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Part A: Examining the Case Study and Identifying Contributing Factors

You have been asked to review a critical incident, as per the case study.

This assessment is in two parts:

Examine the case study and provide a brief, systematic overview of the issues that contributed to the critical incident that occurred for the patient.

o You must use a named process or model (Nursing process or clinical reasoning cycle) to analyse the key issues in the case study.

o This part of your assessment is about identifying all contributing factors and considering the areas that require further enquiry.

To support your review of this critical incident, you are expected to source thre Scholarly, peer- reviewed journal articles. The articles must directly relate to three different issues identified in part A.

Each article must address a different issue.

For each article:

.Provide a summary of the evidence presented within the article.

. Identify and analyse how the evidence in the article could be used to improve nursing practice related to the key issue

.Use additional literature to support this analysis

.Provide a summary of how the article has informed your future practice.

Mr Thomas is a 60 year old gentleman who presented to his local Emergency department on the morning of 10th March, 2018 with a 2/7hx of productive cough and signs of alcohol withdrawal (tremors and hallucinations). He has a known history of chronic alcohol misuse, alcoholic liver disease and COPD. Mr Thomas was admitted to the medical ward that afternoon for management of exacerbation of COPD and was placed on an alcohol withdrawal plan which involved 2nd hourly clinical observations and alcohol withdrawal scale (AWS).

He was also commenced on thiamine and fixed dose regime of Oxazepam as part of this plan.

On transfer to the ward at 1500hrs, Mr Thomas’s observations were charted as P 110, Resp Rate 24, BP 135/85, SaO2 95% and his AWS had increased as he had become increasingly agitated and diaphoretic. The afternoon nursing staff documented this change and that they had administered a PRN dose of Oxazepam in addition to his fixed regime as charted for AWS. At 1800hrs, Mr Thomas was visited by his wife who voiced concerns to the nursing staff. She was very worried that he appeared pale and drowsy and not ‘himself’. The afternoon shift RN caring for Mr Thomas reassured her despite her repeating her concerns to the RN again before she went home.

Ms Kelly was the RN working on the 15-bed medical ward with an Enrolled Nurse (EN) on 10th March. Ms Kelly had been a registered nurse for five years. As per hospital policy, Ms Kelly and the EN were the only two staff members rostered to the ward on night-shift that commenced at 2245 hours. The medical ward

was at capacity on the nightshift 10th March. Two of the other male patients admitted to the unit were distressed; one was admitted for acute exacerbation of his chronic back pain requesting regular analgesia and assistance with ADL’s whilst the other gentleman had an acute delirium secondary to a urinary tract infection.

Part A: Examining the Case Study and Identifying Contributing Factors

Registered nurses are person-centered and evidence-based with preventative, curative, formative, supportive, therapeutic and palliative elements that enable to keep individual and the entire community in a healthy status (Fishman, 2018, p.13).  The codes and principles that guide nurses are set by various agencies across the world such as NMBA and keep on changing according to the safety needs of the public. As a registered nurse, I identify the following two learning needs: Up-to-date knowledge and experience and Leadership skills.

Learning needs are the gaps between the leaner’s current status of knowledge and skills against the level of knowledge required to perform a particular task (Jones-Bell, 2018, p.38). The choice of leadership skills as learning need is essential to the management of all the patients and the nursing fraternity by the code of conduct that requires nurses to practice a safe and competent manner.

The standard requires all registered nurses to always practice using informed knowledge relevant to their registered and scope of practice to ensure quality care to all patients.  I can only achieve this through keeping myself to update. The practices tend to change according to organization and requirement of the patients, who have different values, believes and culture (Robert-Tuner, 2014, p.19). Additionally, as a nurse is required to continuously adjust my knowledge of various care issues that are experienced daily and are not taught in class, to enable me to provide better care to the patients.

The standard requires all registered nurses to establish professional relationship with the healthcare and demonstrate leadership to provide quality healthcare services to patients and the core workers. Therefore, gaining the leadership skills is essential for my profession.

