Portfolio PLP3 Arguing care
Author: Naomi Majoor
Student number: 432186
Education: Nursing bachelor program
Study section: PLP3
Course code: HVVB21MBVZ
Academic year: 2024-2025
Group: PLG Moshi/Turiani
Tutor: Anne-Geertje Hoekema
Supervisor: Costancia Ndunguru
Internship place: Turiani Hospital, Emergency Medical Department
Date: 14-01-2025
Period: Semester 1
,Table of contents
Introduction............................................................................................................................... 4
1. Step 1: Orientation to the situation .................................................................................... 5
1.1 Situation............................................................................................................................ 5
1.2 Background ...................................................................................................................... 5
1.3 Assessment ...................................................................................................................... 5
1.3.1 ABCDE ...................................................................................................................... 5
1.3.2 PEWS-score .............................................................................................................. 7
1.3.3 SIRS-criteria .............................................................................................................. 7
1.4 Recommendation ............................................................................................................. 8
1.4.1 ABCDE ...................................................................................................................... 8
1.4.2 Color code ............................................................................................................... 10
1.4.3 Differential diagnoses .............................................................................................. 10
2. Step 2: Clinical problem statement .................................................................................. 12
2.1 Care topics involved ....................................................................................................... 12
2.2 Elaboration of most concerned care themes ................................................................. 13
2.2.1 Airways and breathing ............................................................................................. 14
2.2.2 Circulation ............................................................................................................... 15
2.2.3 Skin and defense .................................................................................................... 16
2.2.4 Digestive functions .................................................................................................. 17
3. Step 3: Additional research............................................................................................... 18
3.1 Physical examination ..................................................................................................... 18
3.2 Laboratory testing .......................................................................................................... 18
3.3 Conclusion ...................................................................................................................... 19
4. Step 4: Clinical policy ........................................................................................................ 20
4.1 Elaboration of diagnoses ............................................................................................... 20
4.2 Prioritization .................................................................................................................... 23
5. Care outcomes and interventions .................................................................................... 26
2
,6. Step 5: Clinical course....................................................................................................... 31
7. Step 6: Afterthought........................................................................................................... 34
7.1 Patient safety .................................................................................................................. 34
7.2 Quality of the professional ............................................................................................. 34
7.3 Competencies used ....................................................................................................... 35
7.4 Communication methodologies...................................................................................... 36
7.5 ICT-opportunities ............................................................................................................ 38
7.6 Ethical dilemma .............................................................................................................. 38
7.7 Case discussion ............................................................................................................. 39
Literature list ........................................................................................................................... 40
Annexes ................................................................................................................................... 46
Annex A: Complexity of care ................................................................................................ 46
Annex B: Feedback case discussion ................................................................................... 47
Reflections .............................................................................................................................. 48
Reflection 1 ........................................................................................................................... 48
Reflection 2 ........................................................................................................................... 51
Valuation forms ...................................................................................................................... 53
Valuation form 1 ................................................................................................................... 53
Valuation form 2 ................................................................................................................... 56
Anti-plagiarism ....................................................................................................................... 60
3
, Introduction
The module Arguing Care is developed using a case study in the Emergency Medical
Department within Turiani Hospital. This module focuses on determining the nursing process
based on clinical reasoning in practice and using Evidence Based Practice (EBP). The case
study used is of high complexity, according to HAN (2014). For the reasoning for this, see
Appendix A. The elaboration of the Bearing Care module was done using the steps of
ProActive Nursing (klinische problematiek inzichtelijk) by Bakker (2017). This was chosen
because it is a structured method for an acute and critical case. This is because it includes
the SBAR (Situation, Background, Assessment, Recommendation) and the ABCDE (Airway,
Breathing, Circulation, Disability, Exposure/Environment). These are clear communication
methods between healthcare personnel to map and anticipate the patient. The steps from
Bakker (2017) begin with an orientation to the situation. This is done using the SBAR,
AMPLE (Allergy, Medication, Past illness, Last meal, Event) and ABCDE. Step two involves
the clinical problem statement through the development of care themes using the ICF
(International Classification of Functioning, Disability and Health) care themes. Step three
involves the additional examination. Step four describes the clinical management using the
PES-structure (Problem, Etiology, Symptoms). Finally, step five describes the clinical course
and step six the afterthought. Furthermore, this portfolio contains two more reflections on the
student's actions, two appreciation forms and an anti-plagiarism statement.
After completing the Bearing Care module, the student will be able to use clinical reasoning
to establish the nursing process within a high-complexity context. In addition, the student
responsibly uses Evidence Based Practice during the nursing process. The student also
independently carries out and evaluates the process. In doing so, she communicates in a
person-oriented and professional manner with the patient and his/her information network.
Finally, the student applies information and communication technologies (ICT).
The expectation in the module Bearing Care is to stabilize the vitally endangered patient by
systematically going through Bakker's (2017) steps and thus presenting a complete picture of
the patient's admission to the Emergency Department. During this module, we worked on all
CanMEDS roles of V&VN (2020).
