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Professional Nursing: IMG Orientation Program

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Professional Nursing: IMG Orientation Program

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Professional Nursing: IMG Orientation Program

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Question:
Discuss about the Professional Nursing for IMG Orientation Program.
 
Answer:

I had attended the program called the Centralised IMG Orientation Program – Hitting the Ground Running. This program was conducted for about two days. The first day had two important sessions. The first session was based on the orientation to the Australian Healthcare system. Some of the main components are structure and funding, Medicare Australia, department of veterans affairs as well as many others. The second section mainly composed of the different legal frameworks present in the healthcare sectors of Australia and the different legal obligations that are present in the different domains of healthcare. Responsibilities regarding child care and adolescent autonomy, maintenance of confidentially were discussed in details to nursing students (“HITTING THE GROUND RUNNING (HTGR) – CENTRALISED IMG ORIENTATION PROGRAM 2”).
The day two mainly comprised of providing live examples as well as detailed discussion on the topics of communication and maintenance of cultural safety. Respect and competence were also explained to be important part of the nursing practice. These came under section 3. The section 4 mainly comprised of nursing practice in relation to Indigenous Australians giving them detailed insights about their culture and their health requirements.
 
HITTING THE GROUND RUNNING (HTGR) – CENTRALISED IMG ORIENTATION PROGRAM 2 – Day Program had helped me recollect the entire important moral and ethical virtues that a nurse need to follow in my nursing practice within only two days programs. It was a two day program but I got the scope to develop a large amount of knowledge that I can apply in my regular practice which will enhance my reputation as well as my confidence as a skilled caregiver. The communication program helped me develop my listening and feedback giving skills as I always found me poor in these domains in my regular student life and also in my internship sessions. Moreover the program gave us much new information about how to enhance cultural safety. I used to be a culturally bias human being but this program showed me how I could overcome my biasness. Therefore it was really helpful for me. Huge amount of information about aboriginal health and their likes and dislikes also helped me to be prepared when I will attend such patients during my employment years.
Fat embolism syndrome is a disorder that often occurs in a patient who has experienced fracture. In this type of disorder, it is usually seen that embolic fat micro globules enter into different small blood vessels of the lungs as well as other sites. This results in the occurrence of endothelial damage and causes different types of respiratory failures. These may be acute respiratory distress syndrome called the ARDS or may be cerebral dysfunction or might cause a petechail rash. It becomes difficult to diagnose and therefore the nurses have to be very careful in handling such issues if this arise (Blokhuish, Pape & Frolke, 2017).
The patient who is present in the healthcare setting has also undergone such symptoms after a shaft and femur fracture. Aetiology of the disorder mainly involves closed fractures which produce more emboli than open fractures. Long bones, pelvis and ribs cause more emboli. Intramedullary nailing of long bones, knee as well as hip replacements also results in embolism due to severe trauma. Therefore, after the nurse diagnoses that the chest pain in the patient is due to the fat embolism syndrome due to the traumatic injury of fracture in thighbone, she must immediately take necessary steps.
The main management of Fat embolism syndrome is supportive. The nurse should primarily ensure that she is helping the patients to initiate good arterial oxygenation. The main rationale behind the initiation of arterial oxygenation is that high flow rate of oxygen helps in the maintenance of the arterial oxygen tension in the normal range. The second step that the nurse should initiate is the control as well as the restriction of the fluid intake as well as the use of diuretics (Sengupta et al., 2016). These will in turn help in the minimization of fluid accumulation in the lungs. This should be continued as long as circulation is maintained. The third intervention that the nurse should monitor is the maintenance of intravascular volume. This is important because it can result in the exacerbation of the lung injury that is mainly caused by the disorder. The fourth intervention that the nurse should consider is the recommendation of the use of albumen for volume resuscitation. This would be in addition to the balanced electrolyte solution maintenance in the patient. The main rationale behind this intervention is that it would not only restore the volume of blood but at the same time would help in the binding of the fatty acids (Ahmazdai et al., 2014). This will in turn decrease the extent to which the lung has been injured. The nurse should maintain hemodynamic stability, proper administration of blood products, proper hydration and others. Moreover the nurse should also take necessary steps for prophylaxis of stress related gastrointestinal bleeding as well as deep venous thrombosis. The nurse should also know that mechanical ventilation as well as positive end-expiratory pressure (PEEP) are significant in the maintenance of arterial oxygenation. Often drugs were frequently used by nurses like ethanol to reduce the function of lipolysis, use of dextrose for reduction of fatty acid mobilization and heparin anticoagulation. However recently, drugs are rarely used as the benefits have not yet been proven. All these are preventive in nature. Corticosteroids also reduce the risk of mobilization of fats by 78% but evidences are not strong (Hammer et al., 2015).
 
