NRSG355: Clinical Integration Assignment - Nursing Practice

This document presents a comprehensive solution to a nursing assignment (NRSG355) addressing critical aspects of clinical practice. The assignment is structured into four modules, each focusing on key nursing concepts. Module 1 explores prioritization and delegation, requiring the student to analyze patient scenarios and make informed decisions about task allocation, supported by rationale and references. Module 2 delves into collaborative and therapeutic practice, examining the roles within a multidisciplinary healthcare team and applying these concepts to a case study. Module 3 focuses on the provision and coordination of care, emphasizing assessment, problem-solving, and the gathering of patient data to inform care plans. Finally, Module 4 addresses time management and delegation, specifically using the team nursing model to organize care within a surgical ward setting. The solution demonstrates understanding of nursing principles, clinical decision-making, and the importance of teamwork in delivering effective patient care.

Running head: NURSING 1
Nursing
Student’s Name
Institutional Affiliation

NURSING 2
Module 1
Answer 1
Delegation is the process used by a registered nurse to direct another professional to
perform nursing duties and operations (Barrow & Sharma, 2019). It entails a delegator and the
delegatee whereby the delegator is the registered nurse and the delegatee as per the presented
case includes an enrolled nurse, a ward clerk, and an AIN. The delegator distributes portions of
patient attention to the delegates. In the delegation of nursing duties, rights such as the right task
to the right person at the right circumstance with the right supervision and in the right direction
and communication need to be considered. Moreover, the delegates must demonstrate the vital
elements of the delegation which include authority, responsibility along with accountability
(Barrow & Sharma, 2019).
I will start by taking care of the elderly post-operative patient who had collapsed and was
unconscious. To the enrolled nurse, I will delegate her to look after Mrs Chew whose
intravenous infusion had tissued and needed some medications. However, I will delegate to the
Assistant in Nursing (AIN) to take care of Mr Smith's visitor who had fainted. Next will be the
ward clerk whom I will delegate resolving the blocked and overflowing staff toilet. Although the
surgical consultant needed to discuss a medication error, I will first delegate to him to assist in
providing medications to one Mr Esposito who was expected for a cardiac catheterization.
After ensuring that the female post-operative patient is resuscitated and she is stable, I
will confirm the progress of Mrs Chew from the enrolled nurse and enquire from the AIN if she
has stabilized the visitor who had fainted. Then, I will arbitrate in case any nurse needs help and
lastly visit the surgical consultant to discuss the medication error that ensued in the past week.
Answer 2

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The highest priority goes to the post-operative patient because she becomes unconscious
and unconsciousness is a medical emergency which needs urgent attention. Certain factors might
have actuated her conscious loss like a clot might have developed on the artery supplying blood
to the brain hence altering its performance (Macdonald, 2016). Also, loss of consciousness might
have been accompanied by loss of muscle tone which leads to collapse. Moreover, after her
operation, she might have been given analgesics which were ineffective hence causing severe
pain.
For the case of Mrs Chew, her condition also needs urgency in care hence given priority.
Her intravenous fluids are running out and need to be handled since they can deny very
important organs of the body like the brain, liver and the heart adequate blood causing serious
complications. According to the case presented, the enrolled nurse is currently undertaking her
cannulation certificate hence the task fits her since she knows how to resolve the tissued
intravenous.
Since fainting also results in decreased heart rate and blood pressure (Gilchrist,
Vrinceanu, Béland, Bacon & Ditto, 2016) thus reducing blood flow to the brain, the task is
prioritized and delegated to the AIN who is trained to deliver general care to patients that need
emergency care. The tasks that are not prioritized are the medical error discussion and the
blocked and overflowing toilet because they are not urgent. Although the medical error happened
in the past week, it was good for the surgical consultant to inform me but it was not urgent.
Module 2
Part a:
Answer 1

