Factors that determine healthcare professionals involved in a healthcare team
|
Issue |
Priority |
Action and rationale |
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The elderly female post-operative patient |
1 |
A patient who has fallen unconscious is an utmost priority in any medical scenario, since he or she is not showing responsiveness to the surroundings (Hardeland et al., 2014).Due to extensive experience and competence, the Registered Nurse must take over and also delegate the task to the enrolled nurse and NUM for assistance. Hence, this nurse team must immediately treat the unconscious patient since prolonged state of unresponsiveness indicates deteriorating health status which may lead to death. Hence, this issue requires a Code Blue of medical emergency assistance (Sun et al., 2014). |
|
Visitor of Mrs. Smith who has fainted |
2 |
Since the Registered Nurse is busy with the unconscious patient, she may delegate this task to the AIN. Fainting is also a situation of loss of responsiveness towards one’s surrounding and hence requires immediate medical management (Nehme, Andrew & Smith, 2016). The AIN is competent enough due to her experience in assisting the RN and hence, must call for the medical emergency taskforce for immediate mitigation and future investigation. |
|
Waste secretion due to blockage of staff toilet |
3 |
Adherence to Workplace Safety Standards requires maintenance of Workplace Health and Safety for which hospital hygiene and sanitation must be checked (Gul, Ak&Guneri, 2017). The RN may delegate this task to the ward clerk who will further inform the janitor or cleaning staff to immediately clear the blockage and sanitize the environment. If the cleaning staff is unable to manage, the clerk may further delegate the task to the hospital maintenance department, where the concerned officer will repair the blockage and ensure maintenance of optimum health and hygiene of the hospital. |
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Intravenous Infusion of Mrs. Chew |
4 |
The tissuing of intravenous infusion occurs due to a hematoma or misplacement of the tip of the cannula from the vein. If untreated, it may interrupt the infiltration of intravenous fluids due to phlebitis (Mihala et al., 2018). This situation is critical since the infusion of required antibiotics is postponed due to IV being tissued and hence this must be managed by the Registered Nurse due to her extensive experience. Additionally, the registered nurse can also delegate this task to the enrolled nurse, if she feels that they are competent enough. However, since enrolled nurses are still undergoing training for effective IV cannulation, hence the registered nurse must manage this issue immediately. |
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Preoperative medication of Mr. Esposito |
5 |
Prior to the occurrence of any surgical procedure, it is of utmost importance to administer preoperative medications to the patient to avoid any complications (Shwenk et al., 2016). Hence, this task can be delegated by the registered nurse to the enrolled nurse, who is now competent enough to administer medications to the patient. |
|
Medication error discussion |
6 |
Since the issue is of last week and is not an emergency, this task can be performed at the end by the NUM. the registered nurse, AIN and enrolled nurses are already occupied with the pervious issues and hence, the next person who holds the authority and the expertise to manage this issue is the NUM (Feather, Ebright&Bakas, 2014). |
The major factors which determine the type pf professionals to be involved in a healthcare team in any medical institution is policy of organization, the disease type or clinical condition of the patient and the ward in which the team will function (Weaver, Dy& Rosen, 2014). The number of staff members is an additional factor, since unavailability of staff will reduce work efficiency due to increase in work pressure during situations of high work load. The availability of the doctor is highly important as he will diagnose and decide an appropriate treatment plan for the patient. Adequate number of nurses are required to supervise the doctor and treat the patient in his absence (Casimiro et al., 2015). The availability of a multidisciplinary team is a major factor and hence the presence of a nutritionist and occupational therapist will be beneficial. The occupational therapist will help in safe patient mobility while the nutritionist will aid in quick recovery through availability of nutritionally adequate meals (Hayes et al., 2017).
The doctor should lead the healthcare treatment since he lies at the forefront in diagnosing and deciding the treatment plan of the patient, after which care strategies will follow accordingly (Weller, Boyd & Cumin, 2014).
