SUGGESTED TEMPLATE: NRSG355 WRITTEN ASSESSMENT
This is a guide only – you may write this as a long form essay as long as you provide headings for each question.
Q1: Prioritisation and delegation (module one)
You may use a table here to address each of the competing priorities you need to manage, or you can write descriptively - either is acceptable
Ensure you justify all of your choices in depth, using references to support your claims.
Issue Priority Action and rationale
Q2: Collaborative and Therapeutic practice (module two)
(a) The Multidisciplinary team
(b) Case study name: choose one of the available in module two
Q3: Provision and coordination of care (module three)
Q4: Time management and delegation (module four)
Reference List (APA style)
Assessment One: Professional Portfolio
The NRSG355!Professional Portfolio aims to assist students prepare for their graduate practice. This assessment entails a series of professional practice questions associated with contemporary clinical practice issues.
Due date: Weighting: Length and/or format Purpose:
Monday!1stOctober!–6.00 PM.
2000 words(500 words per question)
Purpose of this essay:To enable students to develop clinical reasoning, delegation and prioritisation skills.
Online Modules
• These online modules are for you to work through at your own pace throughout the semester and are due on 1st October 2018. The assessment tasks are embedded into the modules. Please note that module 3 requires you to do some tasks on clinical therefore you need to be prepared regarding what is required if you have a placement early in the semester.
• 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.
• Module 1 - Critical thinking clinical decision making professional developmentFile 257.3KB PDF document
• 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.
• Module 2 - Collaborative and Therapeutic PracticeFile 183.7KB PDF document
• 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.
• Module 3 - Provision and Coordination of CareFile 321KB PDF document
• Module 3 Activity 2 Verbal HandoverFile 2.5MB Audio file (WAV)
• Clinical Reasoning Cycle WorksheetFile 396.7KB Word document
• 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.
• Module 4 - Professional PracticeFile 192.8KB PDF document
NRSG355 Clinical Integration: Towards Professional Practice
Module 1 – Critical thinking, clinical decision making and professional development
Clinical decision making - problem solving and prioritising
This section is borrowed from a module prepared for the High Dependency elective but is relevant to all students approaching graduation and registration.
In the Australian College of Critical Care Nurses (ACCCN) text on Critical Care Nursing, clinical decision making is described as integral to critical care nursing practice (Aitken, Marshall & Chaboyer 2015). This observation is not only true for Critical Care, but is pertinent for all nursing. Clinical decision making is a cognitive process used to understand the significance of patient data in order to identify and diagnose actual and potential patient problems before arriving at a clinical decision regarding appropriate interventions to resolve the problem and ensure optimal patient outcomes. The foundation stones of clinical decision making are clinical information and theoretical knowledge (Aitken et al, 2015).
It might be tempting to see data collection as the simpler of the two foundations of clinical decision making; however, the complexity of some patients and the overwhelming amount of data available via various technologies brings its own challenges. In order to attend to this complexity it is necessary to draw on the basics of patient assessment and to be systematic in the collection and interpretation of data.
While monitoring and assessment of patients can include technology, you already have the basic skills required to assess your patients in any setting. It is important to remember that at the core of all clinical decision making is a full and thorough assessment of the patient. To this end, recording
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and interpreting basic vital signs is the first, crucial, foundation step in patient assessment. Alysia Coventry (ACU) and Malcolm Elliott (ex-ACU lecturer) have written an article on patient assessment in critical care. Alysia and Malcolm propose that:
“Nurses have traditionally relied on five vital signs to assess their patients: temperature, pulse, blood pressure, respiratory rate and oxygen saturation. However, as patients hospitalised today are sicker than in the past, these vital signs may not be adequate to identify those who are clinically deteriorating” (Elliott & Coventry, 2012).
Clinical decision making is a component of the clinical reasoning process that the average nurse performs 2-3 times per minute (Aitken et al, 2015). It takes time, practice, and training to hone this skill. As mentioned already, there is an abundance of technology we can draw on to facilitate patient monitoring and assessment. You might be feeling overwhelmed at the prospect of patient assessment and data collection in the acute care environment. However, you have had plenty of opportunity to practice patient assessment during your course so far and will have ample opportunity on your up- coming clinical placements. You will also get plenty of opportunity to observe and be involved in clinical decision making processes. You already have the basics of clinical reasoning as part of your professional repertoire. During the intensives you will develop skills that allow you to link your critical thinking using the framework of the Clinical Reasoning Cycle (Levett- Jones, 2018). Draw on these basics and learn from the clinicians you work with during your placements.
