Prioritizing Nursing Actions And Clinical Reasoning Discussion Paper
Determining Priority Actions Based On Patient Needs
While you read the article take particular note of how traditional vital signs can be used to assess the critically ill patient as well as the role of the additional three “vital signs”: level of pain, level of consciousness, and urine output.
1. What does tribalism refer to?
2. How do tribalism and power inequities impact on information sharing?
3. What are the five key dimensions for a well-functioning health care team?
Norma Ellis is a 76 year old widow who recently had a fall at the nursing home she has lived in for the past 7 years and fractured her hip. She has subsequently had a hip replacement and has been rehabilitating well and is now due for discharge back to the nursing home. Norma has an extensive medical history including postural hypotension, rheumatoid arthritis and impaired mobility. She mobilised within the nursing home using a walker. Her son is demanding that his mother be kept in the ward as an inpatient as he feels the nursing home staff were negligent and wants his mother to be placed elsewhere but has not arranged this yet. The treating team consists of the doctor, physiotherapist, NUM of the rehabilitation unit, social worker and NUM of the Norma’s wing at the nursing home she was in prior to the fall. You are the designated team leader.
The doctor feels there is no need to have Mrs Ellis on the ward as he feels that her rehabilitation has been maximised, this is an opinion shared by the physiotherapist. Norma wants to go back to the nursing home as she has made many friends there and feels at home there. Prioritizing Nursing Actions And Clinical Reasoning Discussion Paper
Discuss the following questions
1. What are the key issues in this dilemma?
2. How would you deal with Norma’s son? Are his objections warranted?
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 ISBAR format. Further information about the
ISBAR format can be found on page 7 of this module.
Handover’. Listen to this recording, and then please answer the following:
1. What further questions will you need to ask the nurse?
2. List specifically what further assessments you would complete when the patient arrives onto the ward
3. Upload the above answers to your e-Portfolio on LEO. This forms part of your assessment for this unit.
Access the following summary of Benner’s stage of clinical competence and consider these along
with the NMBA competencies and decision making tools. Then, consider what your priorities for your
final semester are and consider what skills you need to consolidate that will assist in you making the
transition from student to registered nurse.
Determining Priority Actions Based On Patient Needs
According to the events listed, the event that will get my highest priority is the collapse of the post-operative elderly patient, who had undergone facial surgery. Facial or skin surgeries can give rise to complications, like excessive bleeding resulting from abnormalities of blood clotting due, medications like heparin, aspirin, warfain can cause excessive bleeding (Hunt, 2014; Agarwal et al., 2012). Excessive bleeding can give rise to wound infections, lightheadedness, syncope or fainting, shortness of breath, chest discomfort, among others. Thus, it is necessary to determine the cause of the excessive bleeding (Www.dermnetnz.org, 2017). This activity will be carried out by me along with the help of the AIN. Moreover, if excessive bleeding is caused due to medications like anticoagulants, then necessary interventions can be applied like protamine sulfate can reverse heparin effects and vitamin K can reverse the effects of warfarin (Kahn, Amara & Halperin, 2016).
The next priority event will be attending to Mrs. Chew. The EN, who is specializing in IV cannulation has not received her certificate. The patient will be examined for signs of thrombosis, which involves painful, swollen and reddened veins along with very poor or negligible IV flow. The procedure will be carried out by me, which will involve removal of the device and carrying out the infusion in the other limb as well as application of warm soaks (Lms.rn.com, 2017).
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The next priority will be the event, where the visitor has fainted. Fainting can be caused due to low blood pressure, low blood glucose levels, cardiac problems, among others. It is necessary to monitor the vital signs of the patient like blood pressure, check the blood glucose levels and determine any medical history regarding cardiac problems (Www.ok.gov, 2017). This monitoring can be carried out by the AIN.
Next, Mr. Esposito will be provided with his medication. The EN can be employed for this but she will be carrying out the administration of the medications under my supervision.
I will discuss the medication error with the VMO and then delegate the EN to provide the right medication. This will be carried out under my supervision as it will help me to determine the competency of the EN in administering medications.
Management of the overflowing of the staff toilets will be delegated to the ward clerk and the AIN. Both the ward clerks and the AIN can carry out the task, since it is their duty to assist the nursing staff in the maintenance of clean environment in the hospitals (Tech.lds.org, 2017).
Importance Of Handovers And Vital Sign Monitoring
Patients affected by motor neuron disease generally require the help of a respiratory specialist, occupational therapist, speech therapist, physiotherapist, among others. The palliative team helps in providing support, while the doctor or the neurologist reviews the symptoms. A dietitian is needed in order to ensure proper nutrition being administered to the patient for effective recovery. Such multidisciplinary approach helps the patient to obtain overall care (Williams, Philip-Ephraim & Oparah, 2014).
A multidisciplinary team is usually led by a team coordinator.
The doctor or the neurologist is an important member as he will carry out the review of the symptoms and the care plan for the patient will be based on his diagnosis.
The patient suffers from postural hypotension and may show symptoms of syncope or fainting, dizziness and can fall when changing positions (Raj & Coffin, 2013). The patient suffers from impaired mobility and following her hip fracture, her condition may have worsened, which may further increase her chances of falling (Ambrose, Paul & Hausdorff, 2013). The complications associated with rheumatoid arthritis involves inflammation of the glands of the eye, dryness which may affect her vision. Rheumatoid arthritis also causes inflammation of the lungs and the pericardium resulting in shortness of breath, chest pain and heart attack (Www.nhs.uk, 2017).
