Case study:

Mrs Glenda Tukey is a 78 year old lady recently discharged from hospital after  IV antibiotic and diuretic treatment for cellulitis of her lower leg and an exacerbation of her congestive heart failure. She has been readmitted to the emergency department with a suspected UTI and management of her heart failure. She weighed 118 kg on discharge last week but her weight has ballooned to 125kg and pitting oedema is evident up to her thighs in both legs. She has compression bandages loosely applied and a damp dressing over a small skin tear on her left shin. Her skin is hard, red and warm to the touch and very dry over both lower legs.

Mrs Tukey also has insulin dependent type 2 diabetes and severe peripheral neuropathy affecting her feet and hands. She is a tall lady 178cm and uses a walking stick for support but her oedema makes it very difficult for her to mobilise into and out of bed and around the house. Her neuropathy mean she has difficulty with fine motor skills and has very poor  proprioception. She also has newly diagnosed atrial fibrillation and started taking warfarin during her last admission. Mrs Tukey has a 48-year-old son with downs syndrome who lives with her and for whom she is the primary carer- he is with her in the emergency department and is quite distressed.

The emergency department is transferring Mrs Tukey back to your ward for further management. You had looked after Glenda during her last admission and met her son Bradley. She is an intelligent widely read lady with very firm ideas about the management of her own health and a strongly expressed desire to remain living independently in the community and caring for her son. She is a big fan of grapefruits which she says are more effective at controlling her blood pressure than the B Blockers she is prescribed. She has not been taking her warfarin and has been tapering down her dose of diuretics as they were making her urinate too frequently. You notice she is not as cognitively sharp as she was last week and seems confused about where she is.

Course Learning Outcomes (CLO) Assessed

1. CLO 1 Apply NMBA RN standards in different clinical practice leadership scenarios.
2. CLO 2  Critically reflect on and appraise RN leadership qualities and skills in the context of clinical practice.
3. CLO 3 Analyse the leadership relationships between the leadership of the Registered Nurse in a collaborative healthcare team and patient outcomes.

Assessment Criteria and Rubric

Rubrics help you to understand what knowledge and skills you need to demonstrate in your assessments. They also show you how your submission will be marked and what is expected at the different grade levels. Your work  will be assessed against the following criteria,

1. Critical appraisal of the role of the registered nurse, and collaborative multidisciplinary healthcare team, in improving patient outcomes relevant to the case study.
2. Analysis of the role of the RN as a leader in collaborating with members of the healthcare team in the case provided.This criterion is linked to a Learning OutcomeExploration of the roles and expertise of three key members of the collaborative healthcare team (other than the RN) in delivering safe and high quality care in the case study

• Application of appropriate elements  of the NMBA Registered Nurse Standards for Practice linked to the case study.
• Academic written communication and presentation skills, using the APA 7 style referencing and citation.

Referencing not less than 5 years ( APA format)

NMBA standard linked

Professional Codes & Guidelines

• Policiesexpand

• Professional standardscollapse

• Registered nurse standards for practice

• Enrolled nurse standards for practice
  • Nurse practitioner standards for practice

• Midwife standards for practice

• Guidelinesexpand
• Position Statements
• Frameworksexpand
• Fact sheetsexpand
• COVID-19 guidance for nurses and midwives

Download a PDF copy of the Registered nurse standards for practice (177 KB)

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Introduction

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How to use these standards

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Registered nurse standards

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Standard 1: Thinks critically and analyses nursing practice

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Standard 2: Engages in therapeutic and professional relationships

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Standard 3: Maintains the capability for practice

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Standard 4: Comprehensively conducts assessments

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Standard 5: Develops a plan for nursing practice

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Standard 6: Provides safe, appropriate and responsive quality nursing practice

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Standard 7: Evaluates outcomes to inform nursing practice

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The task asks for a choice of three members of a collaborative multidisciplinary health care team, but in our modules there is a different concept for collaborative health care team and multidisciplinary team… Am I right to think we are to talk about the first one, in which the different professions would collaborate and come up with an interdisciplinary plan for Glenda?

