NSB231 Integrated Nursing Practice 2: Assessment of Nursing Practice

This report critically analyzes a nursing practice assessment focused on a post-angioplasty patient, Mr. Bright, who experienced chest pain and potential complications. The assessment evaluates the nurses' actions in response to the patient's condition, specifically examining their adherence to the Nursing and Midwifery Board of Australia (NMBA) guidelines regarding patient assessment, communication, and management of potential hematoma and impaired tissue perfusion. The report identifies both correct and incorrect nursing practices, highlighting areas where the nurses demonstrated appropriate care, such as initial patient introductions and timely communication with the doctor. However, it also points out critical omissions, including the failure to properly assess chest pain using a pain scale, incorrect patient positioning, and insufficient communication to the higher authority. The report then presents a structured verbal handover using the ISBAR format to effectively communicate the patient's situation to the doctor. The report emphasizes the importance of professional skills, knowledge application, and person-centered care in ensuring safe and quality patient outcomes. The provided references support the analysis with relevant literature on post-operative care, angioplasty complications, and best practices in nursing. The analysis concludes by emphasizing the need for a more comprehensive care plan that prioritizes patient safety and effective communication in a collaborative healthcare environment.

Running head: NURSING PRACTICE ASSESSMENT
NURSING PRACTICE ASSESSMENT
Name of the Student
Name of the University
Author Note

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Answer 1
Identification of correct nursing practices
The nurses performed some positive measures while treating the patient related to
impaired tissue perfusion related to haematoma or bleeding. They introduce themselves and
collect current information from the patient that seems to be a positive professional approach.
Even every time the nurses took consent to perform their duties and informed the assigned doctor
timely whenever any adverse situation like blood pressure fluctuated (Rassaf, Steiner & Kelm,
2013). The nurses helped to decrease the patient's anxiety and also played the role of a counselor
at the time of significant distress (Rouhi Balasi et al., 2016). This action of person-centered care
is related to nursing practice (Harbman, 2014). Thus they engage themselves in maintaining
appropriate professional and therapeutic relationships according to NMBA practice guidelines.
In postoperative patients, nursing care plays a significant role in the speedy recovery of
the patient. It is more required at the time of critical operation such as coronary heart disease,
angioplasty. More critical care is needed in the patient with angioplasty since it associates with a
related risk factor such as impaired tissue perfusion leading to potential haematoma and
bleeding. In the current case study, Mr. Bright had recently undergone an angioplasty. As
previously mentioned, it possesses a probable risk of bleeding or haematoma (Farsalinos et al.,
2016). The nurses check vital signs of the patient in a regular interval, including the blood
pressure, respiratory rate, temperature, and pulse rate that indicate the current state of the patient.
(Cardona- Morrel et al., 2016). The vital signs are directly associated with the evaluation of
hemorrhage according to their classification. The vital signs have deviated from their normal
limits if the patient has undergone through potential internal bleeding (Johnson, Waheed &

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Burms, 2019). The measurement of blood pressure and heart rate is important and monitored
thoroughly. This is because these two are an indicator of normal body function, fluctuation in
these may indicate abnormalities and require medical attention (Zhang, Zhou & Zeng, 2017).
Therefore, during an operation related to impaired tissue perfusion, it is critical to monitor the
heart rate and blood pressure of Mr. Bright.
Identification of practices not performed during the simulation
The patient does not have a massive bleed during the simulation but could potentially be
developing a haematoma at the wound site leading to blood loss and decreased tissue perfusion.
The first measurement that should have been followed by the nurses was changing the bed
position suddenly from semi-Fowler's position, which is 300 head propped up to the standard
supine position. However, in a postoperative patient of angioplasty, the position should be
unchanged due to some physiological and anatomical reasons. If a postoperative patient is rested
in the supine position for a long time, it leads to elevation of tissue pressure along with
decreasing blood supply (Yu et al., 2019). Eventually, it might triggers vascular complications
such as hematoma, bleeding, and distal emboli, which is caused by arterial wall trauma
(Younessi Heravi et al., 2015). Here, the action of nurses is not compatible with the criteria of
clinical standards of practice by NMBA. According to NMBA guidelines, as a professional, a
registered nurse must endure thinking and analytical power to develop professionally and
maintain their professional skill for providing safe practice (Nursingmidwiferyboard.gov.au,
2016). The second significant error committed by nurses was not taking proper measures for
chest pain management. They did not perform the pain scale score of the patient so that they can
analyze the severity of pain, which can increase the potential risk of tissue perfusion related to