Consequently, the high retiring rate of nurses poses the biggest problem to the healthcare organizations across the world, hence creating the need for leadership development (Morrison, 2016, p.237). Leadership entails the communication and the interpersonal relationship with other nursing staffs and the patients. Competency does require not only the skills gained in class but also the ability to carry out the skills in managing the stakeholders: patents and staffs. The choice of the second learning need that is to up-to-date knowledge and experience in the nursing fraternity is based on the conduct that requires all nurses to practice by the standard of the profession and broader health system.

Learning plan refers to document that is used to facilitate and manage the learning process of a student over a period of time.

My major learning goals will be to obtain more knowledge and experience on the leadership skills that will make me manage and account for the organizational process to balance the resources within health facility to promote quality care and patient safety. The second learning goal is to acquire knowledge and skills that will enable me to update me with the innovative information and technology to deliver quality patient care.

Self-directed continuing professional development

Name:

Date

Identified learning Need

Action Plan

Type of Activity

Description of topic (s) covered during activity and outcome

No./Title/ Description of evidence provided

CPD hours

12/01/2019

Up-to-date knowledge and experience in the nursing fraternity

Continue education program.

Will enroll in an online learning center especially University of Mary’s Nursing education to advance my knowledge on the skills and merging ideas

Attend seminar and workshops

Journal about how studying postgraduate palliative care impact nurse ability in practice by Rawlings D, 2018.

Journal by Fishman explores the evolving roles of registered nurses that are taught in such seminars and workshops

The journal talks about the advantages of continued education of nurse professionalism. Topics that will be covered include updated standards and legal requirements for nursing practice in various countries and organizations.

Topic on Patient Situating Analysis. In most cases, patients situations needs critical analysis since either decision made by nurse has greater risks

Rawlings, D. (2018) ‘Does studying postgraduate palliative care have an impact on student’s ability to effect change in practice?’, Australia an Journal of Advanced Nursing, 36(1), pp. 16–24. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=131905846&site=ehost-live (Accessed: 17 October 2018).

Fishman, G. A. (2018) ‘Attending Registered Nurses: Evolving Role Perceptions in Clinical Care Teams’, Nursing Economic$, 36(1), pp. 12–22. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=128049874&site=ehost-live (Accessed: 15

5 hours per day for two years

8 hours for 3 days

20/10/2018

Leadership skills

Will participate in discussions between patient-nurse and nurse-nurse communications in building a team.

Read all the books related to the nursing leadership skills.

I will make short notes from each of the following books and compare their nursing leadership skill: Effective Leadership and Management Nursing by Eleanor J. Sullivan. Essentials of Nursing Leadership and Management by Diane K. Whitehead, Sally A. Weiss and Rulb M. Tappen. Leadership and Management for Nurses: Core competencies for quality Care by Anita Finkelman

To build on communication skills

Journal by Glassman on Nurse Manager Learning Agility and Observed Leadership Ability.

Books on leadership and leadership development by McGowan, E. and Stokes, E. 2017

I will concentrate on   nursing leadership and emotional intelligence. The two topics will help me have the skills to lead any nursing team effectively to acquire efficient patient care.

The patient-nurse communication process will be improved through learning how to make interpersonal relationship by doing some of the following activities:

Sitting next to patient and having simple communication strategies like BATHE. When a nurse is a good listener and communicator, helps the patient to eliminate any physical and emotional distress that affect the recovery process

Low-Tech Social Network and spectrum mapping. The spectrum mapping provides opportunity to give ideas and opinions and encourage others who have unconventional views about others, work process and patents to speak. Through harmonizing all these ensures that the patients receive the best care

When team creates avatar will show how well they know each other, hence help in understanding the team better

Glassman, K. S. (2018) ‘Nurse Manager Learning Agility and Observed Leadership Ability: A Case Study’, Nursing Economic$, 36(2), pp. 74–82. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=129092701&site=ehost-live (Accessed: 15 October 2018).

