There can be post-surgical risks that the patient may face after laparotomy procedure for appendectomy and when these risk or complications are seen. If there is any post-operative infection which occurs within the first 48 hours in hospitalization, it is termed hospital-acquired infection and the patient Nicole is susceptible to the same (Yousefshahi et al., 2018). The first risk that Nicole can face is a local infection at the operation site. This can be attributed to various reasons like the non-maintenance of hand hygiene by the healthcare staff, the patient, carers and family members (Berríos-Torres et al., 2017; Tanner et al., 2016). The surgical wound should close by primary intention and infection at the site of surgery can hamper the healing process and compromise the safety of the patient and health outcome (World Health Organization, 2018). The surgical site should be assessed and evaluated continuously to make sure that it is free of any contaminant and is undergoing a healthy healing process. The dressing should be kept clean and dry, free from fecal contact and the drain should be evaluated for healthy healing (Gillespie & Chaboyer, 2018). Inadequate and improper hand hygiene is one of the reasons for the cause of surgical site infection. The World Health Organization has given five moments for hand hygiene which the healthcare workers including nurses are to follow to make sure that infection risk is reduced (Stahmeyer et al., 2017).
The second risk that can be seen in Nicole during post-operative phase is the development of peritonitis which is the infection and inflammation of peritoneum leading to distension and fluid retention in the abdomen. Rupturing of the appendix during or before the procedure can lead to leaking of the content into the abdominal cavity causing (Podda et al., 2017). This causes the infection which is bacterial in nature and immediate intervention should be done to make sure that there is no untoward outcome. The symptoms that are seen in case of peritonitis are pain and tenderness of the abdomen which is worse during movement and palpitation, the patient feels bloated, and bowel sounds are present but there is no flatus (Lu et al., 2017). Other symptoms include nausea, vomiting, diarrhea, loss of appetite, fatigue, the rise of temperature, the patient becomes hypotensive, tachycardiac and tachypneic (Lu et al., 2017). The white blood cell count is increased and the urine output is reduced this is a fatal condition and prompt treatment is mandatory as if left untreated may lead to the death of the patient.
The third risk that can be seen in Nicole is reduced cardiac output. This can be attributed to reasons: first, the patient is post-surgical and surgery would have let to a loss of blood which would have reduced the volume of blood and second, due to presence of infection there can be a fluid shift in the body which reduces the afterload causing reduced cardiac output (Choi et al., 2018). Clinically the patient shows hypotension, increased heart rate, increased respiratory rate and the capillary refill time gets increased causing the skin to become cool and clammy. The patient should be carefully monitored for these risks and any change in the clinical condition and vital signs should be updated to the doctor. The changes are recorded, documented so are the interventions that are given are to be documented. Continuous monitoring and prompt treatment are required for positive health outcome of the patient (Ladwig, Ackley & Makic, 2019).
As a recent graduate nurse, it is expected that the nurse follow the registered nursing standard, the national standard for safety and quality of health services, national policies and organizational policies and procedures. The core of the registered nursing practice is to provide appropriate and safe care to the patients to make sure that there is a positive health outcome (Melnyk et al., 2018). Standard one of the registered nursing as given by the nursing and midwifery board of Australia which states that the nurses should be able to think critically and analyze the nursing practice (Nursing and Midwifery Board of Australia, 2016). The nurses should be able to assess, analyze and utilize the best level of evidence that is available as a result of research which is required for the practice of safe and quality healthcare (Portney, 2020). This source can be used by the nurse to better the knowledge and use it for positive health outcome. Another source of evidence that is recommended for the use by the registered nurses is the guidelines given by the centres for disease control and prevention (Berríos-Torres et al., 2017). There are guidelines which are given for reduction of infection, maintenance of hand hygiene, antibiotic stewardship and others to minimize infection risk.