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hematoma or bleeding. Gradually the patient may face an unsafe condition. Due to pain, the
sympathetic system is activated, and catecholamine is released.
As a consequence, it increased blood pressure, heart rate, and respiratory rate as well as
the decreased respiratory volume, which eventually effects on tidal volume. This, in turn, will
raise the risk of myocardial infarction that is correlated with myocardial hemorrhage (Ghugre et
al., 2017). The patient had been suffering from chest pain, which is a common complication that
occurred because of angioplasty. Here, the continuous nausea tendency of the patient increased
the pain sensation that ultimately causes coronary artery spasm and coronary artery wall
stretching (Gori, 2018). These events can end up causing tissue perfusion, internal bleeding, or
hematoma in the case of Mr. Bright. According to NMBA nursing standards of practice, here, the
nurses do not execute an appropriate process to find out the potential and actual risk factors in
this patient. Thereby, the nurses failed to provide safe, proper, and responsive quality care to the
patient.
From the current scenario, the nurses failed to provide a safe hand at the time of handling
the patient. When the patient started vomiting, they cannot accurately move the patient. They
only turned the patient in upper extremities that may result in increased pressure in the groin
region. That is highly coercive for the post-angioplasty patient. If the log roll-up is not
maintained correctly, the patient can increase the potential risk regarding hematoma. The
pressure in the groin can cause bleeding from the wound. Moreover, the patient had a cough
during that period. This also may result in hemorrhage that is deadly to the patient. Apart from
this, they observe the increased blood pressure and severe chest pain, but they cannot provide
effective emergency medication to the patient. Though the drug book was provided to them, they
cannot follow it properly. It is evident from the case study that they did not administer

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nitroglycerin (NTG), which resolved the chest pain previously in the same patient (Young,
2014). They did not prioritize their work according to severity. This contradicts with the NMBA
nursing standard for practice. The nurses also lack providing information to the higher authority,
thus increasing the fatality of the patient. Also, they did not organize a proper team-work
resulting in over-crowding in one action and overlooked the others. After considering the factors
mentioned above, the primary issue that was not accomplished by the nurses was the lack of
appropriate planning that is relevant to patient care. According to the NMBA code of nursing
practice, nurses are responsible for developing and maintaining a proper plan and
communication.
Answer 2
Communication using ISBAR format
Identity:
 Hi, this is Sam from QUT surgical ward looking after Mr. Harry Bright in bed number 6.
Situation:
 He has been currently complained about chest pain
 He started vomiting along with the chest pain
 Before that, he had a sudden cough
 Now he is feeling the respiratory problem
Background:
 History of hypertension and Diabetes mellitus II.

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 active smoker about 20/day
 He had recently undergone angioplasty and stenting of coronary artery
 ECG monitor reported cardiac ischaemia and chest pain
 Nitrogenglycerin spray x 1 resolved pain
Assessment:
 N/Saline 100ml/hr. was advocated
 BGL is prescribed, and the range is 10mmol/L
 Administer the medication of vomiting
 Check the vital signs
Request:
 I need the help of the MO urgently. Are you able to come?
 I'd like your opinion on the most appropriate measures.
The scenario indicates that nurses have to be very persistent and careful as well as skilled
while providing care assessment to the patient, especially for angioplasty disease. The nurses
followed some correct practices, along with some incorrect guidelines. The nurses should engage
themselves in practical professional goals. They should communicate with each other efficiently
to rule out a perfect care plan that prioritizes the person-centered care. The nurses should have
proper professional skills and knowledge that they can apply in their practices. Lastly, they
should provide appropriate, safe, and quality care to their patient by maintaining all these factors.

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Reference
Cardona-Morrell, M., Prgomet, M., Lake, R., Nicholson, M., Harrison, R., Long, J., ... &
Hillman, K. (2016). Vital signs monitoring and nurse–patient interaction: A qualitative
observational study of hospital practice. International journal of nursing studies, 56, 9-
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Farsalinos, K., Cibella, F., Caponnetto, P., Campagna, D., Morjaria, J. B., Battaglia, E., ... &
Polosa, R. (2016). Effect of continuous smoking reduction and abstinence on blood
pressure and heart rate in smokers switching to electronic cigarettes. Internal and
emergency medicine, 11(1), 85-94.
Ghugre, N. R., Pop, M., Thomas, R., Newbigging, S., Qi, X., Barry, J., Strauss, B. H., & Wright,
G. A. (2017). Hemorrhage promotes inflammation and myocardial damage following
acute myocardial infarction: insights from a novel preclinical model and cardiovascular
magnetic resonance. Journal of cardiovascular magnetic resonance : official journal of
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Gori T. (2018). Endothelial Function: A Short Guide for the Interventional
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Harbman, P. (2014). The development and testing of a nurse practitioner secondary prevention
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Johnson, A. B., Waheed, A., & Burns, B. (2019). Hemorrhage.

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Nursingmidwiferyboard.gov.au. (2016). Nursing-and-Midwifery-Board---Standard---Registered-
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Rassaf, T., Steiner, S., & Kelm, M. (2013). Postoperative care and follow-up after coronary
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Rouhi Balasi, L., Salari, A., Nourisaeed, A., Moaddab, F., Shakiba, M., & Givzadeh, H. (2016).
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Yu, C., Gao, Y., Nie, Z., Song, T., Chen, S., Lu, R., & Tang, W. (2019). Effectiveness and
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