This question has 2 parts called Question 1.1 and Question 1.2
Question 1.1: How can you include the patient as an active participant in their medication care (provide 3 realistic strategies supported with references).
Effective communication with the patient can lead to medication adherence and medication compliance, thus making the patient an active participant in medication care. It can enable the patient to understand the rationale behind his/her various medications and warn him against the damage non-compliance and non-adherence of the medication can lead to. The nurse can play a key role in effective communication.
The communication with the patient, Mr. Svenson, should only be a verbal exchange but should encompass psychological, emotional and motivational aspects to leave a deeper and effective impact on the patient.
Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. (Chevalier et al., 2017)
The defining features of patient participation in the context of nursing care include the need to have an established relationship between the patient and nurse, the surrendering of some power or control by the nurse to the patient, the sharing of information and knowledge between patients and nurses and finally active mutual engagement in either intellectual or physical activities. (Oxelmark et al., 2017)
Listening to the patient reflects the nurse’s willingness to help and enables the nurse to understand the patient’s goals, plans and preferences.
Engaging the Mr. Svenson by discussing with him the discharge plans, medications, investigations being performed can make them an active participant in their treatment.
Sharing some responsibilities to relinquish power to the patient, Mr. Svenson, can be brought about by involving the patient in decision making, their own care planning etc.
The ability of nurses to promote and help bring about active patient participation in medication care needs consideration. The use of medical jargon, generic names instead of brand names and display of negative attitude by the nurse while dealing with the patient, Mr. Svenson, can be a barrier in the patient’s participation in medication care.
While nurses demonstrated understanding of the ways they could engage patients in medication management and appeared to appreciate the role patients could play in maintaining their own medication safety, there was little evidence of nurses routinely engaging patients in their medication management or reinforcing their current knowledge. (McTier, Botti and Duke, 2015).
Question 1.2: Promote medication safety (provide 2 realistic strategies supported with references).
Medication errors are the second most prevalent cause of adverse patient incidents in Australian hospital settings. (Wilson et al., 2016) According to Wilson et al., Interprofessional Collaborative Practice (IPCP) can form a strong foundation for medication safety.
In this interdisciplinary approach, the nursing, pharmacy and medical graduates work in close cooperation. Open and direct communication helps ensure medication safety as a part of IPCP wherein the professionals interact with respect and trust, give each other advice, ask questions and acknowledge the limitations of their own knowledge.
Effective IPCP thus results in safe medication prescribing, dispensing and administration as medical, nursing and pharmacy professionals are a part of this practice.
Nurses are positioned to administer medications safely to patients based on their knowledge, clinical reasoning ability, and nurse-patient relationships. The literature does not specifically highlight sufficient evidence of nurses’ clinical reasoning as it supports safe medication administration. (Rohde & Domm, 2017)
The nurse’s decision making for managing medication should entail thorough knowledge of the medication, evaluation of the patient’s condition and clinical reasoning based interventions to ensure medication safety.
With little or no traces of discussion on clinical reasoning of the nurses, it is evident that nurses are sought to partake in only the administration of medication. If they are encouraged to use clinical reasoning and promoted to consult the head staff/doctors on instances they feel the need to cross-check the medication, it could help ensure a safer administration of medicines and incidents as well risk related to medication errors could be significantly reduced.
Discuss how and why you would undertake a medication history of a patient under your care.
Medication history is initiated by the introduction of the nurse to patient, wherein the name and role are mentioned.
This is followed by confirming the name and date of birth of the patient.
The nurse then explains the rationale for undertaking medication history to the patient.
Following this, the patient is enquired about the 6 key questions regarding his/her medication. The questions include:
What is the medication? (drug name or description of the drug)
What is the medication taken for? (indication)
How much of the medication is taken by the patient? (dosage)
How often the medication is taken by the patient? (frequency per day/week/month)
When did the patient start taking the medication?
How is the medication taken/administered?
Medication history is taken because it helps to make the right decisions for care and treatment of the patient. It enables the nurse along with the medical team to take a note of any change in the prescription as compared to any prior visits or pre-surgery scenario, hence to keep a check on medication error through the process of medication reconciliation.
The admission medication history is the “cornerstone of the [inpatient] medication reconciliation process. (Pitman, Ngo & Mester, 2020) Medication history thus ensures patient safety through medication safety.
Three actions you would take in this situation, and a clear rationale or reason for each action. Outline what specifically you would say to the RN.
