Reference no: EM133508553

Introduction to Professional Practice

Assessment Task

For Assessment Three we will be using the scenario to examine issues in teamwork, communication and decision making in healthcare. Your task is to answer, using extended responses, the following questions:

Question 1. Discuss the contextual factors in Bill's background and current circumstances which affect his ability to effectively manage his diabetes.

Question 2. In the Neurology Ward of the Acute Hospital and in the Rehabilitation Centre we witnessed two distinctly different models of teamwork. Describe these models and discuss the impact these had on Bill's care.

Question 3. The Nurse Unit Manager in the Rehabilitation Centre made a quick and intuitive decision to discharge Bill, based only on the resolution of his Neurological symptoms. Discuss the factors which influenced this decision.

Question 4. When Bill was discharged from the Rehabilitation Centre there were no plans made for his continued care in the community. Discuss the purpose of a Discharge Plan and the role of the Discharge Planner. Identify the health professions and services in the community that would have benefitted Bill's ongoing care.

Case Scenario

Bill is a twenty-year-oldaboriginal man who has had Type I Diabetes Mellitus since he was 12. Bill was born in a small town in a rural and remote area of Queensland. In this area Bill had very limited access to Specialist Medical and Allied Health care.
Bill stayed at school until the end of Year 10, but as English is not his first language he struggled throughout school and left functionally illiterate and innumerate.

Bill moved to the city two years ago, but he has not been able to get a job and has very little income. He misses his family, friends and community, but he is ashamed that he has not been successful in the city and does not communicate with them in case they find out. Bill has a history of homelessness, and stays in homeless shelters, temporary accommodation, and sometimes even sleeps outside in parks. Bill does not see the same doctor for his diabetes, he visits many different clinics, depending on where he is living at the time.

One day, while Bill was out walking, he felt ill and dizzy, lost consciousness and fell to the ground. He was brought to the Emergency Department of a major hospital by ambulance for assessment and investigation.

In the Emergency Department (ED) he was cared for by the team of Doctors and Nurses who were in constant communication through discussion and the central electronic medical file. As a consequence of the fall, Bill was diagnosed with a head injury whichresulted in severe headaches, loss of coordination and difficulty with walking. The blood tests revealed that prior to the fall Bill had experienced an episode of hypoglycaemia as a result of ‘insulin shock'.

Bill was transferred to the Neurology ward for assessment and monitoring. In addition to the medical records available in the central electronic filing system, a member of the ED team provided a ‘handover' to the Nurse Unit Manager of the Neurology Ward.

It was when he was on this ward that the nursing staff identified thatBill has very limited knowledge of his diabetes including where to access support and advice, and how to monitor his glucose levels and adjust his insulin dose properly. A team consisting of Nurses, the ward Physiotherapist, a Social Worker, and a Neurologist met on three occasions to discuss Bill's case. They used the information from the Emergency Department admission and the assessments and notes undertaken by the ward team of health professionals.Through their discussions they identified that Bill's mainproblem was his inability to manage his Diabetes.However, as this was a short admission to a Neurology Ward, not an Endocrinology Unit, they did not have the time or resources to follow this up. After a 4 day stay in the Neurology ward, the healthcare team decided that Bill would benefit from being transferred to a rehabilitation centre. A junior Doctor, Dr I.P. Freely, who had just joined the ward was given the task of writing the discharge summary (see attached). Dr Freely had not been part of the team meetings, and he wrote the Discharge Summary quickly because he was under pressure.

Bill was transferred to a Rehabilitation Centre which was not part of the Acute Hospital, but an independently run organisation. The brief discharge summary was sent with Bill describing the initial head injury and noting the need for ongoing therapy to assist his co-ordination and walking. However there was no mechanism available to digitally share the electronic medical record held by the Acute Hospital.

While in the rehabilitation centre, Bill was assessed by a physiotherapist, occupational therapist, doctor, and of course the nursing staff who monitored Bill daily. They did not seek any additional information from the Acute Hospital and only used the discharge summary as a basis for Bill's care. The organisational structure of the Rehabilitation Centre meant that they did not have the opportunity to hold case meetings. However, they each wrote notes in the paper based medical record for Bill which was stored in the ward record room.

On day six of his admission to the RehabilitationCentre, the Nurse Unit Manager observed Bill confidently walking in the ward corridor by himself. As a very experienced Rehab Nurse she decided that Bill could be discharged home based on his ability to independently toilet and ambulate. In addition, she was under considerable pressure by the Senior Management of the Rehab Centre to discharge patients to free up beds. Without consulting the other staff, the Nurse Unit Manager informed Bill that he was to be discharged the following day as he now appeared to be fully recovered from the head injury.

No arrangements were made for further treatment or care for Bill after he was discharged the next day. He had no place to go to, and went to a Homeless Shelter, but was turned away.

Five days following his discharge home, Bill was again admitted to the ED by ambulance, having been found unconscious in a park.His blood sugar was extremely high, and it was apparent that he had not been regularly injecting his insulin.