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Q.1 Order of tasks on the basis of priority: 

Nursing is a noble profession that holds different roles for the nurses. Nurses acts as a care provider, liaison, advocate, educator and many more likewise, nurses also plays an important role as a leader in a medical team and the patients outcome depends upon their clinical judgement that is governed by their communication and delegation skills (Huber, 2014).

It is In the given scenario the first priority would be addressing the elderly patient who is unconscious as it is a medical emergency and if delayed could cost someone’s life having said that, there are other issues going around therefore, I would delegate other staffs according to their scope of practice. According to NMBA (2016) one of the standards of practice that is 6 is to provide safe and quality care that is possible by working as a team according to the scope of practice and delegating right task to the right person. Similarly, I would ask the NUM who is also a RN to get involved in the emergency and also ask the surgical consultant to help with the situation until the emergency team arrives.

Administering medication on time is also very vital for good patient’s outcome. As a student nurses we are taught to check the seven rights of the medication administration before giving the medicine in which the ‘right time’ is indispensable one and it is expected we follow this practice as a RN hence, I would then attend Mrs. Chew to re-site her cannula and give her fluids as soon as the emergency team arrives and ask the NUM to stay there.

With the IV antibiotic I would administer the antibiotic if it’s just late by 30 to 60 minutes of the prescribed time but it is the duty of the nurses to document and write the exact time of the administration which could prevent from overdosing as the antibiotics administration should have certain time in between the second one is administered (Australian Commission on Safety and Quality in Health Care, 2013) simultaneously, I would ask the enrolled nurse (EN) .

whom I am assuming that is a medication endorsed to give medication to Mr. Esposito and send him off for the procedure and then to attend Mr. Smith’s visitor. Likewise, I would ask the Assistant in Nursing (AIN) to attend the fainted visitor and start taking the vitals and to inform the doctor or the EN if there is an abnormal reading as they are able to do some simple tasks such as taking vitals (NSW Health, 2010). Furthermore, I would ask the ward clerk to solve the problem with the blocked staff toilet and to provide reassurance to Mr. Smith and the family members.

Lastly I would discuss the medication error with the surgeon as it can wait till later and also it does not have any negative effect on the patients at the very moment. The nurse faces this type of situation more often as the health of a person is dynamic in nature and it is hard to anticipate what might happen but it’s the responsibility of the nurses to be prepared therefore, nurses should have the knowledge of the five rights of delegation, scope of practice, prioritising tasks accordingly, good communication skills and critical thinking and judgement to bring out the positive outcome in the patient’s health.

References

 Australian Commission on Safety and Quality in Health Care (2013). Literature Review: Medication Safety in Australia. Retrieved from 

Huber, D. (2014). Leadership & nursing care management (5th ed.). St. Louis: Elsevier/Saunders. Retrieved from 

NSW Health (2010). Assistants in Nursing working in the acute care environment. Retrieved .

Nursing and Midwifery Board of Australia (2016). Registered nurse standards for practice. Retrieved from  

Module2 

  1. Identify factors that determine which healthcare professionals are required to be involved in a health care team? The factors mostly depend upon the severity of the disease. MND usually affects the patient’s ability to breathe, talk, walk and swallow hence; respiratory specialist is needed to treat the respiratory problems, physiotherapist and occupational therapist to assist in their mobility and ADLs, case manager or a social worker to look after their social and financial issues, speech pathologists for swallowing and talking, neurologist to treat the neurological symptoms and finally a MND nurse specialist.
  2. Who should lead the health care team?

 It could be the MND nurse specialist because she would be the one liaising all the other health team members to come together and solve the identified issues.

  1. Who is the most important member of the health care team?

 Health care members have their own importance in the team and they are interconnected to each other having said that, the patient themselves are considered to be the most important member of the health care team because they provide a way for better, effective and improved methods of health care as it is lived experience by themselves, also its their right to be involved in their own health care furthermore this concept would change the paternalistic physician and health system regulation in future respecting the autonomy of the patient (Carmen et al., 2013). 

ACTIVITY 2: CASE STUDY 3

Robert Hughes is a 52 year old male who was injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long term care options for Robert. 

