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    Choose an innovative organisation and critically analyse the seven dimensions within a strategic innovation framework to produce a portfolio of outcomes that drive growth in your chosen organisation.   


    Assessment 1: Information Sheet and Case Scenarios For this assessment you are given a choice between two (2) case scenarios. The scenarios are your referral information and no additional information is available. Each student is to select one (1) scenario on which to base their assessment. The completed assessment is to be submitted through the appropriate turn-it-in drop box on the NRSG366 LEO site. The Assessment One marking criteria in the unit outline is to be used to guide the preparation of this assessment. When submitting your assessment, please do not use the scenario as part of your response.


    Option 1: Epilepsy Jessica Williamson is a 28 year old woman with a past history of epilepsy. Two weeks ago Jessica was out socially, drinking alcohol at a dance club. Jessica experienced a seizure whilst on the dance floor. Upon arrival at the local Emergency Department, paramedic staff reported that she had experienced a full tonic-clonic seizure that lasted for three minutes, during which she lost consciousness. Jessica was assessed and admitted. During her hospitalisation, Jessica was stabilised and discharged from hospital 1 week after the episode. Her discharge medications included an anticonvulsant. On discharge Jessica was asked to attend her GP for follow-up. Medical History Jessica was diagnosed with epilepsy in late adolescence. Initially the seizures were very difficult to control using anticonvulsants but her condition stabilised 5 years ago. Three months ago she weaned herself off her anticonvulsants as she wanted to fall pregnant. During her hospitalization she was recommenced on her anticonvulsant. Four years ago Jessica was diagnosed with Type 2 Diabetes Mellitus. Jessica was taught to control her blood glucose levels using diet and oral hypoglycaemics, this is now decreasingly effective. Her most recent observations include: · BP: 150/90 · P: 115 regular · Height: 158 cms · Weight: 122 kgs · BGL 12.9 Her current medications are: · Epilim 1 gm BD · Metformin 850mg BD Social History Jessica lives in a two-storey house with her current partner of six years, Martin. Jessica’s parents live overseas where her mother has been posted for work. Jessica is an only child. She works as a real estate agent selling homes and covers a large geographic area involving long and irregular work hours. This can involve her driving long distances and for long periods of time. Jessica enjoys her work and the challenges of being independent at work and at home. Despite being advised by her GP that she must not drive after suffering this recent seizure, Jessica continues to do so. Current Issue Following the follow-up appointment with the GP, the GP was concerned about Jessica’s seemingly poor acceptance of her medical diagnoses and her compliance with the treatment regime for both her diabetes and epilepsy. Jessica indicated she did not need any more prescriptions for her anticonvulsants at the moment. Jessica is not particularly careful about monitoring her blood sugar levels. She says she often forgets, and tends to check when she “feels fuzzy”. As this is your first visit to Jessica in her home, justify and discuss the immediate plan of care for her. Assessment Focus You are the Registered Nurse from the Community Nursing Service. You will be undertaking an initial visit to Jessica’s home. Prioritise and provide a rationale for the activities you will undertake as part of this initial visit and identify two (2) priorities for your follow-up visit. Option 2: Chronic Pain John Ryan is a 66 year old male with a history of chronic back pain related to spinal stenosis, and degeneration of the left hip. He has been reviewed in the Outpatient Pain Clinic on a monthly basis for the past 4 months, after a sudden increase in pain and changes in his level of activity. His pain specialist is concerned about his level of function at home and has referred John to the community nursing service for an initial assessment and review. Medical history John has spinal stenosis which was diagnosed in his early forties. He has significant pain in his lower back and hip, slight (L) leg weakness and slight loss of sensation in both his feet. He is generally fit, but slightly overweight. His most recent observations are as follows: · BP: 135/80 · P: 60 bpm, · R: 18 bpm, · Height: 180 cm · Weight 95 kg. Current medications: · Ibuprofen 400 mg 6qh · Baclofen 20 mg BD · Diazepam 2.5mg – 5mg PRN Social history: John is an engineer with a mining company who spends his time equally between the mine in a remote location as a Fly In, Fly Out (FIFO) worker. He has an office location in the CBD for his locally based work. John is married to Donna and they have two adult children, both married. Donna works part time as office manager for a small company and is hoping they can retire soon so they can travel and see more of their grandchildren. Their daughter Jean (37 years) lives with her husband and three small children in a large coastal community, 45 minutes drive from John and Donna’s home. Their son Robert (39 years) lives with his partner in another major interstate city. Current Issue John reports being woken up by pain at night. During the day, he has pain if he sits still for too long, but also if he walks or rides a bike for too long, and the time he can spend on these activities varies. John states he is sick of the hours of focused exercise he needs to do to keep his core muscles strong and to keep him mobile and flexible. He is also sick of always having to take pain medications that have not been effective. In addition he reported being ‘fed up with being aware of my back and hip all the time and feeling limited because of them’. Recently, whilst playing with his four-year-old grandchild, swinging him through the air, John experienced a significant flare in his level of pain. John has been alternating between being angry about having ongoing pain, and being depressed because he is increasingly unable to do the activities he has always done. He was a keen hiker and had dreams of spending his retirement hiking in remote places. Now he can barely walk five kilometers on level ground without pain. He was also a keen bicycle rider. Initially this helped with his pain management. But increasingly, he is losing interest in riding as it also causes increased pain. John has been seen by a physiotherapist on a regular basis over the years, but he stopped going, because he felt they were not helping him, as he was progressively experiencing more pain. He has increasing bilateral leg weakness, bilateral muscle wasting and reduced sensation in both feet. He experiences blisters on his feet as a result of pressure on his feet, which he ignores. The specialist at the Pain Clinic is also concerned about John’s level of medication adherence. Assessment Focus You are the Registered Nurse from the Community Nursing Service. You will be undertaking an initial visit to John’s home. Prioritise and provide a rationale for the activities you will undertake as part of this initial visit and identify two (2) priorities for your follow-up visit.


