Reference no: EM132377845

Module – Provision and Coordination of Care

Assessment and problem solving

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:

1. What further questions will you need to askthe nurse?

2. List specifically what further assessments you would complete when the patient arrives onto the ward & provide your rationale for each assessment.

3. Upload the above answers to your Professional Portfolio on LEO. This forms part of your assessment for this unit.

ACTIVITY 2

To understand more about the Clinical Reasoning Cycle please read chapter 1 of the prescribed text. Whilst reading this chapter identify ways that you can incorporate the Clinical Reasoning Cycle into your clinical placement.

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

Please read the article by Felton (2012). While you read the article take particular note of how important it is to take accurate vital obs, and how your thorough assessment can have a major impact on the patient’s prognosis.

Felton, M. (2012). Recognising signs and symptoms of patient deterioration. Emergency Nurse, 20(8), 23-27.

During clinical placement choose a patientthatis of interest to you. Perhaps a patient that you found challenging in terms of linking the theory together. Fill in the Clinical Reasoning Cycle Worksheet that can be found on the LEO page to assist with your understanding of that patient’s condition and how the Clinical Reasoning Cycle can be of benefit to you.

Upload the worksheet along with your ANSAT to Nursing Professional Practice LEO page 2019. This is a part of Clinical Portfolio and a hurdle requirement for this unit.

Development, implementation and evaluation of planned care based on assessment findings

ACTIVITY 3

You have been allocated 4 patients this afternoon shift commencing at 1300hrs. You have received handover for the following patients:

Bed 1: A 45 year old female presented to ED with a haemothorax, and had an ICC inserted. She arrived on the ward at 1230hrs. She has an IVC in-situ in her left antecubital, and currently has 100ml/hr of NaCl 0.9% running. She has a morphine PCA which she is using appropriately, and it has kept her settled and pain-free. She is on 3 doses of prophylactic cephazolin 8 hourly, and she has received a dose in ED at 1200 hrs. There is an IDC in-situ, which is draining 35ml/hr, the urine appears cloudy. She will require a CXR in the morning, physio assessment, as well as a pain review by the medical team. Diet and fluids as tolerated.

Bed 2: A 23 year old male has been admitted with suspected cholecystectomy, and has been placed on the evening emergency theatre list. He is complaining of severe abdominal pain with a numerical pain score of 8/10. He has been fasting for 8 hours since he came to the ward this morning. He has no IV inserted, and has been prescribed PRN oral paracetamol and oxycodone for pain.

Bed 3: A 17 year old male who is Day 4 following a laparoscopic appendectomy with perforation, and is ready to be discharged home. He has been on PRN paracetamol and oxycodone, and has been prescribed amoxicillin and lactulose for use at home. His parents will pick him up at 1700hrs, once they have finished work.

Bed 4: Dirty bed. A new patient is to come up from ED in 1 hour with abdominal pain of unknown origin. She has no relevant past medical history, and has been booked in for an abdominal ultrasound at 1600 hrs. She is fasting and has not yet been prescribed any analgesia.

Now that you have received a handover, please complete the following tasks:

1. Assess your patient’s needs and decide what tasks or nursing care needs to be done

2. Draw up a shift planner with an hourly plan.

3. Prioritise these hourly tasks by rating it A, B, C or D – do the most important first.

Communication of assessment, planned care and evaluation of planned care – handover and documentation

ACTIVITY 4

1. Scovell, S. (2010). Role of the nurse-to-nurse handover in patient care. Nursing Standard, 24(20), 35-39.

Scovell (2010) identifiesthat handover assumes an almostreligioussignificance in a nurse’s day before going on to describe the variousroles that handover assumesin nursing culture. Therefore, apartfrom being a simple information sharing event, handover has a significant influence on the day-to-day,shiftto shift experience of nurses.

2. Street, M., Eustace, P., Livingston, P.M., Craike, M.J., Kent, B. & Patterson, D. (2011).

Communication at the bedside to enhance patient care: A survey of nurses’ experience and perspective of handover. International Journal of Nursing Practice, 17, 133- 140.

According to Street et al. (2011), the primary purpose of handover is “to provide accurate, up-to- date information about the patient’s care, treatment, use of services, current condition, and any anticipated changes in that condition” (p. 134). However dangers to effective handover include omission of vital information, inclusion of irrelevant &/or speculative information, and poor handover technique.

Please read the Scovell and Street articles by clicking on the link. You may not look at handover the same way again after realising what a significant event it is. Take note of the practices you may have experienced already as a student and consider how these two articles can help you to be more effective when giving your own handover now and in the future.