Assignment:
Module 1 - Critical Thinking, decision making and professional development
This Module addresses issues such as problem solving, prioritising and putting decisions into action through good communication.
As part of this module please undertake the following activity and upload your answer into your e- Portfolio. Please remember that this forms part of your assessment for this unit.
On returning from your tea break you are met by several staff members who relate the following information to you concerning your patients.
i. Mrs Chew's intravenous (IV) infusion has tissued, her IV fluids are running behind and she has missed her 14.00 hrs IV antibiotic.
ii. Mr Smith's visitor has fainted.
iii. One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly.
iv. Mr Esposito is scheduled to leave the ward now for his cardiac catheterisation and he has still not received his preoperative medication.
v. One of the surgical consultants (VMO) is waiting to discuss a medication error that happened last week.
vi. As you are taking this handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery.
The other RN is busy with NUM role. Staff currently available on the ward to assist you in addressing these issues include: the ward clerk, an Enrolled Nurse who is currently undertaking her IV cannulation certificate but is not yet competent, and an AIN.
ACTIVITY
Using the above scenario:
1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate.
2: Document your rationales in detail.
Module 2 - Collaborative and Therapeutic Practice?This module requires you to consider your communication with various members of the multidisciplinary team using case studies and scenarios provided.
Your mandatory assessment requirements for module one include
1. Complete Activity 2 and upload your answers onto your e-Portfolio.
2. Choose one case study and upload your answers onto your e-Portfolio.
ACTIVITY 2
Reading:
The "MND Australia Fact Sheet on Multidisciplinary Teams" outlines professional groups who could make up a multidisciplinary health care team for a patient with motor neurone disease (MND).
Please read this fact sheet, answer the following questions, and upload your answers on your e-Portfolio on LEO. This forms part of your assessment for this unit.
1. Identify factors that determine which healthcare professionals are required to be involved in a health care team?
2. Who should lead the health care team?
3. Who is the most important member of the health care team?
CASE STUDY 1
Grant Thompson was a fit 37 year old man, a father of two young children and married for 14 years to Georgina. Grant was a truck driver who was involved in an MVA 6 months ago and suffered extensive injuries to his leg and a mild head injury. His recovery has been slow and he relies heavily on the use of a wheelchair but can now walk for short distances with the aid of a walker. Georgina wants Grant to come home and rehabilitate there. She has made some modifications to their home, ramps put in, handrails in the bathroom and toilet.
The health care team is meeting to discuss this option. The team consists of the treating doctor, physiotherapist, and occupational therapist, NUM of the rehabilitation unit, social worker and psychologist. There is disagreement among the team as to whether Grant would be better to stay in hospital a bit longer or go home. The physiotherapist and the occupational therapist both feel that Grant still requires intensive treatment which can only be provided as an inpatient. The psychologist and the social worker have noted that Grant's separation from his family and homeenvironment has been having a negative effect on Grant, Georgina and their children. The treating doctor feels that we could treat Grant as an outpatient but it would mean he has to attend regular physiotherapy and occupational therapy sessions. You are the team designated leader of the health care team.
Discuss the following questions
1. What are the key issues in this dilemma?
2. What outcomes would be best for Grant and his family?
3. How would you guide the group in achieving this best outcome?
CASE STUDY 2
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.
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?
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.
Discuss the following questions
1. What are the key issues in this situation?
2. Who would be included in the health care team and what role would they play?
CASE STUDY 4
You are working in a health care team on a busy rehabilitation unit. Team meetings and patient reviews are conducted weekly. There has recently been a turnover of staff in the Physiotherapy department and a new representative from physiotherapy has joined the health care team. You notice although that this new member of the team members is often absent, fails to provide patient updates and when challenged on these issues is exceptional confrontational. This behaviour is not only impacting on the effectiveness of the health care team but also on patient outcomes. You are the designated team leader and need to find a resolution.
Discuss the following questions
1. What are the key issues in this situation?
2. What strategies would you employ to address this situation?
CASE STUDY 5
You are the NUM of a Mental Health Unit where case reviews are conducted every 4 weeks. You are the designated team leader and the team members include the medical officer, resident psychiatrist, patient case manager, social worker and employment officer. Several of the team members approach you after the meetings and voice concerns about how the meetings are being dominated by the medical staff. The general feeling was that the medical team dominated all clinical care decisions and most of them felt they did not have a voice at the team meetings. As the designated team leader you are responsible for ensuring equity exists in decisions about ongoing care.
Discuss the following questions
1. What are the key issues in this situation?
2. What strategies would you employ to address this situation?
Module 3 - Provision and Co-ordination of care?This Module looks at assessment and problem solving to care planning. You will need to undertake pre-reading and preparation during placement prior to submission.
Complete Activity 1
ACTIVITY 1
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.
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:
Hi I have got Mr. Jo Blocks. He is 92 year old male who is coming to the ED with abdo pain and a 3kg weight lost in the past week. He has chest cough for sputum production which suspect a pneumonia. He has been on early obs down stairs. His has got a history of gastric ulcer, CCF and CVA. He is currently on 1.5 of oxygen via nasal prong. He has got a cannula on his left hand and he has got IV antibiotics caphzolen and zentromicin which were given as per drug chart. He is currently NBM. He has got good urine output gone to the toilet twice today. He has bowels open yesterday. You will need to please start him on 50ml/hour of IV with normal saline. He needs to have chest X-ray at 1600 hours today. And he will need also a sputum test andrepeat obs please.
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
This activity demonstrates how you have started collecting cues during handover.
After handover as graduate nurses you will most likely develop a care plan. The development of a care plan is a way of processing the information that you have collected during handover to ensure you adequately manage your time in relation to the care you think you will need to provide. It is important to acknowledge that this care plan can often change, as you need to reprioritise care, which is similar to the second activity we undertook in the "ward for a day" simulation.
Whilst you start to process information you will also start to think about cues that you are missing and where you can gather this information. Assessing the patient's chart, communicating with the patient and their family or even increasing your patient assessment are some of the ways in which you will achieve this. During the phase of processing information you are also starting to work out what is relevant information as opposed to information that is irrelevant to the situation.
The Clinical Reasoning Cycle can provide a framework for you structure your thought processes and ensure you can link the knowledge that you have obtained during your undergraduate degree to the clinical context in which you will be working as a graduate nurse.
Module 4 - Professional Practice: Time management, delegation, scope of practice ?This Module requires pre-reading (prior to clinical) and then observation of, and interaction with, the registered nurses on your clinical placement. You will need to discuss delegation with the staff and then make some decisions of your own using a case study. It would also be very useful to discuss the scope of practice of newly registered nurses with your facilitator or preceptor.
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 patients have intravenous access and require antibiotics at some time during your shift.
ACTIVITY:
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.