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Challenges in nursing practice
Challenges in nursing practice
Challenges in nursing practice
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After taking two patients load for three weeks, I finally took full patients load on the fourth week of the placement. When I was taking two patients load, I still had the chance to research about the patients’ conditions, medical history and medications before I administer the medication at the beginning of my shift (especially on morning shift). Unfortunately, when taking four patients load for the first time, I did not have time for research before care for the patients. Moreover, I struggled keep up with the plan that I made and failed to prioritise the care. For example, I almost administer the regular aspirin to a patient who had bleeding during the night. I relied on the information during the handover without reading the patient’s
...estions if not 100% sure of something or use a double checking system. When a nurse is administrating medication, they should use the ten rights of medication administration (right patient, right drug, right route, right time, right dose, right documentation, right action, right form, right response, and right to refuse). Nurses should always keep good hand hygiene and always wear appropriate clothing to prevent from the spread of disease. Good communication with patients and healthcare team members is also key to success. Keeping on the eye on the patient within an appropriate time is important. If the patient ever seems to be looking different than their usual self vitals should be taken immediately. Encouraging patients to ask questions if they are unaware of something can prevent errors as well. Nurses should make sure the patient is on the same page as they are.
Over the last few years, I shadowed a Primary Care Adult Nurse Practitioner whose office is located in the underserved urban area of Irvington, NJ. She also takes care of patients from the surrounding areas of Irvington, Newark, and East Orange, all of which have very large underserved populations including African Americans, Latinos, and patients from the Middle East. During my clinical shadowing, I gained a appreciation for the complexity of treating long term chronic conditions such as asthma, diabetes, HIV, and hypertension. In many cases these conditions were exacerbated due to poor nutrition, non-compliance, and lack of education about healthy lifestyle choices. I gained a keen understanding of the importance of patient education and the ability to connect patients with community services to help them with their economic and social challenges.
Furthermore, short staffing affects the quality direct care each patient receives. The National Coordinating Council for Medication Error Reporting and Prevention (2012) states an estimated 98,000 individuals die every year from medical errors in the United States. One out of many significant tasks nurses do within their scope of practice is medication administration. Research shows a relationship between short staffing on medication errors: the longer the hours nurses work, the higher the chances of medication errors (Garnett, 2008). (include definition of medication error) Administering medications requires knowledge of patient rights, pharmacological information on the drug, adverse effects, proper dosage calculations, and hospital protocols. When nurses are assigned more patients, they are pressured to give due medications on time. Sometimes due to hunger or fatigue, nurses give the wrong medication to the wrong patient (Frith, Anderson, Tseng, & Fong, 2012).
The nurse to patient ratio is unrealistic in many hospitals. In most cases it is almost impossible to give each patient the true amount of detailed care they really need. This is seen in most cases where there is one nurse assigned to 16 patients and each patient requires a different level of attention. Nurses are pressed for time, forcing them to cut corners, resulting in an increase in nosocomial infections and patient deaths. “The past decade has been a unsettled time for many US hospitals and practicing nu...
Professor Cantu and Class, The first article is, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 34 “Handoffs: Implications for Nurses”, this article is applicable not only to my unit, but to every nurse in the profession. It is imperative that the translation of patient information from one person to the next during shift change, patient transfer, or transfer to another facility is clear, accurate, understandable, and complete, conveying all pertinent information about that patient. The article discusses why we have problems with handoffs, and different methods for handoff styles.
It’s very important that the units that are supportive of evidence based practices instill the idea of the patients being as important as family members or close friends in order to carry out the best practice. These would be good areas for individuals of the team to reflect during meetings. What is means to care for patients as a close friends or family members and what areas they can improve their practice; For instance, long term care nurses taking the time to ensure that all of their bedridden residents are turned every 2 hours to prevent bed sores.