Often certain situations arise in a practice setting where a nurse needs to attend more than one patient at a time. At such a situation, it becomes extremely important for the nurse to prioritize the tasks according to the threat level of the patients (Kashyap et al., 2013). This requires the nurse in critical analyzing skills as well as expertise and experiences to handle such crucial moments with skill and rapidity (Levy, 2015).  While analyzing the patients, the nurse should immediately develop the idea that who was the most vulnerable person within the next few minutes.
After critically analyzing the situation, it was found that the patient with asthma is most vulnerable. This is because he was experiencing tightness of muscles mainly due to the response of the cholinergic receptors. This mainly results from limiting of exchange of gases over the lungs (Gullach et al., 2015). As a result blood cannot carry any oxygen to different parts of the body leading to death of the patient. Hence, the nurse should first try to attend this patient and stabilize the condition by proper intervention.
The next patient that the nurse should attend is the patient of another nurse who is suffering from acute pain. Often there are many instances of heart attack, stroke and many other threats and disorders that may result from acute pain. As the patients is not getting any relief from any sort of other narcotic analgesics, endone is provided to the patient for getting relief from acute to moderate healthcare (Athanasou, 2016). The nurse has to maintain the principle where she has to provide such a care to a patient who relieves them from pain and provide a better quality life (Charles et al., 2015). Hence to avoid any other side effects, this patient is attended second.
The third patent who needs to be attended is the patient who was having IV infusion therapy. The alarm had just started ringing signifying that the electrolyte balance is gradually come to an end. This states that there has been a small amount of time which the nurse could have taken to attend to more severe cases. After attending both the cases, she should immediately refill the IV infusion pump so that before the homeostatic balance as well as the electrolyte balance is maintained (Jones  & Vaidya, 2014). This needs to be attended before the electrolyte balance falls (Zhou et al., 2014). Although the time required for the balance to be lost from the body is above an hour and hence the nurse could easily attend the other two sever cases.
The next patient that should be attend is the patient who had stroke two weeks back and is at high risk of fall due to his left hemoplegia. He has the urgency to attend the ensuite for bowel purposes. Although, it an extremely important physiological process that he needs to conduct, he is not at least at a life threatening process that may claim his life (RFurness & Callaghan, 2015). Hence, although it may create huge unpleasure moments, but it can be handled and managed if attained in the fourth position after attending more severe patients.
 
The next patient that the nurse should attend is the patient whose blood glucose level is to be assessed. It is a very important task and the breakfast would be provided within 10 minutes. However in need to attend severe cases, his breakfast can be delayed by 10 more minutes within which the blood glucose assessment would be done after attending the other patients (Chamberlain et al., 2016). Hence, this patients is least vulnerable to harmful risks and therefore can be attended in the last.
The colleague who was performing the dressing of the wound was initially following the correct procedure. Melolin is a low adherent absorbent dressing material that is mainly used for the management of different types of light to moderately exuding wound. These mainly involve clean sutured wounds, minor burns, abrasions as well as lacerations. In  the case study, it was also seen that the wound of the patient had almost dried up and only a small part was moist. Therefore application of melolin was exactly a right decision for the patient. As it was wound this was almost dry and very lightly-exudating, melolin would have been brought the best effect to the wound. The nurse in this selection of intervention initial seemed to be properly educated and had good skill and knowledge. However the situation turned towards a negative side, when her activity revealed a negative aspect about her sense of maintenance of hygiene. The professional codes of conduct instruct a nurse and midwife to follow safe practices that will assure the best health to the patients. Moreover, the theory of beneficence for the nurses always state that the nurse should offer practices that will be the best intervention to the patient making the patient come back to normal lives. Another nursing theory that every nurses should follow is the practice of non-maleficence.  This theory usually guides the nurse to conduct her practices in a way that prevents any short of negative influences on the patients. In other words, it means that the nurses should never take any steps that would harm the patients (Dougerty & Listener. 2015). However, none of the theories were applied by the nurse and she also did not follow the professional codes of conduct. The standard one of the professional codes of conduct states that every nurse should practice in a safe as well as in a competent manner. The standard two of the codes states that the nurse’s activity should remain in accordance with each and every standard of their nursing profession as well as of the broader healthcare system where they are employed. Both the standards assure that a nurse should develop skills and knowledge which will help them to be responsibly treats the patients in ways which are not only competent but also assures safety of the patient. In the present scenario, the nurse did not follow proper hygienic procedures that ensure safe practice. It was seen that although the dressing material fell on the bed, she did not dispose it (El- Soussi & Asfour, 2017). Instead she applied it to the wound, stating that the part would be applied to the dried part. She applied the rationale that as that part of the wound had become dried, it would never create any sort of infection. However, she completely lacked education about proper hygiene that should have been maintained by tem to avoid any sort of hospital acquired infection. Such infections result in increasing the chances of burden of diseases on the patient making his stay longer at the hospitals.
 
