collecting a Basic Patient History

Question 1. You are collecting a Basic Patient History; formulate one closed ended question you would ask when interviewing the patient. (1 mark)

Do you take medications as per the prescription and the advice of the doctor?

Question 2. You are collecting a Basic Patient History; formulate one open-ended question you would ask when interviewing the patient. (1 mark)

How are you feeling now after you have stopped taking the two medicines which have caused a reaction in your body?

Question 3. Harking back to your Week 3 tutorial when introducing yourself to a patient for the first time it is key to establish a rapport to institute a strong and effective therapeutic relationship. Describe what key attributes you need to express when meeting a patient for the first time. (2 marks)

When meeting the patient for the first time, I will try to maintain eye contact with the patient. Further, I will also show empathy as well as communicate with the patient in a simple way. This will help the patient to share his/her problems and open up to me. On the other hand, I must also try to listen to the patient cautiously and assure that I will keep his/her word.

Question 4. You are on clinical placement and you are going to measure a patient’s blood pressure. How will you know if they were giving you implied consent to begin the procedure? (1 mark)

When the patient extends his/her arm, it implies that the patient has given his/her consent to check the blood pressure.

Question 5. Why, when on clinical placement, is it important to identify yourself as a Registered Nursing Student to the clients you are caring for? (2 marks)

It is important to identify myself as a registered nursing student to the client that I am caring for because sometimes the patients are not willing to perform the task that is the nurses ask them to do. It is the responsibility of the patient to adhere to the scope of practice and the actions that are provided to them by the nurse. In some cases, it is found that the patients do not want to take medicines or injections on the supervision of the nurse and thus in such circumstances, it is the responsibility of the nurse to express herself as a registered nurse towards the patient.

Question 6. List the key factors that influence the body’s ability to adjust fluid and electrolytes.(3 marks)

The key factors that influence the ability of the body to adjust the fluid and maintain electrolytes are environment, exercise as well as the overall health of the patient.

You are on clinical placement in a Medical Ward at a tertiary hospital You are looking after Harold Skimpole, a 69-year-old man who was admitted with weight loss. He has told the nurse that he has lost interest in many of his normal activities since his wife died. You decide to read the patient notes to learn more about Harold’s admission to hospital. Below are the nursing notes written by the previous nurse looking after Harold.

Question 7. Identify which “Guidelines for Recording” were not followed by this nurse.

(3 marks).

The factual aspects of the records have not been mentioned by the nurse. Further, the accurate intake of medicines and food by the patient has also not been discussed by the nurse. The record is not complete as well as it lacks an organised way. The confidentiality aspect of the patient has not been maintained in writing the report.

Note Questions 8 to 12 are connected to this case study.

HCCC (Health Care Complaints Commission NSW) versus Nurse Z

Case Heard at the NSW Nursing and Midwifery Tribunal 24th April 2017.

Nurse Z had graduated as a Registered Nurse in 2010.

Nurse Z’s work history shows that he started a new position as a Registered Nurse in a perioperative and critical care ward on 12 January 2015 with three days of orientation to the unit.

From 18 February 2015, the Nurse Unit Manager (NUM) and Clinical Nurse Educator (CNE) on the ward began to respond to concerns raised by staff members regarding Nurse Z’s “nursing competence.”

Management’s concerns were directly discussed with Nurse Z and rosters were altered to ensure senior nursing staff were rostered to work with him for every shift he worked.

A record of “incidents and performance development strategies” for Nurse Z while employed on the ward shows that in March 2015, the NUM and CNE advised Nurse Z that they “expected more nursing competence from a Registered Nurse.” Nurse Z responded by requesting more in-service training. Although Nurse Z attended 15 in-service sessions specifically designed to address his practice deficits, problems continued to occur with greater frequency over the year to January 2016.

Over a twelve-month period, documented practice concerns collated by the NUM and CNE included

1. The respondent did not undertake a patient load independently during the time.

2. He attended 15 in-service training sessions.

3. He was attributed with four medication errors and eleven “near misses” (defined as an error but averted only by interventions by registered nursing staff).

