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Questions:

Assignment 1

1. Using current evidence, discuss communication within health care. Please focus on;

- the role of the Registered Nurse

- the impact of poor communication and patient safety

- the value of TeamSTEPPS and ISBAR in communication

Assignment 2.

Now you have worked through the content of this topic, provide some evidence that you have met some of these objectives. Draw on the resources you have in this topic Write an ejournal entry that addresses the following questions;

  • What are some of the complexities in identifying a deteriorating patient?
  • Identify, describe and reference an assessment tool that you could use in on your placement to identify deterioration in a patient under your care. You must justify your choice.

Scenario 1 – Complicated Gastroenteritis

Veronica, a 7 year old girl, has presented with vomiting and diarrhoea. She is dehydrated and is refusing to drink because she feels sick. Her mother, Sharon, is with her and she states that she has been unable to keep any fluids down since yesterday at 1300hrs. It is now 1000hrs.

Veronica is also complaining of a sore tummy. She has had four episodes of diarrhoea overnight, the last episode being at 0300hrs. Sharon describes Veronica’s bowel action as foul smelling, runny and brown.

The medical staff reviewed Veronica, diagnosed her with complicated gastroenteritis. They have ordered a trial of fluids in the emergency department. 10-20mls/kg of oral fluid per hour is the current order. Veronica is refusing to drink. Sharon is getting very frustrated with her daughter as she continually says no.

Observations on arrival

  • HR – 125 bpm, strong and regular
  • RR – 28 bpm
  • Pale, decreased skin turgor
  • Her hands are cool, her lips are dry, but not cracked
  • She is quietly sitting on her mum's lap
  • Weight – 25 kg
  • Medical history: asthma and bee sting allergy

Scenario 2 - Adolescent

Mitchell is a 16 year old boy who has been brought into the Emergency Department at 2330 via ambulance. He was found semiconscious, outside one of the city nightclubs. He has vomit on his clothes and smells of alcohol. Ambulance officers state that he is able to be roused but only with painful stimulation. His response to this stimulation is verbal bad language. The ambulance officers also state that he has been verbally abusive to them and resistant to their attempts to help him.

Mitchell has a mobile phone on his person and a wallet. His parents Ray and Tania, have been contacted and arrive in the unit shortly after Mitchell. They are embarrassed about his drinking, but are clearly concerned about their son. They are left to visit with their son while the staff retrieve his notes from medical records.

Mitchell responds to his mother's touch with verbal abuse and shouts at her uncontrollably. She is clearly upset and steps back in tears. Ray intercedes and asks his son to stop this behaviour. His response to his father is calmer and he stops yelling. He rolls over in the bed and screams out to everyone to leave him alone.

Assignment 3

Use current evidence to discuss the management of the difficult situation outlined in either of this week’s scenario.  Please outline the key resources that you might use to prepare a plan to support the patient and their family.

Scenario 1 – Complicated Gastroenteritis

Veronica, a 7 year old girl, has presented with vomiting and diarrhoea. She is dehydrated and is refusing to drink because she feels sick. Her mother, Sharon, is with her and she states that she has been unable to keep any fluids down since yesterday at 1300hrs. It is now 1000hrs.

Veronica is also complaining of a sore tummy. She has had four episodes of diarrhoea overnight, the last episode being at 0300hrs. Sharon describes Veronica’s bowel action as foul smelling, runny and brown.

The medical staff reviewed Veronica, diagnosed her with complicated gastroenteritis. They have ordered a trial of fluids in the emergency department. 10-20mls/kg of oral fluid per hour is the current order. Veronica is refusing to drink. Sharon is getting very frustrated with her daughter as she continually says no.

