Module 1: Prioritisation and delegation
Registered nurse (RN) can delegate their work to the other heath members of the team if they need help in their busy schedule. A delegation is an aspect of the nursing to manage the patient care needs and this relationship establish when one staff of the health group transfers the facets of consumer cares to other staff member in which they are proficient and practice in their scope (Berman & Snyder, 2012). There are five delegation rights which must be considered, when delegating a task to another individual, which include the right task, the right circumstance, the right person, the right communication and the right supervision (Marriner-Tomey, 2009). The first right, the right task, it is delegated when the task being delegated is within the scope of practice and competent at the assigned task (Berman & Snyder, 2012). Firstly, as a RN, I would prefer to take the care of a postoperative woman who is collapsed and unconscious as a higher priority. The reason is that RN cannot delegate the aspects of nursing process to others in the critical situation for the patient safety. A patient condition can change quickly in acute care settings. So, RN with good clinical skills can make clinical decisions based on patient condition for a good patient outcome (Berman & Snyder, 2012). According to the Nursing and Midwifery Board of Australia (NMBA), registered nurse standards for practice presents that nurse is a responsible and accountable person who can think critically to deliver safe, sufficient and actual nursing care to the patient (2016). Moreover, RN will undertake the responsibility for I/V infusion and 1400 hours antibiotic administration and re-cannulation. RN cannot delegate this to enrolled nurse (EN) because EN is not competent to administer antibiotic I/V infusion and re-cannulation practices. Moreover, I/V medication administration is not under the scope of practice for ENs, they can perform this activity after the completion of I/V competency or certification (NMBA, 2016). However, RN can ask her to prepare the equipment for cannulation for the help.
The second right of delegation is the right circumstances. Even if an individual has the capability and can complete a certain task, it is important to reflect the circumstances prior to delegating. A nurse can assign the enrolled nurse to administer Mr. Esposito his preoperative medication and so he could leave the ward now for his cardiac catheterization. ENs are eligible to administer medications to the patients under their scope of practice (NMBA, 2016). However, EN must be under the supervision of the registered nurse to while conducting the given tasks which is another right of delegation. RN also will also assign the care of the Mr. Smiths’ visitor if he is still in the ward. EN should be undertaking the task according to their level of competency (NMBA, 2016). Moreover, nurse will ask the ward clerk to arrange someone to fix the overflowing staff toilet and to call the cleaner for cleaning the floor whenever RN get time to talk about this task because at the moment she is busy in saving someone’s life. In the healthcare team, ward clerks also involves to provide organizational support to heath care settings (Armstrong, Rispel, & Penn-Kekana, 2015). Moreover, registered nurse will delegate the AIN to assist her while caring the unconscious collapsed patient because the role of the AINs is to assist RNs and ENs in the provision of patient health care. Furthermore, Nurse may ask to VMO to talk to the NUM about the medication error because NUM is the right person who act a as a leader and exhibits communication and problem-solving skills to handle this situation (Armstrong, Rispel, & Penn-Kekana, 2015).