 Roberts-Turner, R.(2014) ‘Effects of Leadership Characteristics on Pediatric Registered Nurses’ Job Satisfaction’, Pediatric Nursing, 40(5), pp. 236–256. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=98978816&site=ehost-live (Accessed: 15 October 2018).

5 hours per book

5-7 hours per book

3 hours

2 hours

3 hours

  1. Reflection of the need for leadership skills

To effectively achieve the leadership skill, I will participate in a number of activities such as going through the lecture notes that provide strong foundation on the nursing leadership skills. Other activities such as   assuming the role of group leadership, having a group discussion and debate, have active listening sessions among many others.

  1. Reinforcing the active listening session helps in improving the communication ability of an individual (Weger, Bell and Robinson, 2014, p.20) denotes that commination is not about just speaking but it entails listening to others too. Active listening refers to the ability to understand rather than replying and this can be reinforced through building a good listening relationship by always asking questions in class or other mentors in the hospital to clarify unclear issues (Higgins, McLaughlin, Rinnies and Stecker, 2017). Through this, I will be able to understand and be at par with the profession requirement.
  2. Participation in the discussions and debate enable all people to share their ideas, opinions and thoughts and enhance the listening capability of the members (Hoffman and Vorhies, 2017, p.26). The group discussion thus will foster my ability to withstand other people opinion in every decision making process , an aspect that is important in leadership and management since I will be able to understand various body languages and their meaning. Additionally, assuming the group leadership will provide me an opportunity to prove my capability of providing a healthy working environment to my team members who are responsible for the safety of the patients. The group thus provides me with an opportunity to grow and enhance my emotional intelligence, since every group member poses different characteristic and must be effectively accommodated to ensure the realization of the objectives.
  • Reading the books on the leadership will equip me with the relevant leadership skills required at every level of management (Pazetto and Kowal, 2015, p.120). Different skills work differently in every situation such as between staffs, staffs and patients: thus concentrating on the nursing leadership and management skills such as integrity, critical thinking, emotional intelligence, respect, communication skills, mentorship among many others.

Part B: Sourcing Scholarly Articles Directly Related to Identified Issues

My need to have relevant up-to-date knowledge is essential in nursing fields. At the college, most of my lectures use books and technical knowledge to teach us that do not fully expose the different expected issues in the real world (Glassman, 2018, p.76). The issues such as experiencing different patients who suffer different disease some we have never come across pose different challenges in taking care of them, therefore, I require to gain knowledge on such emerging issues and this can only be achieved through engaging or actively involving me in various programs such as continuing education program, attend seminars and workshops, attend professional organizations and continually updating the technological knowledge.

According to Papadopoulos and Jager (2016,p.348)about 55% of clinical students learning take place in class room setting while the other 45% takes place in clinical setting, therefore, it means even after the completion of the nursing educational program, there are a lot to be gained. There are various educational programs provide both on online and institutional setting, that have the capability to enhance the nursing professional. When I enroll into online educational programs in the University of Mary’s online nursing education. Apart from enhancing and filling my knowledge gap, the online program tends to be flexible to me since I will be able to log in anytime at any location to acquire knowledge without interfering with my family life and professional career. Through the use of technology, I will be able to do the classes work at night from the laptop and achieve the desired goal.  the online program tend to be cost-friendly since the curriculum modules will always be sent to me through online as opposed to the conventional lecturing method where the professor has to be at the podium(Kanto-Ronkenen,Paalasmaa and Saami,2016,p.48). The price is reduced since the classroom costs, electricity and any other physical amenities are excluded from the fees.

  1. Additionally, the online educational programs do not offer clinical preceptors as compared to the classroom nursing education. Therefore, I will be required to identify clinical sites to gain the various research skills and apply the theoretical knowledge gained in class. The process of searching the clinical preceptor will motivate me and enhance my communication and relation ability with other nursing staffs, which are highly attributed in the nursing industry (Colbert, 2017, p.353). The programs tend to make students to be more independent and acquire excellent management skills since one is capable to balance the student life, social life, family life and the professional life.