I, as a student registered nurse, would first check with the registered nurse if they have checked the patient for the symptoms and conducted the required checks. If the symptoms have not been checked for or the tests not conducted, I would check and investigate before administration of the medication. Also, I would confirm with the patient and check his reports to look out for any conditions related to liver or liver damage.
The rationale behind this is that paracetamol is given for symptomatic relief of pain and/or high temperature. Paracetamol should be avoided if there are no symptoms and administration of too much of paracetamol can lead to liver damage.
As the number of tablets has been mentioned but their power/strength has not been mentioned, as a student registered nurse, I would confirm the same with the registered nurse before the administration of the medication.
The rationale behind this is that if the strength of the tablets is not confirmed with the registered nurse it can lead to paracetamol overdose. Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose‐dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. (Niedrig et al., 2016)
As a student registered nurse, I would request the registered nurse to supervise while I administer the medication to the patient. If the registered nurse is too busy and unable to supervise, I would then request midwife, enrolled nurse or any other nursing senior staff to supervise while I administer the medication to the patient.
A registered nurse or nurse practitioner or midwife needs to supervise the medication administration to prevent medication errors and to abide to the legislative requirements.
It is a role of the registered nurse, nurse practitioner and midwife, eligible midwife and in limited situations enrolled nurse, to administer medication in accordance with the legislative requirements. (WA Country Health Service, 2018)
Three actions you would take in this situation and a clear rationale or reason why you would take each action.
As a student nurse, I will make the patient understand that it is essential to take the medication on time and it is something that should not be taken lightly.
The rationale behind this is that the medication needs to be taken on time to make sure that the patient at all times has an effective amount of the drug in the body in cases of pain, injury or infection. For chronic illnesses, medication is the most effective when taken daily at the same time. Taking medicine on time also ensures medication adherence.
Even after explaining the rationale behind taking medication on time if the patient doesn’t comply, I, as a student nurse would give the patient a few minutes or until I complete the round and then come back to the patient to check if he is ready for the administration of the medication.
The rationale behind this is that with persistence, the patient might understand the importance of taking medication on time and might get convinced for the administration of medication.
After giving some time, if the patient still does not comply as a student nurse, I would then request the registered nurse to look into the matter and deal with the patient.
The rationale behind this is that it is not acceptable for the patient to miss out on the dose as it will reduce the effectiveness of his ongoing treatment and also disrupt the patient’s schedule.
The timing of drug administration is crucial to the safety and success of different therapies. (Fox & Sheridan, 2019)
APA referencing: http://libguides.newcastle.edu.au/referencing
Chevalier, B. A. M., Watson, B. M., Barras, M. A. & Cottrell, W. N. (2017). Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling. Health Expectations, 20(5), 1121–1132. doi:10.1111/hex.12558
Fox, A. D. & Sheridan, D. J. (2019). Timely medication administration guidelines. Nursing, 49(11), 58–59. doi:10.1097/01.nurse.0000580708.32769.67
McTier, L., Botti, M. & Duke, M. (2015). Patient participation in medication safety during an acute care admission. Health Expectations, 18(5), 1744–1756.
Niedrig, D. F., Bucklar, G., Fetzer, M., Mächler, S., Gött, C. & Russmann, S. (2016). Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme. Journal of Clinical Pharmacy and Therapeutics, 41(5), 515–518. doi:10.1111/jcpt.12427
Oxelmark, L., Ulin, K., Chaboyer, W., Bucknall, T. & Ringdal, M. (2017). Registered nurses’ experiences of patient participation in hospital care: supporting and hindering factors patient participation in care. Scandinavian Journal of Caring Sciences, 32(2), 612–621. doi:10.1111/scs.12486
Pitman, S. K., Ngo, J., & Mester, S. J. (2020). Tips for admission medication history success. American Journal of Health-System Pharmacy, 77(17), 1375–1378. doi:10.1093/ajhp/zxaa148
Rohde, E. & Domm, E. (2017). Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature. Journal of Clinical Nursing, 27(3-4), e402–e411. doi:10.1111/jocn.14077
WA Country Health Service. (2018). Medication administration policy for nurses, midwives and unregulated health workers. Retrieved from http://www.albanyhealthcampus.health.wa.gov.au/fileadmin/sections/policies/Managed/Medication_Administration_Policy_TS4KSNFPVEZQ_89_1573.pdf
Wilson, A. J., Palmer, L., Levett-Jones, T., Gilligan, C. & Outram, S. (2016). Interprofessional collaborative practice for medication safety: Nursing, pharmacy, and medical graduates’ experiences and perspectives. Journal of Interprofessional Care, 30(5), 649–654. doi:10.1080/13561820.2016.1191450
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