Assignment for leadership and care PDF

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Part A As per system perspective, she required close and regular assessment for hydration status using evidenced-based tools and visual inspection such as urine color, skin turgor and inspecting mucus membrane because she had high risk for dehydration due to inadequate intake of fluid and lack of fluid can also play role in dysuria. After using Braden risk assessment tools, I identify that she was at high risk for developing pressure injuries due to immobility and diabetes. Secondly, lack of nutristion can also increase risk for pressure injuries. Additionaly, improper hygiene can also contribute risk for developing pressure injuries. Moreover, me and my buddy nurse had total four patient and two of them required full nursing care as well as my buddy nurse was routinely not working on that medical ward so, I found that work-load and lack of staffing can also be impaired while delivering care to Mrs. Trang because we hadn’t got time for back care and changing position every two hourly. Furthermore, as per handover previous nurse already ordered air matteress but till end of the shift air matteress was not delivered to Mrs. Trang’s room so that factor can also negatively impact on Mrs. Trang’s care. I also identified that nurse-patient relationship also plays important role while delivery care to the patient because Mrs. Trang was feeling awkward to calling nurses for changing diaper and any other needs and my buddy nurse had not got time for broad communication with Mrs. Trang for educating for importance of drinking adequate fluid in the body. Additionally, I also found that physical setting can also contribute major role I deliver care to the patient because Mrs. Trang was sharing room with another patient and she was feeling embers while using bedpan. Part B Identification

As per Australian Commission Safety and Quality in Health Care (ACSQHC, 2019) there are number of ways pressure injuries (PIs) can be identify and preventable such as health care services have to implement appropriate evidence-based policy and protocol to assess PIs. Furthermore, health care organization must have sufficient staff because workload can impair to delivering appropriate care or assess to the patient who are high risk for PIs or who already have PIs (Clinical Excellence Commission, 2014; Coleman et al., 2013)). As well as, regular skin assessment can also important factor for early identification risk of PIs. Additionally, full comprehensive assessment including past history, social history, psychological and family history during admission or within 8 hours can also help for early identification risk of PIs (ACSQHC, 2019; Serrano, Mendez, Cebollero, & Rodriguez, 2017). As per hospital policy and protocol nurses must have to assess patient skin during handover and within shift and appropriate documentation which can increase risk of early identification of pressure injuries (Clinical Excellence Commission, 2014; Serrano et al., 2017). According to ACSQHC, 2019 delivering regular based education regarding PIs to healthcare worker, patient and family can also contribute for early identified risk of PIs. Nurse-patient relationship can also help to identify PIs and decrease risk of PIs. Via using effective communication nurse can educate patient and relative regarding risk factors for developing PIs such soil linen, immobility, lack of nutrition, hygiene and fluid and how to avoid to developing risk of PIs (ACSQHC, 2019; Adebelli and Kormaz, 2019). As per hospital policy nurses must have to use evidence-based tools for assessment of pressure injuries such as Braden scale and Jackson/Cubin scale (Adebelli and Kormaz, 2019; Page, Barker & Kamar, 2011). Adebelli and Korma, (2019) state that If nurses find any abnormalities or high risk for pressure injuries nurses must have to communicate with nurse in charge, patient and family as well as perform documentation accordingly. Moreover, nurses must have to give detail handover such as what is observed regarding PIs, and which

measure taken to prevent or in management of PIs (Serrano et al, 2017). Nurse must have to create and implement nursing care plan individually and involve patient and family in her/his care which helps to manage and decrease risk of PIs (Adebelli and Kormaz, 2019; Serrano et al., 2017). 2. Analysis Pressure injuries are major and complex problem in health care setting (Page et al., 2011). In Australia PIs is fifth leading expensive but preventable problem (ACSQHC, 2019). PIs is not only negatively impacted individual’s physical health, but it is linked to mental, psychological, social and spiritual health (Clinical Excellence Commission, 2019; Chou et al., 2013). PI cause major financial burden on health care system in Australia because PIs require longer term treatment ((Clinical Excellence Commission, 2014). Furthermore, PIs negatively impact on individual’s quality of life because that require hospitalization, impact individual sleep patterns due to pain and increase risk of other infection (Clinical Excellence Commission, 2014). Families and individual may suffer from financial hardship due to hospitalization and treatment cost (Clinical Excellence Commission, 2014). PIs cause individual may have to stay in hospital which can poorly impact on individual’s mental health that can cause individual may suffer from social isolation, stress and other mental health problem (ACSQHC, 2019). Yearly, Australian Government spend billions of dollars to prevent and treat PIs (ACSQHC, 2019). According to Australian Institute of Health and WellFare, 2020 total 12059 cases reported in 2019 related to pressure injuries.