This can help the nurses to ensure that the practice of care that is given to Nicole is as per the required guidelines and untoward reaction is minimized. National standards of safety and quality for health services have given standards that the healthcare professionals including nurses and the organization should follow these standards which are evidence-based for quality of care (Australian Commission on Safety and Quality in Health Care, 2017). As a registered nurse, one should have an understanding of the source of evidence and the strength that is provided by them. There are various kinds of researches which are conducted in the field of medicine and nursing and the nursing professional should understand the implication of those researches. Only then the results obtained from the research can be included in practice and provide safe and quality care to the patients.
According to the hierarchy of evidence, the highest strength is acquired by systematic review and meta-analysis (Del Fabbro et al., 2019; Doleac, 2019). A systematic review is of good strength, if the studies included in these reviews are randomized control trial and the synthesis of result in a systematic review is in such that way only good quality evidence is selected and the result obtained is good (Siddaway, Wood & Hedges, 2019). Meta-analysis is superior to systematic reviews because if the result is inconclusive after the systematic review meta-analysis provides clarity (Deeks et al., 2019). Next level of evidence that is strong and is recommended to be used in healthcare is a randomized control trial. The strength of evidence is good because of the methodology and randomization which creates a good amount of internal and external validity of the results which means it can be applied to patients. As a fresh graduate nurse, they are given education for evidence-based practice but the application of the same comes with practice and experience (Li et al., 2016). There are various medical and nursing databases which have research that is published by other healthcare providers. While choosing evidence the nurse should be careful whether the source is peer-reviewed or not as peer-review procedure help in the refining the procedure of publication and weed out the shortcomings (Pickler, 2019).
The core of nursing is to provide the best level of care to the patient which is safe and appropriate. The whole team of healthcare of a patient works with a single goal of positive health outcome of the patient and betterment of the patient. One of the most important aspects of care is to make sure that the care process is more person-centred care (Byrne, Baldwin & Harvey, 2020). Earlier the care process is in such a way that it was paternalistic in nature that is, the care provided by the doctor is best. This thinking has been changed and to more of a person-centred care in which the patient’s beliefs, values and other process are taken into considerations (Evans, 2017). This is called person-centred care where the care process is focused only on the patient and if the care process is for the patient who has a cognitive problem or for the pediatric problem then this is called family-centred care.
When the patients are involved in the care process is termed is called partnering with consumers. This partnership can be done at the level of the individual, at the level of organization and the level of policymaking. Involving the patient in their case process from the perspective of patients makes them feel that they are important and care is for them (Australian Commission on Safety and Quality in Health Care, 2017).
The information giving process is improved which is required as a part of effective communication between the healthcare professionals and patient. Involving patients in the care process and having transparent communication can help the patients to make medical decision for them which is called shared decision making. In case of Nicole, it is seen that she shares a concern that she is not aware of the care process and how long she is going to be in the hospital which is a reason for the cause of anxiety. Involving patients in the caregiving process can cause relief from anxiety which can improve the safety of the patient and have positive health outcome in the patient. A national standard for safety and quality of health service, standard three is related to the partnering of the care with the consumers. Here the consumers are not just the patients but also their carers and family members are considered as the consumers (Australian Commission on Safety and Quality in Health Care, 2017).
At the individual level, the partnership is related to giving education and makes the patient literate in such a way that they are able to choose the extent of care received. As a fresh graduate nurse, it should be understood that the core of the caregiving process is the patient. All the measures should be taken to make sure that the care is not generic but is customized to the needs of the patient being treated. Involvement of the patient in the care process is not just related to the physical aspect of the health also mental, psychological, spiritual and other aspects. Nurse can educated Nicole for medication safety, her positioning so that her wounds do not open and maintenance of hand hygiene. It is evidenced that patient involvement and shared decision making have improved the health outcome and increase faith patient has on the health services and the healing is enhanced (Rajabiyazdi et al., 2016).
Scope of nursing practice that is to be performed by the registered nurses involves a range of roles, responsibilities, functioning and taking part in the activity which they have been educated and are authorized to undertake (Déry et al., 2018). These functions, roles and responsibilities that the nurse undertakes can be performed autonomously or under supervision of superior nurse or doctor depending on the role and complexity of the procedure. As a fresh graduate nurse, who does not have much experience in handling cases like that of Nicole might require the nurse to seek assistance and expertise of nurse leader. As a part of education, the nurses taught to work complying with the registered nursing standards and the national standards of safety and quality for health services. These are important so that the patient safety and health outcome of the patient are maintained which a legal and ethical responsibility of the nurses (Andersson et al., 2017).
