Case Study : The Shock Trauma Hallway

The patient should then teach back to the RN so he or she knows the patient has an understanding of calling first.

During the shift when I cared for him, the nurse and I would go in to provide for the family and the patient to the best of our ability. We would routinely go in and assess the patient and the morphine drip, and I remember how quickly the patient’s blood pressure was going down the entire shift. Our goal that night was to keep the patient comfortable. He

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

Lack of situation awareness by the nurse and failure to use the SBAR protocol when on the phone to the cardiologists.

The client is stuporous on arrival to the emergency room and is in a medical emergency; you may or may not have time to administer pain medication. Preparing the chest tube set-up takes priority because your client is near death and this is what will reverse her grave situation. If you do have time after set-up or have other nurses helping you -- the quickest and fastest would be IV administration – it is a common order to administer morphine 2- 6 mg IV titrated (example: 2 mg at a time assessing each dose after approximately 5 minutes to see how the patient is doing; then giving 2 mg more, waiting, assessing; etc until pain relief is observed)

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

Staff also provide emergency response when needed immediately, and may call for support from ambulance personnel in more severe cases. Emergency responses include providing oxygen and in cases of an overdose sometimes administer an opiate antagonist (Kerr, 2007).

Situational leadership focuses on adapting your leadership style or approach based on the situation and the amount of direction and support that is needed by followers. As Jesus trained and equipped his disciples from simple fishermen to fishers of men, who carried on his ministry after he ascended to heaven, he integrated different styles and theories of leadership that best served and supported his followers (Blanchard & Hodges, 2003). Depending on the level of competency and commitment of their people, leaders will adjust their style to provide the necessary support and direction. The core competencies of situational leaders are the ability to identify the performance, competence and commitment of others, and to be flexible (Paterson, 2013). From being highly directive, telling their people exactly what to do and how, to delegating, clearly stating the objective and allowing them to complete the task with little direction and support, situational leaders adapt their approach to the needs of their people and the particular situation.

satisfied with the sedation level and ordered an additional dose of each of the medications only

At the nurse station, she raised her voice and said:” We have a problem if you can pass your medications by 10pm. I want to make sure you chart early and there will be no overtime!” I told her I appreciated her help,

There’s a high dependence on the leader for guidance and direction. Everything is new and individual roles and responsibilities can be unclear. Leader must be prepared to answer lots of questions about the team's purpose, objectives and external relationships. Processes may sometimes be ignored. Leader directs (similar to Situational

The simulation exercise presented a complex situation when Charge Nurse Janice didn’t have enough nurses in her unit and the VP of Support Services called and her about the scheduled meeting. At the start of the shift, she responded unprofessionally to the situation by giving directions to the staff while on a personal call and reacting negatively to any patient update provided by the staff. Janice also created a bad impression to Elise, the new nurse, when she asked about her assignment. Janice addressed the patients’ names with the procedures they had. Knowing that there was a situational problem, Janice should have communicated properly and emphasized to the staff about teamwork to facilitate the workflow in the unit. Elise is new and inexperienced, but Janice could have utilized her help with basic tasks as long as she had been directed and coached properly.

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne & Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley & Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, & Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

Situational leadership requires a leader to be mature enough to properly assess and execute the best leadership style based on the current situation that faces the organization. In many situations, if the leader can satisfy the

The set up was similar to my clinical routine. On entering the room, my teammates and I greeted her and asked her how she was doing. She was alert and oriented. She sounded exhausted. She was having generalized pain. I asked her if she was feeling short of breath she said “no.” She was already on 3L of oxygen through nasal cannula with an oxygen saturation of 93%. Her skin was warm to touch and her pulse bounding. She had crackles throughout her lung field. During my clinicals, I learned to link my patient’s assessment findings to her labs and orders. I also practiced using the SBAR to contact the physician. I attended an interdisciplinary round at the oncology unit where the team was planning palliative care for a patient. I noticed that the team was more directed towards pain management and therapeutic interventions. The team also made sure to include the family and the patient in the care. During the simulation, we contacted the doctor for an order of morphine.