Professional organizations such as America Nurse Association since they are critically in generating ideas and proactive work needed for healthy profession (Daw, 2017, p.20). The organizations have varied benefit such as professionalism since after the completion of the nursing course students tends to lack the professional umbrella hence the organization provides a base for applying jobs. Networking is found in the professional organization since I will be capable to know potential colleagues and build a potential mentors (Dhakal, 2018, p.316). Finally, the professional organizations tend to sponsor trainings and workshops that facilitated the development of career.

The health sector as whole experience tremendous technological change, thus it is imperative for each nurse to continually update their knowledge on the available machines that assist in taking care of the patients (Hoffman and Vorhies, 2017, p.22).  The technology have advanced from the use of tablet computers, electronic charts to radio-frequency identification enabled devices making the healthcare fraternity to be more technologized hence requires the need to update ones knowledge.

By the end of this session, I will have covered the required leadership skills and strategies to up-to-date knowledge and experience; however, I will need to work more on critical thinking that is also essential in clinical reasoning and decision making process. Critical thinking is defined as active and continuing cognitive process of logical reasoning whereby an individual systematically explores and analyses issues interpret complex ideas and considers all aspects of as situation to make a prudent judgment (Srisawad and Kidee, 2017, p.68). The development of critical thinking still continues to be a big challenge to moist of the nurse educators hence several strategies needed to be developed and reviewed to ensure sound judgment in complex situations.   Personally I will enhance my critical thinking during the first year of practice as a registered nurse through various methods such as simulation, problem-based learning and Nurse Residency Programs.

Analysis of Each Article and Identifying How it can Improve Nursing Practice

Simulation offers safe, controlled environment that allows the leaner to make a mistake without causing harm to the patient, hence the student has the capability of learning from the self-committed errors. In most clinical setting, critical thinking is achieved through the role-playing in simulated activities. In such situations, I will take the role of both the patient and the clinical staffs to understand both perspectives. According to Cazell and Anderson (2016, p.85) simulation always make clinical staffs to be more prepared for the live clinical setting.

Through the use of problem-based learning whereby actual patents are presented to the fresh clinical staffs to analyze the best course of action (Aziz, Sedaghat and Direkvand-Moghadam, 2018, p.5). Most of the newbies tend to shy away, however, I believe  that undertaking such opportunity helps in bring into practice the theoretical knowledge into practice without fear of intimidation, hence one will be able to make correct judgment in case of future encounter with the same problem. The use of problem-based learning will enhance my confidence in making decisions.

In most cases, nursing graduates tend to being their career in acute care settings as others migrate to non-acute care such as ambulatory clinics, schools and public health setting since most of them does not mandate one to have the clinical reasoning capability(Belvins,2016,p.368). NRPs are an evidence-based curriculum that incorporates area leadership and patients outcomes therefore, through having NRPs, as a new registered nurse I will have the required preceptors to enhance my independent thoughts and sound clinical reasoning.

References

Azizi, M., Sedaghat, Z. and Direkvand-Moghadam, A. (2018) ‘Effect of Critical Thinking Education on Problem Solving Skills and Self-Esteem in Iranian Female Students’, Journal of Clinical & Diagnostic Research, 12(1), pp. 4–7. doi: 10.7860/JCDR/2018/27993.11128.

Blevins, S. H. (2016) ‘Nurse Residency Programs: Supporting Nurse Graduates’, MEDSURG Nursing, 25(5), pp. 367–369. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=118640447&site=ehost-live (Accessed: 15 October 2018).

Cazzell, M. and Anderson, M. (2016) ‘The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students’, Nursing Education Perspectives (National League for Nursing), 37(2), pp. 83–90. doi: 10.5480/15-1553.

Colbert, C. Y. (2017) ‘Fairness: the hidden challenge for competency-based postgraduate medical education programs’, Perspectives on Medical Education, 6(5), pp. 347–355. doi: 10.1007/s40037-017-0359-8.

Daw, P. (2017) ‘Program Evaluation of a Nursing Workforce Intervention: The Maryland Nurse Support Program II’, Nursing Economic$, 35(1), pp. 14–38. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=121353610&site=ehost-live (Accessed: 15 October 2018).