Out of the two types of wounds like the traumatic wounds and the surgical wounds, surgical wounds are those acute wounds which need to be closed with sutures, adhesives as well as staples.  For patient in the case study had wounds from where suture was removed and therefore need to be dressed properly with melolin dressing which is a low adherent dressing material. he main standard principles that she needs to educate about to practice best practices regarding the wound management is that she should maintain proper hospital environment hygiene, hand hygiene, safe use of sharp objects and their proper disposal, proper hygiene maintenance with equipments of wound care, use of personal protective equipment as well as maintenance of set of principles for asespsis (Lewis et al., 2015). With assigning proper strategies for light, moderate or heavily exudating wounds, the nurse can assure fast recovery. However, the nurse in this case has not maintained the hygiene principles by picking up the dressing form the bed of the patients which might contain microorganisms harmful for his wounds. The causality that the nurse showed in her profession by stating that infected melolin of applied t the dried area stating that it would be safe was totally unethical and harmful for the health of the patient. as a nurse she is assigned with the duty of providing the best care to patients ad her profession does not allow this type of risk taking attitudes. This is totally immoral and the nurse who was asked for help should enlighten the other nurse making her realize the correct procedure and principles of wound management. The other nurse would advice her to follow te professional codes f conduct, and evidence based searches to develop her practices in wound management. She should never compromise with the health of the patient and must be very careful while handling such risky situations of wound management with proper principles and guidelines.
Researchers have even stated that the part of the dressings which is cut and kept inside the sterile wrapper may get colonized by bacteria and hence this practice becomes unsuitable for later use (Kashyap et al., 2013). Similarly, the dressing which is not directly applied after opening and has fallen on somewhere may get colonized by bacteria. Application of such dressing is harmful and may affect quality life.
 
References:
“HITTING THE GROUND RUNNING (HTGR) – CENTRALISED IMG ORIENTATION PROGRAM 2”. Pmcv.Com.Au, 2017, https://www.pmcv.com.au/computer-matching-service/resources/1016-htgr-program-sessions/file.
Ahmadzai, H., Campbell, S., Archis, C., & Clark, W. A. (2014). Fat embolism syndrome following percutaneous vertebroplasty: a case report. The Spine Journal, 14(4), e1-e5.
Athanasou, J. A. (2016). Chronic Pain. In Encountering Personal Injury (pp. 69-78). SensePublishers.
Blokhuis, T. J., Pape, H. C., & Frölke, J. P. (2017). Timing of definitive fixation of major long bone fractures: Can fat embolism syndrome be prevented?. Injury.
Chamberlain, J. J., Rhinehart, A. S., Shaefer, C. F., & Neuman, A. (2016). Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in DiabetesSynopsis of the 2016 ADA Standards of Medical Care in Diabetes. Annals of internal medicine, 164(8), 542-552.
Charles, B., Hardy, J., Anderson, H., Tapuni, A., George, R., & Norris, R. (2014). Should the dosage of controlled-release oxycodone in advanced cancer be modified on the basis of patient characteristics?. Supportive Care in Cancer, 22(2), 325-330.
Dougherty, L., & Lister, S. (2015). The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.
El-Soussi, A. H., & Asfour, H. I. (2017). A return to the basics; nurses’ practices and knowledge about interventional patient hygiene in critical care units. Intensive and Critical Care Nursing, 40, 11-17.
Furness, J. B., & Callaghan, B. (2015). Output Report: Bowel Project, Animal proof of principle.
Gullach, A. J., Risgaard, B., Lynge, T. H., Jabbari, R., Glinge, C., Haunsø, S., … & Tfelt-Hansen, J. (2015). Sudden death in young persons with uncontrolled asthma-a nationwide cohort study in Denmark. BMC pulmonary medicine, 15(1), 35.
Hammer, S., Kroft, L. J., Hidalgo, A. L., Leta, R., & de Roos, A. (2015). Chest CT examinations in patients presenting with acute chest pain: a pictorial review. Insights into imaging, 6(6), 719-728.
Jones, A. G., & Vaidya, B. (2014). Preoperative Endocrine Function and Fluid Electrolyte Balance. In pituitary apoplexy (pp. 95-105). Springer Berlin Heidelberg.
Kashyap, S. R., Bhatt, D. L., Wolski, K., Watanabe, R. M., Abdul-Ghani, M., Abood, B., … & Kirwan, J. P. (2013). Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes. Diabetes care, 36(8), 2175-2182.
Levy, M. L. (2015). The national review of asthma deaths: what did we learn and what needs to change?. Breathe, 11(1), 14.
Lewis, S. L., Maltas, J., Dirksen, S. R., & Bucher, L. (2015). Study guide for medical-surgical nursing: Assessment and management of clinical problems. Elsevier Health Sciences.
Sengupta, R., Veljanovski, J., Sudasena, D., Michaels, A., Jain, T., Rahman, M., & DiGiovine, B. (2016). The Devastating Pulmonary Complications Of Sickle Cell Disease: Fat Emboli Associated Acute Chest Syndrome Mimicking Massive Pulmonary Embolism. In B54. CASE REPORTS IN THE PULMONARY CIRCULATION (pp. A3942-A3942). American Thoracic Society.
Zhou, F., Peng, Z. Y., Bishop, J. V., Cove, M. E., Singbartl, K., & Kellum, J. A. (2014). Effects of fluid resuscitation with 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis. Critical care medicine, 42(4), e270.

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