The most important member of the healthcare team is the patient whose consent is of utmost priority before commencement of the treatment procedure. Hence, every healthcare team must adopt a patient-centred approach for efficient performance and continuously inform the patient about the selected treatment plan and update him regarding his progress or deterioration. Additionally, the doctor and the nurses are equally important members, since the final and best treatment plan is decided by the doctor based on his expert diagnosis and the nurses are involved in supervising and caring for the patient in his absence (Carayon et al., 2014).
As per the case study, the outcome of patient medical choices seems to be the ethical dilemma. This dilemma occurs due to the importance of valuing patient’s decision and consent, during conductance of patient centred approach in treatment and medical decision-making (Monrouxe et al., 2015). Despite the requirement of further treatment of Grant due to his medical condition, his wife’s Georgina’s eagerness to have him home as well as Grant’s grief of being away from his family also has to be considered since patient demands are also important for quality treatment.
Family involvement and family therapy has been documented to quicken the recovery of the patient (Fox & Reeves, 2015). As evident, from the case study, Grant as well as his family are exhibiting considerable disinterest in treatment due to their separation from each other. Hence the best outcome for Grant would involve shifting to the outpatient department which would reunite with his family.
As a team leader, I will adopt a family centred approach to treatment, which involves placing the opinion and consent of the family of the patient at the highest regard, especially during the decision-making process of diagnosis, care and treatment (Coyne, 2015). Hence, during the meeting of the healthcare team, I would also involve Grant and Georgina in the discussion in order to receive their feedback. Adequate occupational and physiotherapy by professionals enhances the mobility of the patient. Hence, I would clearly explain Georgina this information as Grant still requires further treatment as per the expert opinions of the professional team. I would also instruct my team to consider Grant and Georgina’s interest since for ensuring patient satisfaction, a healthcare team must always prioritise the patient and his family through adoption of patient-centred and family-centred approach (Rankin, 2015).
Key issues related to a patient’s medical choices
According to the Australian Medical Association, obtaining an effective handover is of utmost importance for the deliverance of optimum treatment to the patient, as it provides vital information about the clinical signs and symptoms of the patient, his family background as well as past medical history (Whitty et al., 2017).
In accordance to the handover, the nurse did not seem to ask about the vital signs of the patient. Hence, for an appropriate handover, we must ask about the vital signs of the patients, which indicates the how efficiently the basic functions of the body are being conducted which includes, pulse rate, rate of respiration, blood pressure and body temperature. If such an assessment produces abnormal values, it would indicate a critical fatal situation, where the patient would require immediate medical emergency treatment (Dominguez et al., 2015).
There is no mention by the emergency nurse about the measurement and assessment of pain and its treatment. Hence, the nurse must be asked about the data associated with the pain, since it has an impact on the level of anxiety, ability to cope and vital signs of the patient. For this, the conductance of PQRST pain assessment tool is important (Fink & Brant, 2018).
Despite being admitted for an abdominal pain, the nurse did not mention about an abdominal pain assessment, which would be indicative about the presence of any fluids, palpations or protrusions in the abdominal area through auditory and visual inspection (Hall, 2017).
The nurse did not mention about fluid balance chart. The fluid balance chart of the patient will indicate electrolyte status and hydration of the patient through documentation of the amount of fluid consumed as well as excretion. Hence it is required to ask about the fluid balance chart since this will determine which medicines and treatments are required to be given to the patient (McGloin, 2015).
Other information which is missing in the handover is the medications taken by the patient currently, since they may indicate presence of any disease or comorbidity. Other missing information is the family details and social status since according to family centred care, patient’s family must be contacted during treatment and emergency (Pucher et al., 2015).
- An ABCDE assessment which is used to assess airway, breathing, circulation, disability and exposure. The rationale behind this is to indicate whether the health status of the patient is at a critical detrimental condition which may lead to death if left untreated (Steele, Greenwood & Desai, 2017).
- Vital signs: The purpose of this assessment is to understand basic body functioning, as a deteriorating vital signs means the patient needs immediate treatment and may succumb to his injuries. This requires assessment of blood pressure, heart rate, temperature of the body and rate of respiration and hence, evaluation of efficacy of basic body function is the rationale behind its conductance (Middleton, Fritz & Lusardi, 2015).