  1. What are the key issues in this situation?

One of the main concerns in this case is the primary carer of Robert who is his 75 year old mother who is not capable enough to take care of her son. Secondly, Robert being intellectually flawed and his inability to take care of himself and his dependence on his mother is also a major issue similarly, socioeconomic factor could be another issue in this scenario as Robert being 52 year old and unable to earn his own living and depending on his old mother and also he could be looked down upon in the society being intellectually imperfect furthermore, it looks like the mother is unable to control and protect him as the case reveals that he had a bicycle accident and is verbally abusive to the staff and other patients. Additionally, another issue also could be the lack of information to Robert’s mother about the support system in the community to help Robert and her. 

  1. Who would be included in the health care team and what role would they play?

First of all a neurologist or a clinical psychologist could be included to manage Robert’s neurological symptoms because of the fact that he is intellectually impaired. Secondly, an orthopaedic surgeon could play a vital role in managing his presenting physical problem alliancing with the pain team to address his pain because of the fracture.

Thirdly, physiotherapist could help him with his mobility and exercises that could strengthen his muscles and bones, also; occupational therapist could be placed as he might need some equipment to assist himself to do certain activities at home. Similarly, in this case a nurse specialist in the field of intellectual disability could be included to work as an advocate, educator and liaison between the other team members and also to help with the holistic assessment that includes biopsychosocial aspects of Robert.

Furthermore, a social worker and a case manager could be assigned so that Robert could get better place to live with the good medical, physical and psychological environment suited for him and also his mother could be relieved from the thought that Robert might hurt himself at home or unsuited environment; in addition, recreational therapist or vocational trainers in arts or music could be arranged so that Robert could do something practicable for himself (Clare et al., 2016). Lastly, speech pathologist and optometrist could be referred for Robert according to his symptoms (Carmeli & Imam, 2014). 

References

 Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-31. Retrieved from 

armeli, E. & Imam, B. (2014). Health Promotion and Disease Prevention Strategies in Older Adults with Intellectual and Developmental Disabilities. Frontiers In Public Health, 2. doi: 10.3389/fpubh.2014.00031

Clare, I., Madden, E., Holland, A., Farrington, C., Whitson, S., & Broughton, S. et al. (2016). ‘What vision?’: experiences of Team members in a community service for adults with intellectual disabilities. Journal Of Intellectual Disability Research. doi 

MODULE 3:

 You are working on the morning shift on the ward, and receive a patient from ED. The ED nurse provides you with the following handover, using the ISOBAR format. Further information about the ISOBAR format can be found on page 7 of this module. Please click on the handover link in LEO within Module 3 section, titled: ‘Module 3 Activity 2 Verbal Handover’. Listen to this recording, and then please answer the following: 

  1. What further questions will you need to ask the nurse?

The given handover is a satisfactory handover that covers all the aspects of the ISOBAR framework although it lacks few details. The questions that I would ask could be the exact vital signs so that I could determine if the patient has any signs of infection that is hyperthermia, tachypnoea, tachycardia and also increased blood pressure and decreased oxygen saturation as the handover affirms that pneumonia is suspected for this patient. Additionally, I would ask about the medication if the patient is taking any and the indications furthermore, any significant surgical history or allergies and also if the patient is suspected with pneumonia then does he/she needs to be kept for droplet precaution and lastly about the plan for his abdominal pain and weight loss. 

  1. List specifically what further assessments you would complete when the patient arrives onto the ward 3. The assessments that I would perform when Joe arrives on the ward would be a comprehensive assessment that would include a head to toe systematic assessment such as orientation to time, place and person, temperature and pain assessment, then CVS assessment that includes vitals, capillary refill and perfusion followed by detail Respiratory and GI assessment that includes the inspection, auscultation, palpation and percussion as the presenting problem revolves around these systems.
  2. Following this, I would assess the condition of the skin and look for the signs of pressure injuries, patency of the IV cannula and also ability to ambulate additionally; I would check the BGL and weight of the patient for baseline record. I would also take some subjective data related to the suspected pneumonia like the duration of the cough, swallowing difficulty as he is 92 years old that could possibly contribute in aspiration pneumonia or recent hospital stay that could cause hospital acquired pneumonia (Suarez & Ortega, 2011) .
  3. in addition, social history like living arrangements and primary carer and finally about the medication and allergies. During clinical placement choose a patient that is of interest to you. Perhaps a patient that you found challenging in terms of linking the theory together. Fill in the Clinical Reasoning Cycle Worksheet that can be found on the LEO page to assist with your understanding of that patient’s condition and how the Clinical Reasoning Cycle can be of benefit to you. References

