Discuss the role of the RN in the medication management related to the ongoing nursing management

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Case Report:

Based upon the Horizons Hospital & Health Service (HHHS) Mary Young, construct a case report. The case report will draw upon your knowledge of pathophysiology and relevant academic literature to support an evidence-based plan of care.

Headings and a description of the content for each section of the report have been provided. These serve as a guide for how you will present your case report; however, it is important that all sections of the report are conceptually connected. For example, your knowledge of pathophysiology and your understanding of this particular client should underpin the nursing problems that you identify which should, in turn, drive the nursing management that is relevant for this clinical situation.

The case report should include the following:

Introduction (150 words)

Introduce the client and provide a brief overview of their case. Provide an outline of the purpose and structure of the report.

You might like to think about the overview of the case study like a verbal clinical handover: what is the key information from the HHHS patient information, progress summary and medication chart that would be relevant for the plan of care for this client?

Primary admission diagnosis (200 words)

Identify the primary diagnosis for the client (i.e. the reason the client was admitted to the HHHS). Provide a brief description of the pathophysiology for the primary diagnosis.

As part of this discussion, it is important to relate the pathophysiology to client’s risk factors and relevant previous medical history.

Nursing problems (200 words)

Use your knowledge of pathophysiology and the subjective and objective data provided in the HHHS progress summary notes to identify five (5) nursing problems that may arise as a result of the client’s primary diagnosis. These problems may be actual or potential nursing problems. Provide a brief description for why these problems may arise for this client.

From these, select two (2) nursing problems as the focus for the remainder of the case report. Provide a rationale for your selection.

Nursing Management (600 words)

The nursing management should focus on the nursing assessment, nursing interventions and the role of the Registered Nurse (RN) related to medication management for this client and will address the two (2) selected nursing problems.

Nursing Problem 1: Nursing assessment, nursing intervention, medication management.

Discuss one (1) method of nursing assessment that would need to be performed related to the ongoing

nursing management of this nursing problem. Provide a rationale for this type of assessment and briefly

describe how this assessment would be conducted in this case.

Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing

management of this nursing problem. Provide a rationale for the intervention.

Discuss the role of the RN in the medication management related to the ongoing nursing management

of this nursing problem.

Nursing Problem 2: Nursing assessment, nursing intervention,medication management.

Discuss one (1) method of nursing assessment that would need to be performed related to this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted in this case.

Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.

Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.

Discharge planning (250 words)

Identify five (5) issues/challenges that you may need to address for this client prior to discharge home. Discuss how you would facilitate discharge planning for this client, with consideration to two (2) of these concerns?

Analyze the moral, ethical, and legal implications utilized in this situation

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Effective leaders have a high degree of self-awareness and know how to leverage their strengths in the workplace. Assessments are a valuable tool that professionals can use to learn more about themselves and consider how their temperament and preferences influence their interactions with others.
As you engage in this learning process, it is important to remember that everyone—regardless of temperament type or related preferences—experiences some challenges with regard to leadership. The key to success is being able to recognize and leverage your own strengths while honoring differences among your colleagues.
At some point in your leadership career, you will encounter an ethical or moral dilemma that requires you to take a stand and defend your position.
For this Assignment, you evaluate an issue and consider how you could act as a moral agent or advocate, facilitating the resolution of the issue for a positive outcome.

To prepare:

Consider the examples of leadership demonstrated in this week’s media presentation and the other Learning Resources.
To further your self-knowledge, you are required to complete the Kiersey Temperament as indicated in this week’s Learning Resources. Consider your leadership style, including your strengths for leading others and include your results from Kiersey Temperament Sorter to describe potential challenges related to your leadership style.
Mentally survey your work environment, or one with which you are familiar, and identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly).
What ethical, moral, or legal skills, dispositions, and/or strategies would help you resolve this dilemma? Define the differences between ethical, moral, and legal leadership.
Finally, consider the values and principles that guide the nursing profession; the organization’s mission, vision, and values; the leadership and management competencies addressed in this course; and your own values and reasons for entering the profession. What motivation do you see for taking a stand on an important issue even when it is difficult to do so?

To complete:

Write a 4 to 5 page paper (page count does not include title and reference page) that addresses the following:
Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the paper.
Consider an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it.
Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.
Consider your leadership styles identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma.
This Assignment is due by Day 7 of Week 10.
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Learn how to conduct EBP research and find EBP guidelines.

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Appendix B
Nursing 314
Evidence Based Practice (EBP) Clinical Paper

OBJECTIVES:
1. The purpose of this exercise is for students to have the opportunity to see in the clinical setting how hospital RN’s relate to EBP interventions in their practice and then compare with research supported literature the practice intervention chosen.
2. Learn how to conduct EBP research and find EBP guidelines.
3. Write observations and express ideas in APA format.

SKILLS TO DEVELOP:
Observation, oral communication skills (interview), EBP research, and written communication skills using logic and critical thinking.

