Leadership & Management

Foundation University College of Nursing, Islamabad

Clinical Portfolio

Submitted by: Muhammad Ahsan

FUCN/SP21-BSN-007/FUI

Submitted to: Ma’am Aisha Parveen

Date: 27th May, 2024

 Fauji Foundation Hospital, Rawalpindi
Objective/Task - 1

Unit: Female Medical Ward - 1

Staff Name: Ms. Nabila Bashir

1. Case Summary of Five Patients:

Patient Age/Gender Diagnosis Current Status Interventions Concerns
Name
Fatima 60/Female Hypertension Stable, blood Blood pressure Close
Khan and Chronic pressure monitoring, monitoring of
Kidney controlled with renal function renal function
Disease (Stage medication. tests, low- and blood
3) sodium diet. pressure.
Aisha 45/Female Rheumatoid Stable, pain Pain Monitor for side
Ahmed Arthritis managed with management, effects of long-
NSAIDs and physical therapy, term medication
DMARDs. regular blood and ensure
tests for adherence to
medication side physical
effects. therapy.
Saima 50/Female Type 2 Stable, blood Blood sugar Risk of foot
Malik Diabetes glucose levels monitoring, foot ulcers and
Mellitus with managed with care, pain infections, strict
Diabetic insulin. management for blood sugar
Neuropathy neuropathy. control
required.
Noor 30/Female Asthma Stable, on
Respiratory Prevention of
Bibi inhaled therapy, asthma
corticosteroids monitoring for exacerbations
and asthma triggers, and ensuring
bronchodilators. patient education proper inhaler
on inhaler use. technique.
Shazia 55/Female Ischemic Stable, on beta- Monitoring for Monitoring for
Akhtar Heart Disease blockers and chest pain, ECG, signs of angina
antiplatelet regular or myocardial
therapy. cardiovascular infarction,
assessment. adherence to
medication.

2. Hand Over Report

Time: 01:30 PM

To: On-Coming Shift Nurse Ms. Sonia

Patient 1 - Fatima Khan

Patient is stable with controlled hypertension and chronic kidney disease. Regular
blood pressure checks and renal function monitoring are required. Watch for any signs of
renal function deterioration.

Patient 2 - Aisha Ahmed

Patient is stable with managed rheumatoid arthritis. Continue pain management,

physical therapy, and monitoring for medication side effects. Ensure adherence to physical
therapy.

Patient 3 - Saima Malik

Blood glucose levels are controlled with insulin. Monitor for foot care and manage
neuropathy pain. Prevent foot ulcers and infections through diligent care.

Patient 4 - Noor Bibi

Patient is stable asthma with inhaled medications. Ensure regular respiratory therapy
and monitor for asthma triggers. Educate on proper inhaler use to prevent exacerbations.

Patient 5 - Shazia Akhtar

Patient is stable ischemic heart disease on beta-blockers and antiplatelet therapy.

Regular cardiovascular assessments and monitoring for chest pain are essential. Adherence to
medication is crucial.

Special Instructions:

 Ensure regular monitoring of vital signs for all patients.

 Administer medications as per the prescribed schedule.
 Implement interventions as outlined in the patient summaries.
 Communicate any changes in patient condition promptly to the medical team.
 Maintain strict infection control measures throughout the ward.
 Provide emotional support and education to patients and their families as needed.

3. Rounds with Doctors

Patient Name Doctor Name
Fatima Khan Dr. Shahid Abbasi
Aisha Ahmed Dr. Shahid Abbasi
Condition
Stable with controlled
hypertension and chronic
kidney disease.
Stable rheumatoid arthritis.
Discussion Points
Monitor renal function and
blood pressure closely.
Monitor for medication side
effects and ensure adherence
to physical therapy.
Saima Malik Dr. Shahid Abbasi Stable diabetes with Strict blood sugar control
neuropathy. and diligent foot care to
prevent complications.
Noor Bibi Dr. Shahid Abbasi Stable asthma. Prevent exacerbations
through proper inhaler use
and respiratory therapy.
Shazia Akhtar Dr. Shahid Abbasi Stable ischemic heart Monitor for angina or
disease. myocardial infarction signs
and ensure adherence to
treatment plan.