The son should be informed about her medical conditions that have resulted in her fall and he will be informed that extra precaution will be administered in the case of his mother, so that such falls does not occur in the future.
Yes, because patients with impaired mobility should be kept under the monitoring of an AIN, since, it is the duty of the AIN to help the patient in mobility and other daily activities (Algoso & Peters, 2012).
Handovers are a form of communication that helps in the passing of patient information between nurses. This is essential when there occurs a shift of the patient from one department of the hospital to another department (Johnson, Jefferies & Nicholls, 2012).
The questions that can be asked to the nurse during handovers include patient’s medical history. It is also necessary to ask about whether the patient is to remain nil-by-mouth or whether require barrier nursing, requires help in moving, eating or going to the toilet. It is necessary to determine the surgical procedures the patient underwent and the treatment plan that was developed for the patient. Additionally, it is necessary to determine whether there was any change of treatment plan after the surgery and presence of allergies. It is also necessary to determine the culture of the patient and whether the patient is capable of verbal communication (Rayo et al., 2013).
Application Of Clinical Reasoning In Nursing
When the patient is shifted to another ward, the nurse of that ward can carry out the assessments regarding her vital signs like blood pressure, heart rate, respiration rate, blood sugar levels, assess the cognitive status of the patient, assessment of mobility, pain assessment using the visual analogue scale.
Clinical reasoning enable nurses to carry out effective decision making by reviewing and understanding the patient condition. Proper nursing education, excellent procedural skills and timely judgments are some of the important features of clinical reasoning skills. The ways in which clinical reasoning can be applied includes the ability of the nurses to use the knowledge of behavioral or biophysical sciences to provide a holistic nursing care to the patients. The nurse should have the ability to analyze the patient environment, identify the important cues, communicate the events and carry out interventions in order to prevent any adverse patient outcomes (Levett-Jones & Hoffman, 2013; Victor-Chmil, 2013).
Determination of vital signs helps in planning of treatment protocols and making decisions in order to save the lives of patients. Monitoring of vital signs helps in early diagnosis of the severity of a medical condition, thereby enabling timely actions to prevent adverse situations and even death (Felton, 2012; Elliott & Coventry, 2012)
Module 4The responsibilities of a RN is to carry out physical exams, determine the medical history of the patient, administration of medications, health promotion, education and counseling of patients. Evaluating patient information in order to carry out timely decisions, supervising the care provided by ENs, nursing assistants and other healthcare personnel. Moreover, they are also involved in research in order to improve nursing practices or interventions, thereby improving patient outcomes. ENs work under the guidance of a RN. They are involved in providing nursing care and dealt education promotion. They are also involved in care planning, implementation of the care and its subsequent evaluation. They help patients carry out daily activities, administer medications, among others. They work in collaboration with a team of healthcare experts and are accountable for the nursing care provided by them. The role of the AIN is to support the registered and the EN in delivering care for the patients. The duties of an AIN, include monitoring vital signs, enabling the patient to take their meals properly or feeding the patients, assist patients in bating, brushing teeth, dressing, determine the skin integrity, carry out hair and nail care, assist patients in their mobility, assist nurses during transfer of patients, application of anti-embolic stockings, report to RNs about abnormalities in the patient’s urine, carry out communications with RNs and the patients. They also ensure a safe environment for the patients and provide patient surveillance. The shared care model will be used in this scenario since, shared care involves the participation of a number of healthcare workers in providing effective care to patients (Primdahl et al., 2013). This also helps in monitoring and exchanging of informations regarding patient condition. The RNs will be involved in the patient surgeries along with the doctor. The ENs can also be involved in assisting the RNs in during the surgeries by monitoring the vital signs, giving the desired medications. After the surgeries, the ENs can prepare a care plan for the patients under the guidance of the RN. The AINs can help in the shifting of the patients to the wards after their surgeries. The AINs can also provide intravenous access and antibiotics to the patients under the guidance of the RN.Reference:Agarwal, B., Wright, G., Gatt, A., Riddell, A., Vemala, V., Mallett, S., … & Burroughs, A. (2012). Evaluation of coagulation abnormalities in acute liver failure. Journal of hepatology, 57(4), 780-786.Algoso, M., & Peters, K. (2012). The experiences of undergraduate Assistants in Nursing (AIN). Nurse Education Today, 32(3), 197-202.Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. 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Annals of the Rheumatic Diseases, annrheumdis-2012.Raj, S. R., & Coffin, S. T. (2013). Medical therapy and physical maneuvers in the treatment of the vasovagal syncope and orthostatic hypotension. Progress in cardiovascular diseases, 55(4), 425-433.Rayo, M. F., Mount-Campbell, A. F., O’brien, J. M., White, S. E., Butz, A., Evans, K., & Patterson, E. S. (2013). Interactive questioning in critical care during handovers: a transcript analysis of communication behaviours by physicians, nurses and nurse practitioners. BMJ Qual Saf, bmjqs-2013.Tech.lds.org. (2017). Responsibilities of the Ward Clerk – LDSTech. Tech.lds.org. Retrieved 19 December 2017, from https://tech.lds.org/forum/viewtopic.php?t=19019Victor-Chmil, J. (2013). Critical thinking versus clinical reasoning versus clinical judgment: Differential diagnosis. Nurse Educator, 38(1), 34-36.Wells, A. (2013). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons.Williams, U. 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