4. He had made eight documentation errors.

5. He was associated with 16 clinical knowledge issues and 21 clinical care issues, 22 clinical communication issues as well as an ongoing lack of incorporating correct hand hygiene practices (Case continues next page)

An external assessor (a Registered Nurse from a different facility) conducted a performance assessment which concluded:

1. His practical nursing skills and competence was marginal.

2. Serious inadequacies in knowledge relating to responses to emergency situations were found.

The external assessor recommended that Nurse Z should work with another Registered Nurse, all care to be supervised until he could demonstrate safe emergency care and management of an acutely unwell child. The assessor stated she expected a new graduate Registered Nurse to perform at a higher level.

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Question 8. On page 66 of your textbook under the heading of Professional Governance there is a list of notification categories. Which classification/s does the case study you have reviewed today include? It could be more than one. (3 marks)

Question 9. Identify two of the standards below this nurse has breached and explain your selection. (Maximum 100 words). (4 marks)

Standard 1: Thinks critically and analyses nursing practice: The registered nurse lacked the skills of nursing practices and thus he was assigned duty under the senior nurse. This has created a problem and thus the nurse has failed to tackle the different nursing practices adequately. Standard 4: Comprehensively conducts assessments: In carrying out the assessment, the registered nurse has failed to carry out the diagnosis in a proper way. Many errors have been done by the registered nurse and thus it is regarded as a breach of practice.

Registered Nurse Standards for Practice

 Standard 1: Thinks critically and analyses nursing practice

 Standard 2: Engages in therapeutic and professional relationships

 Standard 3: Maintains the capability for practice

 Standard 4: Comprehensively conducts assessments

 Standard 5: Develops a plan for nursing practice

 Standard 6: Provides safe, appropriate and responsive quality nursing practice

 Standard 7: Evaluates outcomes to inform nursing practice

Question 10. Identify two elements below this nurse has breached and explain your selection. (Maximum 100 words). (4 marks)

Element of the Code # 2: Nurses and Practice: It can be said that the registered nurse did not carry out the nursing practices with proper care. As a result of this, he has faced different types of problems in carrying out the task and thus he failed to do the task with a proper level of competence. Element of Code # 3: Nurses and the Profession: The registered nurse did not take his profession seriously. Despite repeated warnings, he has failed to carry out the task with great care and thus has faced complaints from his colleagues, seniors and the patients.

The ICN Code of Ethics for Nurses.

 Element of the Code # 1: Nurses and People

 Element of the Code # 2: Nurses and Practice

 Element of the Code # 3: Nurses and the Profession

 Element of the Code # 4: Nurses and Co-Workers

Question 11. Identify two principles below this nurse has breached and explain your selection. (Maximum 100 words). (4 marks)

Principle 2: Person-centred practice: The registered nurse has failed to provide person centred practice in assisting the patient. There were different types of problem and development registered strategies faced by the nurse in carrying out the nursing practices. The registered nurse has breached this person-centred practice in a proper way. Principle 4: Professional behaviour: The registered nurse has failed to carry out the nursing practices in a systematic way. Different errors were done by the nurses and thus this has highlighted that the registered nurse lacked professional expertise in carrying out the task.

Code of Conduct for Nurses

 Principle 1: Legal compliance

 Principle 2: Person-centred practice

 Principle 3: Cultural practice and respectful relationships

 Principle 4: Professional behaviour

 Principle 5: Teaching, supervising and assessing

 Principle 6: Research in health

 Principle 7: Health and wellbeing

Question 12. Working in partnership with Nurse Z could be professionally distressing.

When you reflect on the case study which key moral-framework are you most drawn to, to clarify this challenging situation, i.e. Consequence-based, Duty-based or Caring/virtue based?

Choose one of the moral frameworks (from Week 7) and discuss how this nurses actions/ behaviours might challenge your moral position related to patient care.

(3 marks)

Question 13. Joel Harmon identifies as a non-indigenous Australian has had a two pack a day smoking habit. He has smoked for 35 years.

He has a severe chest infection.

Previous medical conditions: three (3) chest infections but has never been hospitalised. At present he states he feels breathless and is finding it difficult to shower and dress himself.

Using the nursing diagnosis as the starting point develop a goal and implement care to resolve Joel’s problem. (3 marks)