...MIDW113 – Jodie Sparke S00163149_assess2 b). Postnatal case study – Gina is a 34 year old G2 P2 woman, day 2 post caesarean section. You enter her room to find her teary and upset; she tells you she had planned on having a natural birth in a midwifery led model of care. However, she experienced an emergency caesarean section after her baby showed signs of fetal distress. Describe and discuss the role and responsibilities of the midwife in providing pre and post-operative care to a woman in Gina’s position. You are expected to demonstrate, plan and evaluate safe, holistic, woman centred evidence-based midwifery care. This paper considers a postnatal case study of Gina, a day two post-operative, 34 year old Gravida 2 Para 2 woman. She experienced an Emergency Caesarean Section (ECS) resulting from fetal distress. This essay will investigate why birth can become an emergency and the evidence-based indications involved in decision making. It will explore the roles and responsibilities of a midwife in both the pre and post-operative support of a woman; based on a safe, woman centred and holistic approach to maternal care. It will discuss the emotional effects an ECS can have on a woman and her family as a crucial aspect in this case. An integral part of the preparation for birth is a birth plan. This allows the woman to detail how she would like her labour/birth to progress. It often includes the expectation of a natural vaginal birth. However, due to a variety of physiological...
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...Pre-Operative 1. The nursing responsibilities in the pre-operative phase of surgery are to do a patient screening, this includes any blood and lab work, history of surgery, any allergies to medications, history of chronic illness, nutrition level including any dietary regimens the patient should be on before and after surgery, as well as assessing all medications the patient is on and if there are any contraindications to surgery. To prepare the patient mentally physically and spiritually and also to conduct a patient teaching to ensure the patient has all the information that they have the right to know. The nurse also acts as a witness to the signing of the informed consent. 2. The nurse must assess the needs of the patient pre-operatively this can include the need for information, education, the need for comfort, the need for spiritual guidance. The patient may need to use the bathroom; the patient may feel ill or need some calming techniques shown to them. 3. The nurse has the responsibility of ensuring the patient is ready for surgery. The nurses’ duties usually include placing the patient on NPO status, starting an IV line, prepping the intestinal tract and skin and administering the preoperative medicines. The nurse is usually following orders from the surgeon or guidelines of the facility they work in. The nurse also had the responsibility of ensuring that the patient feels as though they have all the information that they have rights to and that they have...
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...Pre-Operative 1. The nursing responsibilities in the pre-operative phase of surgery are to do a patient screening, this includes any blood and lab work, history of surgery, any allergies to medications, history of chronic illness, nutrition level including any dietary regimens the patient should be on before and after surgery, as well as assessing all medications the patient is on and if there are any contraindications to surgery. To prepare the patient mentally physically and spiritually and also to conduct a patient teaching to ensure the patient has all the information that they have the right to know. The nurse also acts as a witness to the signing of the informed consent. 2. The nurse must assess the needs of the patient pre-operatively this can include the need for information, education, the need for comfort, the need for spiritual guidance. The patient may need to use the bathroom; the patient may feel ill or need some calming techniques shown to them. 3. The nurse has the responsibility of ensuring the patient is ready for surgery. The nurses’ duties usually include placing the patient on NPO status, starting an IV line, prepping the intestinal tract and skin and administering the preoperative medicines. The nurse is usually following orders from the surgeon or guidelines of the facility they work in. The nurse also had the responsibility of ensuring that the patient feels as though they have all the information that they have rights to and that they have...
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...A 31-year-old multigravida woman presents to the office for options on sterilization. She reports that she has four healthy children at home and is "finished" with being pregnant and childbirth. She states because of her hectic schedule she cannot remember to take pills daily and her husband does not like condoms. After further discussion, her last pregnancy was during her failed attempts with a diaphragm device and the third pregnancy was using the rhythm method. She does not like the idea of hormone injections. As a practitioner, I would inquire about her understanding of the procedures, surgical history which would include any gynecological, abdominal or cosmetic surgery (Hawkins, Roberto-Nichols, & Stanley-Haney, 2015). I would...
