Clinical And Recording Incompetence: A Case Of Nursing Care

1). What happened in this clinical incident?

2). What activities did the nurse or midwife need to completed in the Immediate Situation?

3). What Professional Behaviors may have made a Difference in this situation?

3). What do you learn from this case study about own Preparedness for Professional?

Clinical and Recording Incompetence

1). Clinical and Recording Incompetence

Health care is a service to humanity aimed at heightening the wellness of the clients. To achieve quality health care outcomes, health professionals must uphold high levels of competence in both clinical and recording skills (Anderson, 2014). In caregiving setting, competence calls for adeptness in clinical hands-on skills, clinical judgment skills, interpersonal skills and an up to date knowledge base to enhance informed decision-making process (White, Dudley-Brown,  & Terhaar, 2016). Professional incompetence is a major issue that directly affects the patient outcomes, and the clinical team members are held accountable for their actions.

Having considered the clinical case under study, there is evidence of caregiving gaps perpetrated by the team in charge of patient A. Firstly; the nursing team had no a plan of care for the patient. It was therefore impossible to determine the patient progress since no goals were set. In this way, the patient care was random rather than specific. The action of the nursing team to omit a nursing care plan constituted clinical incompetence.

Moreover, RN John and the morning shift nurse failed to document their assessment findings. At 1315 hours, the nurse reported other vital signs to be normal instead of the actual figures. Also, John assessed the patient at 1810 hours but did not document the findings. In the face of such omissions, patient care is fragmented to the extent of disrupting the continuity of care thus mismanagement of the client. Similarly, as a manager, John failed to maintain a standard of competence of the junior nurse by violating the professional rules.

Lastly, incompetence is demonstrated in the team’s inability to make informed decisions regarding the patient’s changing health status. Poor priorities in addressing the patient needs are also evident for example the delays in communication and referral arrangements.

2). Activities that need to be completed in the Immediate Situation

According to the Institute of Medicine (IOM), patient-centered care involves informing, listening to and engaging the clients in their care. The patient’s expression of their symptoms together with provider assessment findings, provide a holistic image of the disturbance in the client’s health patterns (Huston, 2017). Although it is required that all professionals uphold competency, the nurse in the case study failed to ensure individualized patient care. The nurse as a patient advocate should have presented the client’s complaints appropriately to the visiting medical officer to avoid the diagnosis of depression and anxiety. In this case, the complaints of abdominal pain and weakness do not lead to the above diagnosis. Thus, mobilization did not heighten the wellness of the patient.

Activities that need to be completed in the Immediate Situation

Furthermore, an assessment conducted at 1910 hours indicated tachypnea and tachycardia and later the patient’s skin was cold and clammy. In this scenario, the nurse failed to utilize his critical thinking skills to understand the disease process (Ledlow & Stephens, 2014) whose leads suggest a cardiovascular problem. Also, with the persistently high respiratory rate and heart rate, the nurse would have organized for a referral to a facility with equipment for respiratory and cardiovascular monitoring.

On the other hand, the nurse had poor priorities with regards to the client’s care.  At the commencement of his shift, nurse John assessed the patient and noted the significant problem that required attention but did not intervene. With hypotension and continual diarrhea, an immediate intervention of fluid resuscitation is paramount to restore hemodynamic stability. Contrary to the expectations, the nurse postponed the response to a time when the locum arrives. In this instance, the nurse would have called for a physician for immediate review as well as arrange for a possible referral of the patient through the clinical nurse manager.

3). Professional Behaviors that Make a Difference in Patient Care

A clear understanding of what professional behavior entails is a requisite to the provision of quality care to patients (Duffy, 2016). Nurses should, therefore, be cognizant of the behavioral aspects that represent true professionalism. The behavior is developed intrinsically by a sense of self-competence and through learning from good role models. A proper understanding of the fundamentals of professional behaviors prevents misconduct and errors in the career (Baron, 2014).

