Mr Stanley Case Study Sample

Section 1: Reflection: Gibbs Model

Description

I think it will be suitable for me to apply to the program in emergency department (ED) for my further training. The objective of the program is to provide the student nurses with an opportunity to experience and practice nursing abilities in the nursing program. 

Feelings

 I feel that I will be able to work in the emergency department as I have developed discipline, collaborative, and hardworking attitude. I feel, I will be able to gain skills and work on my potentials to be a good emergency department nurse.

Evaluation

I feel confident that I will be able to develop the required competencies as I have been able to learn and perform in my curriculum and also in a series of training that I have attended thus far. I am also a fast learner depicted through my performance in the course that will help me achieve the skills required to be a developed ED nurse.

Analysis

The course is inclusive of key responsibilities that include management of the ill patients that come with the emergency presentations. It is also the responsibility of the ED nurse to ensure recording of the patient vitals and accurate patient history for diagnosis. The ED nurse must demonstrate the ability to analyse the 12 lead ECGs and provide safe delivery of oxygen. Ability to assess pediatric patients and understand the principles of intravenous fluid therapies is also essential (Western Health Organization, 2020). With core knowledge of these fundamentals, I think, I will be able to advance as a competent ED nurse. 

Conclusion

Through this reflective analysis, I have concluded that being an ED nurse requires a diverse set of skills that I should learn and furnish for best results. 

Action

As a nursing student, I have always been diligent and hardworking. But to advance as an ED nurse, I will chart my strengths and weaknesses and work hard to develop skills required to be a competent ED nurse.

Section 2: Clinical Question

Patients with seizures can find it difficult to complete their daily tasks. Seizures are defined as an uncontrolled activity in the brain that results in physical convulsion in the patient (Pitakanen et al., 2017). Seizures can also impact the behaviour, and movement of the individuals and can alter their level of consciousness (Morrow & Hunt, 2017). Having found the patient under an attack, immediate short-term management goals to ease the patient and long-term management goals. The primary action would be to enable the seizure protocol. I will place a pillow, or a soft cushioning under the head of the patient and turn the face upwards if it is in a downward position. I will also ensure that I do not restrict the movement of the patient undergoing a seizure but try and turn the patient on one side. The rationale for this approach is, by placing a soft cushioning under the head of the patient, the occurrence of head injury can be prevented that may occur due to uncoordinated and repetitive movements in a patient undergoing a seizure (Wang et al., 2017). Moreover, the head of the patient is tilted upwards to avoid suffocation and allow a free exchange of air to prevent respiratory problems.

Further, it is also suggested to not restrict the patient who is undergoing a seizure as it may create confusion in the brain and generate an aggressive response (Pitakanen et al., 2017). The patient should also be ideally turned on a side to prevent respiratory distress after the seizure is over (Sarma et al., 2016). It is suitable to inspect the surroundings of the patient and his environment and remove all the objects that may pose harm to the patient to avoid injuries (Wang et al., 2017). The healthcare professional needs to remain calm and composed during the episode as some incidences of seizures can be extreme and discomforting.

Patience and composure, hence, in these cases help the nurse to make rational decisions and apply the suitable protocol accurately. Once the episode is over, the nurse must assess the patient to find the signs of injury. The patient should also be taken into assessment for severe incidences like limb displacements and other complications. The patient must be approached with a calm and reassuring voice to maintain composure in the patient and provide comfort. The patient should also be followed back to his initial position to ensure the well being (Morrow & Hunt, 2017). To undertake long term or the future management of seizure, the time of the seizure of the patient must be noted for a medical record. Falling is commonly associated with patients who suffer from seizures (Sarma et al., 2016). Rescue medications that are prescribed to the patient by the healthcare professional for these conditions must be provided with proper authorization to help the patient.

Section 3: Prioritization

After the analysis of the situations given for all the patients, the primary priority will be given to Mr. Young as his IV flask is emptying. The IV flask of the patients is indicating low volume by beeping and requires immediate attention. This patient has been selected as the primary priority as unfilled flask on the IV can result in the development of air embolism in the patient (Yu et al., 2020). The air that will pass through the IV in the absence of fluid can result in the development of embolism that can lead to complex health conditions and severe chest pain in the patient. The consequences of embolism development in the patient can be extremely fatal as it results in the elevation of the chest pressure affecting blood circulation and may cause respiratory distress, respiratory failure, and cardiac failure in the patient (Singh, 2020).

