NRSG355 Clinical Integration For Fluid Therapy and Oxygen Therapy

The third priority issue is the one of Mrs. Chew’s tissued Intravenous (IV) infusion and her IV fluids are behind the schedules and she has also missed her IV antibiotics for 14.00 Hours. Patient’s medications are very essential in the treatment and healing of the patient’s condition.  I would make it a third priority since it is not an emergency but at the same the IV fluids were running behind time. I would do this to prevent the patient from missing another dose of the IV medications which can reduce the efficacy and effectiveness of IV antibiotics. This may cause relapse of the patient’s medical condition. I would not delegate since the Enrolled nurse undertaking intravenous cannulation certificate is not competent enough to handle it.  I would handle this issue by removing the tissued intravenous infusion and fix a new one in another place to ensure its patent enough for an effective flow of the IV antibiotics and other significant fluids given to the patient. I would work with the enrolled nurse who is undertaking a certificate in intravenous cannulation but not competent enough. This would help her improve her level of expertise and competence in IV cannulation (Papathanasiou,  Kleisiaris,  Fradelos,  Kakou, & Kourkouta, 2014).

The fourth priority issue would be the case of Mr. Esposito who is scheduled for cardiac catheterization now and has not been given his preoperative medications.  Based on the issue, the degree of urgency is low. Regarding the primary vital signs namely temperature, oxygen saturation, respiratory rate, pulse, and blood pressure, the patient is stable. He has no signs of emergency which might immediate attention. Therefore, I would make this a fourth priority compared to the first and second scenarios whose vital signs were deteriorating and they required immediate intervention to save their lives. I would take an action of delegating this task to the Assistant In Nursing who would prepare and escort the patient for cardiac catherization. I would also advice the AIN to give the preoperative medications (Shaw, Davidson, Smilde, Sondoozi, & Agan, 2014). 

The fifth priority issue would be the staff toilet which has blocked and waste is pouring and overflowing rapidly.  It is an essential issue in the ward because it is of hygienic concern. I would delegate this issue to the ward clerk to handle it and ensure the toilet has been unblocked. I would also advice the ward clerk to notify the other staff members not to use the toilet until its ready for use

I would give the last priority to the issue of the surgical consultant (VMO) who wants us to have a discussion regarding a medication error that had occurred the previous week. This is because its degree of urgency is low when compared to other incidences. Additionally, the discussion regarding a medical error requires and humble time and a conducive environment to find out the primary cause of the error, its impacts, the implemented measures of combating, and the most effective approaches or strategies that can be used to prevent further occurrence of medication errors in the future (Nemeth, 2017). 

Collaborative and Therapeutic practice (module two)

• The Multidisciplinary team

A multidisciplinary team is a group of various professionals in healthcare who collaborate in the provision of holistic care to the patient.  The team consists of a doctor, allied healthcare professionals such as occupational therapist, dietitian, social worker, speech pathologist, physiotherapist. It also includes the community and local palliative care workers (Choi, P. (2015).  Some of the factors that are used in the determination of the healthcare professionals needed to be engaged in a healthcare team include patient’s healthcare needs and requirements, specialization and level of expertise of an individual, personal training, and development, team leadership. The healthcare team should be led by a physician. The most important member of the team is the patient who forms the integral part of the team. The patient is the source of information to the entire team. The information provided by the patient helps in the establishment of a diagnosis hence dictating the role of every member of the team in the provision of patient care (Hartgerink et al., 2014).  

• Case study name:  CASE STUDY 4

The key issues presented in the case study include a recent turnover of staff members in the physiotherapy department, and a new physiotherapy representative who has recently joined the healthcare team. The new member is often absent from work and he does not provide updates on patients and he is exceptional confrontational once he is challenged regarding the issues. The behavior is affecting both the patient outcomes and the effectiveness of the team. As the designated team leader, I would employ various strategies to resolve the problem (Levett-Jones, 2013).  I would first conduct an employee assessment to determine the ability of the candidate to carry out specific duties and reveal particular personality traits which can help me in resolving the problem.  In the assessment, I would also be able to find out any possible factors that could be the contributors to the new employee’s behaviour and actions (Weaver, Dy, & Rosen, 2014). This would help me in identifying the most appropriate actions and strategies to employ. Other strategies that I would employ in the case include keeping an open ear and open door, taking the bull by its own horns, specificity about the problem, discussing the problem, providing actionable and clear direction, setting consequences if no change of the employee’s behaviour (Papastavrou, Andreou, & Efstathiou, 2014).

Provision and coordination of care (module three)

Time management and delegation (module four)

My allocation would be based or determined by task allocation, total patient care, and team nursing. I in the ward, there are two RNs, three AINS, and one EN.  Having in mind that there is a total of 22 patients in ward, with 14 intraoperative and 8 of them would be joining my shift, I would allocate of the RNs to care for 11 patients with the assistance of one EN and one AIN (Bratzke et al., 2015).  On the other hand, I would allocate the myself, as an RN 11 patients with the assistance of two AINs. The rationale for this would be the level of expertise and competency of the individual staff members. The fact 14 patients went for surgical does not mean they will all come back at the same.  I would accordingly prioritize as the patients come back to the ward from theatre. It would be unfair if one RN was allocated 15 patients and the other one 7 patients. I would split the number evenly to ensure fairness. My allocation would also be because the EN and the AINs are not medically endorsed and not fully competent. I would therefore allocate a RN in each team to do the medications and supervise the AINS and the EN who are not capable of performing technical and demanding procedures of healthcare. Perhaps, the AINs and the EN could perform other duties such as responding to calls and taking patients’ vital signs while the RNs oversee their work (Owen et al., 2014).   

Reference List (APA style)

Bratzke, L. C., Muehrer, R. J., Kehl, K. A., Lee, K. S., Ward, E. C., & Kwekkeboom, K. L. (2015). Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. International journal of nursing studies, 52(3), 744-755.

Choi, P. (2015). Patient advocacy: the role of the nurse, Nursing Standard, 29 (41) 52-58.

Reay, G., Rankin, J. A., & Then, K. L. (2016). Momentary fitting in a fluid environment: a grounded theory of triage nurse decision making. International emergency nursing, 26, 8-13.

Hartgerink, J. M., Cramm, J. M., Bakker, T. J. E. M., Van Eijsden, A. M., Mackenbach, J. P., & Nieboer, A. P. (2014). The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients. Journal of Advanced Nursing, 70(4), 791-799.

 Levett-Jones, T., (2013) Clinical Reasoning: Learning to think like a nurse, Frenchs Forests,
NSW: Pearson

Nemeth, C. P. (2017). The context for improving healthcare team communication. In Improving Healthcare Team Communication (pp. 1-7). CRC Press.

Owen, J. A., Brashers, V. L., Littlewood, K. E., Wright, E., Childress, R. M., & Thomas, S. (2014). Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration. Journal of interprofessional care, 28(3), 212-217.

Papastavrou, E., Andreou, P., & Efstathiou, G. (2014). Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies. The International journal of health planning and management, 29(1), 3-25.

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: the development of an essential skill for nursing students. Acta Informatica Medica, 22(4), 283.

Shaw, D. J., Davidson, J. E., Smilde, R. I., Sondoozi, T., & Agan, D. (2014). Multidisciplinary team training to enhance family communication in the ICU. Critical care medicine, 42(2), 265-271.

Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf, 23(5), 359-372.

Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: state of the science. Journal of Nursing Management, 23(3), 275-278.