3. Evaluation Pressure injuries are major problem in health care as well as in community setting and that require proper policies and protocol to prevent and manage PIs and related risks such as

increasing individual health and well-being and early identification of high risk for PIs (Van, 2020). Health care organization play major role in evaluation and management of PIs using evidence-based practice, policy, protocol, physical setting, well-trained staffing and appropriate equipment (Van, 2020). Appropriate and regular staff training can also help to prevent and manage PIs because evidence-based knowledge enhance safety and quality in delivering patient care (Lawrence, Fulbrook & Miles, 2015). If staff are well trained, they perform full comprehensive assessment, repositing, regular skin assessment using evidencebased tools according to hospital policy and protocol that ultimately helps to early identification of PIs (Lawrence et al., 2015). Moreover, accurate documentation and informing appropriate authority on time that also helps in prevention and management of PIs (Yilmazer, Inkaya & Tuzer, 2019). Additionally, involving multidisciplinary team in patient care who have high risk for PIs can help in improving patient’s health and well-being and preventing and managing PIs (Van, 2020; Yilmazer et al., 2019). For example, if patient have lack of interest in diet so involving dietician can helps to improve patient’s nutrition status (van, 2020). Next, creating, implementing and regular evaluating individual care plan as per patient needs, situation and stage of pressure ulcer can also enhance patient’s outcomes (Oomens, Zenhorst, Broek, Hemmes, Poeze, Brink & Bader, 2013). Importantly, educating patient and family regarding PIs such risk factors, how to avoid PIs and involving in patient care can enhance mental awareness, physical health and prevent from PIs (Oomens et al., 2013). Moreover, pivotal factors such encouraging patient’s for nutrition, hygiene, mobility, skin care and repositioning can also help to prevent and manage PIs (Ledger, Worsley, Hope & Schoonhoven, 2020). 4. Management Nurses play central role in preventing PIs in hospital settings because majority of the patients are indirectly risk of developing PIs such as elderly patients, semi and unconscious patients,

patient’s who’s mobility impaired or restricted and bedridden patients (Mitchell, 2018; Asimus, MacLellan & Li, 2011). During admission through comprehensive assessment nurses identify high risk patient for PIs and create nursing care plan and involve patient and family in her/his care (ACSQHC, 2019; Sving, Idvall, Högberg & Gunningberg, 2014). Van, (2020) & Sving et al., (2014) state that if patient’s mobility is impaired or restricted due to some reason then nurses must have to repositioning every 2 hourly which increase blood circulation and decrease pressure in on specific area where high risk for developing PIs such as heels, tailbone, elbows, shoulder blades and ear lobes and back of head. if patients are able to mobilize, nurses have to encourage and educate about importance of mobility and how to prevent PIs (Latimer, Chaboyer, & Gillespie, 2015). Moreover, if patient require aids or support nurses have to arrange and provide and if require further support nurses have to referred physiotherapist because mobilization not only prevent PIs but helps to decrease risk of constipation and deep vein thrombosis (Latimer et al., 2015; Samuriwo, 2012). As well as, in PIs adequate nutrition is primary preventive and curative factors so nurses have to encourage patient for diet and fluid and if require referred to the dietician which is also helps to prevent and manage PIs (Balzer, Kremer, Junghans, dassen, & Kottner, 2014). Moreover, dry skin, too much moisture skin, perspiration, friction sheet and patient who have incontinent urine or fecal problem should require frequent skin assessment and clean and dry linen in terms of to prevent PIs and nurses play central in delivering full nursing care to the patient (Sving, Gunningberg, Högman & Mamhidir, 2012). Nurses perform accurate documentation and inform authority to evaluate and manage PIs and related risk such as skin colour, temperature, if patient already have PIs then PIs appearance, measurement of wound size and depth, exudate, odor and stage (Sving et al., 2012; Balzer et al., 2014).

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