Explain how you would prioritize care of these clients in order of importance, and why
I will triage these patients with regard to their needs. The one with the immediate and most pressing needs is Mr. Richard. He takes first priority since he is in severe pain and nursing care dictates that the nurse should ensure that the patient is comfortable and one way to achieve is this is through pain relief. I would administer moderate analgesia such as morphine or pethidine. The fact that Mr. Richards was experiencing difficulty in breathing affirms me making him my first priority. Dyspnea translates to the fact that there is inadequate tissue perfusion. This in itself is cause for alarm. After relieving the pain, I would go ahead to administer oxygen through a nasal cannula or a face mask. This will ensure that Mr. Richards gets sufficient oxygen thus preventing cases of organ failure due to hypoxia. The fact that the wife is also at the bedside also makes Mr. Richards a priority since I would want to address whatever questions or worries that the wife might have concerning the patient. The second person I would attend to after Mr. Richards is Ms. Smith since she is on digoxin, Lasix and potassium chloride due to her end-stage congestive heart failure, which requires close monitoring of the vital signs as well as monitoring input and output. Close monitoring is also vital since patients with end-stage congestive heart failure can easily develop complications due to their cardiac insufficiency. The last on the list of care delivery is Ms. Franklin since she is unresponsive 10 days after experiencing a stoke and the fact that they share the same room with Ms. Smith will make it easier for the nurse to deliver nursing care to Ms. Franklin soon after getting done with Ms. Smith.
Which aspects of their care may you delegate to an LPN? To an UAP?
The aspects of care that I would delegate to a LPN include parenteral feeding of Ms. Franklin as well administration of multiple medications and hydration which involves intravenous infusion of fluids. All these require a certain skill that the LPN already has, hence enabling her to readily carry out such. In addition, the fact that an LPN is licensed, means that she is fully qualified to carry out such aspects of care and if by any chance any error might happen, then she will be responsible and accountable. Those aspects of care that I would delegate to an UAP include taking of vital signs of the different patients in the ward as well as 4-hourly turning of the unresponsive patients to prevent incidences of pressure ulcers.
Describe for Mr. Richards and his wife the options available to him. Address specifically how an advance directive and a DNR (Do Not Resuscitate) order would impact his care
There is an array of options available to Mr. Richards and his wife including an advance directive, which informs your doctor the type of care you would desire in the event you become incapacitated in making medical decisions. There are different types of advance directives and they include a living will, a durable power of attorney (DPA), and a do not resuscitate order (DNR). A living will be a written, legal document that describes life-sustaining medication you would want given when you are terminally or seriously ill. On the other hand, DPA states the person you have chosen to decide health care matters on your behalf in the case where you are unconscious or not in a position to make any decisions. Lastly, a DNR is a requests that CPR (cardiopulmonary resuscitation) will not be done once the heart stops or if one ceases to breath. All these influence the care one will get once they are medically incapacitated. First, it influences the medication that will be administered since the patient might prefer certain medication over others. Second, upon agreeing to a DNR the nurse will not go further to provide CPR once the patient’s heart halts. Otherwise, in the case of a DPA the person responsible for the patient might decide that they want palliative care provided to the client by relieving the pain the patient might have as well as providing supportive care through managing of symptoms.
One of the RNs comes to you and says “I’m going to lose my license and get sued! I just gave Ms. Smith’s IV digoxin to Ms. Franklin!” As you counsel the nurse, thoroughly discuss how the steps in the medication administration process interface with the five components of professional negligence
The medication administration process involves five steps namely: ordering, verifying, dispensing, administering and monitoring. Professional negligence can occur at any stage in this process as a result of a breach of a professional standard. The 5 components of professional negligence include: standard of care being in existence, failure to meet such standards, foreseeing the harm, the existence of a correlation between harm and care and the occurrence of actual patient injury. At the prescribing stage the wrong drug or even drugs to which the patient has known allergies might be ordered. This may in the long run cause harm to the patient since they would have received the wrong drug hence making it a case of professional negligence. At the dispensing stage the pharmacist or nurse may fail to deliver the right medication to the right patient. During ad mistering of medication, the nurse may knowingly or unknowingly administer the wrong medication to the wrong patient or may administer the drug using the wrong route or administer it at the wrong time. All this may negatively impact the patient hence harming the patient thus portraying how the steps in the medication administration process interface with the five components of professional negligence.