- Cardiac assessment: The purpose behind this is to uncover if the patient has the risk of developing any cardiovascular problem or has any existing shortcoming in cardiovascular functioning. It measures previous patient history of strokes, hypertension, hyperlipidemia and cardiovascular disorders. Identification of any pathological disease of the heart is the rationale behind this assessment, especially if there is chest pain in the patient (DeKoninck et al., 2014).
- Respiratory assessment: The rationale and purpose of this is to identify any pathological condition of the patient’s pulmonary system, such as pneumonia through observation of breathing and presence of wheezing in the patient. Abnormal sounds of bubbling, crackling and rumbling are produced during breathing if lungs are affected by pneumonia (Kalu et al., 2016).
- Pain assessment: The purpose behind this is to obtain data about pain history faced by the patient. Evaluation of nature of pain and its severity, through assessment of provocation or palliation, quality or quantity, radiation and region, severity and pain occurrence timings is the rationale behind this tool (Young, 2017).
- Abdominal assessment: The purpose behind this is to identify excessive fluid deposition or oedema in the patient which may cause kidney diseases in the future. Inspection of abdominal protrusions, abdominal palpations and abnormal abdominal sounds to monitor nature of patient abdominal functioning is the rationale behind this assessment (Markiet et al., 2017).
Five nursing allocation models are present, as stated by the government of New South Wales. These are task, team, primary nursing, allocation and modular models. Delegation of a single registered nurse to only one patient is the primary care model. Nursing involving delegation and allocation based on level of competency is the task allocation model. Delegation of a single, competent nurse to multiple patients is the feature of allocation model. Team leaders are present in team nursing model, as they are solely responsible for staff functioning by delegating work according to expertise. In modular approach, a group of patients – or modules, determine the nature of work to be performed by the medical team (Zlotnik et al., 2015).
In the case study, out of a total of 22 patients, 14 patients have faced surgery. While 4 patients have encountered treatment intravenously, remaining 8 have encountered conventional care. There is 1 enrolled nurse, 1 NUM and 3 AINs. For this case, usage of team nursing model would be useful for providing efficiently, quality treatment to the patients which will lead to their quick recovery and positive outcomes in health. This approach requires a team leader who will ensure unity and collaborative functioning of the medical team which will help to meet the clinical objectives of the organization. This model is advantageous since it has been documented to improve satisfaction amongst nurses, provide a supportive occupational surrounding and improvement in the interaction between members which results in patients receiving safe and high quality treatment (Deravin et al., 2017). Hence, for the team nursing approach model of allocation, the registered nurse must adopt the role of the team leader. For this, she must recognize the scope of practice and competency of each nursing staff member.
Outcomes related to a patient’s medical choices
Delegation is a process of task allocation or instruction to the team members, which is followed by team leaders such as registered nurse. Delegation must be performed based on the level of experience and competence possessed by each team member, which the registered nurse must consider before allocating a task.
For appropriate delegation which considers the expertise of the nursing workforce, the registered nurse of team leader must adopt a team nursing approach (Yoon, Kim & Shin, 2016). Hence, the registered nurse should be aware of the low level of competency presented by the enrolled nurses since they are undergoing training and are new to critical medical emergencies. Hence, being the team leader, the registered nurse should attend to the surgical patients herself. This is due to the fact that she has vast scope of exhibiting her expertise and skills since she possesses extensive experience and competency to manage critical health situations. The registered nurse can delegate the enrolled nurse to manage conventional care patients. This is due to the fact that the scope of practice of enrolled nurses is low, since they are still undergoing training, are relatively new to the surrounding, have reduced experience and present low levels of competency. The AIN can be delegated to assist the enrolled nurse for patients receiving intravenous treatment this is due to the fact that the AIN’s scope of functioning lies at assisting the registered nurse. Due to acquiring this scope of practice by working with a highly competent nurse member, AIN will have enough experience to assist as well as teach the enrolled nurses in the management of patients receiving intravenous infusion.
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