Lasater Clinical Judgement Model

* Personnel Issues: One of the key barriers to effective interaction for the pre-op nurses is that they are not getting any information from the registrar or the surgeon related to the patients unique circumstances. There is not a communication process in place for the pre-op nurse to actively communicate with the surgeon or his office regarding a patient’s care during their day of surgery. An additional factor in this situation was the pre-op nurse documented the mother’s contact information in her notepad, but not on the

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

The pre-op nurse did not pass the information on when giving report to the OR nurse. The OR nurse is responsible for giving addition hand off information both about the patient along the information from the procedure she all so communicates with the surgeon during the procedure. It was during this interview that some insight about a breakdown in communication between departments became apparent.

Clinical reasoning is embedded in nurses’ thinking for patient care (Levett-Jones 2013). It is a spiral, continuous mental process, underpinned by critical thinking theory and a sound body of nursing knowledge (Levett-Jones 2013). The clinical reasoning cycle includes considering patient’s situation, collecting cues, processing information, identifying problems, establishing goals, taking action, evaluating outcomes and reflecting on the process undertaken (Levett-Jones 2013). Nursing practice for registered nurses is guided both by the National Competency Standard (Nursing and Midwifery Board of Australia 2006) and the Nursing Practice Decision Flowchart (Nursing and Midwifery Board of Australia 2010) to ensure patients’ safety and to optimise care by challenging medical assumptions and facilitating evidence-based practice. The clinical reasoning framework, therefore, allows nurses to prioritise the most time sensitive and specific information, to recognise deteriorating patients and to manage complex clinical situations (Levett-Jones & Bourgeois 2011). This paper will focus on processing information and identifying the two major problems in the case study of Mr. Brown, a 74-year-old man, who was admitted to hospital after a ‘fainting’ episode with chief complaint of dizziness.

Nurses often have to make quick decisions, usually without adequate time to consider the entire situation. Have you ever wondered, how a person knew what to do, seemingly without ever thinking about it? Barbara Carper, was able to answer this question in detail with her “Ways of Knowing Concepts”, which she developed particularly for the nursing profession (Zander, 2011). A few of her concepts will be compared to a clinical situation, personal to this author. The above question will be explained in multiple ways so the reader will better understand Carper’s concepts and how they may apply to their own situation. This will be accomplished by: describing the clinical situation, observing applicable concepts and then relating them to the situation, visiting how an understanding of her concepts explains interventions and critical thinking, and how evidence affects critical thinking and knowing.

The values such as communication, innovation, quality, and collaboration is key to the growing field of perioperative nursing (AORN, 2015). During surgery communication is important between surgeons, anesthesia and nursing. Surgeons are focused on surgery, anesthesia takes care of breathing and vital signs, nurses are at the bedside or circulating and can assess the OR and what is happening during the procedure. The ARON believes that every patient has the right to receive the highest quality of perioperative nursing care of every surgical or invasive setting; all health care providers must collaborate and strive to create an environment of patient safety; and every patient experiencing a surgical or invasive

Objective #3. Analyze the collected data to determine the strengths and weakness is the final goal. It appears the pre-anesthesia screener corrects most of the system failures prior to the patient’s scheduled surgery. The pre-anesthesia screener spoke of most of the day dedicated to problem solving and reiterating information with the patient and caregivers prior to surgery. If the pre-operative instructions and education were more transparent, then it may lessen the amount of phone calls and

In the midst of attending a party with his friends, a random, ricocheted bullet pierced the right side of his head while he was trying to break up a fight. The bullet blew away part of his skull and lodged into his brain. When he arrived in the trauma bay, medically he was dead- no pulse, no spontaneous respirations. His family was forewarned that if he woke up there was a strong possibility that he would never speak or walk again. The patient- B.H., was a seventeen-year-old high school senior, who was class president, and captain of the football team when he was shot. During his month long stay in ICU, the hospital staff worked around the clock to ensure that his issues were properly managed. Despite all odds, B.H. is currently in his senior year of college, plays semi-professional football, and works two jobs. What was particularly fascinating, was the way the physicians were able to prioritize and execute their management in a dire situation. The intricate thought process of managing the patient as a whole,

