Critical thinking and Decision making
E-module 1:
1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate with critical thinking and decision making skills.
2: Document your rationales in detail.
Parham, (2012) states that Registered Nurses (RNs) are charged with the key responsibility of prioritising care whereby they ensure that patients receive safe and quality care within clinical settings. Care prioritization should be based on the condition of a patient as well as the severity of the disease. Critical thinking and decision making skills are some of the important parameters that nurses need for them to prioritize care (Levvet-Jones, 2013). From the scenario, I would first give priority to the elderly woman who has collapsed on the floor.
Usually, an unconscious condition can predispose an individual to situations that are life threatening when urgent medical interventions are not provided (Parham, 2012). I will employ the primary survey technique DRABCDE so that I can optimize the condition of the patient quickly and initiate met call or code blue if necessary (Thim et al, 2012). Usually, post-operative individuals are predisposed to the risk of clinical deterioration.
In managing the elderly woman my primary concern would be to stabilize her airway. This is because the analgesic and anaesthetics used during the operation depress the respiratory system and this can worsen her condition if not well managed (Farrell & Dempsey, 2014). Moreover, I will maintain contact with the met call teams for documentation and medication.
Similarly, I would assign tasks to the enrolled nurses (EEN) as well as assistants in nursing (AINs) to evaluate and offer support to the individual that fainted in the living room to reduce the potential risk. The delegation of these tasks will be done according to the scope of practice of an individual. I will frequently supervise them to ensure there is patient safety and legal requirements are observed (Eager, Cowin, Gregory & Firtko, 2010).
I would also give priority to Mr Esposito who is meant to leave the ward for cardiac catheterization and requires perioperative medication. I will therefore ask an EEN to administer the medication to reduce the risk and complications encountered after surgery (Farrell & Dempsey, 2014). Moreover, I will double check the patient’s perioperative check list and consent to avoid any legal or ethical issues (Nursing and Midwifery Board of Australia, 2015). I would then request the AIN to help in transferring Mr Esposito to have cardiac catheterization.
Thereafter, I would call the ward clerk and inform him about the toilet overflow; this is a code yellow criteria due to crisis and mechanical damage (Government of Western Australia, 2013). The overflow may increase chances of infections spreading and smell in the hospital environment, and therefore, proper and timely intervention should be put in place by the members responsible (Government of Western Australia, 2013).
In the patient that is due for antibiotic, I will check the IV cannula site to determine whether there is any sign of infiltration or inflammation. Any sign of inflammation will prompt me to remove the cannula and I will inform the doctor on the need for the patient’s recannulation. I would also notify the EEN to prepare antibiotics for Mrs Chew and I will supervise the EEN closely when she is preparing the antibiotics.
According to the Nursing and Midwifery Board of Australia (2015), enrolled nurses can administer most medications but they are not competent enough to administer IV antibiotics without completion of the IV medication competency. I will lastly discuss with the VMO about medication error that were recorded the previous week. I will then convey the information to the next shift staff to offer clarification of this discussion to avoid similar risks to patient and clinicians.
References
Eager, S. C., Cowin, L. S., Gregory, L., & Firtko, A. (2010). Scope of practice conflict in nursing: A new war or just the same battle? Contemporary Nurse: A Journal for the Australian Nursing Profession, 36(1/2), 86-95. Retrived from http://search.informit.com.au/browseJournalTitle;res=IELHEA;issn=1037-6178
Farrell, M., & Dempsey, J. (2014). Text book of medical surgical nursing (3rd ed.). Philadephia PA
Government of Western Australia, (2013). Emergency codes in hospitals and health care facilities. Retrieved from http://www.health.wa.gov.au/CircularsNew/pdfs/12974.pdf
Levvet-Jones, T. (2013). Clinical reasoning: Learning to thinking like a nurse. Pearson, Melbourne Australia,
Nursing and Midwifery Board of Australia. (2015). Enrolled nurses and Medication Administration Fact Sheet. Retrieved from:file:///C:/Users/Owner/Downloads/Nursing-and-Midwifery-Board—Fact-Sheet—Enrolled-nurses-and-medicine-administration.PDF.
Parham, G. (2012). Recognition and response to the clinically deteriorating patient. Australian Medical Student Journal, 3(1), 18-22. Retrieved from: www.amsj.org/ Thim, T., Krarup, Grove, Rohde, & Lofgren,. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of General Medicine,117. http://dx.doi.org/10.2147/ijgm.s28478
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