Introduction
A medical ward round is, according to the Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) guidelines “a complex clinical process during which the clinical care of hospital inpatients is reviewed” . Unfortunately, the importance of ward rounds for achieving good medical care is often underestimated by healthcare professionals . While their real life application varies from one clinical setting to another, ward rounds have several important purposes. These include aspects that directly influence the patient’s medical care, such as establishing or reassessing the patient’s diagnosis, creating a management plan, and arranging for their discharge, while communicating this to the patient in appropriate terms. The ward round should also function as a point where the multidisciplinary team (MDT) responsible for the patient can communicate and coordinate their efforts towards holistic treatment.
Ward-round Guidelines
The RCP/RCN guidelines suggest maintaining a clear structure for ward rounds in order to achieve a good quality of care . Prior to starting, a pre ward-round briefing should occur, where all members of the team should be prepared for the ward round, for instance by being brought up to date on their patients’ cases or being informed about their individual roles for the ward round. Similarly, a post-round debriefing should be held to ensure that there is no uncertainty about the decisions and plans that have been made about the patient care. Lack of clarity and differences in prioritising tasks among healthcare professionals in a team has been found to be a common cause of preventable adverse patient outcomes .
The guidelines also indicate the importance of the MDT approach to the ward r...
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...w prepared patients are for ward rounds when they occur and how involved they feel in the decision making process of their own care. This would ensure that patient needs are being met by the ward round process.
• In the pre ward-round briefing, assign each MDT member specific roles. This should aid the ward round process by increasing efficiency and reducing errors.
• Encourage the nurses to take an active part of the ward round whenever possible, and ensure that they are also briefed on their roles. Extensive literature suggests that nursing involvement is crucial for a successful ward round.
• Establish a pilot ward round proforma and subsequently audit its efficacy. The proforma should be ward-specific, and should have considerable space left for free text and comments, in order to allow note-taking for the dynamic situations that occur in hospital.
Appendix
A team led by RN, should mentally prepare their patients to understand their responsibility towards good health. This can be done by showing them special documentaries during their stay in the hospital, in a common room where other patients can also join them in a group of six to twelve. After the session, patients should be given a short comments form with multiple choice answers (Appendix A). The purpose is to check their positivity towards the message conveyed through the documentary. At this time patient's vitals should be checked and recorded for the future
In conclusion, Leonard, M et al (2004) point out that The complexities of patient care, coupled with the inherent limitations of human performance, make it critically important that the multi-disciplinary teams have standardised communication tools. looking back over Mrs X’s journey along this pathway. It was unquestionably the exemplary teamwork and communication, that were so fundamental in providing the holistic care that Mrs X needed. The responsibility and roles of the multi-disciplinary team were varied and often overlapped within the theatre suite. The team members had differing and varying levels of experience and expertise, but combined these when working together to care for Mrs X.
Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge planning between any health care settings can be detrimental to patient care.
This is counterproductive towards the patients’ own recovery from the ward to a normal life
There are six set standards of the nursing practice; assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ANA, 2010; pp. 9-10). Throughout a typical shift on the unit I work for, I have set tasks I am expected to complete in order to progress the patient’s care, and to keep the patient safe. I begin my shift by completing my initial assessment on my patient. During this time, I am getting to know my patient and assessing if there are any new issues that need my immediate intervention. From here, I am able to discuss appropriate goals for the day with my patient. This may come in the form of increasing mobility by walking around the unit, decreasing pain, or simply taking a bath. Next, I plan when and how these tasks will be able to be done, and coordinate care with the appropriate members of the team; such as, nursing assistants and physical therapists. Evaluating the patient after any intervention assists in discovering what works and what does not for the individual. “The nursing process in practice is not linear as often conceptualized, with a feedback loop from evaluation to assessment. Rather, it relies heavily on the bi-directional feedback loop...
As a provider of care an AD nurse uses a systematic approach in all areas. Using the process of assessment, analysis, implementation, and evaluation the nurse is able to be consistent and efficient when providing care. As a provider of care the AD nurse must assess a patient’s health status, gather medical history, plan, coordinate, and implement care. The nurse will use continual assessment and evaluation in order to ensure the best outcome for the patient. The AD nurse must develop a therapeutic relationship with the patient in order to effectively treat and provide advocacy. During my clinical rotation I was able to implement many of these steps. I provided daily physical assessments, took vital signs, implemented hygiene care, fed patients, re-positioned patients and changed bed linens. During each shift I was respons...