The second priority in the management and dealing with the patient should be given to Mr. Stavropoulos who is suffering from asthma and requires Ventolin. The medicine Ventolin is often used for the management of the patients suffering from respiratory distress as it helps in ease of breathing through bronchodilation (Price et al., 2018). If the patient is not provided with the due medication, asthma may develop exacerbation and cause bronchospasms in the patient. This may cause respiratory distress and hypoxia due to lack of oxygen availability and result in organ failure in an extreme fatality (Wang et al., 2017). The administration of the medication will prevent this exacerbation and help the patient by easing the respiration through bronchodilation.

The third treatment and management priority should be given to Mrs. Peterson who has recently suffered from a stroke and also possess a high risk of falls. Since the patient requires assistance with the movement for her bowel, she should be handled with care and precision to ensure her safety. She has been given a lower priority than the first two patients as her medical need is not clinical but of care and can be provided by care nurses or other healthcare staff on request. However, her condition is critical and requires essential supervision of healthcare professional as falls have been identified as one of the major cause of morbidity in the elderly, therefore, she should be directed and accompanied for her bowel movement as it should not be delayed any longer (Dennisen et al., 2019).

The fourth priority has been given to Mrs. Walters for preparing her to go to the theatre. She has been provided with a penultimate priority as no immediate repercussions are associated with her needs in the present clinical scenario. She has been placed before the need to find the preoperative checklist as the list can only be validated and verified once all the requirements according to the protocol have been addressed. Once the patient is ready for the theatre, the preoperative checklist can be found in the meantime with the assistance of their healthcare professionals like the student nurse from the databases to verify the process and ensure patient safety.

Section 4: Professional Nursing

Since I am already undertaking the report of a patient for his blood sugar content, my current priority will be to complete this procedure with my full attention and make suitable recordings. I will write sugar levels of the patient and generate a handover so that when I can join the surgical procedure, the coming nurse can see a detailed handover and perform further tests or analysis as required. Secondly, I will check the time and see if it is already 1:30 and then move to the surgical ward. As I move to the surgical ward I will also inform the ANUM in charge of the movement of the RMO and ensure of the procedure. Once I am informed about the surgery and ensured that I have to join, I will talk to the senior nurse and request her to foresee and appoint a healthcare professional and handover my clinical readings of the patients with hypoglycemia.

I have taken this approach based on three essential traits of competent nursing, that is, effective communication, prioritization, and time management (Suhonen et al., 2019). Since I am already under a clinical procedure it will be unethical and wrong to leave the current patient unattended due to any discourse. The primary goal of nursing is to ensure the wellbeing of the patient and provide the highest quality care (McCleary et al., 2020). Another crucial aspect of nursing is justice, where all patients must be treated equally and prioritized with their needs (Christiansen et al., 2019). I was initially informed by the ANUM about the timings of the surgery and therefore, it becomes my responsibility to immediately confirm with her and get the update on the action of RMO. If the movement of RMO is justified, I shall generate a handover that is descriptive and comprehensive for the hypoglycemic patient so that the upcoming healthcare professional is not aware of the proceedings and can take care of the patient.

Handovers serve as the coherent form of written communication in nursing practice as they provide succinct details regarding the patient condition and the clinical procedure (Kitneyet al, 2018). After drafting the handover, I will move to the surgical ward and inform the senior nurse about the need for the healthcare professional in the hypoglycemic ward. This will ensure that the patients are not left alone and their need are catered in my absence. I will participate in the surgical procedure and once the surgery is over, I will take follow up on the hypoglycemic patient as well to ensure that their needs were addressed in my absence. I will also thank the nurse who would take my place when I had to go to the surgical ward as it was an essential help that helped me regulate my presence in the clinical conditions.

Once the patient needs are prioritized and addressed and there is a conducive environment, I will undertake the responsibility and talk about the conflict resolution in the medical setting with the ANUM and the RMO. Conflict resolution is an essential component of nursing and helps in eliminating the hindrances that may arise due to various reasons in a clinical setting (Cherry & Jacob, 2016). This will also assert the importance of collaborative effort in nursing and healthcare for ensuring the beneficence of the patient (Lahana et al., 2019). It was a chance event that I was able to see the RMO carry procedure trolley in the room of a patient, without which the entire surgical process would have been hampered as the assistance of the nurse was required. I will help in establishing a stronger communication with the team and ensure that such incidences are not repeated in future as it may directly impact the health of the patient.