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...information after day case knee arthroscopy R. E. da Assuncao • J. Neely • J. Lochab • ¸˜ N. Mizumi-Richards • A. Barnett • H. Pandit Received: 29 November 2011 / Accepted: 19 July 2012 / Published online: 2 August 2012 Ó Springer-Verlag 2012 Abstract Purpose Day case knee arthroscopy is frequently performed on dedicated lists designed to optimise the throughput of patients. This could affect patient recall of clinical information with clinical, ethical and medicolegal consequences. The purpose of this study was to assess patient recall after knee arthroscopy and identify potential contributory factors. Methods Seventy-two patients undergoing day case knee arthroscopy were provided with information about their surgery post-operatively and tested for recall of the information prior to discharge. All patients underwent cognitive assessment when information was delivered and again when tested. Patient recall was correlated with demographic and anaesthetic factors and a multivariate regression model was used to identify risk factors for reduced recall. Results Recall overall was poor. Significant independent risk factors for reduced recall were reduced cognitive state at the time of information delivery and a shorter time between surgery and information delivery. Duration of R. E. da Assuncao (&) Á J. Lochab Á N. Mizumi-Richards ¸˜ Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX37LD, UK e-mail: ruy@doctors.org.uk J. Neely Canberra...
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...be the best time to have it done again either for screening or diagnostic. 3. (a) Explore the client feelings for a frozen section and possible mastectomy by encouraging her to express her feelings about her illness and determine her level of knowledge. (b) Evaluate the client and family coping ability (c) Provide a clear explanation of the procedure and her post operative care such as the placement of tube to collect the drainage from the incision and that her arm on the affected side will be elevated. In addition to the above, she would have to begin arm exercises shortly after sugery. Nurse to demonstrate the exercise and have client repeat the exercise. (d) If the client seems able to absorb the above information, provide other information such as the types of beast prostheses available. (e) Take measurement on both sides of the breast to obtain baseline data (f) Explain to the client that if she is going to have a radical mastectomy, the skin on the anterior surface of one thigh may be shaved and prepared in case she needs a graft. 4. My priorities in planning the immediate care for the client and the family include : Client:- (a) Keep client arm elevated on a pillow to enhance circulation and prevent edema. (b) Check the suction tubing to ensure proper function, and observe the drainage site for erythema, induration,...
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...Reducing Risks of Child Abductions at Nightingale Community Hospital A sentinel event in the hospital is an unexpected occurrence that involves or poses a high risk for death, serious physical injury or severe psychological damage (Joint Commission, 2013). Incidences that lead to adverse outcomes necessitate immediate attention and plans of actions to prevent recurrences. The Joint Commission, a non-profit certifying body for healthcare organizations, sets safety and quality standards for hospitals. It requires hospitals to conduct root cause analyses (RCA), implement processes to reduce risks of recurrence and evaluate the effectiveness of those processes for sentinel events (Joint Commission, 2013). Nightingale Community Hospital (NCH) had a child abduction sentinel event. The legal guardianship of a child who had surgery was not communicated to various departments of the hospital. The parents of the child were divorced and the mother had legal custody. The child was discharged home with her father. Fortunately, law enforcement located the child at her father’s home and no charges were filed. National statistics show that 9% of missing children are abducted by family members and 3% are kidnapped by non-family members (Polly Klass Foundation, n.d.). Less than 1% of abducted children are victims of homicide, physical abuse and/or sexual assault (Polly Klass Foundation, n.d.). Although these percentages are very low, the impact is great! This means a child who is abducted...