Subject Nursing Pages 7 Style APA



Assessment of chronic pain is paramount in the process of identifying health issues in patients. Chronic pain is caused by several factors which include; psychosocial, behavioral and medical factors. In the assessment of care in the given scenario, the assessment will include an evaluation of patient’s medical history and behaviors. This will help in determining the real cause of pain and thus be able to apply the right intervention. Questions play a great role in the understanding of the patient’s condition and making decisions on whether such assessment should be made again. As a nurse from community nursing service, I will visit John in order to carry out the assessment. The paper will include a rational based on activities that I will undertake. It will also include my two priorities from my initial visit.

In assessing patients with chronic pain, there are various activities which are undertaken. As stated, chronic pain is caused by a number of factors. In my visit, I will seek to identify first the behavioral factors which may be contributing to the condition of the patient. This includes the context of the patient given that he is an old man who has a career. The context in which a patient is situated plays a big role in the evaluation of the patient. The context may affect the body functions and thus, cause chronic pain. This is why health professionals are advised to consider the place in which patients live. In this case, the person in the discussion may be affected by the state of the place in which he lives (Melzack, 1983). Through identifying environmental risks or factors which may affect the state of a patient, it is possible to make recommendations in order to change the situation of the patient. In these recommendations, patients are advised on ways that they can change their context in order to boost the process of recovery. In my assessment, I would seek any item in the context which would contribute to the condition of the patient, and this would help me to make proper recommendations (Melzack, 1983).

Analyzing the context in which John lives would be my priority. This is before applying other methods of assessments. As mentioned, John may be affected by his environment and thus immediate changes may be needed in order to change his condition. This being the case, my first visit would include the analyzes of the area and identification of any environmental factors which may have an effect on John. Health professionals have proven that environmental factors may affect the state of patients considering that low or high temperatures have an effect on people (Williams, 1988). The state of the place in which people live which includes the hygienic status also affects their health. This means that my priority which involves the evaluation of the context may have much effect in the process of identifying the cause of the chronic pain in John (Waddell, Somerville, Henderson, & Newton, 1992).

The second priority includes the evaluation of the psychosocial state of John. This includes his mood, beliefs, patience and expectations. The psychosocial state of patients contributes to their state of health considering that healthcare professionals have provided information regarding the effect of one’s emotional state (Warden, Hurley, & Volicer, 2003). As stated in John’s story, he has not been happy with his current condition and medical therapies which he has been receiving. This being the case, John may be affected by his emotional status and is capable of contributing to his current condition (Bombardier, 2000). According to reports, healthcare professionals are supposed to assess the emotional state of patients during evaluation since they have much effect on their health. John may also be expecting a lot from his medical therapies, and this may make him be more unctuous especially if his activities have not been producing better results. This includes parts of the evaluation that I would make during my visit to John (Main, Wood, Hollis, Spanswick, & Waddell, 1992). Through this, I would be seeking to know whether John may be experiencing some emotional challenges when it comes to handling his case. Stress may lead to pain since it affects the mental conditions of people. The change of mood is very common to people who experience chromic pains. This has been identified as a greater contributor to cases of chronic illnesses in patients. As a nurse, I would seek to know instances which John has been under a state of mood change. This report would help in offering him proper help and stating the right recommendations which ought to be worked on in order to change the condition of John. Though this is the case, it is important to note that chronic pain cannot be fully eliminated since it takes time for patients to recover. However, when patients are offered proper care, their conditions change, and they recover from pain. This is why evaluations and assessments are considered to be very important for patients (Rosenstiel, & Keefe, 1983).