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A multi-disciplinary team is a group of clinical workers who are members of distinct
disciplines, each delivering particular services to the patients. Using a care plan, the operations
of the team are brought together and this co-ordinates their services and enables the team to work
towards a defined goal (Morley & Cashell, 2017).
For a professional to be included in a health care team, the collaboration factor is
essential. Collaboration id described as a health care practitioner assuming duties and
cooperatively working as a group, sharing accountability for problem-solving as well as making
decisions to devise and execute patient care plans. Collaboration between health professionals in
the team escalates the team’s awareness of each other’s type of skills and knowledge and result
in a continued improvement in decision making.
Another factor is good communication that encourages effective teamwork and promotes
clarity and continuity in the team. When there is good communication in the health care team
medical errors is prevented, teamwork is fostered and collaboration is encouraged. Moreover,
professional competence and experience are considered while including a professional in a health
care team. The team needs a member who is competent and experienced to attend to and come
out with a care plan for the patient who has a neuron disorder.
Answer 2
The professional to lead the team should be a motor neuron disease advisor because the
patient has that disease. His role as a leader in the group would be providing specialist care in
addition to advising the motor neuron disease patient and his family. Furthermore, the advisor
will spend a lot of time with the patient and when the patient needs change he would start timely
and fascinating responses. The motor neuron disease advisor will also communicate with other
team members and connect the patient with that disease to the services they require.

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Answer 3
The most vital member would be a neurologist. His work involves the nervous system
and since the patient has a motor neuron disease this professional would be the best. Here, the
neurologists will coordinate the diagnostic tests, monitor the progress of the patient’s condition
and control the symptoms and then liaise with the other members of the health care team.
Part b:
Answer 1
From case study 3, the key problems are the mental instability of the patient, social
support and care for Robert’s fractures.
Answer 2
In the case of Robert Hughes, a psychologist needs to be involved in the team to be able
to promote the patient's health behaviour by finding out the reason behind Robert’s aggressive
flare-ups to the staff and other patients. Also, the psychologist will be able to comprehend the
patient’s condition. Robert Hughes will also need a social worker nurse whose role is to counsel
him on the emotional as well as mental attitude of staying with his mother. Also, the nurse will
advise the patient concerning the legal and accommodation services that he can benefit from
since his mother says that she can no longer continue to look after him. In that case, the social
worker nurse will look for community services where Robert can be accommodated.
A physiotherapist will also be included in the team to play a role in improving the
mobility as well as the physical activity of the patient. Moreover, he will devise and review
therapy procedures by using manual therapy like massage and therapeutic therapy.
Module 3
Answer 1

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A clinical shift is the transfer of professional role and accountability for aspects of care
for a patient to another professional on permanent or temporary grounds (Eggins & Slade, 2015).
It is an innately communicative event and can be attained via linguistic exchange by nurses
talking and writing to each other. Efforts to improve shift communication are disrupted by the
lack of factual communication information of shift events. In that case, the incoming clinician
and the outgoing clinician need to exhaust all the questions during the handover (Eggins &
Slade, 2015).
I will ask the ED nurse if there is any sensitive information concerning the preferences of
the patient and the involvement of the family in Joe's care. The information that will be provided
will help to avoid asking the patient things that can upset him. Also, it will help in associating
wisely with the patient and ground a healthy interaction.
Another question would be to ask the clinical practitioner's expected time for the
presentation of the tests. This ensures that necessary plans are made and reduce wastage of time
as well as deliver the correct data to the patient. Furthermore, I will ask if other people are
connected to Joe's case to ensure there is continuity of care. The care consolidation increases the
assessments, effectiveness, and investigation in addition to management.
It will be necessary to enquire whether there are any expected risks from the patient.
Here, the ED nurse will clarify if the patient’s health has deteriorated or has improved. The
information provided guides in observing the patient’s health and ascertaining the necessary task
to take care of the condition.
Answer 2
Assessment in nursing is a key element of practice which is required for planning and
provision of patient-centered care. It is the systemic gathering of information pertinent to the

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patients’ sociological, spiritual, physiological and mental needs (Toney-Butler & Unison-Pace,
2019). Before a health professional can begin an assessment, he must establish therapeutic along
with the professional mode of communication which establishes a rapport and lays a base for
trust between the nurse and the patients.
Apart from the indicated tests, the immune system of the patient needs to be assessed.
The assessment will notify whether the patient is allergic or not to the drugs prescribed and
provide information about the condition’s progress. While doing the assessment, I will be fervent
on the retaliation of the patient to the medicine because this information is very crucial in
developing the appropriate plans of therapy.
Moreover, since the patient has a respiratory problem, respiratory system assessment
needs to be conducted. The purpose of the respiratory system is to supply oxygen and remove
carbon dioxide from the body. In that case, the patient should be able to breathe in and breathe
out without problems (Mezidi & Guérin, 2019). This assessment will give updates about the
outcomes as the patient undertakes the indicated medications.
To assess the necessity of pain medications, I will complete a pain assessment. Through
determining the progress of the pain, I will be able to evaluate whether the patient’s wellbeing is
improving. Also, I will increase the comfort of the patient and elevate pain management
satisfaction. This assessment exhibits tissue damage and therefore there is a need for
documentation so that other management strategies can be developed (Main, 2016).
Module 4
Answer 1
The model of nursing chosen depends on nursing resources along with patient care
requirements. Here, the patient allocation model is team nursing. This model utilizes the