A. Explain how this situation involves ethical principles such as autonomy, Nonmaleficence, Veracity, beneficence, paternalism, and so on, and the American Nurses Association Code of Ethics for Nurses
The fact that the Registered nurse (RN) does not want what she did come to light goes to show that she is inconsiderate of certain codes of ethics such as fidelity which simply means having the best interest of the patient at heart. Also she violates the code of veracity which simply means honesty without deception. She prefers that the in charge keeps silent on the matter rather than her being at risk of losing her license of practice. She cares less about preventing any harm to the patient since the pulse rates have dropped significantly and there is nothing much she can do other than reclining to the fact that the patient is a DNR. This clearly goes to show a breach of non-maleficence. These code of ethics are closely in line with those of the American Nurses Association Code of Ethics for Nurses.
B. Discuss with the Registered nurse (RN) why you would or would not generate an incident report about the medication error
I would generate an incident report thus I would tell the RN that this is necessary, since the post mortem will reveal traces of digoxin in the patient’s blood, which in the long run will lead to the nurse caring for the patient to answer queries as to why such happened. In a bid to prevent all that, I would write an incident report so as to honestly spell out what actually happened despite the fact that the patient is a DNR.
Second Assignment
1. Describe the restraining forces keeping you from suggesting this change:
There are several forces which restrict fresh graduates who have already been through NCLEX from making suggestions to nurses who have been employed in a given facility over a long time on how to undertake procedures based on evidence-based demonstrations. One of these restrictive force is time barrier. This is as a result of there being too much work pressure which inhibits the implementation of evidence-based practice and therefore as a new employee it is preferable to conform to the existing practice for convenience. Another restraining force for suggesting change is low level energy this in terms of fearing opposition from the existing political and cultural organization of the facility which might be intentionally avoiding the change (Ford et al., 2012).
2. Describe the driving forces urging you to suggest the change:
There are several driving forces which drive a practicing nurse to suggest evidence-based change to long term employees. One of the forces is the opportunity for advancement, whereby the new nurse having been equipped with the evidence-based knowledge stands a better chance of being promoted to a position of influence and as an agent of change for the facility. Another force is the enhanced self-esteem within an individual which makes it uncomfortable for the nurse to withstand observing the outdated demonstrations and practice being practiced.
3. Discuss how you would be able to suggest this change and impact the status quo
The best way to suggest the evidence –based practice which can impact the status quo is by communicating to the long term serving nurse of why it is important to back practice on evidence based knowledge. The message would be received best if it is passes to the nurse in an informal setup such as ‘hallway chats’ where nurses get to interact. This is because at such a time the nurse will not be distracted by time factors and the interpersonal direct communication will be more effective as compared to interjecting the nurse in the line of her duty (Titler, 2008).
4. What skills should you use to enhance effective communication during this scenario?
Some of the skills which are effective and applicable in such a scenario include being in a position to seek the views and opinion of the nurse by establishing a two-way conversation. Another skill which would come in handy in this communication would be by backing the theoretical knowledge with practical skills and explaining the reason as to why the evidence-based practice is preferred more. When doing this it is important also to show understanding to the views passed by the nurse and ensuring that she does not get to a point where she feels like her skills and knowledge is being undermined and dismissed by avoiding dominance and choosing the words to use carefully ("5 Effective Tips to Improve your Negotiating Skills | Negotiation Experts", 2016).
References
Ford, S., Ford, S., Ford, S., Williams, D., Ford, S., Ford, S., & Stephenson, J. (2012). Senior
nurses 'resistant' to evidence-based practice. Nursing Times. Retrieved 14 June 2016, from http://www.nursingtimes.net/roles/nurse-managers/senior-nurses-resistant-to-evidence-based-practice/5048816.fullarticle
Titler, M. (2008). The Evidence for Evidence-Based Practice Implementation. Agency For
Healthcare Research And Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2659/.
5 Effective Tips to Improve your Negotiating Skills | Negotiation Experts. (2016).
Negotiations.com. Retrieved 14 June 2016, from http://www.negotiations.com/articles/negotiating-skills/
