Clinical Reasoning Cycle For A Patient With Uncontrolled Diabetes And Obesity

Consider the patient situation

1. My first priority would be the elderly postoperative patient, for which I will initiate an emergency code blue situation requiring immediate medical help. My second priority would be the case situation of Mrs. Chew, for which, delegating the task to the NUM would be appropriate for management. The requiring administration of medications to Mr. Esposito would be the third priority, for which appointing the newly enrolled nurse would be appropriate. My fourth priority would require management of the visitor who is associated with the patient Mrs. Smith by delegating the work to the AIN who can further delegate the task to additional professionals, would suit best. The fifth priority concerning my duties would entail the management of the blocked toilet, for which delegation of the activity to the ward services would be appropriate. The sixth priority would be management of error during medication.
2. My first priority would be the elderly postoperative patient. The rationale behind this is the severity of her condition, since she has encountered a state of unconsciousness, for which immediate treatment is required for treatment. Further, in the situation concerning prolonged lack of treatment of a fall, there may be a number of fatal negative health consequences such as injuries to the head and face, as well as possibilities of reduced mobility and fractures. For this reason, this case is my first priority, resulting in calling for an emergency medical team through a code blue. My second priority would be the case highlight of Mrs. Chew. The rationale behind this is her prolonged deprivation of necessary tissues, infusions and antibiotics. For this task, delegating the NUM would seem appropriate, since I will be occupied with the elderly postoperative patient and the newly enrolled nurses would lack enough competence for this case management due to their relative occupational inexperience. My third priority would be Mr. Esposito for whom no emergency has been reported, hence outlining the rationale for this decision. For this task, delegation to the newly enrolled nurse would seem appropriate, the rationale being that this activity requires to emergency specification and is within her new expertise. For my fourth priority, I have selected the case of Mrs. Smith’s visitor, the rationale being that she is an outsider and it will not be possible for the nurses to manage her in the critical units. Hence, delegation of this activity to the AIN would be appropriate, since she call appoint the required emergency ward along with required doctor for the purpose of management. Finally, the rationale behind the fifth priority, that is management of the blocked toilet, is due to its non critical and non medical nature. Hence the ward clerk would be ideal in management of the situation, who would use required maintenance services. The sixth priority would be the error concerning medication, with the rationale being the already present delay and requiring merely my reasoning. There are immediate emergencies at hand, and hence, this task would be done at last due to its lack of emergency and a week’s delay being already present.

1. The act of communication conducted by a team comprising of multidisciplinary professionals, is dependent upon the severity and rate of emergency outlining the disease. The additional factor determining the communication activities performed by a multidisciplinary team, would involve the status of health of the concerned patient. Hence, an interplay of this factors leads to the initiation of appropriate communication between patients, which finally leads to the decision concerning the functioning members of the concerned multidisciplinary team (Horton, Lane & Shiggins, 2016).
2. The leading members of the concerned multidisciplinary team, would include the neuropsychologists and additional specialists associated with the him.
3. The care practices performed by the concerned multidisciplinary team, would aim to provide optimum treatment for the patients which are suffering from neurological disorders on a long term basis. The major members of this team, would include a general physician along with a specialist. The function of the specialist, would be to  emphasize the major core details pertaining to the symptoms of the disease as per his specialized discipline in the medical team. Prior to this, the general physician would be involved identifying the disease and its key features which would require treatment. Hence, for this purpose, professionals such as a neurologist and the occupational therapist has been appointed as the primary members of the multidisciplinary team.

1. As evident from the above case study, one can identify certain key issues especially concerning the presence of inequality and prevalence of the freedom for every employee to participate in the decision making process. Hence, the major issue here is the dominance exhibited by the medical team, possibly the medical officer and the associated medical professionals such as the psychiatrist and patient case manager, in undertaking key decisions, without providing equal opportunity to the additional non medical members in provision of equal say in the decision making process.
2. As a leader I will be required to adopt several important strategies for the purpose of ensuring adequate equality and participation in the decision-making process, which is relative absent in the workforce as evident in the above case study. One of the key methods to be used is to clearly communicate with the team members, concerning the importance of fairness and equality in participation of every member of the workforce, who are participating in the decision-making process. This may involve conductance of labor meetings and group discussion, where I would actively advocate the same (Adam Cobb, 2016). Additional strategies would involve educating the employees on the protocols of Workplace Health and Safety Standards, where prevalence of distress or bullying amongst any team member, may lead to legal repercussions and compensations (Powers, 2017). Another strategy which I may adopt is the provision of rewards and appreciation to the team members, irrespective of the amount of participation exhibited by every member in decision-making, in an attempt to curb the dominating behavior exhibited by the medical team. Communicating the importance of non medical professionals in the team to the medical staff would also be an additional strategy to reduce the dominance and initiate equity in the workplace (Jacob, 2015).

