Registered Nurse: A Case Study

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

Every one of us has relied on a medical professional at least a few times in our lives. When we get seriously ill, or suffer a serious injury, we put our health in the hands of doctors, nurses, and pharmacists, fully expecting to be treated with a certain degree of professionalism and safety. Unfortunately, sometimes the expected care is not given, or not given to the extent which the ailment requires. In these situations, we can feel blindsided, confused, even taken advantage of.

Interprofessional working is defined as ‘persons belonging to a profession, relating between and among each other, for the mutual benefit of those involved’ (Day, 2006), whilst attempting to improve the quality of patient care and unite the multidisciplinary team to focus on patient centred, excellent care (Goodman & Clemow, 2010). Interprofessional workers in the healthcare setting can include nursing staff from all fields; adult, mental health, learning disabilities and paediatrics, as well as the wider multidisciplinary team within the ward setting, such as occupational therapists, physiotherapists, doctors, podiatrists, furthermore, expanding from the ward setting to include community nurses, social workers, health visitors and midwives. Interprofessional working enables and encourages these professionals to combine their values and beliefs to focus on the patients and to deliver excellent, patient centred care. This therefore allows them to share a common purpose and goal whilst combining their knowledge, skills and resources as a team (Day, 2006).

Another important aspect of healthcare is effective interprofessional practice. This allows practitioners from different disciplines to work together to provide the best care for patients. There are four areas of competency in interprofessional collaborative practice. They are values/ethics, roles/responsibilities, interprofessional communication, and teams/teamwork (American Association of Colleges of Nursing, 2011). Each of these areas contribute to skilled interprofessional

Beneficence compounded by nurse-physician communication created ethical problems in this case. Mainly, Joanna’s assessment of Mrs. Kelly being ignored by the resident physician and the nursing supervisor. Joanna worked within the scope and standards of practice, she assessed, evaluated, and monitored her patient’s condition. She then reported her findings to the resident twice, and also sought nursing support from her shift supervisor. After Joanna’s first call to the resident, and her continued concern she needed to advocate in a proactive manner. Continuing her assessment of Mrs. Kelly to include palpation and auscultation could have offered additional clinical information enabling her to articulate the problem to the resident and nursing supervisor.

Nurses play an important role in achieving the competencies of interprofessional collaboration, quality improvement, and human flourishing. Successful interprofessional collaboration requires the willingness to step outside of one’s comfort zone and initiate interactions with other professionals. Nurses must also possess a well-rounded understanding of patient needs in order to know which types of professionals with which to collaborate. Communication skills are

Interprofessional team collaboration for professional nurses is viewed as a method to improve the care and safety for patients. However, interprofessional team collaboration presents both advantages and challenges for nurses and other team members. One of the advantages is the coordination of care for the patient and the sharing of knowledge to improve the outcomes for the patient. Challenges for interprofessional team collaboration is: poor role-definition, miscommunication, conflict, lack of accountability for assignment of responsibilities and tasks (Reeves, 2012). This paper will discussion the role of a nurse on an interprofessional team and the challenges, why interprofessional teams promote patient safety, and strategies to promote success interprofessional teams.

Hall and Waver ( 2001) defines Interprofessional as a group of professionals from different disciplines such as nurses, doctors, pharmacist that are working and communicating with each other while providing their knowledge, skills and attributes to enhance and support the contributions of others. Suter et al (2009) also said that the ability to work in an interprofessional team to convey collaborative, patient-centered care is an important aspect of professional practice that involves a possession of a particular set of competencies, such as communication skills. In relation to (Weinstein et al., 2003) Collaboration is the collection of knowledge, skills, values and motives which transforms to effective practice when applied by practitioners.

As a way to promote interprofessional collaborative practice the HPHA IPC model recommends the implementation of an Interprofessional practice council, unit action councils, interdisciplinary care plans, documentation, and “bullet” rounds (HPHA Interprofessional Practice Model, 2010). Similarly, Weller, Boyd and Cumin recommend supporting interprofessional collaboration with protocols and procedures, using procedures that encourage information sharing among the whole team, such as checklists, briefings and IT solutions (2014).

Healthcare is continuously changing with the modern times and whilst there have been many advancements in technologies and techniques; the roles of health care professionals have also changed significantly and the crucial need for inter-professional practice emerged. Interprofessional practice is essential as there is no single profession that can meet all of a patient's needs. (Matziou et al., 2014) For an effective interprofessional collaboration, it is essential that all professionals have a clear definition, awareness, and recognition of each profession and they are able to communicate effectively between different professions (Caldwell and Atwal, 2003). This essay will explain interprofessional practice and why it is essential for quality health outcomes, outline the roles and responsibilities of several health care professions and discuss the importance of interprofessional communication.

Interprofessional communication and collaboration are a significant part of ensuring safe and effective patient outcomes. In the case detailed below the health care team failed to communicate and collaborate care of patient A, ultimately leading to a negative outcome.

Working in a team is an important responsibility by understanding each other’s role which may include doctor, nurse, occupational therapist, physiotherapist and many more. Team members divide the work based on their scope practice such as acute care, metal health care, homecare etc. Interprofessional collaboration practice is decision making and communicating between individuals for their patient’s health based on their knowledge and skills. It helps to promote habits, maximizing health resources, leading care to be safer with patient’s satisfaction and Canada’s health care (Kenaszchuk, Reeves, Nicholas, & Zwarenstein, 2010).

“Interprofessional working involves complex interactions between two or more members of different professional disciplines. It is a collaborative venture in which those involved share the common purpose of developing mutually negotiated goals achieved through agreed plans which are monitored and evaluated according to agreed procedures. This requires the pooling of knowledge and expertise to facilitate joint decision making based upon shared professional viewpoints” (Barrett, Sellman & Thomas, 2005, p18). How individuals collaborate and work towards a common goal for the benefit of the patient is essential for a swift recovery.

According to American Nurses Association (2010) Scope and Standards of Nursing Practice, collaboration is defined as, “a professional healthcare partnership grounded in a reciprocal and respectful recognition and acceptance of: each partner’s unique expertise, power, and sphere of influence and responsibilities; commonality of goals; the mutual safeguarding of the legitimate interest of each party; and the advantages of such a relationship”.(p. 64). Collaboration amongst health care providers is very crucial in providing quality care to patients. Integration of disciplinary teams, improves communication, coordination, and most importantly, the safety and quality of patient care. It provides interaction between team members allowing

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to