The two communication barriers that I experienced during the simulation were a lack of attention and destruction. After introducing myself to the patient, I tried to ask the reason why the patient came to Montgomery college hospital (MC), but there were no answers to my questions. I immediately noticed that the patient was hearing voices, which was telling him to open the door and to answer the telephone. It was very difficult for me to assess the patient. I even told the patient that we can open the door later, for now just follow my instruction. Even though I redirected the patient, it was hard for me to help this patient.

This is my ninth clinical shift with my preceptor at Saunders Medical Center in Wahoo, NE, and it was on May 15, 2018 (Wednesday). Today I had the chance to work back in the OR. I had the choice to stay after my shift to place an IV in a treatment room patient, so I did as well. My duties were to place IV’s, gather report, preoperative care, a little bit of postoperative care, and helping clean up the OR after surgery. The patient census included: K. S. a 51-year-old female scheduled for a laparoscopic cholecystectomy with intraoperative cholangiogram; and T. M. a 30-year-old male scheduled for excision sebaceous cysts x2 scalp with full thickness skin graft from left neck donor site. Plus, one IV on a treatment patient, which I don’t have the information for this patient because I was only going in to place the IV. It was an eventful day and I learned how to work under pressure when things can turn for the worse in OR; it was a learning experience and I’m forever grateful! My shift started

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

The plan I would need in place would first to address her respiratory status and maintain a patent airway. I would also want to have the patient demonstrate how to splint while deep breathing or coughing. I would ask the Cna to help with position changes every 2 hours or more if needed for comfort for the patient. I would need to do a full assessment at this point if the patient is more stable. By having the patient deep breath will also help her return to consciousness, (Ahmed, Latif and Khan, 2013). I would want to keep her comfortable and in as little pain as possible. I would also want to try to educate her as to when to push for pain medications from her PCA pump. If there were any family I would want to try to get them involved with the education as well. The use of an incentive spirometer should be included in the teaching too. I would keep monitoring the incision site and watching for signs that the patient is in pain. While I was working on patient education with this patient, I would ask the CAN to do vitals on the 2 postop patients every 15 minutes for the first hour, reporting abnormal vital signs to myself or the other R.N. I would also ask the other R.N. if she/ he would do the discharge for that patient, while I remain with this patient and make sure she is going to stay stable.

A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional

As a result, the schedule is only as good as the implementation efforts. As a nurse, one might develop an efficient framework to fulfil their objectives (Pikos, 2015). Patients are more at risk of complications post-operatively, that is why implementation is necessary to minimise it from happening. To achieve this, nurses must prioritise actions, organise resources and the delivery of care based on clinical judgement and evidence based practice (Hoch, 2014). Educating the patient, monitoring their vital signs (includes oxygen saturation, temperature, etc.), pain assessment, oxygen saturation, temperature, IV infusion, medication management and wound management are all part of Kelly’s intervention. (Refer to Appendix

This paper will write the story of JT, clinical patient of mine. The paper will document her account of our interactions using her eyes and voice. The story will include health assessment data, labs, and a physical assessment. Elements of JT’s journey will also include her culture, level of pain, spiritual and psychosocial stance and ethical issues that arose. The paper will then detail the patient decision making process and strategies in a systemic manner to analyze the situation and help determine what could have been done better. The decision making process will also attempt to identify elements where the patient care could have been improved and determine what went well and what actions or assessments made had no basis in the guidelines or protocol. Additionally, analysis concepts will be integrated with continuous quality improvement (CQI) initiatives. An approach for change process using the Plan-Do-Study-Act (PDSA) model will be described as it applies to this patient scenario and will include clinical guidelines. The paper will then utilize the results from my completed self-assessment tool as well as the self-reflection and self-discovery to analyze the process of clinical decision making.