According to reports which have been presented regarding John’s condition, he has been under medical care. This being the case, medicines has effects on the patient’s body, and this may lead to chronic pain which is reported. John may be suffering from the effects of drugs which are provided in order to reduce pain or change his condition (Sprangers, & Aaronson, 1992). There are numerous effects of drugs as the paper will discuss. Medical professionals have stated that some medicines which are used by patients contain substances which affect the state of patients. This being the case, patients experience pain, and this leads to farther complications. As part of priority, I would consider evaluating biomedical help which John has been getting in order to identify the possible cause of his condition (Turk, & Rudy, 1988). I would identify medicines which may have effects on John’s body and those which can cause pain. This will help in providing recommendations as part of the solution which needs to be undertaken in order to change the condition of John. These recommendations would provide a solution which would help to reduce pain. As mentioned before, the process of recovery for patients with chronic pain can be sometimes slow. Many patients may not experience the effect of help that they are offered since their state changes slowly. Pain may keep on coming, and patients may be affected by this. In John’s case, he has been experiencing a condition in which he has been tired due to lack of a solution to his problem. This may be part of recovery process which takes a long time. John case is not severe, but if necessary help is not offered, his condition may lead to other problems. This is why immediate and early help is very important since it ensures that patients are able to recover easily (Carlsson, 1983).

Patient’s history provides a clear view of the source of problems. In this case, the evaluation of John’s condition would help in identifying ways that he can be able to gain help and thus be able to recover. John has also been undertaking various activities which are part of his jobs. This being the case, John may be affected by the amount of work that he does and the condition in his workplace. I would evaluate the state of his job in order to identify possible causes of his situation (Dworkin, Turk, Farrar, Haythornthwaite, Jensen, Katz, & Carr, 2005). This would help to provide a clear solution which would ensure that John is able to recover. There are believes which are held within individuals, and they affect the ways that they recover from their conditions (McCracken, Vowles, & Eccleston, 2004). These beliefs may provide negative views which may lead to farther complications in patients. As a matter of fact, John may be having believes which may be contributing to chronic pain. John is an old man who may have the belief that people of his age cannot be able to recover from this condition. He may also believe that his condition is common, and thus there is no possible help which can be offered. In my assessment, I would seek to know whether John may be affected by these believes which may lead to his state.

A proper interview would ensure that John was able to give information which helps in proposing a proper procedure for John and giving him a solution. I would also introduce a follow-up visit in order to ensure that John is able to recover. Health professionals have recommended physical therapies in the process of changing the conditions of patients. It is important to note that patients with chronic pain require this kind of intervention since it helps them in recovering. Physical therapies help the flow of blood especially parts which may be affected. After a clear evaluation of john’s condition, I would recommend a clear solution based on clear assessments and consultations with medical professionals. Based on recommended procedures I would ensure that John was able to apply the recommended intervention through follow-up. I would establish a way in which I would be visiting John few days in a week in order to make sure that he is able to recover and incase of any need, I would make sure that he is able to get the necessary help. This is part of intervention based on the state of John. As mentioned, patients are affected by various factors which affect their conditions. In this case, I would help John in eliminating believes and emotional challenges which may be contributing to his condition (Gatchel, Polatin, & Mayer, 1995).


In conclusion, John condition may be as a result of biomedical, behavioral and psychosocial factors. As part of my activities, I would evaluate the environment, believes and emotional state of John since they have much effect on his condition. I would also help him to overcome challenges which may be evident as part of intervention. Recommendations would also be based on clear evaluation and consultations with health professionals in order to change John’s condition. Proper care would be based on identified challenges which may be emotional, biomedical and psychological.  Helping a patient to overcome such challenges plays a great role in the process of recovery. Lastly, the source of chronic pain may not be identified easily and thus why continues care is recommended. 





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