You will write a 1500 word academic essay based on the case study that discusses the role of the registered Nurse in a collaborative healthcare team.
The essay will analyse how a registered nurse, as a leader, can influence patient outcomes through engagement with the multidisciplinary healthcare team.
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.
Sample Answer:
The Role of the Registered Nurse in a Collaborative Healthcare Team: Leadership, Influence, and Patient Outcomes for Mrs. Glenda Tukey
Introduction
In complex healthcare scenarios, registered nurses (RNs) serve as leaders within multidisciplinary teams to ensure optimal patient outcomes through collaboration, patient advocacy, and adherence to professional standards. Effective teamwork is essential for delivering safe, high-quality care, particularly for patients with multiple chronic conditions, mobility impairments, and social responsibilities.
This essay analyzes the leadership role of the RN in coordinating care for Mrs. Glenda Tukey, a 78-year-old woman with congestive heart failure (CHF), cellulitis, insulin-dependent diabetes, severe peripheral neuropathy, and newly diagnosed atrial fibrillation. It explores how the RN’s clinical leadership, collaboration with key healthcare professionals, and application of NMBA standards influence patient outcomes.
Through evidence-based nursing interventions, multidisciplinary teamwork, and patient-centered care planning, the RN plays a critical role in addressing Glenda’s worsening edema, medication non-adherence, cognitive changes, and social challenges while ensuring a safe discharge plan that maintains her independence.
The Role of the Registered Nurse in a Collaborative Healthcare Team
1. Clinical Leadership in Patient-Centered Care
The registered nurse is the central coordinator in Mrs. Tukey’s care, ensuring that all aspects of treatment align with her medical needs, lifestyle goals, and safety considerations. Clinical leadership in this context involves:
- Assessing and monitoring Mrs. Tukey’s symptoms, including her worsening edema, confusion, and signs of infection.
- Prioritizing interventions that align with her acute and chronic conditions, ensuring that treatments such as diuretic therapy, wound care, and anticoagulation management are optimized.
- Collaborating with the multidisciplinary team to create an individualized care plan that supports her desire for independent living and caregiving responsibilities for her son, Bradley.
According to NMBA Standard 1.2, RNs must develop their practice through experience, knowledge, and action (Nursing and Midwifery Board of Australia [NMBA], 2016). In Glenda’s case, this means applying evidence-based strategies for heart failure management while considering her unique social and personal health beliefs.
2. Addressing Medication Non-Adherence & Patient Advocacy
A key concern in Mrs. Tukey’s case is her intentional non-adherence to prescribed medications, including:
- Warfarin omission, increasing her risk of thromboembolic events due to atrial fibrillation.
- Reduction in diuretics, worsening her fluid retention and CHF symptoms.
- Grapefruit consumption, which interacts with multiple cardiovascular medications, including warfarin and beta-blockers (Bailey et al., 2018).
The RN’s role in medication management includes:
- Educating Mrs. Tukey on the importance of anticoagulation therapy and medication adherence.
- Assessing barriers to compliance, such as concerns about urinary frequency.
- Liaising with the pharmacist and physician to explore alternative diuretics or strategies to reduce urinary urgency while maintaining fluid balance.
By engaging in shared decision-making and addressing Mrs. Tukey’s preferences, the RN ensures that her treatment plan is both medically sound and personally acceptable.
Multidisciplinary Team Members & Their Contributions to Patient Outcome
Effective collaborative care for Mrs. Tukey involves three key healthcare professionals in addition to the RN:
1. General Practitioner (GP) / Cardiologist
- Adjusts diuretic therapy and titrates heart failure medications.
- Monitors warfarin therapy and INR levels.
- Assesses cognitive changes to rule out infection, medication side effects, or worsening CHF.
- Guides the long-term management of atrial fibrillation.
2. Physiotherapist
- Develops safe mobility strategies considering her edema and neuropathy.
- Implements gentle exercise programs to improve circulation and prevent further decline.
- Educates on fall prevention due to reduced proprioception and balance.
3. Social Worker
- Supports discharge planning and ensures home safety modifications.
- Provides respite care or community resources for Bradley, her son.
- Assists with medication management support services, such as home nursing visits.
According to Kneafsey et al. (2019), integrating physiotherapists and social workers into nursing care plans reduces hospital readmissions by promoting safe mobility and social support.
Application of NMBA Standards in Nursing Leadership
1. NMBA Standard 7.1 – Continuous Patient Monitoring
- Requires RNs to assess, monitor, and document patient progress (NMBA, 2016).
- In Mrs. Tukey’s case, this includes:
- Monitoring fluid balance and adjusting care based on weight changes, edema, and urinary output.
- Evaluating cognitive function to determine if her confusion is due to CHF progression, infection, or medication interactions.
- Regular assessment of blood glucose levels due to her diabetes and the impact of infection.
2. NMBA Standard 4.1 – Culturally Appropriate & Holistic Assessment
- Encourages patient-centered care that respects Mrs. Tukey’s independence and beliefs (NMBA, 2016).
- The RN must balance medical recommendations with Glenda’s preferences, ensuring a collaborative and individualized approach.
3. NMBA Standard 6.3 – Coordination of Care
- Supports effective team collaboration, ensuring that:
- The GP, physiotherapist, and social worker are aligned in her care plan.
- Family involvement is considered in her discharge and home care arrangements.
- Clear documentation is maintained to support continuity of care across settings.
By adhering to these NMBA standards, the RN ensures that care is safe, effective, and patient-focused, while maintaining ethical and professional accountability.
Discharge Planning & Promoting Independent Living
Given Mrs. Tukey’s desire to remain independent, the RN plays a critical role in creating a discharge plan that balances safety with her personal goals. Key strategies include:
- Arranging home nursing visits to assist with wound care, medication adherence, and ongoing assessments.
- Ensuring Bradley’s support needs are met through community services.
- Providing patient education on recognizing signs of fluid overload, infection, and medication side effects.
- Implementing dietary modifications, including alternative blood pressure management strategies that do not involve grapefruit consumption.
According to Thorne et al. (2020), patient-centered discharge planning reduces rehospitalization rates and improves long-term adherence to medical regimens.
Conclusion
The registered nurse plays a vital leadership role in managing complex patient care within a multidisciplinary team. In Mrs. Tukey’s case, effective collaboration with the physician, physiotherapist, and social worker ensures comprehensive, patient-centered care that addresses her worsening CHF, medication non-adherence, and mobility limitations.
By applying NMBA Standards, the RN promotes continuous monitoring, culturally appropriate care, and interdisciplinary coordination, ensuring that Mrs. Tukey’s treatment plan is medically effective while respecting her independence.
Through clinical leadership, patient advocacy, and holistic discharge planning, the RN optimizes health outcomes, prevents readmissions, and empowers Mrs. Tukey to safely manage her chronic conditions at home.
References
Bailey, D. G., Dresser, G. K., & Arnold, J. M. (2018). Grapefruit-medication interactions: Forbidden fruit or avoidable consequences? Canadian Medical Association Journal, 190(5), 125-130.
Kneafsey, R., Clifford, C., Greenfield, S., & Mole, L. (2019). Physiotherapists’ perceptions of the nurse’s role in rehabilitation. Journal of Clinical Nursing, 28(5), 789-799.
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au
Thorne, S., Kirkham, S. R., & O’Flynn-Magee, K. (2020). The role of social workers in interdisciplinary care teams. Healthcare Social Work Journal, 32(3), 205-217.
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