Objective/Task - 2

Problem-Solving Skills for Effective Decision-Making in a Management

Role.
a) Spend a day at the nursing counter:

Pay close attention to medical issues that commonly arise in a medical ward, such as
medication management, patient monitoring, and responding to acute medical needs. Work
closely with nurses, doctors, pharmacists, and other healthcare professionals to understand
their perspectives and challenges in delivering care effectively. Listen to patients' concerns
regarding their treatment, comfort, and overall experience in the medical ward. Actively seek
solutions to improve patient satisfaction and outcomes.

b) Work at staffing assignment for the on-coming shift:

Evaluate the current patient census, including their medical conditions and care needs,
to determine the appropriate staffing levels for the upcoming shift. Take into account any
patients requiring specialized care or interventions that may necessitate specific staffing
arrangements. Allocate nursing staff according to their expertise and experience, ensuring
that each patient receives the necessary level of care.

c) Organize meal breaks for staff:

Develop a schedule that allows for adequate staffing coverage during meal breaks to
ensure uninterrupted patient care. Implement a flexible meal break schedule that
accommodates variations in patient acuity and workload throughout the shift. Encourage staff
to take regular breaks to prevent burnout and promote their well-being, which ultimately
enhances the quality of patient care.

d) Observe the head nurse requesting extra staff:

Determine if the request for additional staff is driven by an increase in patient acuity,
a surge in admissions, or other factors impacting patient care delivery. Clearly communicate
the urgency of the situation to the manager or supervisor, emphasizing the potential impact
on patient safety and outcomes. Advocate for the allocation of additional staff resources
based on the demonstrated need to maintain safe and effective patient care standards. Follow
up to ensure that the request for extra staff is addressed promptly and that appropriate support
is provided to the medical ward staff to meet patient care needs effectively.

Objective/Task - 3

Under Supervision Evaluate and Supervise Patient Care & Summary of

Five Policies:
1. Narcotics Management Policy:

It outlines the procedures for the storage, administration, and documentation of narcotics
within the hospital. It includes guidelines for the safe handling of controlled substances, such
as who is authorized to access them, how they should be securely stored, and protocols for
disposal of unused medications. The policy also addresses measures to prevent diversion or
misuse of narcotics, including regular audits and inventory checks.

2. Medication Administration Policy:

It governs the process of medication administration to patients. It covers aspects such as

medication reconciliation, prescription verification, dosage calculation, and documentation of
administered medications. The policy also specifies the roles and responsibilities of different
healthcare professionals involved in the medication administration process and outlines
protocols for addressing medication errors or adverse reactions.

3. Crash Cart Management Policy:

It details the procedures for maintaining and restocking crash carts, which contain
emergency medications and equipment needed to respond to medical emergencies such as
cardiac arrest or respiratory distress. It outlines the contents of the crash cart, including
medications, defibrillator pads, airway management devices, and other essential supplies. The
policy also specifies the frequency of checks and restocking of the crash cart to ensure
readiness for emergency situations.

4. Narcotic Cupboard Access Policy:

It regulates access to the narcotic cupboard, where controlled substances are securely
stored. It delineates who is authorized to access the cupboard and under what circumstances,
such as for medication administration or restocking purposes. The policy may include
measures such as requiring dual verification for access, maintaining an electronic log of
entries, and conducting periodic audits to monitor for discrepancies or unauthorized access.

5. Documentation Policy:

It outlines the standards and requirements for documenting patient care activities,
including assessments, interventions, and outcomes. It specifies the use of electronic health
records or paper-based documentation systems, as well as the format and content of
documentation entries. The policy also emphasizes the importance of timely and accurate
documentation, confidentiality of patient information, and compliance with legal and
regulatory standards governing medical recordkeeping.