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distinction of education, qualification level alongside skills of every member of the team. The
group works collaboratively with shared responsibility and the leader of the team must have
good leadership and communication skills (King, Long & Lisy, 2014). Team nursing model is
utilized in the general ward environment and it relies on a leader who is a registered nurse.
Since the model is used in a general ward setting, I chose it because the ward patients will
need integral management where several clinical nurses work together to achieve the best
outcome from the patients’ health. Moreover, since the health professionals who are the
registered nurse, an enrolled nurse and three AINS (Assistant in Nursing) will use their diversity
of skills, education and qualification; the model will be the most appropriate to achieve
consistent care. Also, as per the case presented many patients in the surgical ward need to be
attended to differently. Therefore, the model remains the only effective one as the leader will use
his or her skills to allocate the health practitioners to ensure efficient care during the handover
(King, Long & Lisy, 2014).
Furthermore, less workload, as well as optimal attention to patients, will be ensured
because every health practitioner will be responsible to care for a chosen group (Deravin,
Francis, Nielsen & Anderson, 2017). A registered nurse has various roles in the surgical ward
because he works before, during and after an operation. For instance, before patients can undergo
the procedure the registered nurse has to prepare the surgical room as well as the patients.
Throughout the operation, they help the surgeons and the anaesthetists and after the procedure is
completed they provide therapy and make sure that they are stable.
Using this model, I will allocate the enrolled nurse to observe the 14 patients who went
for an operation in the morning. In the scope of practice of the enrolled nurse, he will help the
registered nurse; provide therapy, monitor patients and changes in their conditions and report

NURSING 9
back to the registered nurse. In this case, the enrolled nurse will prepare and deliver antibiotics to
the patients with intravenous access as per the prescriptions. Moreover, the enrolled nurse will
assess the intravenous infusions to ensure smooth flow and observe the patients identify any
adverse reaction and report immediately.
I will allocate two of the Assistant in Nursing (AIN) to prepare equipment along with the
eight patients for the surgery and allocate the other AIN to prepare analgesics for the patients. In
the scope of practice of the AINs, they will determine the patients' vital signs such as the blood
pressure, pulse rate, pulse oximetry along with respiration and levels of iron. The AINs have to
be sure to take the vital signs on time as per the schedule and then report back to the registered
nurse. They are also qualified to take care of simple dressings as instructed by the registered
nurse. For instance, after the medical procedure, the AIN can be requested by the registered
nurse to help in taking care of patients’ wounds, clean them, dress them and make sure they
remain clean.

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References
Barrow, J. M., & Sharma, S. (2019). Nursing five rights of delegation. In StatPearls [Internet].
StatPearls Publishing.
Deravin, L., Francis, K., Nielsen, S., & Anderson, J. (2017). Nursing stress and satisfaction
outcomes resulting from implementing a team nursing model of care in a rural
setting. Journal of Hospital Administration, 6(1), 60.
Eggins, S., & Slade, D. (2015). Communication in clinical handover: improving the safety and
quality of the patient experience. Journal of public health research, 4(3).
Gilchrist, P. T., Vrinceanu, T., Béland, S., Bacon, S. L., & Ditto, B. (2016). Disgust stimuli
reduce heart rate but do not contribute to vasovagal symptoms. Journal of behaviour
therapy and experimental psychiatry, 51, 116-122.
King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient
care on staff wellbeing when organizing nursing work in acute care ward settings: a
systematic review protocol. JBI Database of Systematic Reviews and implementation
reports, 12(1), 59-73.
Macdonald, R. L. (2016). Subarachnoid Hemorrhage and Loss of Consciousness. JAMA
neurology, 73(1), 17-18.
Main, C. J. (2016). Pain assessment in context: a state of the science review of the McGill pain
questionnaire 40 years on. Pain, 157(7), 1387-1399.
Mezidi, M., & Guérin, C. (2019). Complete assessment of respiratory mechanics during pressure
support ventilation. Intensive care medicine, 45(4), 557-558.
Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of medical imaging and
radiation sciences, 48(2), 207-216.

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Toney-Butler, T. J., & Unison-Pace, W. J. (2019). Nursing Admission Assessment and
Examination. In StatPearls [Internet]. StatPearls Publishing.