Observations on arrival

  • HR – 125 bpm, strong and regular
  • RR – 28 bpm
  • Pale, decreased skin turgor
  • Her hands are cool, her lips are dry, but not cracked
  • She is quietly sitting on her mum's lap
  • Weight – 25 kg
  • Medical history: asthma and bee sting allergy

Scenario 2 - Adolescent

Mitchell is a 16 year old boy who has been brought into the Emergency Department at 2330 via ambulance. He was found semiconscious, outside one of the city nightclubs. He has vomit on his clothes and smells of alcohol. Ambulance officers state that he is able to be roused but only with painful stimulation. His response to this stimulation is verbal bad language. The ambulance officers also state that he has been verbally abusive to them and resistant to their attempts to help him.

Mitchell has a mobile phone on his person and a wallet. His parents Ray and Tania, have been contacted and arrive in the unit shortly after Mitchell. They are embarrassed about his drinking, but are clearly concerned about their son. They are left to visit with their son while the staff retrieve his notes from medical records.

Mitchell responds to his mother's touch with verbal abuse and shouts at her uncontrollably. She is clearly upset and steps back in tears. Ray intercedes and asks his son to stop this behaviour. His response to his father is calmer and he stops yelling. He rolls over in the bed and screams out to everyone to leave him alone.

Assignment 4

In your eJournal, cite and summarise a journal article which takes into account the role of the Australian Registered Nurse in the discharge planning process. Briefly outline how this discharge planning in the paediatric setting may maximise health and minimise costs.

This can be done as an annotation. You can find out more regarding annotations and annotated bibliographies on the web link below.

 

Answers:

Assignment 1

Communication forms an integral part in the health care services, as it is the key player in deciding the fate of health and social care outcome. In simple terms the approach of exchange the view, ideology, concern, expression and emotional attributes are crucial along with the treatment regime and medications. It is equally important to understand the requirement of patient, the concern of the health care professionals and sustaining the morale of the patient, which ensures the effectiveness and efficacy of the completely health care service exchange system. The advantage of effective communication skills lies in the context of framing partnership models, establishing trustworthy relationship; reduce the complication of information dissemination and accurate exchange of information among both the health care providers and health care consumers. Notably the communication means include both verbal as well as non-verbal communication. For an RN, it is essential to consider (Brunetto, 2012, pp.7; Allen, 2013, pp.226):

  • Review the present case and any background information is present, to define the problem.
  • The communication objective is to make the patient understand the concern of action, such as making her understand the form and requirement, use of symbols to understand the dilemma of patient and use of patience.
  • Identify the target audience and attempt should be taken to make patient understand and identify the concern or need.
  • Communication channel such as non-verbal communication, translator, family member or carer and symbols in communication should be used.
  • Pretest the message and concern appropriately in conjunction to the patient
  • Use of empathy in non-verbal actions
  • Evaluate each action or strategy of communication with the patient.

It is obvious to understand that a poor communication strategy will not only brings poor patient output, but will also ensure loss of patient satisfaction and progress for wellbeing. Absence of any communication strategy may leads to the patient in shame that is more depressed, and guilt like condition. Likewise, the coordination among the various professionals and workflow is also likely to hamper.

 TeamSTEPPS and ISBAR is the measure of process and outcome related for the patient wellbeing and maximum patient output in any health care settings. These include evaluation of process, clinical outcomes and structural outcomes in terms of records, notes, handovers and communication with patient as well as health care professionals. The representation of the TeamSTEPPS is done with X-axis representing the duration of the procedure and Y-axis with the description of the issue. Similarly, ISBAR is related to identification, Situation, Background, Assessment and Recommendation that are necessary to be considered within the scope of treatment and intervention. Following of these protocols and procedures not only help in maintaining the coordination among the health care professionals, but also ensures maximum benefit to the patient condition and satisfaction (McCaskill, 2011, pp.S44).

References;

ALLEN, J., OTTMANN, G., BROWN, R., & RASMUSSEN, B. (2013). Communication pathways in community aged care: an Australian study. International journal of older people nursing, 8(3), pp.226-235.

BRUNETTO, Y., FARR-WHARTON, R., & SHACKLOCK, K. (2012). Communication, training, well-being, and commitment across nurse generations. Nursing Outlook, 60(1), pp.7-15.

