare professionals based on their competency. Module two explores collaborative and therapeutic practices within a multidisciplinary team, examining the factors influencing team composition, leadership, and the roles of various professionals, including nurses, dietitians, and therapists. It includes a case study on a patient's treatment preferences, highlighting the importance of collaborative decision-making. Module three delves into the provision and coordination of care, discussing the need for further patient assessment, including questions to ask the nurse and assessments to complete upon the patient's arrival, with rationales for each. Module four focuses on time management and delegation in a surgical ward setting, outlining the allocation of tasks among registered nurses, enrolled nurses, and assistants in nursing, considering their respective scopes of practice and competencies, and applying models for patient allocation in an acute inpatient environment.

Q1: Prioritisation and delegation (module one)
Ans- The task that I will do or undertake and the task that I will assign or delegate are
in the following manner in terms of prioritisation -
i. Firstly, I will attend the elderly post-operative female with the facial surgery who
is unconscious and has collapsed. After attending her I will call the MET
(Medical Emergency Team) immediately.
ii. The unconscious visitor of Mr.smith will be assigned to the AIN (assistant in
nursing). I will ask the AIN to call for code blue in the hospital as it could be the
case of cardiac or respiratory attack.
iii. Mrs.chew’s IV intravenous fluid behind will be assigned to the enrolled nurse, I
will ask the EN to call for the treating team and I, myself after attending the
elderly post-operative female will give EN the proper instructions about which
intravenous fluid to give.
iv. Mr. Esposito’s case will be handed over to the EN, I will ask her to give him
proper medication for his operation in cue.
v. I will ask the ward clerk to look into the problem of staff’s toilet overflowing. I
will ask him to get it done by proper services and to get it in under control.
vi. Lastly, I will meet the VMO (Visiting Medical Officer) and listens to his
complaints regarding last week’s problems.
The most important and serious issue out of all the above 6 is that of the unconscious,
fainting woman. She needs to be assessed immediately as she is old. If the patient is
not taken care of immediately the condition of the patient can worsen or deteriorate
with time. The case is complicated with the involvement of her age,her physiological
changes due to disease and the various drug interventions (Kraft & Nisell, 2018). It is
important to call for the MET in this case, as the patient is disabled ("eastern health
great health and wellbeing annual report", 2012).

In the second situation a code blue was called as it was an outside patient. According
to ("eastern health great health and wellbeing annual report", 2012) an MET is called
for the inpatients and a code blue for the outside patients, visitors or staff. I assigned
this task to the AIN as she/he is not competent for the other tasks and EN was
assigned there because they were free.
I am well aware that the enrolled nurse has not got her IV cannulation certificate and
is incompetent in providing the fluids (Queensland nursing council, 2009). Therefore,
I will ask her to call the treating team and not let her provide the fluids.
Since the EN is free after Mrs. Chew case I will ask her to attend Mr. Esposito as she
is eligible to give the oral medication before the operation, because her major task
being an EN is to look into the patient’s assessment and their health status and giving
out the pre - operative medication falls under the requirement (Queensland nursing
council, 2009).
Meeting with the VMO is an important case but not serious, after dealing with all the
problems I will assist the VMO for the last week’s mistake in the medication.
Q2: Collaborative and Therapeutic practice (module two)
(a) The Multidisciplinary team
(b) ANS- a neurodegenerative disease causes death in around 2-4 years after the onset
of it. Motor neuron disease is one such disease leading to loss of upper motor neuron
as well as lower motor neuron in the motor cortex and the brains and spinal cord of
the person, respectively (Williams, Philip-Ephraim & Oparah, 2014). A
Multidisciplinary team contains of professionals from various backgrounds and
different professions looking into one single case. It includes a specialised doctor,
general physician, social workers, nurses, physiotherapist, psychologists, dietitians
and occupational therapist (OT).
i. Identify factors that determine which health care professionals are required to be

Involved in a health care team?
Following are the factors which shows who all should be in a health care team-
 The diet the patient follows (dietitian)
 Swallowing and speaking of the patient (speech pathologist)
 Care and care coordination (MND nurse and a district nurse)
 Doctor with specialization in the disease (neurologist)
 A general physician.
 Social workers.
ii. Who should lead the health care team?
The health care team should be led by the district nurses. They are the key to success
as they look out for the needs of the patient and communicate about it to the doctors
or the other members of the health care team (O’Brien, Jack & Douglas Mitchell,
2011)
iii. Who is the most important member of the health care team?
The most important member of the MDT is the district as well as the MND nurses.
(c) Case study name: case study number 1
i. What are the key issues in this dilemma?
ANS- The key issue is regarding the treatment of grant, his wife wants to continue
the treatment at home, the psychologist and the social worker agrees with this