Module 2 – Collaborative and Therapeutic Practice
ACTIVITY 2: ASSESSMENT
Motor neurone disease (MND). MND is a fatal neurogenerative disease, characterised by loss of lower motor neurone in the brain stem and spinal cord and upper neurone in the motor cortex (O’Brien, Jack and Douglas Mitchell, 2011). As disease progresses, motor neuron stops the stimulation of voluntary muscles and cause muscle wastage and weakness which further cause speech problems, swallowing difficulties, mobility issues, pain, discomfort, cognitive deviations, breathing problems and drooling (Williams, Philip-Ephraim and Oparin, 2014). Because of such type of symptoms in the MND, A multidisciplinary team work together to deliver synchronized care. A case manager, doctor, neurologist, allied health professionals, MND clinic nurse, palliative and a respiratory specialist are the most important in the MDT (Ndoro, 2014). Firstly, the general practitioner (GP) provides general medical care and liaises with the neurologist for further case management (Harwood, McDermott, ; Shaw, 2012). Neurologist further arranges the investigations which are essential for analysis and management. Furthermore, nurse plays the function to provide continuing treatment and care to the patient (Ndoro, 2014). Occupational analysts focus to guide about home adjustment, diverse ways of carrying out everyday jobs and education on acquiring and adapting special utensils (Harwood, McDermott, ; Shaw, 2012). In addition, physiotherapists assist the patient to preserve physical movement and mobility by providing mobility aids and muscle strengthening exercises (Ndoro, 2014). Moreover, the role of speech pathologist is to assess the person’s communication and swallowing needs and advise appropriate consistency of food and fluids (Williams, Philip-Ephraim and Oparin, 2014). Dieticians assess the specific nutritional requirements of the patient. Social worker helps the patient to receive appropriate available services that might be helpful in counselling, housing, legal and other financial issues and palliative care workers help to manage the disease symptoms to promote comfort and improve Quality of life (MND Australia, 2016).
The case coordinator and team leader would be the key persons who are the in charge of leading the health care team who initiate the effective and timely response when need changes (MND Australia, 2016). The team leader’s functions are to ensure to keep interaction with the person and evaluate the special needs. Moreover, the team coordinator also communicates with other team members to deliver detailed care (MND Australia, 2016). Team leader also organises the team conferences and support them with debrief. Anyone from the health care team may be act as team leader who is more experienced. Team leader always work together with the team, associates to run detailed information of the patient needs and give directions to them (MND Australia, 2016).
Activity – Case study 4
In the given case study, the main key issues are regular employee turnover in the physiotherapy department and a new physiotherapist work mostly found absent in the weekly ward meetings in the rehabilitation unit, and this member not providing any kind of significant data to the other team members. This member always found verbally confronted whenever asked for the reasons for such problems. Face-to-face discussions involves in confrontations, in which someone is considered responsible. As a result, patient safety may be under threat if any conflict and any other dysfunctions occur in the team.
There are some approaches have been established that may help to solve conflicts in the workplace. Firstly, team leaders should develop a balance in their teams to foster communication that will assist group members to resolve issues (Overton, ; Lowry, 2013). Secondly, team leaders must continuously monitor the performance of their employees. Poor working skills in individual team members must be identified immediately in order to avoid problems in the group (Yang, 2014). This doesn’t mean that team leaders always require to expel the staff who has a poor performance immediately (Overton, & Lowry, 2013). Sometimes, it is vital to communicate with the physiotherapist, so he could explain about the situation that is happening (Tomajan, 2012).
Moreover, education, coaching and mentoring are the different methods to handle the conflicts. Team leader must provide training and education to the physiotherapist to solve the problems that he/she is facing during the job (Tomajan, 2012). When attitudes need to be changed and having the person to commit change, awareness can be carried to how a team member’s attitude negatively affects the team and attitude can be improved by invitation (Overton, ; Lowry, 2013). Thus, an education, effective interactions and powerful management aids are beneficial to promote self-efficacy of the worker and to control the disruptive behaviours in the given case (Tomajan, 2012)
Module 3 – Provision and Coordination of Care
Clinical Handover is vital to ensure the continuity of the patient care and patient safety. It is a key activity to enhance persistent wellbeing. In the given scenario, patient received from the ED to ward, after receiving the handover, nurse needs to ask of questions. As Mr. John Block came with abdominal pain, ED nurse did not mention about the pain score, pain severity and how pain is controlled in the ED? So, I will ask this concern to the ED nurse. Even, I need to ask how is the pain at moment? Moreover, patient has lost a 3kg weight in the past week, nurse will ask further clarification to know how did he lose the weight what was the reason? Moreover, patient is coughing, I will ask what specific treatment done in the ED to soothe the cough and any other percussions needed. I will ask ED nurse, why patient is on 1.5 L O2 via nasal prongs? Why he is on one hourly observations in the ED and were there any alterations in the vitals, if yes than what were the changes in the vitals and what was done to maintain the patients’ vitals? I will further ask about the nausea and vomiting. Is he eating and drinking? Why patient is NBM now, is he nil by mouth due to abdominal pain or for any surgical or diagnostic procedure? I will ask nurse how patient is mobilizing because he has history of CVA, he may be using any mobility aid or assistance with ADLs and is patient at falls risk. As patient is going for chest X-Ray, it is important to ask if patient needs any specific paper or consideration when going to radiology. Nurse will also ask about Acute resuscitation plan as well, if he signed any consent.
