For the nursing graduate program, I settled for the program offered by St. Vincent Private Hospital Melbourne. This is a catholic based hospital with various branches at Fitzroy, East Melbourne, Kew, and at Worrigee. Their program is dedicated at facilitating a smooth transition from student to registered nurse and this program is only offered in the East Melbourne, Kew and Fitzroy branches. The program is set off to consist of an information session on Saturday 27th May at 10 am in the St Vincent’s Private Fitzroy hospital reception and another similar session is scheduled on Wednesday 7th June 2 pm at St Vincent’s Private East Melbourne seminar room (GNMP Hospital/Health Service Directory, 2017/18). These information sessions have been made in a way to cater for both the individual and group tours. The program is scheduled to include two internal clinical rotations that will be done in a span of twelve months in all the departments of the hospital. These rotations will include two weeks of night duty with only seven shifts for those looking to participate in the program part-time. The program offers only twenty positions for both full-time and part-time applicants and begins its intake on 20th January 2018. Both group and individual interviews will be conducted and the eligibility for this program requires an applicant to be a nursing graduate, who is registered with APHRA as an enrolled nurse and is available to commence the program on Monday 18th September 2017. The application requirements include a cover letter, a Curriculum vitae outlining the applicant’s clinical placements and work experience with two professional referees, a certified copy of academic transcript with a legend, and a certified copy of your care placement logbook that is inclusive of the formative and summative appraisals and competencies (St Vincent’s Private hospital Melbourne, 2017). The hospital will not be accepting any further applications as from 21st July 2017 at 4 pm.
Personally I am a very disciplined and determined person. I obtain the drive to strive and offer best quality work from my love of human dignity and my exceptional and uncontested levels of responsibility. I am particularly interested in expanding my skills in nursing and this coupled with my ambitious personality, I believe, place my application in the forefront in securing me a position with the hospital and in line with the specific objectives of the graduate nursing program that is being offered at St Vincent’s Private Hospital Melbourne. This is so as the program aims at increasing enrolled nurses’ confidence and is dedicated at strengthening their skills in nursing.
Section2. Clinical Question
In the clinical question, my patient is depicted as having undergone a laparotomy procedure conducted two days ago. Laparotomy is one of the many surgical procedures that are conducted to help in the examination of the abdominal organs. This procedure is mainly done for diagnosis purposes to try and identify the cause of any problem that has been reported in relation to the abdominal cavity (Medline Plus, 2017). It includes a surgical incision into the peritoneal cavity (University Hospital Southampton, 2015) that can be done by various incision technics. It is an invasive surgical procedure into the sterile areas of the abdominal cavity and often leaves the patient predisposed to infections and to the possible formation of scar tissues within the alimentary canal (Better Health Channel, 2017). The other complications of the procedure include hemorrhage and abdominal discomfort caused by an abdominal obstruction that could be brought about by abdominal adhesions.
The patient has just begun taking fluids and is complaining of abdominal discomfort and nausea. My immediate actions in this case would be to carry pout interventions that are aimed at reducing and/or eliminating the patients’ symptoms as I strive to achieve patient comfort in the recuperation period. This is in line with the aim of individualized nursing care that is dedicated to attaining complete patient comfort as they rest and try to recover (Radwin and Alster, 2002). I believe that the reduction and/or the complete elimination of the patient’s abdominal discomfort and the feeling of nausea will work best at achieving patient’s comfort.
My intervention will include a re-assessment of the patient’s incision wound in response to their complaint of abdominal pain. This will be in an attempt to find out the source of the abdominal discomfort. This re-assessment will include checking for any signs of inflammations such as tenderness around the wound and checking for any foul smelling discharge coming out of the surgical. This is because post-laparotomy patients are at high risks of secondary infections to their wounds that could be caused by bacteria. These bacterial infections could manifest in many different ways including the feeling of nausea and abdominal discomfort. The presence of inflammation and any foul smelling discharge will indicate a possible infection that could necessitate cleaning of the wound and changing of the wound dressing accompanied with the administration of antibiotics.
In this wound re-assessment, I would also check for the integrity of the surgical fissure. The lack of or reduced integrity of the surgical fissure will indicate an open surgical wound that is likely to cause pain and hence the abdominal discomfort. This open wound will most likely also act as a route for the entry of microbes into the abdominal cavity and hence result in further secondary infections. This will necessitate the re-suturing of the incision wound to close it up and avert the likelihood of further complications.
The wound re-assessment will be followed with the administration of antiemetic drugs to relieve the feeling of nausea experienced by the patient. Eliminating the feeling of nausea will help increase the comfort of the patient as they try to rest as a therapy to speed up their recovery process (Quizlet, 2017). Also, the exploratory forces that might accompany any vomiting reflexes as a result of nausea could re-open the incision wound and lead to further complications.
In this nursing case scenario, I would begin with Patient 3. Mr. Young is nil by mouth and has a sounding infusion pump alarm. This alarm is a warning sign that the infusion rate is not favorable and needs immediate attention (Mary, 2016). I would attend to him first as the sounding alarm attracts everyone’s attention as they enter the room and it could prove to be a major hindrance in my attempt to remain calm and attend to each patient with precision. The high infusion rate possesses the danger of possible introduction of air into the circulation as the IV flask runs empty. My intervention would include re-programming the infusion pump to reduce the rate of the infusion or stop the infusion altogether; this is to ensure that the integrity of the patients’ circulation is kept intact.