McCASKILL, C. (2011). TeamSTEPPS: The introduction of leadership, situational monitoring, mutual support and communication to improve patient safety in an Emergency Department. Australasian Emergency Nursing Journal, 14, S44.

 

Assignment 2

Identification of clinical deteriorating condition is important as it helps in preventing further deterioration and mortality of the patient. Health care professionals such as nurses and medical staff have the responsibility to recognize and respond to the sign and symptoms, before the condition of the patient deteriorates to any serious extent. It is essential to communication with the multi-professionals groups and work for the aggregation of the root cause analysis, which can help in obtaining the key information and gain of understanding for the reason (Preece, 2012, pp.1111). Some of the key points in this regard, that are essential as a part of nursing competency as well as resources for identification and intervention of deteriorating condition are (Newman, 2013, pp.213; Preece, 2012):

  • Communication with focus groups including nurse and doctor, which include sharing of idea and view with respect to the concerned health issue. More importantly, the scope of clinical decision, decision-support, clinical judgment and arguments with respect to the use of wisdom and evidence in the care practice is covered with this aspect.
  • Interviews with the clinicians, is also referred to, as semi-structured consultation. The intervention and the ideas obtained with the consultation can be used for analysis with thematic approach. This helps in elucidation of the factors, which contribute to the reason, policies and protocols that are necessary to be adopted for the concern and recommendation to be used as future prospects.
  • Identification of root cause analysis helps in figuring the timeline of the event and address the adverse effects. This will also be helpful in pointing out the elements that have been carried out of analysis or those, which are necessary to be done (analysis) in future. This helps in finding out crucial factors and inference with respect to the corresponding factors. More importantly, the step of care practice is crucial for the calculation and use of statistical tools for the analysis.
  • Triangulation method is the most important approach, which include the utilization of various theories, data sources, analytical methods, literature and epidemiological studies to gather insight and find possible solution of the concerned health issue. Crucial elements covered within this scope are communication factor, working cum environment condition, task related factors, education and training, patient factor, team work, equipment and resources and individual factors.

References:

Newman, L. (2013). Seeking Asylum—Trauma, Mental Health, and Human Rights: An Australian Perspective. Journal of Trauma & Dissociation, 14(2), 213-223.

Preece, M. H., Hill, A., Horswill, M. S., & Watson, M. O. (2012). Supporting the detection of patient deterioration: observation chart design affects the recognition of abnormal vital signs. Resuscitation, 83(9), 1111-1118.

 

Assignment 3

Support for the health care is considered as one of the prime requirement for the health care practice related competencies. The elements that are contained within the scope of the support includes effective communication skills, identification and assessment of the health issue, collaboration with other health care professionals, clinical decision and adoption of optimum as well as effective treatment regime and educating patient as well as family members. According to the present case, in first study, it was found that Veronica (7 year girl) is suffering from diarrhea, dehydration and is refused to take any medication or oral fluids. Likewise, in second study, Mitchell (16 year old boy) has been found to be drunken and is showing abusive behavior (Goodall, 2012, pp.304). The condition is worsening as the irritation and agitation is not being controlled in front of parents as well as against the support team. Both of these condition leads to frustration and mental tension to parents, as children are reluctant to understand and their health condition is being worsen. The standards or approach that should be adopted by the health care professionals, especially nurses are (Walczak, 2014, pp.e005745):

  • Assessment - Delivery of the health care service should be sensitive to the nature of requirement and appropriate to the time. More importantly, there is requirement of specialized professionals in the medical, paramedical and palliative care team, which can handle the varieties of specific social and cultural group.
  • Coordination of treatment and bereavement service – As some instance it was found that veronica was refusing to take fluids and hence her mother is worried and tensed. Likewise, Mitchell is not being calm and is displaying abusive behavior. These condition should be handled with utilization of alternative of treatment such as administration of sedative (IV), and then administration of fluids through IV route. In addition, there should be communication with the parents, which should include empathy both verbally as well as non-verbally.
  • Training and support – The health care professionals engaged in the service and intervention should have been prepared with training and support resources for the corresponding situation. This will not only ensure for the optimum treatment, but will also help in rectifying the health concern. The key requirement in this paradigm is associated with correct identification and intervention, selection of accurate medication and treatment regime.
  • Screening - Another approach of getting maximum patient satisfaction and providing optimum care is to screen for any spiritual, cultural and ethnical belief of the patient and individual. Although such notations are not included in the give case, but these are important to consider, which also includes the scope of obtaining the consent from parents.