Matching staff skill to patient and family needs highlights the difference between delegation and assignment” (Weydt, 2010, Delegation and Related Concepts, para. 1). This principle came handy, when I was assigned to care for a patient who had multiple injuries from a car accident. The care was complicated with the presence of a Foley catheter, total parenteral nutrition (TPN), chest tube, wound vacuum, and ventilator machine to support the patient’s airway. Under normal patient care assignment, the nursing assistant would perform the bedside care, e.g., bed bath, turning and repositioning of patients who were on bed rest, assisting with feeding, to mention a few. However, for this particular patient, the medical conditions were complicated by the multiple machines and equipment that nursing assistants were not trained to manage. Hence, I was fully engaged in most of the patient care activities. My presence and involvement were required from the provision of bed bath to turning the patient every two hours. I made sure that even with the simplest activity, the safety of the patient was not compromised. The only task that I allowed the nursing assistant to perform on her own, was the emptying of the urine drainage bag for the output
Utilising John’s model of structured reflection I will reflect on the care I instigated to a patient with complex needs. The patient in question was admitted to the Emergency Assessment Unit for surgical patients then transferred to the ward where I work as a staff nurse.
come classmates how it is not safe to give medications out in the dining room where all the residents gather for breakfast. We are taught that medication administration should be done in the patient 's rooms to avoid medication errors and keep the patients safe. A lot of these patients are not fully with it physiologically and could accidentally take someone else 's medication. I also found it very disappointing how the nurses don’t take part in any AM care. When getting a patient washed up it is a great time for a nurse to assess the patient. The nurses here do not get that opportunity which is a
During handing and taking over of shift i.e. change of shifts, all necessary plan and information about the patient’s condition should be relayed to the next shift for proper care to be carried out. All planned procedure should be handed over orally and in written form to avoid neglect or forgetting the procedure.
Before my shift started, I did my research about my new client for week three clinical. I thought I was well prepared for the clinical, I knew the client’s mental and medical conditions but I was more focused on the client’s mental health issues and not the medical illnesses. When the nurse informed me that client W was experiencing shortness of breath due to his COPD, I was a bit shock because I was not expecting that to happen.
The compulsion by our university and the respective facilities during my clinical placements to always be updated in clinical skills and practices played a major role in keeping me well informed and self-assured to perform my duties well. However, one of the main setbacks in maintaining practices is the subtle differences in protocols in different facilities while on clinical placements. This differences in protocols sometimes made it difficult for us to adapt with the change as we would have already been familiarised ourselves with different practices whilst in other
The plan was updated in June of 2014. The policy states that “ The Clinical Nurse Manager (CNM) are responsible for routine scheduling to allow for provision of quality patient care for every patient on his/her unit 24 hours a day” (Helen Keller Hospital,2014). The policy states that care levels from one to seven are assigned to each patient at the end of the shift and patient assignments are dispersed based on the care levels. Although our nurse manager does not follow the policy in fact I do not believe any nurse manager does for staffing. This assignment was difficult for me because I am a pre-operative nurse and so are all my co-workers we all left from medical units due to the issues of staffing. So instead the author decided to use comparison and contrast to develop this interview. The author chose pre-operative nurses with medical nursing backgrounds because she would not dare bother medical surgical nurses because they are understaffed and overwhelmed from patient care. For pre-operative nursing a certain amount of nurses are scheduled to work based on the number of surgical patients, so sometimes some nurses are sent home due to low census. On the medical surgical floor the amount of patients are just decided by the number of scheduled nurses. The requirement of care and skills are not taken into account when making out the assignment. My nurse manager makes a schedule for 28 days, she decides how
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.
I was also responsible for monitoring medication orders and reviewing patient profiles to ensure that the proper drugs and dosages were prescribed and that the pharmacy technician had prepared them properly. In many instances there were mistakes made in the preparation phase and sometimes even before, with incorrect dosages or drugs being prescribed and prepared, which could result in serious adverse effects for the patient. A clinical pharmacist’s role, however, is to make sure that these mistakes never reach the