Reference no: EM132345965 , Length: word count:2000

Assignment Part A

Read and carefully analyse the case below and answer the questions following

Case Study
Patient - Background

Mrs Daisy Mayes, an 85 year-old woman was admitted with a chest infection and diagnosed with Bilateral lower lobe pneumonia. Whilst in hospital she sustained a fracture of the right neck of femur.

Medical History:
1. Hypertension. 2. Hypercholesterolaemia 3. COPD 4. Osteoarthritis 5. Bowel cancer (treated surgically 20 years ago)

Social situation:
Daisy is a widow of 5 years and has been living in a low care aged care facility since her husband's death. She participates in the social activities within the aged care facility. Daisy has a supportive family (1 son and 1 daughter - her daughter lives locally and visits twice a week; her son lives interstate with his family). Members of her church parish also visit her once a week. She is a retired office worker. No longer drives - uses family and taxis to get around. Daisy is an ex-smoker who gave up smoking 10 years ago.

Daisy does not have an Advanced Care Plan in place, however her daughter Carol has medical power of attorney.

Reason for admission (10 days ago):

10 days ago at 0200 hours Daisy was brought in via ambulance to the Emergency Department (ED) following a period of high temperatures, shortness of breath and chest congestion. Her daughter, Carol, was notified of her hospitalisation and came into the ED to sit with her mother. A chest x-ray and blood tests conducted in the ED revealed that Daisy had pneumonia and she was commenced on intravenous (IV) antibiotics, HHFN oxygen therapy and Ventolin and Normal Saline nebulisers. Later that afternoon Daisy was transferred to the respiratory/medical ward. She was accommodated in a 4 bed ward quite a distance away from the nurses' station.

Her daughter Carol stayed with Daisy throughout the shift. She asked the nursing staff whether her mother had been given any of her usual morning medications because Daisy could not remember having had them whilst in the ED. Staff checked the medication chart and found that Daisy's usual medications had not been written up on her medication chart. Staff paged Daisy's doctor to have her medications written up. Carol left for home at 9 pm. Before leaving Carol spoke with the nurse in charge of the shift and left her name and contact details. She asked to be contacted immediately if there were any changes to her mother's condition. She told the staff that she was concerned that her mother was not ‘quite herself'. She seemed to be ‘a bit confused'. She also told staff that this was not a usual occurrence for her mother, as she was normally quite alert and orientated.

Overnight Daisy became quite distressed and more confused, calling out for her daughter and removing her oxygen. Nursing staff attended to her on one occasion and reapplied the oxygen prongs, re-orientated Daisy to the hospital and ward and then left to attend to other patients. At 2 am, a fellow patient in Daisy's room rang the staff call bell and called out in a loud voice for help. The nurse allocated to Daisy answered the call and discovered Daisy laying on the floor next to her bed. Her IV was pulled out, blood was all over the floor. Daisy was moaning. A brief assessment revealed that Daisy had a laceration to her forehead and her right leg and foot looked like it was externally rotated. Daisy had also been incontinent of urine on the floor.

Daisy was reviewed by the resident medical officer, who ordered an urgent head CT scan and x-ray of Daisy's legs. Results from the CT Scan was NAD, however the x-ray revealed that Daisy had sustained an intracapsular fracture of her right neck of femur. Daisy was scheduled for review by the orthopaedic team later that morning.

At 11 am, Daisy's daughter Carol came in to visit her mother. She was very distressed to find that her mother had sustained a fall overnight and that she had a laceration to her forehead and had fractured her hip. She demanded to speak with the nurse in charge. She was angry that she had not been contacted and informed that her mother's condition had changed and that she had sustained a fall. She said that she had told the staff that her mother was confused before she left for home last night and demanded to know why her advice regarding her mother's confused state had not been listened to. She angrily stated that she wished to speak with the Patient Advocate officer as she was going to put in a formal complaint. The Nurse Unit Manager organised a meeting for Carol with the Patient Advocate. She also organised for Carol to meet with Daisy's doctors to discuss Daisy's progression of care.

Progression of Care
Daisy was reviewed by the orthopaedic team and it was decided to treat Daisy's condition conservatively until her chest infection had improved. One week later Daisy had surgery for her fractured right neck of femur and a dynamic hip screw was inserted. Daisy was transferred to the orthopaedic ward post surgery. During her recovery, Daisy was reluctant to attempt to ambulate, and told staff that it ‘hurt too much to walk now'. 4 days post surgery, it was noted by the nursing staff that Daisy's hip wound edges were not healing and there was a distinct odour coming from her wound. A swab of the wound revealed that Daisy's wound had developed an infection.
Instructions for this assessment

Please answer the following questions, using academic language and format. There should be only one reference list with a minimum of 10 references, the majority from peer-reviewed literature published within the past 5-6 years.