The nurse is expected to tap into the knowledge that is provided and apply critical thinking, judgment and skill. The profession of nursing is an art which includes the principles of nursing, medicine, social and public health sciences (Taylor, Lynn & Bartlett, 2018). Now that the definition of health has included all the aspects and it is the holistic concept and the same should be included in the care process by the nurses as well. In the present case of Nicole, the other aspects like cultural, social, psychological, spiritual needs should be identified by the nurse so that holistic care is provided to the patient. The information deficient that is present in present should be fulfilled by the nurse who can help in the promotion of self-reliance and self-determination.
Theories and principles of nursing should be utilized for a comprehensive assessment, nursing diagnosis, development of care plan, provide nursing intervention and evaluate the same. The scope of practice in the present case includes interprofessional coordination between the members of the healthcare team (Fleming & Willgerodt, 2017). This important for the provision of safe and quality care and it should be maintained at all the points of care and should follow the patient. Proper documentation and effective communication electronically and verbally is necessary and has to be maintained by the nurses even at the time of handover. In the present case, the patient is in post-operative care where there are few risks that the patient can face. It is the duty of the nurse to monitor the patient continuously for the change in the vital signs and discomfort of the patient so that acute deterioration can be identified and prompt measures for the rectification can be taken (Kellett, 2017). It is the responsibility of the nurse to be available for their patients physically as well as emotionally and one of the things that are expected from the nurse is to provide reassurance. According to the scope of practice, nurse can assess Nicole and administer medication but she cannot prescribe any medication.
The culture of the nursing unit can influence the care process which of the patients directly as well as indirectly. As a culture of the nursing unit, it is a possibility that there are practices which can affect the practices of nurses in the way care is provided to the patients. This influence on the practice of the nurses is in such a way that it can affect the safety of patient and quality of care (Manojlovich & Ketefian, 2016). For example, the nurses can have a rule of shared responsibility of taking care of the patient which might affect the safety of the patient. For example, if a nurse is supposed to be checking up on the patient and for some reason is unable to do so. She can ask her colleague to do so which is not the right practice and at the same time, the other nurse might have divided attention for the patient as well as for the patient of the former nurse. The positive influence of the nursing culture that can be seen is the pattern of research that is conducted and followed as a part of the caregiving process which can affect the safety of patients. From the perspective of nurses, it is seen that due to hierarchical structure of authority that influences the care and bedside manner in which innovation is discouraged and clinical experience is given more emphasis than the evidence-based practice (Schoenmaekers et al., 2019). This results in the practice that is to follow the instructions of the patient and merely following the routine than critically analyzing the instructions.
Role of nursing leaders is also important in influencing the practice of the fresh graduate nurse which in turn influences the quality of care provided to the patient and compromising the safety of the patient (Sfantou et al., 2018). The nurse leader acts as a role model for the nurses who work in their team in such a way that the practice can be affected positively or negatively. There are different types of leadership styles which have their own influence on the team members and they were transformational, transactional, autocratic, laissez-faire, task-oriented, and relationship-oriented leadership. Nurse in the present case for the registered nurse is able to escalate the problem if there is any in case of Nicole to the nurse leader. Nurse leaders are not just a bridge between the experience, unit culture and the nurses but also act as a moderator between the nurses and organization (Farokhzadian, Nayeri & Borhani, 2018). This is necessary to make sure that the policies and procedures present in the organization for the safety of the patient are being applied appropriately. Nurse leader works as a supervisor so that they have an overview of all the patients in a unit and they should be aware of all the progress and deterioration (Sonğur et al., 2018). In the case of Nicole also the working of the nurse leader can affect the safety and quality of care that is being provided to her. A fresh graduate nurse is catering to the care a nurse leader’s responsibility is to supervise the work done and if required provide effective delegation and impart direction and instructions to novice nurse.
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