NRSG355 – Clinical Integration: Transition to Professional Practice. – Nursing Assignment Case… 

NRSG355 – Clinical Integration: Transition to Professional Practice. – Nursing Assignment

Case Study:

Grant Thompson was a fit 37-year-old man, a father of two young children and married for 14 years to Georgina. Grant was a truck driver who has involved in an MVA 6 months ago and suffered extensive injuries to his leg and a mild head injury. His recovery has been slow and he relies heavily on the use of a wheelchair but can now walk for short distances with the aid of a walker. Georgina wants Grant to come home and rehabilitate there. She has made some modifications to their home, ramps put in, handrails in the bathroom and toilet.The health care team is meeting to discuss this option. The team consists of the treating doctor, physiotherapist, and occupational therapist, NUM of the rehabilitation unit, social worker and psychologist. There is disagreement among the team as to whether Grant would be better to 
stay in the hospital a bit longer or go home. The physiotherapist and the occupational therapist both feel that Grant still requires intensive treatment which can only be provided as an inpatient. The psychologist and the social worker have noted that Grant’s separation from his family and home environment has been having a negative effect on Grant, Georgina and their children. The treating doctor feels that we could treat Grant as an outpatient but it would mean he has to attend regular physiotherapy and occupational therapy sessions. You are the team designated leader of the healthcare team.

Questions:

1. What are the key issues in this dilemma? 
2. What outcomes would be best for Grant and his family? 
3. How would you guide the group in achieving this best outcome?

Case Study 2:

Norma Ellis is a 76-year-old widow who recently had a fall at the nursing home she has lived in for the past 7 years and fractured her hip. She has subsequently had a hip replacement and has been rehabilitating well and is now due for discharge back to the nursing home. Norma has an extensive medical history including postural hypotension, rheumatoid arthritis and impaired mobility. She mobilised within the nursing home using a walker. Her son is demanding that his mother be kept in the ward as an inpatient as he feels the nursing home staff were negligent and wants his mother to be placed elsewhere but has not arranged this yet. The treating team consists of the doctor, physiotherapist, NUM of the rehabilitation unit, social worker and NUM of Norma’s wing at the nursing home she was in prior to the fall. You are the designated team leader. The doctor feels there is no need to have Mrs Ellis on the ward as he feels that her rehabilitation 
has been maximised, this is an opinion shared by the physiotherapist. Norma wants to go back to the nursing home as she has made many friends there and feels at home there.

Questions:

1. What are the key issues in this dilemma? 
2. How would you deal with Norma’s son? Are his objections warranted?

Case Study 3:

Robert Hughes is a 52-year-old male who has injured in a bicycle accident two months ago where he suffered fractures to his (R) tibia/fibula and (R) radius. Robert is intellectually impaired and was living with his elderly mother until the accident. Robert has been known to engage in verbally aggressive outbursts towards staff and other patients. His mother who is now 75 years of age feels she can no longer look after Robert. You are the NUM of the rehabilitation unit that is admitting Robert for his ongoing rehabilitation. You are required to gather together a health care team to determine immediate and long-term care options for Robert.

Questions:

1. What are the key issues in this situation? 
2. Who would be included in the health care team and what role would they play?

Case Study 4:

You are working in a health care team on a busy rehabilitation unit. Team meetings and patient reviews are conducted weekly. There has recently been a turnover of staff in the Physiotherapy department and a new representative from physiotherapy has joined the health 
care team. You notice although that this new member of the team members is often absent, fails to provide patient updates and when challenged on these issues is exceptional confrontational. This behaviour is not only impacting on the effectiveness of the health care team but also on patient outcomes. You are the designated team leader and need to find a resolution.

Questions:

1. What are the key issues in this situation? 
2. What strategies would you employ to address this situation?

Case Study 5:

You are the NUM of a Mental Health Unit where case reviews are conducted every 4 weeks. You are the designated team leader and the team members include the medical officer, a resident psychiatrist, patient case manager, social worker and employment officer. Several of the 
team members approach you after the meetings and voice concerns about how the meetings are being dominated by the medical staff. The general feeling was that the medical team dominated all clinical care decisions and most of them felt they did not have a voice at the team meetings. As the designated team leader you are responsible for ensuring equity exists in decisions about ongoing care.

Questions:

1. What are the key issues in this situation? 
2. What strategies would you employ to address this situation?