The healthcare world has simply grown too large, too quickly and, as a result, has forgotten the reason behind which it stands: the patient. Continuity of care is in dire need of repair and without effective communication and coordination of care, the problem will not be corrected.
...be beneficial for the hospital. The nurses are the front runners in patient care, and their input should be taken into serious consideration. Testing this plan, and revising it before it is fully implemented, can only have positive outcomes for the hospital and patient care.
Nurse rounding is important to hospital-based practice because it directly impacts patient satisfaction (Blakley, Kroth, & Gregson, 2011). It serves as a method to improve quality of care by allowing nurses to routinely visit their patients and provide for any needs while also anticipating any safety concerns. Patients’ overall perceptions of hospital experiences are heavily dependent on how successful nurses are in satisfying the basic needs (Blakley et al., 2011). Rounding permits nurse-patient interaction and communication periodically, allowing observation and exchange of relevant information and also implementation of proper interventions. Nurses must practice rounding competently with compassion. By doing so, the patient has the opportunity to be involved in their own care which builds a trusting and positive relationship between the nurse and the patient, ultimately leading to improved quality of care and safety.
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.
Nursing is a unique system that requires good collaboration with others and working together to reach the goal of providing good quality care based on evidence-based-practice. “The role of a colleague is a vital one in any profession. The status of colleague within the care generates pictures of nurses, doctors, pharmacists discussing, on an equal basis, problems and concerns related to healthcare” (Zerwekh & Zerwekh Garneau, 2015, p.144). If nurses can’t get along with other healthcare providers that will jeopardize the patient’s recovery and can take a huge turning point and guide nurses away from providing high quality
Also, includes examples of nursing hands off that will be implemented, such as including the patient at the bedside. Having small trainings to provide information that will be needed to implement this, being sure all the important parts are cover, such as vitals, assessment, labs, and medication. Using online aids to help assist, providing additional information to those who need it.
ANA describes “The Scope of Nursing Practice (as) the “who,” “what,” “where,” “when,” “why,” and “how’ (8).’ In other words, it is the responsibility of the nurse to know who their patient is, what the patient’s diagnosis and treatment are, where it is they will be delivering treatment, the rationale behind their actions, and how they will deliver the care. By following the scope of practice, nurses reduce avoidable errors and are aware of the liability their actions entail. The ANA also puts forth a nursing process to guide nurses in treatment. The constantly evolving process is currently assessment, diagnosis, identification of outcomes, planning, implementation, and evaluation (ANA 9). Though this method has dramatically improved nursing care, it may be necessary to repeat steps to adapt to a patient’s changing needs and pathologies. By following guidelines set by the ANA, nurses are able to better connect with their patients and instill the image of professionalism to the public while also optimizing safety
middle of paper ... ... The priority for this patient was to establish that she was fully aware of what the procedure involved and the possible risks and complications. I feel that the pre-assessment form used within the unit is far too fundamental, if elements of the roper et al activities of daily living were to be incorporated this would help in achieving a much more in-depth holistic nursing assessment enabling for the best quality and level of care to be given to all patients arriving in the unit. Whilst I feel a full nursing assessment is not fully necessary for a day case unit, as previously stated I feel that the communication element is an excellent way of ensuring a better holistic approach is achieved, it will also help to achieve better documentation and communication between all staff members.
There are many members of the inter-professional team, all of which are contributing to the healthcare of acute and critically ill patients. Every member of the team has had education and obtained a license of practice compatible to their level of knowledge (Prater, Fundamentals of Nursing, 2013). As a practical nurse you need to be mindful of your scope of practice in relation to registered nurses, certified nurses’ assistants and other healthcare professionals. With so many different people involved in the immediate care of a patient, there is always the possibility of a mix up. The purpose of this paper is to help differentiate between the roles of the healthcare staff, which will in turn help develop a knowledge base for prioritizing care;