Questions:

1. Identify and discuss all the clinical practice issues of concern in Daisy's care during her hospitalisation. Your discussion should include
a. examples from the case study
b. identify which standards have been breached
c. link how those practice issues demonstrate a breach to the National Health and Safety Standards (word limit for this section is approximately 500 words)

2. From the list of clinical practice issues that you have identified in Question 1 above, discuss

a. the 4 top priority issues that require attention in Daisy's care

b. recommendations related to the priority issues you would make to staff/NUM for changes to health care practice generally at the ward level to ensure a similar situation does not happen with other patients. Provide rationales for your recommendations. Recommendations and rationales are to be supported by evidence-based literature.

(word limit for this section is approximately 500 words).

Assignment Part B

Poster Presentation Background

In some graduate nurse programs new graduates are required to complete a clinical project related to change or innovation in clinical practice. That may mean reviewing and researching an area of clinical practice in the ward that requires improvement, or an area where practice in the ward has been delivered at an excellent level.

The new graduate may present their completed project as an in-service education session for ward colleagues or perhaps as a poster during the hospital Research Week. For this assessment, you are required to use the information and feedback from Assessment 3, Part A (Daisy Mayes) to develop a poster which is to be presented to your colleagues in Workshops 5 & 6. In Assessment 3, Part A you identified and discussed a number of National Health and Safety Standards that were compromised in Daisy Mayes' care during her hospitalisation.

In this assessment, you are required to *choose one of those standards to guide and focus your poster. Useful Resources The following book and chapters are suggested as a resource to assist with the structure of your poster and class presentation. Higgs, J., Ajjawi, R., McAllister, L., Trede, F. & Loftus, S. (2012).

Communicating in the Health Sciences. 3rd ed. Chapter 12, page 113 Giving Effective presentations in class Chapter 33, page 329 Preparing Posters.

Instructions on how to approach this assessment: *A basic poster template has been uploaded onto the LMS site under the assessment link for Assessment 3, Part B. However students may choose to use a different poster template if they wish.

Step 1 - Follow the guidelines in Section 1 Poster Development.

Step 2 - Follow the guidelines in Section 2 Oral Presentation of your Poster

Section 1 - Poster Development

In Case Study Part A, you identified, and discussed how the clinical practice issues experienced by Daisy Mayes and her family were linked to breaches of the National Health and Safety Standards. There are quite a number of National Health and Safety Standards that were breached in her care. For the purpose of this assessment you are asked to *choose only one high priority National Health and Safety standard that was breached in Daisy's care and recommend practice improvement changes that could be implemented to ensure that a similar situation does not occur in the future for other patients on the ward.

*Please note: Your recommendations for change must be supported by peer-reviewed evidencebased literature. Structure of Poster (Approximately 300 words)

Your poster should include the following:

• Title The name of the chosen National Health and Safety Standard you will be addressing.

• Introduction Provide a statement which summarises Daisy's case and link how the chosen Standard was breached. This will help to set the scene for the rest of the poster.

• Key Sections Include several key sections in which your topic is to be reported (Some examples, of key sections to be included in your poster are: o clinical issue being discussed o Discussion of what the literature states is best practice for the clinical issue o Recommendations for Change supported by peer-reviewed evidence-based literature

• Reference List (this can be printed on the back of your poster).

Section 2

Oral presentation of your poster (10 minute presentation) Oral Presentation Instructions

1. Students will display their poster on the classroom wall.

2. Student is to deliver a 10 minute oral presentation of their poster to the class and allow time for questions from the audience.

Time for this activity is allocated as follows:

• Oral Presentation = 5 minutes

• Questions from audience = 5 minutes

3. The oral presentation should expand the information in your poster as follows:

• provide a brief explanation of the chosen standard

• state how the Standard was breached in Daisy's case

• explain current best practice, i.e. what is the best practice recommended by the Standard

• explain in more detail the recommendations and a rationale

• elicit feedback/questions from your audience.

4. A presentation schedule will be displayed on the classroom wall on the day of presentation.

5. Marking rubrics will be supplied by your workshop facilitator at the time of your presentation.

6. Marking guidelines for the poster and presentation are located below

Attachment:- Assignment A and B.rar