After receiving the patient from the ED to ward, as a nurse I will conduct comprehensive assessment on Mr. Jones. According to Berman & Snyder (2012) assessment is a crucial aspect of the clinical practice for essential improvement in patient condition with implementing nursing interventions (Berman & Snyder, 2012). The comprehensive assessment of patient is important for the recognition of the clinical deterioration of the patient (Berman & Snyder, 2012). According to Farrell, Dempsey, Smeltzer, & Bare, (2014), nurse will conduct the following further assessments on Mr. John
? Physical examination: –
• Airway: chest sounds, secretions, cough, airway support artificially
• Breathing: Rate of respirations, rhythm, breathing pattern
o Ventilator and oxygen support with adequate delivery.
Circulation: pulses (location, rate, rhythm and strength); centrally and peripherally eg. pink and warm.
o Skin integrity: pressure area, injury and colour of skin.
• Disability: Fall risk assessment including safe environment, provide physical aids, glasses, hearing aids, prosthetics.
• Nutritional assessment: appetite, height and weight as age appropriate, digestion capability, nausea or vomiting and nutritional supplements,
• Renal function assessment
o Patients overall Wellbeing can be assess by looking these factors:
? Psychological, emotional and state, comfort, sleeping pattern, social support, Mental Status Examination (MSE)
Module 4 – Time Management and delegation
Primary nursing, patient allocation, task assignment and team nursing are some of the allocation methods. Patient allocation meaning is to allocate total care of patients in which nurses are allocated to care group of patients that is very popular method of allocating patient loads. Task allocation is a method in which work is allocated to the nursing and ancillary workers based on the staff work experience. The RN outlines the more complex tasks, whereas lesser skilled staff more routine activities such as personal care.
Team nursing is a model where team of nurses and other non-professional nursing personnel’s such Nursing assistants (AINs) work together to provides all the care to specific group of patients. In this model RNs is leader who always supervise the enrolled nurses and AINs. In this RN perform direct patient care whereas other team members provide direct care to the assigned patients. Primary nursing model of care is when one nurse focuses to comprehensive care of one patient only. In the given activity, RN will allocate the patient by skill mix and experience based on the team nursing model.
1- RN+EN+AIN = This first group will take responsibility of total 12 patients which includes seven patient who went for surgery in the morning, two patients who have I/V access and due for antibiotics in this shift, three patient who does not have I/V access.
2- RN(NUM)+AIN+AIN= this second group will also take the care of total 10 patients which includes seven patient who went for surgery in the morning, two patients who have I/V access and due for antibiotics in this shift. One patient, who does not have I/V access.
Other RN is acting as a NUM as well, so she might have more workload, it might be good to allocate more patients to RN+EN so then they can work together. Moreover, both RNs are taking seven -seven those patients who went for the surgery when they will come back to the ward. All the 14 patients will not come back to the unit together on the same time, they will come back one by one. So, nurse will prioritize the care of the post-operative patients accordingly when RNs will receive the postoperative patients. Moreover, team nursing, and skill mix the best way to deliver the care in the hospitals. Registered nurses are responsible and accountable persons to deliver safe and comprehensive care to the patients. According the scope of practice the RNs, they can perform complex tasks such as conduct the assessments, administer I/V medications and infusions, and handle the postoperative patient with critical thinking, whereas, the ENs practice with the assistance of RNs as a part of the health care professional and become competent in the provision of patient care (NMBA, 2016). Enrolled nurses support well-being of consumers by assist them in their daily activities, identify variations in patient’s health conditions and notify to RN, medication administration and assume other nursing procedures adequate to their assessed proficiency. ENs are responsible for their nursing practice by delivering safe and appropriate nursing care. However, the role of the Assistant in Nursing is to support registered nurses (RN) and enrolled nurses (EN) in the delivery of general patient care Nursing assists can respond to the patient buzzers, take the vital signs, perform personal hygiene, provide bedpans, assists patient with meals, help patients with in ADLs etc.