Dhakal, K. (2018) ‘Librarians collaborating to teach evidence-based practice: exploring partnerships with professional organizations’, Journal of the Medical Library Association, 106(3), pp. 311–319. doi: 10.5195/jmla.2018.341.

Fishman, G. A. (2018) ‘Attending Registered Nurses: Evolving Role Perceptions in Clinical Care Teams’, Nursing Economic$, 36(1), pp. 12–22. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=128049874&site=ehost-live (Accessed: 15 October 2018).

Glassman, K. S. (2018) ‘Nurse Manager Learning Agility and Observed Leadership Ability: A Case Study’, Nursing Economic$, 36(2), pp. 74–82. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=129092701&site=ehost-live (Accessed: 15 October 2018).

Higgins, N. C., McLaughlin, S. A., Rinne, T., & Stecker, G. C. (2017). Evidence for cue-independent spatial representation in the human auditory cortex during active listening. Proceedings of the National Academy of Sciences of the United States of America, 114(36), E7602–E7611. https://doi.org/10.1073/pnas.1707522114

Hoffman, J. L. and Vorhies, C. (2017) ‘Leadership 2.0: The Impact of Technology on Leadership Development’, New Directions for Student Leadership, 2017(153), pp. 21–33. doi: 10.1002/yd.20227.

Jones-Bell, L. J. (2018) ‘Transition to Practice - Part 3: Implementing an Ambulatory Care Registered Nurse Residency Program: RN Residency and Transition to Professional Practice Programs in Ambulatory Care - Challenges, Successes, and Recommendations’, Nursing Economic$, 36(1), pp. 35–45. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=128049878&site=ehost-live (Accessed: 15 October 2018).

Kanto-Ronkanen, A., Paalasmaa, P. and Saarni, L. (2016) ‘User-centered continuous professional education for AT service personnel’, Technology & Disability, 28(1/2), pp. 47–52. doi: 10.3233/TAD-160443.

McGowan, E. and Stokes, E. (2017) ‘Leadership and leadership development within the profession of physiotherapy in Ireland’, Physiotherapy Theory & Practice, 33(1), pp. 62–71. doi: 10.1080/09593985.2016.1230659.

Morrison, J. (2016) ‘Nursing Leadership in ACO Payment Reform’, Nursing Economic$, 34(5), pp. 230–235. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=118640423&site=ehost-live (Accessed: 15 October 2018).

Papadopoulos, C. and Jager, J. M. (2016) ‘The effect of an educational program on strength-training adherence in older adults’, Educational Gerontology, 42(5), pp. 342–351. doi: 10.1080/03601277.2015.1121752.

Pazetto Balsanelli, A. and Kowal Olm Cunha, I. C. (2015) ‘Nursing leadership in intensive care units and its relationship to the work environment’, Revista Latino-Americana de Enfermagem (RLAE), 23(1), pp. 106–113. doi: 10.1590/0104-1169.0150.2531.

Rawlings, D. (2018) ‘Does studying postgraduate palliative care have an impact on student’s ability to effect change in practice?’, Australian Journal of Advanced Nursing, 36(1), pp. 16–24. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=131905846&site=ehost-live (Accessed: 17 October 2018).

Roberts-Turner, R.(2014) ‘Effects of Leadership Characteristics on Pediatric Registered Nurses’ Job Satisfaction’, Pediatric Nursing, 40(5), pp. 236–256. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=98978816&site=ehost-live (Accessed: 15 October 2018).

Srisawad, K. and Kiddee, K. (2017) ‘The Development of Structural Equation Model of Critical Thinking among Nursing Students’, Walailak Journal of Science & Technology, 14(1), pp. 65–73. Available at: https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=120014120&site=ehost-live (Accessed: 15 October 2018).

Weger, H., Bell, G. C. and Robinson, M. C. (2014) ‘The Relative Effectiveness of Active Listening in Initial Interactions’, International Journal of Listening, 28(1), pp. 13–31. doi: 10.1080/10904018.2013.813234.

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