 Suarez, M. & Ortega, S. (2011). Pneumonia. New York: Nova Science Publishers. Retrieved from 

MODULE 4:

You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) surgical ward. One other RN, an EN and three AINs are also on duty. The NUM is off sick and the other RN is acting as NUM as well as taking a patient load. The ward is full: there are 22 patients, 14 of whom went to surgery in the morning, and 8 are going on your shift. Half of these a patients have intravenous access and antibiotics at some time during your shift. 

Using your knowledge and experience of various patient allocation models (e.g. total patient care, team nursing and task allocation), outline how you would allocate the staff to the patients. Include in your discussion your rationale for the model of allocation chosen and the scope of practice of the various staff.

There are various models of patient allocation and care such as total patient care, individual patient allocation, team nursing, functional nursing and primary nursing but it has still not been clear that which of these is most efficient in providing quality patient care although, most of the studies supports the team nursing to be effective and widely used (Fairbrother, Jones, & Rivas, 2010; Dubois et al., 2013). Choosing the model of allocation and patient care depends upon many factors such as organisational policies and its structure, complexity of the situation, funding, scope of practice, increase need of skilled health care members and skill mix (King, Long, & Lisy, 2014).

In this case I would follow the team nursing model as this approach is managed by a team leader who is a RN furthermore, the patient load is high and the nurses available have different level of education and competency skills; also this model helps to bring out the maximum potential of the nurses to deliver quality care to the patient (Tran, Johnson, Fernandez, & Jones, 2010). Similarly, team nursing holds the potential to promote and advance the role of a RN as a team leader and care coordinator but it is imperative to have good communication and delegation skill; in addition, knowledge of scope of practice of the other team members is crucial (Tran et al., 2010). Polis, Higgs, Manning, Netto and Fernandez (2015) asserts that team nursing exhibited good patient outcome and safety, reduction in mishaps and deaths furthermore;

it increased the job satisfaction and retention of staffs and also provided support and supervision to the less experienced staffs from more experienced and learnt members. The concept of team nursing is used when there is a mixture of skills for instance; the RNs have different level of competency then ENs and also with the AINs but they have to work together in the same setting (Ferguson & Cioffi, 2011) having said that, I would allocate each AINs to the RNs and EN. I would divide the patient load into 8 to the EN and the AIN similarly, 8 to me and the AIN partnered with me and 6 for one of the AIN and RN who is also working as the NUM because she will also have some other concerns in the ward to manage.

According to the NSW Health (2010) it states that the scope of AINs includes ability to perform simple tasks such as taking vitals that are allocated in acute settings hence, I would ask all the AINs to take vitals and also take care of the ADLs of their allocated patients. With the IV antibiotics I am assuming that the EN is medication endorsed and is also competent with IV medication because in given scenario I would presume that in the surgical ward of the hospital they would recruit medication and IV competent staff hence, I would delegate the EN to administer the IV if there is any in her lot and tell her to ask for assistance if needed. NMBA (2016) declares that the EN is able to do the IV medication if they have completed the intravenous medication administration education. Furthermore, I would focus on other IV antibiotics for my patient and also try to help the other RN as the main idea of team nursing is to help and supervise each other when in need. 

References

 Dubois, C., D'amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal For Quality In Health Care, 

Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from 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

Ferguson, L., & Cioffi, J. (2011). Team nursing: experiences of nurse managers in acute care settings. Australian Journal Of Advanced Nursing, 28(4), 5-11. Retrieved from 

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. doi: 10.11124/jbisrir-2014-1533 

NSW Health (2010). Assistants in Nursing working in the acute care environment. Retrieved from. 

polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2015). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian. doi: 10.1016/j.colegn.2015.09.002 

Nursing and Midwifery Board of Australia [NMBA] (2016). Enrolled nurses and medication administration. Retrieved from 

Polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2015). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian. doi: 10.1016/j.colegn.2015.09.002 

Tran, D., Johnson, M., Fernandez, R., & Jones, S. (2010). A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes.International Journal Of Nursing Practice, 16(2), 148-158. doi: 10.1111/j.1440-172x.2010.

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