Through this approach, I will be able to cater to the need of both patients and ensure their well-being. This approach is also suitable as it provides scope for conflict resolution and improvement of communication and collaborative efforts in healthcare.

References for Mr Stanley Case Study

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. United Kingdom: Elsevier Health Sciences.

Christiansen, A., Salamonson, Y., Crawford, R., McGrath, B., Roach, D., Wall, P., ... &Ramjan, L. M. (2019). “Juggling many balls”: Working and studying among first‐year nursing students. Journal of Clinical Nursing, 28(21-22), 4035-4043.

Denissen, S., Staring, W., Kunkel, D., Pickering, R., Lennon, S., Geurts, A. C., ... &Verheyden, G. (2019). Interventions for preventing falls in people after stroke (review. Cochrane Database of Systematic Reviews, 2019(10), 55.

Kitney, P., Bramley, D., Tam, R., & Simons, K. (2018). Perioperative handover using ISBAR at two sites: A quality improvement project. Journal of Perioperative Nursing, 31(4), 17.

Lahana, E., Tsaras, K., Kalaitzidou, A., Galanis, P., Kaitelidou, D., &Sarafis, P. (2019). Conflicts management in public sector nursing. International Journal of Healthcare Management, 12(1), 33-39.

McCleary, N., Desveaux, L., Reis, C., Linklater, S., Witteman, H. O., Taljaard, M., ... &Presseau, J. (2020). A multiple-behaviour investigation of goal prioritisation in physicians receiving audit and feedback to address high-risk prescribing in nursing homes. Implementation Science Communications, 1(1), 1-10.

Morrow, J., & Hunt, S. (2017). Subclinical seizures: No alternative facts here!.Canadian Journal of Critical Care Nursing, 28(2), 445.

Pitkänen, A., Buckmaster, P., Galanopoulou, A. S., &Moshé, S. L. (Eds.). (2017). Models of seizures and epilepsy. USA: Academic Press.

Price, D. B., Gefen, E., Gopalan, G., McDonald, R., Thomas, V., Ming, S. W. Y., & Davis, E. (2018). Real-life effectiveness and safety of salbutamol Steri-Neb™ vs. Ventolin Nebules® for exacerbations in patients with COPD: Historical cohort study. PloSOne, 13(1).

Sarma, A. K., Khandker, N., Kurczewski, L., & Brophy, G. M. (2016). Medical management of epileptic seizures: Challenges and solutions. Neuropsychiatric Disease and Treatment, 12, 467.

Singh, K. (2017). Acute pulmonary edema of non-cardiac origin causing cardiopulmonary arrest following injection of non-ionic intravenous computed tomography scan contrast: A case report and brief review. Journal of Medical Cases, 9(1), 5-7.

Suhonen, R., Stolt, M., Habermann, M., Hjaltadottir, I., Vryonides, S., Tonnessen, S., ... & Scott, P. A. (2018). Ethical elements in priority setting in nursing care: A scoping review. International Journal of Nursing Studies, 88, 25-42.

Wang, J. Z., Vyas, M. V., Saposnik, G., &Burneo, J. G. (2017). Incidence and management of seizures after ischemic stroke: Systematic review and meta-analysis. Neurology, 89(12), 1220-1228.

Wang, P. (2017). Efficacy and security of triple aerosol inhalation of pulmicortrespules, ventolin and ipratropine in treatment of severe acute asthma exacerbations. Chinese Journal of Primary Medicine and Pharmacy, 24(11), 1719-1723.

Western Health Organization (2020).Discovery Program-ED. Retrieved from: http://www.westernhealth.org.au/EducationandResearch/Education/Pages/Discovery-Program---ED.aspx

Yu, Y., Liang, X., Wang, Z., Wang, J., Liu, X., Chen, J., & Liu, W. (2020). Internal limiting membrane peeling and air tamponade for stage III and stage IV idiopathic macular hole. Retina, 40(1), 66-74.

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