4
Author: Naomi Majoor
Student number: 432186
Education: Nursing bachelor program
Study section: PLP3
Course code: HVVB21MBVZ
Academic year: 2024-2025
Group: PLG Moshi/Turiani
Tutor: Anne-Geertje Hoekema
Supervisor: Costancia Ndunguru
Internship place: Turiani Hospital, Emergency Medical Department
Date: 14-01-2025
Period: Semester 1
,Table of contents
Introduction............................................................................................................................... 4
1. Step 1: Orientation to the situation .................................................................................... 5
1.1 Situation............................................................................................................................ 5
1.2 Background ...................................................................................................................... 5
1.3 Assessment ...................................................................................................................... 5
1.3.1 ABCDE ...................................................................................................................... 5
1.3.2 PEWS-score .............................................................................................................. 7
1.3.3 SIRS-criteria .............................................................................................................. 7
1.4 Recommendation ............................................................................................................. 8
1.4.1 ABCDE ...................................................................................................................... 8
1.4.2 Color code ............................................................................................................... 10
1.4.3 Differential diagnoses .............................................................................................. 10
2. Step 2: Clinical problem statement .................................................................................. 12
2.1 Care topics involved ....................................................................................................... 12
2.2 Elaboration of most concerned care themes ................................................................. 13
2.2.1 Airways and breathing ............................................................................................. 14
2.2.2 Circulation ............................................................................................................... 15
2.2.3 Skin and defense .................................................................................................... 16
2.2.4 Digestive functions .................................................................................................. 17
3. Step 3: Additional research............................................................................................... 18
3.1 Physical examination ..................................................................................................... 18
3.2 Laboratory testing .......................................................................................................... 18
3.3 Conclusion ...................................................................................................................... 19
4. Step 4: Clinical policy ........................................................................................................ 20
4.1 Elaboration of diagnoses ............................................................................................... 20
4.2 Prioritization .................................................................................................................... 23
5. Care outcomes and interventions .................................................................................... 26
2
,6. Step 5: Clinical course....................................................................................................... 31
7. Step 6: Afterthought........................................................................................................... 34
7.1 Patient safety .................................................................................................................. 34
7.2 Quality of the professional ............................................................................................. 34
7.3 Competencies used ....................................................................................................... 35
7.4 Communication methodologies...................................................................................... 36
7.5 ICT-opportunities ............................................................................................................ 38
7.6 Ethical dilemma .............................................................................................................. 38
7.7 Case discussion ............................................................................................................. 39
Literature list ........................................................................................................................... 40
Annexes ................................................................................................................................... 46
Annex A: Complexity of care ................................................................................................ 46
Annex B: Feedback case discussion ................................................................................... 47
Reflections .............................................................................................................................. 48
Reflection 1 ........................................................................................................................... 48
Reflection 2 ........................................................................................................................... 51
Valuation forms ...................................................................................................................... 53
Valuation form 1 ................................................................................................................... 53
Valuation form 2 ................................................................................................................... 56
Anti-plagiarism ....................................................................................................................... 60
3
, Introduction
The module Arguing Care is developed using a case study in the Emergency Medical
Department within Turiani Hospital. This module focuses on determining the nursing process
based on clinical reasoning in practice and using Evidence Based Practice (EBP). The case
study used is of high complexity, according to HAN (2014). For the reasoning for this, see
Appendix A. The elaboration of the Bearing Care module was done using the steps of
ProActive Nursing (klinische problematiek inzichtelijk) by Bakker (2017). This was chosen
because it is a structured method for an acute and critical case. This is because it includes
the SBAR (Situation, Background, Assessment, Recommendation) and the ABCDE (Airway,
Breathing, Circulation, Disability, Exposure/Environment). These are clear communication
methods between healthcare personnel to map and anticipate the patient. The steps from
Bakker (2017) begin with an orientation to the situation. This is done using the SBAR,
AMPLE (Allergy, Medication, Past illness, Last meal, Event) and ABCDE. Step two involves
the clinical problem statement through the development of care themes using the ICF
(International Classification of Functioning, Disability and Health) care themes. Step three
involves the additional examination. Step four describes the clinical management using the
PES-structure (Problem, Etiology, Symptoms). Finally, step five describes the clinical course
and step six the afterthought. Furthermore, this portfolio contains two more reflections on the
student's actions, two appreciation forms and an anti-plagiarism statement.
After completing the Bearing Care module, the student will be able to use clinical reasoning
to establish the nursing process within a high-complexity context. In addition, the student
responsibly uses Evidence Based Practice during the nursing process. The student also
independently carries out and evaluates the process. In doing so, she communicates in a
person-oriented and professional manner with the patient and his/her information network.
Finally, the student applies information and communication technologies (ICT).
The expectation in the module Bearing Care is to stabilize the vitally endangered patient by
systematically going through Bakker's (2017) steps and thus presenting a complete picture of
the patient's admission to the Emergency Department. During this module, we worked on all
CanMEDS roles of V&VN (2020).
4
