How can I work with my colleagues to minimize interruptions during shift change report and other nursing tasks (e.g. medication administration)?

How can I work with my colleagues to minimize interruptions

CASE SCENARIO
Sheila is a new graduate Registered Nurse working on a medical rehabilitation unit. It is 0645 hours and she is walking onto the unit to start her day shift. As she walks toward the nursing station for the morning shift report, Sheila notices that more patient call bells are alarming, than usual. When at the nursing station, she mentions this to one of the night shift nurses, who is frantically trying to finish charting. The night shift nurse explains that a patient had to be sent to acute care overnight. The night shift nurse expresses that this was difficult to do with just two nurses on unit during night shift. The patient was in critical condition, so one nurse had to stay with the patient at all times.

The other nurse had to ready all of the transfer documentation and keep in communication with the doctor-on-call, the overnight manager, security and dispatch. As a result, care for the other patients was delayed. Sheila listens and wonders how she might manage a similar situation. At 0700 hours, the nurses start reading the morning shift report. At 0720, the charge nurse, Monique, interrupts the report to announce that one of the day shift staff nurses has called in sick. Monique has asked the clerk to call for a replacement, but until someone agrees to take the shift, each nurse will have an additional patient or two. Sheila starts to feel anxious because she is just becoming proficient at managing six patients per shift.

She feels as though she might help managing extra responsibilities, but can also see that the other nurses might not be able to support her, given their extra workloads.

Sheila realizes that she has no choice but to start the day and provide care in the best way that she can. Prior to starting the morning assessments, Sheila takes a few extra minutes to read over her patients’ Kardexes (charts). She finds that when morning report is interrupted, she needs to ensure that he hasn’t missed any patient information.

After completing the initial morning assessments, Sheila starts checking orders. She notices that one of her patients requires an extensive wound (pressure ulcer) care dressing over the sacral area, and reads the detailed order and supplementary notes provided by the wound care nurse. Sheila gathers her supplies prior to entering the patient’s room, such as normal saline, gauze and a hydrocolloid dressing. Sheila removes the old dressing, cleanses the wound with normal saline and assesses it. She notices erythema and mild edema at the wound site and asks the patient if there is any discomfort.

The patient states that the area is sometimes itchy and painful. Sheila takes note of this and completes the wound dressing as ordered. However, when she returns to the nursing station, she calls and leaves a message for the wound care nurse. Sheila is concerned about some of her assessment findings and would like to discuss different wound care options with the nurse. NURS 3092 – Fall 2020 2 Sheila continues providing care for her patients throughout the morning.

She feels a little rushed, as she is still caring for seven patients instead of six.

At 1100 hours, the physiotherapist, Jill, finds Sheila in the medication room and says that she has an appointment with the patient in Room 115, but he doesn’t seem to be ready. Sheila clarifies that he is showered and dressed, but she hasn’t had time to transfer him from the bed to his wheelchair via ceiling lift. Sheila explains that she couldn’t find another nurse to assist her with the ceiling lift because they are short staffed. She offers that they transfer the patient together now. Jill agrees, but tells Sheila that the patient should be ready next time because the transfer time is cutting into his therapy time.

After transferring the patient with Jill, Sheila returns to the nursing station and expresses to Monique that she feels badly about not having the patient ready for therapy on time. Monique listens to her concerns and shares that she often has the same experience when staffing is limit. She counsels Sheila to ‘let it go’ and says that some of the physiotherapists and occupational therapists act as though their time is more important. Monique explains that it’s just a part of the culture on this unit.

Sheila continues her shift and finishes her charting. When providing shift report to the evening shift nurse, she expresses that it was difficult to provide care due to the sick call. The evening shift nurse quietly jokes that Sheila should get used to that. As Sheila commutes home from work, she feels uneasy. She has many questions that remain in her mind about work today.

PLEASE ONLY PICK ONE QUESTION FOR THE QUANTITATIVE RESEARCH

QUESTIONS OF CONCERN (with corresponding articles):

Question #1:
How can I work with my colleagues to minimize interruptions during shift change report and other nursing tasks (e.g. medication administration)? •

Quantitative article:
Craig, J., Clanton, F., & Demeter, M. (2014). Reducing interruptions during medication administration: The White Vest study. Journal of Research in Nursing, 19(3), 248-261. https://doi.org/10.1177/1744987113484737

Question #2:
Given that my patient was late to his physiotherapy appointment, how can I improve my skills related to transferring patients using a ceiling lift?

Quantitative article:
Cheung, K., Dai, J., Cheung, C. L., Cho, H. K., Chow, Y. L., Fung, K. Y., … & Szeto, G. (2020). The biomechanical evaluation of patient transfer tasks by female nursing students: With and without a transfer belt. Applied Ergonomics, 82, 102940. https://doi.org/10.1016/j.apergo.2019.102940

 Question #3:

Reflecting on the frequent miscommunications between physiotherapists and nurses, how can interprofessional collaboration be enhanced on my unit?

Quantitative article:
Museux, A. C., Dumont, S., Careau, E., & Milot, É. (2016). Improving interprofessional collaboration: The effect of training in nonviolent communication. Social Work in Health Care, 55(6), 427-439. https://doi.org/10.1080/00981389.2016.1164270

ASSIGNMENT COMPONENT

Prior to incorporating the findings of research into nursing practice, the research itself should be judged on its strengths and weaknesses related to scientific merit. Students will review the clinical case scenario and choose one (1) question of concern as provided by the course professors. As part of addressing this area of concern, student will critically appraise one (1) quantitative research study from the nursing literature. Research studies should be linked to one of the questions of concern pre-assigned by the course professor.

Each research appraisal submission should include the following components:
1. Brief introduction

 Provide a short synopsis of the clinical case scenario as it relates to the chosen question of concern

 Establish the context of the study as it relates to the clinical case scenario and chosen question of concern

2. Summary of the research study (i.e., what happened?)

 Provide a brief summary of key elements of the research study. This should include information about the research purpose, context/population, research processes, and relevant findings

3. Summary of the appraisal of the article (i.e., what do we think about it?)

 Engage in an appraisal of the study using the Modified Guide to an Overall Critique of a Quantitative/Qualitative Research Report [Available on the course Blackboard]

 Choose elements from the appraisal process that best reflect key strengths and limitations of the study, and summarize these for the reader. Rationale should support the discussion.

4. Implications/conclusion (i.e., what does this mean/ what should we do about it?)

 Identify and discuss two (2) implications from the study that are most relevant to the clinical case scenario. Include clear explanations about how these key implications best address the chosen question of concern, with rationale.

Appraisal must be a maximum of two (2) pages in length (not inclusive of title page and reference pages). In addition to relevant course materials, students must reference the research article provided and two additional peer-reviewed journal articles that support the appraisal: specifically, the discussion of the clinical context of the case and/or question of concern. Submissions must adhere to APA 7th edition (2020) guidelines.

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