whereas, the occupational therapist and the physiotherapist disagrees(Elenburg, Foley,
Roberts & Bayliss, 2016).
ii. What outcomes would be best for Grant and his family?
ANS- Grant should be treated as an outpatient and should be allowed to stay with his
family but he ought to attend regular weekly checkups at physiotherapist and at
occupational therapist (Elenburg, Foley, Roberts & Bayliss, 2016).
iii. How would you guide the group in achieving this best outcome?
ANS- I would held meeting regarding this issue and try to sort the disagreements
between the team members. People who agrees to the decision as well as people who
disagrees to the decision should be able to give proper reasons for their decisions.
Q3: Provision and coordination of care (module three)
i. What further questions will you need to ask the nurse?
ANS- As the patient has a history of CCF and CVA that is stroke and congestive
cardiac failure, it is important to know whether he has a history of hypertension and
diabetes as well (Jelinek & Ansari, 1998). As the patient is on intravenous antibiotic
it is important to know that how much dose does the patient requires of the given
antibiotic. The patient is suspected to have pneumonia, it is necessary to know about
the cough and the phlegm associated with it. The nurse should always be asked about
what type of phlegm the patient has and the coughing is severe or not. The nurse need
to be asked about the food and the fluids taken by the patient as pneumonia can cause
the body to lessen down the fluids in it also the patient’s medication is through
intravenous antibiotics and not orally, he could have difficulty in swallowing due to
cough ad phlegm.
ii. List specifically what further assessments you would complete when the
patient arrives onto the ward & provide your rationale for each assessment.

ANS- Firstly, Mr. Block needs to start with his saline at 50mls/hour, after the saline
he needs to be assessed with the oxygen supply through his nose. As the nurse suspect
pneumonia, chest x-ray at 1600 hours, after the X-ray the patient should get some lab
tests done like sputum tests along with ABGs to find out the pathogen responsible for
the pneumonia. As the patient is on oxygen flow it is necessary to maintain a clean
airflow or passage for him to not have difficulty in breathing. The patient is currently
nil by mouth that is no medicines or fluids and food intake from the mouth. As the
patient is suspected with pneumonia, fluid intake is necessary for the body by
intravenous cannulation. The patient should be assessed with breathing and
swallowing exercises due to case of pneumonia. As the patient has a history of gastric
ulcer or peptic ulcer, proper care should be taken as it can lead to hemorrhage. The
patient should be provided with relief of pain, relief of anxiety and maintenance of
nutritional requirement in the body. As the patient is old and has a history of
complicated diseases proper care must be taken and absence of complications should
be seen properly.
Q4: Time management and delegation (module four)
ANS- According to the models given in the paper by (Fairbrother, Jones & Rivas,
2010) there should be proper allocation of the patient in an acute inpatient
environment. There are 2 registered nurses (RN), one enrolled nurse (EN), 3 Assistant
in nurse (AIN) and 22 patients in the ward. During my shift 8 are going for the
surgery therefore, total number of patients that stays in the ward is 14 from the
morning surgery. 7 of them require IV and antibiotics.
Since only RN can give IV, I myself will handle the 7 patients requiring the IV along
with me an AIN to whom I can assists for giving out the antibiotics during the shift as
AIN cannot provide the patient with IV fluids. The other remaining patients will be
under the care of an EN and along with her 2 AIN to assist her during the shift. The
other RN nurse will do the usual task of NUM (Nurse Unit Manager) and will look
out for the patient’s load in the ward.

The EN can only provide with the oral administrative drug only and only if they do
not have a notation on their certificate. If the EN has a notation he or she cannot
provide the patients with the drugs. EN’s also can never provide with IV intravenous
medication but if they have completed intravenous medication administration
education they can provide the patient with the IV fluids (Kerr, Lu, Mill & McKinlay,
2012).
The AIN cannot look into the patient’s care. They are not eligible for this. The AIN
can only and only assist a registered as well as an enrolled nurse. With the large
number of patient’s in the surgical ward, it is a necessary requirement of AIN in the
ward. AIN can provide the patients with the basic necessities of food and fluids along
with proper care of the patient’s hygiene, bath and manicure etc. They are to assist the
head nurses by observing and doing any changes required in the patient’s care. They
should also maintain the privacy of the patients.

References
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individual patient allocation to team nursing in the acute inpatient environment.
Contemporary Nurse, 35(2), 202-220. doi: 10.5172/conu.2010.35.2.202
Jelinek, M., & Ansari, M. (1998). Congestive cardiac failure (CCF) as a cause of fatal
stroke and all cause death. Australian And New Zealand Journal Of Medicine,
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Kerr, D., Lu, S., Mill, D., & McKinlay, L. (2012). Medication Administration by
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in motor neurone disease: patient and family carer views. British Journal Of
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