I would respond to Patient 4, Mr. Stavropoulous next. This is in line with the ABCs of emergencies that encourage tackling of the airway issues, followed by breathing issues and then circulation issues in that order (Nelson, 2010). Shortness of breath limits the amount of oxygen received by the body tissues and can cause profound damage to the organs of the body resulting in multiple organ failures and death in worst case scenario. A clear and effective airway is vital in patient care and since Mr. Stavropoulous is depicting signs of shortness of breath with increased work of breathing, he comes second in my priority list. My intervention in this case would involve the positioning of the patient in a comfortable position that eases breathing to reduce the work of breathing induced by the previous upright siting position (Wayne, 2016). I would then check his airway to ensure that there is no obstruction and subsequently administer the drug Ventolin to help relieve the short-term asthma symptom that is the shortness of breath depicted by the patient and also administer the drug Seretide to help avert the reoccurrence of the symptom.
Thirdly, I would respond to Patient 2. Mrs. Walters is a known diabetic, has missed a scheduled blood glucose assessment and hence, requires this assessment prior to any meal in accordance with the sliding scale insulin therapy she is currently on. This assessment is important in guiding on the insulin requirements of the patient. The blood glucose assessment comes prior to the other two remaining requests since it’s almost meal time and Mrs. Walters is on the sliding scale insulin therapy that might necessitate the administration of insulin prior to eating (Martha, 2017).
Fourthly, I would respond to the registered nurse, An Nguyen’s request to check for the drug Endone for her patient. This comes fourth on the priority list as I am on my way out to assist Patient 1 Mrs. Peterson attends to her bowels. Also, this drug is used for pain relief and as such, pain relief is secondary to the ABCs of emergencies and to the blood assessment for Mrs. Walters.
Finally, I would help Mrs. Peterson attend to her bowels as the last nursing care response since it might include leaving the room to the washrooms and as such it will be safe to leave all the other patients in the room in safe conditions and not predisposed to any attacks due to further complications of their disease conditions.
Section4.2 Morphine Administration
Nursing as a profession and the provision of nursing care is among the most delicate jobs that are carried out on a daily basis. They involve the caring for an individual in recuperation. The professionals are required to depict careful skills, specialized knowledge and independent decision-making abilities (National Council of State Boards of Nursing, 2017) as well as competent team building abilities. Anyone working in the health care sector is expected to uphold and demonstrate high levels of responsibility, trustworthiness, integrity, belief in human dignity, equality, and sympathy in the desire to alleviate suffering (Nursing Council of New Zealand, 2012). Relating well with other colleagues is also a value of importance in offering nursing care as it determines the attitudes of the staff and favorability of the work environment (Health eCareers, 2011).
This case study employs the concept of good conflict resolution in the workplace as one tries to uphold professionalism in nursing. It is outlined in the day procedure unit, where there is a post-operative patient that requires Morphine 2.5mg administered intravenously. The patient’s drug order prescribes the administration of a first dose that consists of 2.5 mg of Morphine every ten minutes up to a maximum of three doses. My colleague has helped me through the drug preparation and advises me to administer the drug alone and only 2.5 ml of the drug in the syringe.
My colleagues’ advice to administer 2.5 ml only is incorrect. The syringe contains 10 mg Morphine in 10 ml of normal saline. This implies that the syringe contains 10mls of diluted 10mg Morphine. Hence, to fully administer the complete ordered first dose, I would have to administer 2.5ml that is equal to the 2.5mg but every ten minutes up to a maximum of three doses. This implies that in this first dose, I will have to administer 7.5mls of the drug in my syringe.
In managing the situation, I will employ effective conflict aversion techniques to try and avoid the eruption of a big conflict that will diminish the staff morale to work together as a team and undermine patient safety (Johansen, 2012). My strategy in handling the situation will involve clear communication and an attempt to achieve a common ground in understanding the perceived area of the disagreement (Sportsman and Hamilton, 2007). I would carefully approach my colleague and when she is alone. I would bring the patient’s drug order with me to serve as the evidence and a source of reference for my argument to avoid baseless arguments. In explaining my thoughts to my colleague I will use simple and courteous language to avoid getting off as s strong, know-it-all or rude, all negative characteristics. I will strike a friendly rapport with my colleague by implying that maybe her statement, “Just remember only give 2.5ml” was but a big misunderstanding. This will be in an attempt to intrigue my colleague in what I am about to say in order to avert any further misunderstanding that might arise due to miscommunication (Miracle, 2008). Also, the use of her own words will be to call her to mind and reflect on what she had implied with the statement.
I will then carefully explain my understanding of her statement and employ the correct interpretation of the order as I inquire from her if that is what she had implied: to give only 2.5mls as I wait to re-administer another 2.5mls after a span of ten minutes. Giving her the room to explain herself will make her feel appreciated and not like she is being reprimanded for a statement that might have been made by mistake and as a half-thought. This will see to it that I approach my colleague carefully, courteously and in a professional manner without demeaning them in any way.
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