1. A number of additional questions are required to be asked from the nurse, for the purpose of obtaining information concerning the patient. One of the key data required for questioning, is the health condition of the required patient, prior to undergoing admission in the emergency and critical care department (Johnson, Sanchez & Zheng, 2016). Other questions which are required to be asked, would include the details of the medicine required by the patient, the method of diagnosis and treatment and most importantly, the results of the diagnostic procedures so conducted. In addition to these, information related to the appropriate methods required for assessment would also need questioning, along with the medical history details of the patient and the expected health outcomes of the patients, upon commencement of the required treatment procedures (Cowan et al., 2018).
2. After the patient has arrived in the required ward, the nurse may be entrusted with further duties to conduct the necessary assessment. Hence, an assessment tool known as PQRST may be utilized, which helps in obtaining information related to the amount of pain encountered by the patient (MacSorley et al., 2014). For this, the nurse is required to assess several factors such as those which related to position of the patient, along with provocation and pulling (P), factors which are qualitative (Q), features concerning the region of the pain along with level of radiation and referral (R3), factors which highlight how severe the pain is (S), and finally, temporal factors which highlight whether the pain has arrived in the past, how did it progress along with mode and time details of its onset (T3) (Downing et al., 2015).

Upon careful reading and observation of the required case study, we can derive certain information from the above, mainly the fact that a total of 14 patients have been required to experience surgical operative methods, amidst the total patient population group comprising  a total of 14 22 patients. Of these, the number of patients who have been granted usage to the procedures outlining intravenous requirements is 4, along with a total number of 8 patients, who are under the provision of conventional treatment procedures. Apart from the service which I am providing, the delegation of a nurse unit manager is also performed by an additional nurse. Additional members of the team, would include 1 enrolled nurse along with AINs, amounting to a group of 3. As evident in the case study, there is a need for the adoption of appropriate theoretical approaches, for the purpose of conducting adequate decision-making, which would further aim to provide quality treatment and care performance to the patients, further resulting in the positive health outcomes in the form of betterment in health. For this purpose, adoption of a team nursing approach would be an ideal solution pertaining to the management of the problem (Deravin et al., 2017). Hence, based on this, one of the key functions pertaining to the position of the NUM would emphasize on supervising the treatment and care procedures, which are received by the patient group of 22 patients. As evident from the case study, the patient who would require emergency and rapid supervision, are those who are encountered with surgical procedures. Hence, for the management of such critical care patients, the person who will be entrusted with greatest responsibility would be the registered nurse. This is because the registered nurse has garnered enough experience and professional in the management of patients belonging to critical situations pertaining to the post operative type (Smolowitz et al., 2015). Thus, in accordance to my duty as a registered nurse, I would promptly delegate 16 nurses for the management of such patients. In addition, I would also recruit the NUM, since she also possess enhanced expertise due to being a registered nurse. For the purpose of management of patients who are under administration of antibiotics through intravenous routes, I believe delegating the task to the enrolled nurse would be appropriate, since her reduced experience and expertise is ideal for such non-critical situations (Endacott et al., 2018). For the treatment and supervision of the group of patients who would require appropriate conventional and traditional care procedures, I believe delegating the newly enrolled nurses would be highly appropriate. Further, I believe that delegating the same task to the AINs would be ideal for the situation, since they will be able to help the newly enrolled nurses in the process and would require further assistance (Alexander, 2015). The duties of a registered nurse, lie beyond the mere alleviation of somatic symptoms in the patient and require additional responsibilities such as delegation, leadership, supervision and patient diagnosis (Young & Siegel, 2016). Hence, such delegation activities by the registered nurse, is an ideal way to ensure quality treatment and care for the fellow patients (Kim & Gu, 2015).

Collect Cues/Information

References

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Horton, S., Lane, K., & Shiggins, C. (2016). Supporting communication for people with aphasia in stroke rehabilitation: transfer of training in a multidisciplinary stroke team. Aphasiology, 30(5), 629-656.

Jacob, D. (2015). Every vote counts: equality, autonomy, and the moral value of democratic decision-making. Res Publica, 21(1), 61-75.

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