Also, I thought of choosing a pharmacist, a podiatrist and ACAT referral for home package assistance… should I go with something that is more related to her presentation to the hospital instead of ACAT that is relevant for discharge? I’m just unsure if there is a right or wrong answer for the professionals we are choosing, or is it just dependant on our rationale for our choices?

Hello Juliana, This can be quite confusing and in reality the terms are used exchangeably. But yes you are correct this task requires the RN to collaborate with different health professionals to plan Glenda’s care.

Discharge planning starts at admission – so it is perfectly reasonable to flag Glenda’s case with the ACAT team as early as possible. 

There is definitely no right or wrong answer for task 3- its all bout how well you justify your choices,

Much like Task 2- I would spend my first efforts highlighting all of the current and potential problems faced by Glenda Tukey –

• Once you have those I would think about which members of the MDT I would wish to involve in her care to ensure that she can be safely discharged and in a situation that meets the patients needs and goals.
• I would then write referenced notes on the roles of the MDT team members I have selected and how they could influence Glenda’s care positively.
• Your module 3 resources will also lead you to articles exploring the role of the nurse in the MDT- which you will need to discuss. The importance of discharge planning might be one of many  areas you could  explore here.
• Once you have notes on all of the above- I would have a think about how I might structure my essay to cover all the criteria mentioned in the task instructions,

1) I just wanted a better understanding regarding what is needed for the “Critical appraisal the role of the registered nurse in a collaborative multidisciplinary healthcare team, and how effective leadership in that space will influence Glenda Tukey’s outcomes”.

Would talking about effective communication and understanding the roles of other health professionals be sufficient?

or are we supposed to talk about various skills and qualities of the RN? – support, teamwork, communication …

Also are we talking about the leadership role of the RN and how that effective leadership will impact the patient- linking to NMBA standards?

I am having some trouble understanding what exactly is needed. 

2) Would this be an appropriate way to structure the essay?

Introduction:

Body 1 – Critical appraisal the role of the registered nurse in a collaborative multidisciplinary healthcare team, and how effective leadership in that space will influence Glenda Tukey’s outcomes. – Linked to NMBA standards 

Body 2: 1st member chosen of the collaborative healthcare team – Roles and expertise … Contribution

Body 3: 2nd member chosen of the collaborative healthcare team – Roles and expertise … Contribution

Body 4: 3rd member chosen of the collaborative healthcare team – Roles and expertise … Contribution 

Conclusion: 

 This point made (Exploration of the roles and expertise of  three other  members of the collaborative healthcare team explaining their  contribution to delivery of the best outcomes for Glenda.)

Highlighting in the comment OTHER MEMBERS is the registered nurse not counted in the “3” members .? 

So the RN + 3 members.? 

Answer. —– that’s right Emma – Discuss  the role of the RN in the MDT (be it the bedside RN, The CNC or the CHIP nurse or any other nurse that could be relevant in Glenda’s care ) . And then the role of 3 Multi disciplinary colleagues in delivery patient centred care for Glenda Tukey.

You should definitely develop a comprehensive list of what you assess Glenda’s issues to be before you start writing your essay- But your introduction should introduce the concept of the collaborative MDT and what you will be discussing 

• The role of the RN in the MDT – whether that is the Bedside RN, the heart failure CNC the CHIP nurse or any other RN role you wish to focus on. 
• The roles of 3 MDT colleagues in delivering patient centred care for Glenda.

In both cases you will be identifying specific issues that Glenda has that can be addressed by the team member- and in the case of the RN roles -linking to relevant NMBA standards.

This criterion is linked to a Learning OutcomeExploration of the roles and expertise of three key members of the collaborative healthcare team (other than the RN) in delivering safe and high quality care in the case study

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