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...RESEARCH Proposing a carpal tunnel treatment centre: The Shouldice model revisited Hazim Sadideen, Faddy Sadideen ABSTRACT The Shouldice Hospital prides itself with excellent hernia repair outcomes. The Shouldice concept exhibits a unique, successful business model, and is a clear example of the concept of a highly innovative value proposition. Exploring Shouldice's fundamental principles and extrapolating them to other settings might help healthcare professionals offer improvements to patient care. Carpal tunnel syndrome (CTS) is the most common elective hand disorder, which can be debilitating for patients. Surgical intervention is extremely effective when necessary. It would be prudent to develop efficient pathways for the treatment of CTS, and other common disorders in the future. This review aims to explore the successes behind the Shouldice model, cross-fertilise surgical and management grounds by familiarising surgeons with the Shouldice model to help generate key ideas for the future, and extrapolate key information to postulate the 'carpal tunnel treatment centre' as a potential enterprise that can be designed on the basis of the Shouldice model. Optimal healthcare delivery while improving the patient journey, in a cost-effective manner, requires careful planning and execution. It is important to further explore and capitalise on this knowledge, to improve our service to patients and the multidisciplinary healthcare workforce, particularly in light of restructuring...
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...org/sentinel_event). A three year old female presented to the hospital on September 14th for a planned outpatient procedure. The child was accompanied by her mother. The mother registered the patient with the registrar prior to the procedure. The patient and her mother went to the pre-operative area to complete the informed consent and the necessary physical assessment. The pre-operative nurse obtained the necessary contact information from the mother who notified staff she would be leaving the hospital during the surgery to attend to a sibling matter at home. The mother left her cell phone number as the best contact number to call. This number was entered into the nurse’s personal notebook but was not entered into the patients chart. Post-surgery, the child was taken to the recovery area. The mother had not yet returned to the hospital. During the recovery period the child became more anxious without her mother at bedside. A male presented to the recovery area and identified himself as the child’s father. The patient identified the male as “daddy” and appeared to be comforted by his arrival. The father was provided discharge instructions by the post-operative nurse and was released to his care. Approximately 2 ½ hours later the mother arrived at the unit and was notified the patient had been discharged to home with her father. Mother became very upset, stating the she and the father were divorced and she was the custodial parent. At this point security was notified and...
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...Name And Student Number (Bolded)Course, Semester, Year | SITI ROHAIDA BINTE RAHMAT12B057ZADVANCE DIPLOMA IN NEUROSCIENCE, 2012 | Managing Client with Cerebrovascular Disease Introduction Stroke is a part of a cardiovascular disease that occurs when the supply of blood or oxygen to the brain is disrupted by a blockage in the artery or when there is usually a trauma that causes spontaneous bleeding in the brain (Duncan, Zorowitz & Lambert, 2005). Bleeding in the brain, is referred to as a haemorrhagic stroke which results from either ruptured blood vessels or due to an abnormal vascular structure such as arterio-venous malformation. Although stroke can be classified into two different categories (ischemic and haemorrhagic), one should note the indispensable relationship between the two. This would be later explained at a greater detail into the case study. The following would be a brief introduction of my chosen case study. Emergency Department A 22 year old gentleman was brought to the Emergency Department at 1235hrs on 28th October 2012 via ambulance. Patient was unresponsive upon arrival, GCS= 3, E1V1M1, bilateral pupils non-reactive to light and slight epistaxis noted. History obtained from eye-witnesses stated that patient just finished boxing practice and complained of severe giddiness before fainting shortly after and never regained consciousness. On arrival at Emergency Department, patient was sent for a CT (computed tomography) Brain with chest and cervical...
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...Accreditation Audit (AFT2) Task 2 Executive Summary: Root Cause Analysis Accreditation Audit (AFT2) Task 2 Executive Summary: Root Cause Analysis A. Aspects of Root Cause Analysis 1. Description of Sentinel Event Nightingale Community Hospital is conducting a root cause analysis of a pediatric abduction which occurred during a post-operative discharge process. “A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. Such events are called "sentinel" because they signal the need for immediate investigation and response.” (The Joint Commission, n.d.) In this event, a three year old child was admitted to Nightingale Community Hospital for a bilateral myringotomy. The mother of the child stepped out during the surgery in order to run an errand involving her other child. The mother was told the surgery would take about 45 minutes. The mother relayed that she should be back after the surgery to pick up her child. The mother did not respond after the recovery, even though the recovery nurse called out to the waiting area and paged for the mother. The patient was then transferred to the discharge nurse. The child was agitated waiting for her mother to return. Coincidentally, the father was at the desk and the nurse invited him to see his child. The nurse was relieved as the child changed her affect to one of excitement and called him daddy...