It can be seen from the above explanation that some professional behaviors were violated by the nurses in the case study, thus the poor patient outcomes. Among the behaviors is critical thinking and problem-solving. In this case, the nurse should have thought through the challenging situation of the patient’s deteriorating health status to determine the correct intervention ( Colbert, 2016 ). For example, evaluation of the cause of the persistently abnormal vital signs of the patient. Proficient skills in problem-solving would have enabled the nurse to apply listening skills and stepwise analysis of the patient problems to resolve the complaints of the client.

Another professional behavior is ethical and responsible undertakings. This aspect requires that the professional portrays responsible actions and moral decision making (Finkelman, 2017). In the healthcare setting, it is accomplished through strict adherence to the standard operating procedures as well as keeping accurate records. In the case presented, the nurse would have considered communicating with the clinical nurse manager about patient A’s worsening condition, but he didn’t. Responsibility, on the other hand, calls for the performance of duties with a due commitment to producing the expected outcomes.

Professional Behaviors that Make a Difference in Patient Care

Further, autonomy and accountability of the care providers promote positive outcomes of the patients (Porter, 2016). Nurse John did not demonstrate authority in decision making relative to his professional knowledge base. Failure to intervene after assessing the patient, as well as, unrecorded findings are omissions that John is held accountable

4. Personal Preparedness for Professional Practice

The transition from being a student to a professional nurse requires a clear understanding of the professional practice to be effective in the career. This is achieved through the exploration of the professional behavior and the roles of a nurse (Mckimm, 2016). The case study provides an insight into the conduct of nurses that defines professionalism. The following is a discussion of the elements for preparation to professional practice.

Firstly, a rich knowledge base in nursing is a requisite to informed decision making as well as a foundation for evidence-based practice (Anderson, 2014). Nursing knowledge is essential for the quality of patient care and understanding the disease process. The knowledge is obtained from biological and social sciences and practical skills through training. This kind of awareness enables a nurse to assess and plan care for the client to enhance their wellbeing.

Another lesson from the case study is strict adherence to the accurate and mandatory documentation of the client’s assessment findings. The practice prevents gaps in the healthcare and allows for easy follow up on the patient care (Porter, 2016). For example, omitting assessment data in the nursing notes interrupts the continuity of care, and thus proper interventions are not made. Moreover, documentation is the formal communication about a patient to the other staffs as well as a legal document in case of a lawsuit.

Setting goals and priorities is another aspect of professional practice. It is of great importance to understand the criteria of setting priorities depending on the patient’s health status. The nursing care plan is a tool that enables one to identify the priority needs of a client (Huston, 2017). Therefore, every client should have a care plan to ensure delivery of competent care. Patient triaging is also an effective way to know the sickest and who require immediate review or referral.

References:

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Anderson, L. E. (2014). Professionalism: Skills for workplace success. London: Pearson Publishers.

Baron, P., & Corbin, L. (2014). Ethics and the legal profession in Australia. South Melbourne, Victoria, Australia: Oxford University Press.

Colbert, B. J., & Katrancha, E. (2016). Career success in health care: Professionalism in action. Australia; United States: Cengage Learning.Top of Form

Duffy, J. R. (2016). Professional practice models in nursing: Successful health system integration. New York: Springer Publishing Company.

Finkelman, A. (2017). Professional Nursing Concepts. Burlington: Jones & Bartlett Learning.

Huston, C.J. (2017). Professional issues in nursing: Challenges and Opportunities. Philadelphia:       Wolters Kluwer.

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Ledlow, G. R., & Stephens, J. H. (2018). Leadership for health professionals: Theory, skills, and applications. Burlington, MA : Jones & Bartlett Learning.

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Porter, T., & Malloch, K. (2016). Leadership in nursing practice: Changing the landscape of health care. Burlington, MA: Jones & Bartlett Learning.

Thistlethwaite, J., & McKimm, J. (2016). Healthcare professionalism at a glance. Chichester, West Sussex, UK; Malden, MA: Wiley Blackwell.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care. New York, NY: Springer Publishing Company, LLC.