Clinical Nursing Practice
Whilst on clinical placement you are to choose 4 examples of fundamental nursing care that you have either observed or participated in.
These examples are to correspond with 4 skills found in your clinical skills book.
You are to summarise the evidence base that supports the important aspects of each of these skills.
Do not describe how the procedure is to be conducted.
A comparison and critique of the observed practice in line with the evidence should be made. The marking guide below will be used to assess the submission. I prefer to write about wound dressing, pressure area care, hand hygiene, blood sugar level checking. word count 2000 all together.
Portfolio
Nursing 7204 – Clinical Nursing Practice 1
Introduction:
Fundamental Nursing Care is how nurses enable patients to receive fundamental care needs in a way which is structured and focused on them. SA Health (2014) outlines the framework of fundamental care in the healthcare setting, and how these fit into four overarching patient needs: relational, psychosocial, clinical, and physical needs. All elements of fundamental nursing care adhere to the framework of these elements. Relational needs involve the patient’s right to dignity, privacy, choice, and diversity. Psychosocial needs are about the patient’s comfort, safety, and facilitation of communication. Clinical needs involve basic needs such as nutrition, hydration, and activities of daily living. In addition to assessments and interventions by medical personnel including symptom management and vital sign measurement. Physical needs involve mobility and adequate rest and sleep.
Four individual areas of fundamental nursing care will be discussed whilst relating them back to observations during clinical placement in an acute ward of a major hospital, and how this compared to national standards and best practice. Oral medication administration will be examined including the rights of medication administration and how these were adhered too. High numbers of cases involving MRSA and VRE were observed, so contact precautions will be discussed, such as the use of gowns, gloves, and patient isolation. The common task of measuring and documenting vital signs will be covered. Finally, nurse’s roles in patient elimination for continent patients will be discussed.
Oral Medication Administration:
Oral medications are the most common, least expensive, and least invasive form of medication administration available to both the nurse and patient (Tollefson & Hillman 2016). Including tablets, pills, capsules and liquids, this route of medication administration is preferred by patients. Oral medications usually have a slower onset and a more prolonged effect, along with being more unpredictable than other routes (Crisp & Taylor 2009). Be it personally administrating drugs or supervising self-administration, oral medication administration has many important underlying skills and procedures. Nurses need to know what the drug is for and its actions on the body, both intended and unintended. Therefore, maintaining a level of competency is essential in minimising harm and promoting the health of the patient under their care (Broyles et al 2017).
The ease of taking oral medications comes with risks. Therefore, procedures and regulations are in place around administration of oral medication. The most common procedure is the ‘Rights of Medication Administration’. Tollefson & Hillman (2016) state that at a student level there are 6 medication rights; right client, right medication, right time, right route, right dose, right documentation. The SA Government also has procedures and regulations surrounding the storage and administration of controlled substances (Drugs of Dependence) to minimise harm relating to dependency and misuse of the medication (SA Health 2012). Accurate documentation is also an integral part of administering medication to ensure accountability of staff.
During clinical placement in an acute ward, nurses administering oral medications mostly adhered to known policies and regulations in place surrounding medications. The medication rights were well known and followed, with some nurses lapsing only on checking patient identities. This was more due to frequently caring for that patient so seeing verbal identify confirmation redundant. Nurses were knowledgeable of medications knowing its use, effects, and side effects. Documentation was well implemented having each individual medication signed off as it was administered and nurses repeatedly checked it was administered for both their shift and the shift prior. In addition, access to controlled substances was limited by a single key per ward. Any drugs of dependence required a signature from two nurses after calculation and before administration (Tollefson & Hillman 2016). Some nurses would dispense medication and leave it on the over way for the patient to self-administer. This would be fine for some patients, however there are many elderly patients in the acute setting. If that patient had memory decline, nurses would not know if the patient took that medication at the prescribed time, if at all. There is also the risk of wandering patients taking medication not meant for them.
Being a paper based hospital meant doctors and pharmacists prescribing medication did so by hand. As is the stigma, the handwriting on the medication forms was often barely legible, particularly to those unfamiliar with drug names and medication orders. Reading illegible drug orders is not only time wasting but dangerous as wrong medications or doses may be administered, leading to serious harm or even death (Sokol & Hettige 2006). Pharmacists and doctors need to be sought-out to confirm the illegible orders so that clarification and re-documentation can occur (Tollefson & Hillman 2016). In these cases, luckily the prescriber was often on the ward and could be asked. However, the prescriber did nothing to write a clearer order or improve their handwriting.
References:
Australian Commission on Safety and Quality in Healthcare 2009, Recognising and responding to clinical deterioration, Australian Commission on Safety and Quality in Healthcare, accessed 31 May 2017, https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/UsingObservationCharts-20091.pdf
Broyles, B, Reiss, B, Evans, M, McKenzie, G, Pleunik, S, Page, R 2017, Pharmacology in Nursing, 2nd Edition, Cengage Learning, South Melbourne, Victoria
Carter, P 2008, Lippincott’s Essentials for Nursing Assistants, 2nd Edition, Lippincott and Wilkins, Philadelphia, US
Cretikos, M, Bellomo, R, Hillman, K, Chen, J, Finfer, S, Flabouris, A 2008, Respiratory Rate: The neglected vital sign, The Medical Journal of Australia, 118(11), pp 657-659
Department of Health and Human Services 2014, Transmission Based Precautions: A guide for healthcare workers, version 2, Tasmanian Government, accessed 30 May 2017, https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0007/75715/Transmission_Based_Precautions_Guide_V2_2014.pdf
Dhar, S, Marchaim, D, Tansek, R, Chopra, T, Yousuf, A, Bhargava, A, Martin, ET, Talbot, TR, Johnson, LE, Hingwe, A, Zuckerman, JM, Bono, BR, Shuman, EK, Poblete, J, Tran, M, Kulhanek, G, Thyagarajan, R, Nagappan, V, Herzke, C, Perl, TM, Kaye, KS 2014, Contact Precautions: more is not necessarily better, Infect Control Hosp Epidemiol, 35(3), pp213-21
Gettinger, H, Werner, B, Saxer, S 2013, Patient experience with bedpans in acute care: a cross-sectional study, Journal of Clinical Nursing, 22(15), pp2216-2224
Hand Hygiene Australia 2017, What is hand hygiene? Hand Hygiene Australia, accessed 31 May 2017, http://www.hha.org.au/AboutHandHygiene.aspx