REQUIREMENTS: THE FOLLOWING ELEMENTS MUST BE INCLUDED IN THE PAPER
Background Information Summary:
? Demographics
? History of present illness
? Relevant past medical and surgical history
? Admitting diagnosis (diagnoses)
? Course of current hospitalization to date
? Significant assessment findings during day(s) of care. Include vital signs, focused assessment,
and data from monitoring devices. (This information can be presented in a table).
Laboratory and Diagnostic Tests
Identify and list a summary of relevant and significant lab values and diagnostic tests/procedures performed. Include the rationales for performing the tests and for any abnormal results. Provide an analysis of the relationships between/among the diagnostic tests and lab results with the critically?ill individual?s current condition(s).
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?Medications
Identify and list a summary of relevant and significant medications. Indicate the trade name and generic name, the medication classification, the therapeutic use, major adverse effects, timing, dosage, route of administration, and the nursing implications. Also include the rationale(s) as to why the medication is prescribed for treatment. For example, document the rationale for how the treatment corrects the critically?ill individual?s condition or a side effect of another drug that is prescribed for treatment. *This information can be presented in a table.
Nursing Diagnoses
In order of priority, identify three (3) nursing diagnoses for the individualized plan of care for this patient. Two of the nursing diagnoses must address actual problems, and one of the nursing diagnoses must be a ?Risk for? or ?Potential Complication? (PC). For each nursing diagnosis, include three (3) nursing outcomes, three (3) nursing interventions, and three (3) collaborative interventions. *This section can be presented as a table or concept map.
Interventions ? ROUTINE NURSING MANAGEMENT
Describe independent nursing care you provided in the care of the critically?ill individual. Examples include, but are not limited to: activity level, position, ongoing monitoring, and nutrition (prescribed diet, tube feedings/TPN, formula, rate, and calculation of basal energy expenditure (BEE), patient education, wound care etc.). The rationale must be included for each intervention.
Interdisciplinary (ID) Care Collaborative Management
Identify the members of the interdisciplinary team caring for the critically?ill individual. Provide a brief description of their roles and responsibilities. Interdisciplinary team members include, but are not limited to: physician, pharmacist, lab/diagnostic tests personnel, respiratory therapy, physical therapy, occupational therapy, speech therapy, social work/case management, pastoral care, ethicist, etc.
Therapeutic Modalities
Describe the various therapeutic modalities used in the management of care for the critically?ill individual. Discuss the extent of the nurse?s responsibilities and skills required to manage the therapeutic modality in comparison to the responsibilities of the members of the interdisciplinary team. Therapeutic modalities include but are not limited to: oxygen therapy (mode, FiO2,), dialysis/CRRT (settings), ventilator therapy (mode of ventilation, settings, FiO2). The rationale must be included for each modality.
Nursing Role Reflection
Provide a brief summary of how your role interacted with the members of the interdisciplinary team. Include in your summary
? Analysis of communication style preferences among interdisciplinary team members and with the critically?ill individual and family members. What is the impact of your own communication style on others?
? System barriers and facilitators. Did the organizational framework for interdisciplinary management of care facilitate or hindered the quality of care/outcomes for the critically?ill individual? What recommendations can you make to the organizational system for enhancing
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interdisciplinary collaboration? Provide at minimum two (2) evidence?based literature sources
to support your recommendations.
? Professional Development. Based on your experience(s), write ideas for your own professional
self?development plan to enhance your potential for becoming an effective member in an interdisciplinary team.

Details

Students draw on the National Safety and Quality Health Service Standards and the NMBA professional competencies and standards to develop a critical response to a clinical incident. Students self-select a clinical incident discussed in the workshops and write an individual critical reflection paper.

Case Study A. Incorrect administration of a blood product

This incident draws attention to checking procedure roles and responsibilities for blood products.

An 86 year old man was admitted with a fractured neck of femur, scheduled for surgery that afternoon. The patient’s international normalised ratio (INR) was elevated at 1.6, and the decision was made to treat this elevated level with a unit of fresh frozen plasma (FFP) prior to surgery. The medical officer (MO) went to the laboratory to collect the unit of FFP. On arrival the scientist pointed to where the FFP was located and requested the MO to sign the unit out of the laboratory in the blood register. The unit collected by the MO was allocated for another patient and labelling not yet completed. The MO signed the unit out against his patient details in the blood register without checking the product details matched. He then took the unit to the ward.

On return to the ward the MO handed the FFP to the nurse caring for the patient, who was unaware of the request for transfusion. The nurse noted the lack of paperwork accompanying the FFP and sent the patient services attendant (PSA), with the unit, back to the laboratory to collect the appropriate paperwork. The PSA returned and stated that there was no paperwork for this FFP unit and that it did not need to be checked, although the laboratory staff stated they did not speak to the PSA regarding the FFP.

The nurses on the ward took the word of the PSA that they did not need the paper work, and checked the FFP to the patient. The unit was group O, the patient’s blood group was group A, therefore making this an incompatible transfusion. The staff were unaware of this at the time as both medical and nursing staff were under the impression that O was the universal group for FFP as well as red cells. Later the laboratory staff noted the FFP for the patient was still in the fridge and when they checked the register realised the error. They immediately rang the ward; however the product had already been administered. As a result the patient had a mild rise in bilirubin, and his procedure was delayed as a precaution to monitor the patient for further consequences of the transfusion therapy.

Students analyse the clinical incident from the perspective of a new graduate registered nurse or midwife in the first twelve months of practice (see the framework in Chang & Daly, 2016, pp. 278-280). Use the following points to guide your answer:

1. Provide a concise description of the incident (i.e, what happened?)
2. Outline why you chose this incident and how it is relevant to your professional practice
3. Identify the relevant factors in the clinical context that potentially contributed to the incident (i.e., why did it happen…so what?)
4. If you were involved in a similar clinical situation in the future, what alternative actions would you take? (i.e., what would you do differently…now what?)

Support your answers with reference to the relevant clinical and professional standards that apply.