Objective/Task - 4

Risk management as it is applied in the units.

a. Risk Management in Units:

Risk management in healthcare units involves identifying, assessing, and mitigating

potential risks to patient safety and well-being. This includes risks related to fire, electric
shocks, accidents, falls, and infections. Measures such as regular safety inspections, staff
training on emergency protocols, proper maintenance of equipment, and adherence to
infection control practices are implemented to minimize these risks. For example, fire drills
are conducted periodically to ensure staff readiness in the event of a fire, and electrical
equipment undergoes routine maintenance and safety checks to prevent electric shocks.
Additionally, precautions such as non-slip flooring and handrail installation help reduce the
risk of patient falls, while strict adherence to hand hygiene protocols and isolation
precautions helps prevent the spread of infections within the unit.

b. Ward Records Maintenance:

Different ward records are maintained in healthcare units to ensure comprehensive

documentation of patient care and administrative activities. These records may include
patient medical records, medication administration charts, vital sign monitoring logs, incident
reports, inventory logs for equipment and supplies, and staffing schedules. Accurate and
thorough documentation is essential for continuity of care, communication among healthcare
team members, and compliance with regulatory requirements.

c. Role of the In-Charge Nurse:

The In-Charge Nurse plays a crucial role in ward management and learner teaching
within the unit. They are responsible for overseeing daily operations, coordinating patient
care activities, assigning tasks to staff, and ensuring adherence to protocols and policies.
Additionally, they provide guidance and support to learners, such as nursing students or new
staff members, by facilitating their integration into the unit, assigning them appropriate tasks,
and providing opportunities for learning and skill development.

d. Qualities/Characteristics of a Leader:

Effective leadership in healthcare units is characterized by several qualities, including

strong communication skills, empathy, integrity, adaptability, and a collaborative approach to
problem-solving. A good leader fosters a positive work environment where team members
feel valued, supported, and empowered to contribute their best efforts. They lead by example,
demonstrate professionalism, and prioritize patient safety and quality of care above all else.

e. Procurement of Equipment and Supplies:

 Procuring equipment and supplies for the unit involves filling out requisition forms
and understanding the system of procurement, such as through the Central Sterile Supply
Department (CSSD). Requisition forms typically include details such as the item name,
quantity needed, reason for request, and budget allocation. The CSSD plays a crucial role in
ensuring the availability of sterile instruments and supplies by processing requests, sterilizing
equipment, and maintaining adequate inventory levels to meet the unit's needs.

f. Incident Reporting and Form Completion:

Incident reporting is a vital component of risk management and quality improvement

in healthcare units. It involves documenting any adverse events, errors, or near misses that
occur during patient care delivery. Incident forms typically require detailed information about
the incident, including the date, time, location, individuals involved, description of what
happened, contributing factors, and any actions taken. Completing an incident form
accurately and promptly facilitates investigation, analysis, and implementation of corrective
measures to prevent similar incidents from occurring in the future.

Objective/Task - 5

Budgeting and the Measures to Control Expenses:

Budget Planning: Collaborate with the unit in charge to establish a detailed budget plan,
considering all foreseeable expenses, such as staffing, medical supplies, equipment
maintenance, and facility upkeep.

Expense Tracking: Implement a system for tracking expenses regularly to ensure they align
with the budget. This could involve designated staff members documenting all expenditures
and comparing them against the budgeted amounts.

Prioritize Spending: Identify essential expenses and prioritize them over discretionary
spending. This ensures that crucial aspects of patient care and operational efficiency are
adequately funded.

Cost-Effective Practices: Encourage staff to adopt cost-effective practices without

compromising patient care. This might include minimizing waste, negotiating better prices
with suppliers, and exploring opportunities for bulk purchasing.

Regular Reviews: Conduct periodic reviews of the budget and expenses to identify any
deviations or areas where adjustments may be necessary. This allows for timely intervention
and corrective measures to keep expenses in check.

Staff Training: Provide training to staff members on budget management and expense
control techniques. This empowers them to contribute to cost-saving initiatives and be
mindful of their spending habits.