 

 

References:

GOODALL, S., KING, M., EWING, J., SMITH, N., & KENNY, P. (2012). Preferences for support services among adolescents and young adults with cancer or a blood disorder: a discrete choice experiment. Health policy, 107(2), pp.304-311.

WALCZAK, A., BUTOW, P. N., CLAYTON, J. M., TATTERSALL, M. H., DAVIDSON, P. M., YOUNG, J., & EPSTEIN, R. M. (2014). Discussing prognosis and end-of-life care in the final year of life: a randomised controlled trial of a nurse-led communication support programme for patients and caregivers. BMJ open, 4(6), e005745.

 

Assignment 4

Discharge process and planning is crucial and integral part of health care settings, which is being undertaken by the RN. Particularly in Australia, there are key guidelines sourced from local and national framework by policy agencies and health care settings, which demonstrated for the coherence and consistency, with respect to discharge planning. Some of the key elements that to be considered within the scope of discharge planning, in conjunction to the role of RN are (Graham, 2013, pp.2338; Bar-Zeev, 2012, pp.366; Chaboyer, 2012, pp.40):

  • Monitoring for the records, handovers, instrumental data and other important assessment should be intact in files, with respect to the patient condition and intervention history.
  • Necessary routine checkups such as heart rate, respiratory rate, blood pressure, bowel movement, coordination of eyes, sensory function, bowel movement, patient posture and other related terms should not be in concern.
  • Communication with other health care professionals has been executed to collect the response for the patient and relevant risk associated with the health condition.
  • Monitoring for the provision that appropriate referrals has been given to the patient and related person for the dietary, psychological, medication and paramedical related care.
  • Education to the patient, family members and carer has been done, which ensure the dietary measures, physical activity, medication management, further routine checkup and other related paradigm of self-management of health.
  • Patient billing and other hospital bed related formalities and requirement has been done.
  • Privacy and dignity of the patient is maintained and will be maintained in the near future with respect to patient condition and intervention course.
  • Entry of the patient records with respect to the medication, history, treatment regime, adverse events and other billing information has been done in the computer and hospital database.

Particularly, in paediatric setting, it is more important to take consent from the parents with respect to the medication and intervention choice. It is more important to take care of the education of parents for the self-management of any concern. Such self-management archetype include the scope of medication, dietary and hygienic needs and other related requirements. For an RN, it is most important to monitor the record keeping and preservation of all notes related to intervention, assessment and instrumental results. Moreover, there should be a referral note to the parents, for a routine checkup after particular days, for the intervention and assessment of health restoration and maintenance (Wilson, 2012, pp.1594).

 

References:

BAR-ZEEV, S. J., BARCLAY, L., FARRINGTON, C., & KILDEA, S. (2012). From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. Midwifery, 28(3), pp.366-373.

CHABOYER, W., LIN, F., FOSTER, M., RETALLICK, L., PANUWATWANICH, K., & RICHARDS, B. (2012). Redesigning the ICU nursing discharge process: a quality improvement study. Worldviews on Evidence‐Based Nursing, 9(1), pp.40-48.

GRAHAM, J., GALLAGHER, R., & BOTHE, J. (2013). Nurses' discharge planning and risk assessment: behaviours, understanding and barriers. Journal of clinical nursing, 22(15-16), pp.2338-2346.

WILSON, S., HAUCK, Y., BREMNER, A., & FINN, J. (2012). Quality nursing care in Australian paediatric hospitals: a Delphi approach to identifying indicators. Journal of clinical nursing, 21(11‐12), pp.1594-1605.

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