ACTIVITY 1
Reading:
Please read the article by Coventry and Elliott. 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.
Elliott, M. & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10), 621-625.
Sharing assessment data & putting clinical decisions into action
The challenge
As mentioned above, a particular challenge associated with the multidisciplinary team is the nurse- physician relationship. The factors that contribute to this challenge are also relevant to other nurse/co-worker interactions. However, there is evidence that suggests a positive relationship between physicians and nurses contributes to improved patient outcomes (Benner, Tanner & Chelsa, 2009).
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It is important that you don’t get intimidated by physicians or other health care practitioners; but, that you recognise your limitations while ensuring appropriate, professional communication channels are maintained.
ACTIVITY 2 Reading:
Benner et. al., (2009) have dedicated a chapter to the nurse-physician relationship. Follow this link to “Expertise in practice; Caring clinical judgement, and ethics 2nd Ed” by Benner et al, and then click on Chapter 11: The nurse-physician relationship: negotiating clinical knowledge.
The chapter is quite long and includes a number of clinical scenarios that are used to illustrate specific aspects of the nurse-physician relationship. There is specific reference to junior nurses in some of the scenarios.
Please take some time to identify the aspects of each scenario that relate to the neophyte RN and their place in this key clinical relationship including the pivotal role of the RN as patient advocate.
The solution = Communication
Central to the nurse’s role is the diagnosis, treatment, and evaluation of patient responses to actual &/or potential health problems (Campbell, Gilbert & Laustsen, 2010). However, as alluded to already, this is not done in isolation; but as a member of a team. The ability to communicate a patient’s condition, response to therapy, and plan of action is a foundation on which effective team- work is built. This communication can be between the nurse and other nurses, the patient, the patient’s family, and other members of the multidisciplinary team (Campbell et al, 2010). Therefore different strategies for communication are necessary in order to facilitate effective communication depending on the setting, the issue, and the participants. The importance of effective clinical communication cannot be overstated. In an investigation of nursing handover practices, Street, Eustace and Livingston et. al., (2011), report ineffective communication as the most frequently cited cause of sentinel (adverse) events in the U.S and Australian hospitals. Handover will be explored in more detail later in this module.
ACTIVITY 3
Reading:
Please read Chapter 7: Communication-mastering collaboration, delegation and documentation from Campbell, L., Gilbert, M. & Laustsen, G. (2010) Clinical Coach for Nursing Excellence
when you read the chapter you can skip over the general discussion of communication techniques if time is short; however, please focus on the key aspects of the rest of the chapter. In particular, pay close attention to the sections on ISBAR, delegation and documentation.
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Reading:
Casey, A. & Wallis, A. (2011). Effective communication: Principle of Nursing Practice. Nursing Standard, 25(32), 35-37.
Please read the Casey, A. & Wallis, A. (2011) article by clicking on this link:
Please take particular note of the principles described under documentation and reporting.
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* Assessment Question One
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.
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References: Module 1
Aitken, L., Chaboyer, W. & Marshall, A. (2105). Scope of critical care practice. In: L. Aitken, D. Marshall & W. Chaboyer (Eds.). ACCCN’s Critical Care Nursing, 3rd Ed. Chatswood, NSW: Elsevier.
Benner, P., Tanner, C. & Chelsa, C. (2009). Expertise in practice; Caring, clinical judgement, and ethics 2nd Ed. New York: Springer.
Campbell, L., Gilbert, M. & Laustsen, G. (2010). Clinical coach for nursing excellence. Retrieved
from http://ezproxy.acu.edu.au/login?url=http://ACU.eblib.com/patron/FullRecord.aspx?p=474457
Casey, A. & Wallis, A. (2011). Effective communication: Principle of nursing practice. Nursing Standard 25(32), 35-37. Retrieved from
http://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011015656&site=ehost-live
Chaboyer, W. & Hewson-Conroy, K. (2015). Quality and safety. In: L. Aitken, D. Marshall & W. Chaboyer (Eds.). ACCCN’s Critical Care Nursing, 3rd Ed. Chatswood, NSW: Elsevier.
Elliott, M. & Coventry, A. (2012). Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10), 621-625. Retrieved from
http://ezproxy.acu.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm &AN=2011651321&site=ehost-live
Images:
Decision Making retrieved from: http://www.mindwerx.com/articles/critical-thinking-decision-
making
Staff station retrieved from: http://acanthajohnson.blog.com/2011/06/08/cna-training-programs/ Thinking Statue retrieved from:
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