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...I am a trained nurse working in one of major reference hospital in a capital city of Sabah. I have 14 years experience working as a trained perioperative nurse in operating theatre. Working through the years gives me ample experience in this field. Over this year, the workforce development in health care system has change the nursing profession and become more challenging. These changes had affected the nursing role and also their boundaries. Extending nursing role has happened in order to improve patient care. In Malaysia, registered nurses had given a credentialing to be able to undertake a wider range of clinical activity. The National Council of State Boards of Nursing has stated that definition of professional boundaries are the spaces between the nurses power and apply the following concepts are a spaces between nurses and a patient, nurses and doctor and also to other healthcare worker. College & Association of Registered Nurses of Alberta stated in their article “professional boundaries separate therapeutic behavior which well intentioned or not could lessen the benefit of care clients, families and communities”. Professional boundaries is a guideline for all nurses to perform their work as a professional without violent or crossing the limit of responsibility. Nurses need to practice and consistent with professional standards. Maintaining appropriate boundaries controls these power differentials and allows for a safe connection between the professional...
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...Healthcare is experiencing significant and rapid change and dramatic change is still to come. Healthcare organizations must ensure high levels of technical and professional expertise during these challenging times. Nursing leadership that promotes creativity and innovation will succeed in change that is growth-producing, renewing, and invigorating for nurses and healthcare organizations, improving patient care and outcomes (Huber, 2014). An essential leadership competency to achieve this trend is, highly developed collaborative and team building skills. Relationship age leadership focuses on the relationship between the leader and his/hers followers, on discerning a common purpose and working together cooperatively to achieve a desired outcome...
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...Running head: OR EXPERIENCE Observational Experience in the Operating Room and Post Anesthesia Care Unit Bothayna Bader LaGuardia Community College Professor Rosenberg SCR 210 March 19th, 2013 Preoperative Phase The preoperative phase is the time period between the decision to have surgery and the beginning of the surgical procedure. For some patients, the preoperative period may last for months, during which testing and other procedures may be done. For an emergency, such as an appendectomy, the preoperative period may last only a few hours. During the preoperative phase, preadmission testing is done to assess health history, family medical history, and any known allergies to medications. During which time explanation of the surgical procedure and patient education is taking place. Patient education advises the patient on pre-surgical preparation such as bowel preparation, nutritional and fluid intake the day before the procedure and when to stop eating, and how to proceed with medication therapy the day before surgery. Diagnostic testing includes ECG monitoring, blood testing and vital signs. The trauma of surgery can greatly be relieved by psychological preparation of the patient before surgery, so during preadmission testing psychological evaluation is also taking place to assess the patient for any fears or anxiety related to the surgical procedure. The nurse should discuss techniques to aid physical recovery and ways to lessen the pain and anxiety that...
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...in making decisions about their healthcare, but when the decision is in effect, taken away from them, who has that right? When the nurse and stand staff struggle with the decision that is being made, it complicates the picture, leads to a lot of frustration and nurses feel helpless Several years ago there was an incident of a pt that received a kidney transplant, but during the immediate post operative course the patient, suffered a respiratory arrest, was anoxic for a period of time leaving the pt with anoxic brain damage. This was an individual who, prior to surgery, was a fully functional person. After time in the ICU the patient was able to be on the nursing floor; trached, unable to swallow, g-tube, very limited ability to walk, or transfer to a chair w maximal assistance of typically 2 staff members. The individual also tended, what seemed to be intentional, to try and injure nursing staff, by pinching, kicking and biting.. I was often assigned to this pt, and on several occasions had been nearly kicked, definitely pinched and scratched. When put in those situations, the immediate reaction is to become angry, and in when I’m put in that situation, I don’t even want to go to the pts room. In this situation, I had to step back and try to look at the big picture. It was very difficult to know exactly what the patient’s intention was. I had no way to know what the pt...
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