DIRECTIONS:
1. Identify a staff RN with whom you have worked in a clinical setting.
2. Explain to the RN that you would like to complete an assignment by observing him/her performing a nursing practice intervention then asking a few questions about how and why it was performed that way – note that individual RNs will not be identified in class discussions, only observation and interview themes.
3. Observe the RN performing a discrete intervention (e.g. changing a dressing, educating a patient on a specific module, assessing one or more vital signs). Students are encouraged to NOT make medication administration a focus of this activity.
4. As soon as possible after the observation, ask the RN the questions listed in the boxes below. Be sure to be non-judgmental and thank the RN for assisting you with this activity. Please write your answers in complete sentences with explanations. A yes or no answer will not receive credit.

ACTIVITY 1: Write Up (from interview questions) Clinical Setting

• A. Why did you perform the [intervention] in this manner?
• B. From what source(s) did you learn do perform it this way?
• C. What other acceptable ways are there to perform this intervention?

ACTIVITY 2: Locate and answer -Clinical setting. Locate and review the policies, protocols, procedures or standards (on TCBC website or Mosby’s) available in that clinical setting related to the intervention you observed, and answer the second set of questions listed below with explanations.
• D. Are there policies/protocols/procedures that define practice standards for this intervention? Were there any references used to support the policy/procedure?
• E. Do the written standards include dates of development and review or modification and when was the last review or revision?
• F. Did the RN you observed perform the intervention according to those standards?

ACTIVITY 3: Research and write (outside clinical setting). Using the information search strategies you have learned previously, locate the best published evidence regarding recommendations related to the intervention you observed and complete the third set of questions below. Be sure to cite at least 3 peer reviewed medical or nursing journals in your evidence that are published within the last 5 years.

• G. How difficult was it for you to locate quality, relevant, timely evidence?
• H. How do the policies/protocols/procedures compare with the best evidence you located?
• I. How does the observed RN’s performance compare with the best evidence you located?
• J. Critically thinks by giving a detailed plan to how they should change if needed or how they can update practice.

ACTIVITY 4: Reflect and write (outside clinical setting). Finally, include a reflective journal entry of no more than one page describing your conclusions and reactions to this exercise.

Discuss the process of translating this evidence into clinical practice demonstrating an awareness of the factors that may inhibit the implementation of the best practice.

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Examine the Evidence supporting a clinical topic and appraise the evidence underpinning this. Discuss the process of translating this evidence into clinical practice demonstrating an awareness of the factors that may inhibit the implementation of the best practice. 3000 words (+ or – 10%). 1 Chose a topic wisely. Make sure that it is clear and of a sensible size; in reality not too big. It is also helpful, but not obligatory, to use a topic from your eight week placement so that your work is really grounded in practice. 2 You can look at an area of hospital policy and evaluate its evidence base: this could be a care pathway, a hospital policy, a computerised care plan. Or: you could look at a more general topic of nursing care, for example injection technique, and look at the evidence behind it. It may be helpful to use the PICO formulation to clearly define an issue. (PICO is: population; which patient group you will be looking at: gender or age, community or hospital settings etc. Intervention: what test or treatment you are going to look at: medication, risk assessment tool etc. This could be a lot of different actions. Comparison; Possibly an optional part of your PICO. If you want to compare a new intervention with the current standard practice for example. Outcome: How you are going to measure how successful the intervention is: this could be in terms of morbidity or mortality rates, number of pressure sores etc.). Use PICO to help your identify a clear problem, but do not be ruled by it. 3 You need to look at the evidence base for your chosen topic. This will require good literature searching skills and a clear account of the search strategy you used. This will involve a discussion of the volume of research or writing about the topic, the time frame of this body of evidence and the kind of research: qualitative or quantitative. 4 You will need to address the quality of the research. This will involve a discussion of the hierarchy of evidence. If there is a good systematic review on the topic, this would normally count as very persuasive evidence in terms of influencing practice and would need to be a central part of your account… At the other end of the spectrum the body of evidence might consist primarily of expert opinion then there might be more doubt over how trustworthy the findings are. Chronology is important too. Research is iterative. This means it builds on previous work. Your account must take this into account. Often you will find the evidence is ambiguous and does not give us a clear roadmap. There needs to be some discussion of context and risk. If you are planning to change a practice which might slightly improve care and not put lives at risk (nursing handover practice for example), you might accept different evidence than if changing practice which might have dramatic effects on mortality or morbidity (for instance a major new anti-cancer drug).Your account must include a discussion of these issues. 5 You will need to address the quality of the research articles you have found. But this requires some flexibility. If the research base is very small, you will be able to talk about the articles in some depth and assess their quality. If you have a large research base, then you will need a broader discussion of the nature of this evidence base as a whole as there will not be enough space to look at each article in depth. But both approaches might be appropriate and a spectrum of approaches in between. 6 The last quarter (roughly) of the assignment) will look at issues of implementation. What might be preventing change from taking place; attitudes, lack of clarity in the evidence base, finance or education: there might be more… You might chose to use tools like SWOT or Force field analyses but certainly draw on the literature on implementing good practice. If you feel that the practice has been implemented successfully, you certainly can write about why it was successful. 7 A brief conclusion bringing the key ideas together.