Armstrong, S. J., Rispel, L. C., & Penn-Kekana, L. (2015). The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox? Global Health Action, 8, (10), 3402. doi:10.3402/gha.v8.26243
Berman, A., & Snyder, S. (2012). Clinical handbook for Kozier & Erb’s fundamentals of nursing: Concepts, process and practice (9th ed.). Boston: Pearson.
Berman, A., Snyder, S., Kozier, B., Erb, G., Levett-Jones, T. Dwyer, T….; Stanley, D. (2010). Kozier and Erb’s fundamentals of nursing, First Australian Edn. Pearson, Frenchs Forest
Farrell, M., Dempsey, J., Smeltzer, S., & Bare, B. (2014). Smeltzer and Bare’s textbook of medical-surgical nursing (Third edition; Third Australian and New Zealand ed.)
Harwood, C., McDermott, C. and Shaw, P. (2012). Clinical aspects of motor neurone disease. Medicine, 40(10), pp.540-545. 10.1016/j.mpmed.2012.07.003
Marriner-Tomey, A. (2009). Guide to Nursing Management and Leadership (8th ed.). St. Louis, Mo.: Mosby Elsevier Pte. Ltd.
MND Australia (2016). Australia Fact Sheet on Multidisciplinary Teams. Retrieved from http://www.mndaust.asn.au/Get-informed/Information resources/Living_better_for_longer/WEBMND-Australia-Fact-Sheet-EB3- Multidisciplinary.aspx
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/Professional-standards/registered-nurse-standards-for- practice.aspx
Nursing and Midwifery Board of Australia. (2016). Fact sheet: Enrolled nurse standards for practice. Retrieved from | http://www.nursingmidwiferyboard.gov.au/Codes- Guidelines-Statements/FAQ/Enrolled-nurse-standards-for-practice.aspx
Nursing and Midwifery Board of Australia. (2016). Enrolled nurses and medicine administration fact sheet. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/FAQ/Enrolled-nurses-and-medicine-administration.aspx
Ndoro, S. (2014). Effective multidisciplinary working: the key to high-quality care. British Journal of Nursing, 23(13), pp.724-727. 10.12968/bjon.2014.23.13.724
O’Brien, M., Jack, B. and Douglas Mitchell, J. (2011). Multidisciplinary team working in motor neurone disease: patient and family carer views. British Journal of Neuroscience Nursing, 7(4), pp.580-585. 10.12968/bjnn.2011.7.4.580
Overton, A. R., & Lowry, A. C. (2013). Conflict Management: Difficult Conversations with Difficult People. Clinics in Colon and Rectal Surgery, 26(4), 259–264.
Tomajan, K., (2012). Advocating for nurses and nursing. OJIN: The Online Journal of Issues in Nursing, 17(1), 1-4. 10.3912/OJIN.Vol17No01Man04
Williams, U., Philip-Ephraim, E. and Oparah, S. (2014). Multidisciplinary Interventions in
Motor Neuron Disease. Journal of Neurodegenerative Diseases, 2014, pp.1-10. 10.1155/2014/435164
Yang, Y. (2014). Transformational leadership in the consumer service workgroup: competing models of job satisfaction, change commitment, and cooperative conflict resolution. Psychological Reports, 114(1), 33-49. doi: 10.1177/0033294116657586