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Role of Nurses in Patient Safety

Question:

Discuss about the Analyze The Conduct Of The Nurse And Ethics.

Nurses have always played major role in patient safety. They are the professionals who are with the patient around the clock. They are the bed side professional and are also positioned for preventing the medication errors, ensuring the patient to get the safety treatment. A proper registered nurse is also well aware of the problems of the health care system that delay care (Johnstone, 2015).

The following essay aims to focus on the type of  nursing that has been used in this case study and would analyze the conduct of the nurse. The essay will further give ideas about the NMBA standards of the nursing and how some of the standards have been breached in this case. For discussing the breaching of the standards we will provide a distinct idea about the different NMBA standard (Butts & Rich, 2012).

The essay is based on the analysis of a case study where some of the codes of ethics for the nurses and the midwives have been breached in this case. The essay proceeds with the overview of the patient. Patient A had been admitted to the hospital due to several comorbidities like acute breathlessness, tachycardia, leg edema and diabetes. Two days before his admission to the hospital he was found to visit the hospital with low BP and respiratory distress, where he was diagnosed and was found with fine creps in his lungs and low BP. He was applied oral Latix to relieve breathlessness, but according to the convict of Patient A, it did not decrease his breathlessness. He was admitted in to the hospital with more serious conditions. As per the report by HCCC commission, the condition of the patient was worsening day by day. It was reported that before the demise of Patient A, he was suffering from diarrhea and acute chest pain. On his last days, when he was being monitored for a clinical handover to some other improved setting, he died. It was reported that he died out of Septicemia.

The essay aims to throw light on the malpractices and the indifference attitude of the health care professionals, towards a deteriorating patient, whose negligence succumbed death in Patient A.

The case study already provides with the fact that the patient was suffering from very low blood pressure which is a matter of concern for an elderly patient. But the complaint said that the health practitioner failed to document the assessment of Patient A. The patient’s B.P was 89/53 and the respiratory rate was 40-44, signifying bradycardia. Inspite of observing the patient’s vital sign to be in the ‘red zone’, the respondent did not call or any medical review or did not inform the clinical nurse manager. As per the complaint, the respondent did not document the observations of the patient. The patient was suffering from prolonged back pain, but neither the health officer nor the respondent bothered to investigate the reason. It was visible that the white cell count in patient A has increased from the normal count, which was a clear condition of infection. The respondent had admitted in front of the committee that she was concerned about the patient’s condition and supported the fact that the hospital was not well equipped to deal with such critical conditions. As per the statement of the respondent, she had been informed at the clinical handover that the health practitioner who was attending the patient had gone away, and as there was no doctor available she waited for the locum to attend the patient.  

Type of Nursing Used in the Case Study

Registered nursing practice is normally evidence based and is person centered with curative, preventive, supportive, formative and palliative elements (Dawson, King & Grantham, 2013). An RN should focus not only in establishing professional and therapeutic relationship with the patient but also with the patient’s family. In some cases the nurses have to establish non clinical relationship with the patient. It is her duty to look after the patient safety and care at any cost.


There are seven standards of NMBA nursing that should be followed to ensure the best care to the patients. Out of these seven standards, the 3 standards that have been breached in this case are standard 1, standard 4 and standard 6 (Chadwick & Gallagher, 2016).

Standard 1: Critical thinking and analysis

Standard 4: comprehensive conduction of the assessments

Standard 6: Provision of safe and appropriate quality of nursing.

A registered nurse should be capable of accessing and allowing the best available evidences and should be able to develop practice reflecting on her experiences. The registered nurse should be able to use the ethical framework of nursing, but in this case it can be easily seen that the nurse failed to access the credibility of the vital signs and could not assess the deteriorating condition of the patient. It was clearly visible from the case study that the patient was suffering from leg edema, and the infection can spread if left untreated (Gastmans, 2013).  It can be known from the evidences provided in the case study that the respondent was an experienced registered nurse. She had worked in pathology for long 9 years. Another feather in her cap was that the respondent was the nurse in charge of the hospital and she is First line emergency care trained. Therefore it is expected that she should employ all her experiences in providing an evidence based care to the patient. The respondent was well aware of the fact that the patient was suffering from leg edema, but she did not find it important to administer any therapeutics to control the infection (Gastmans, 2013). According to RN Parker, the respondent failed to document anything in the patient’s medical record.

It is evident from the case study, that in spite of finding the patient in the “red zone”, the RN did not arrange for any medical review. Since the registered nurse already had training in critical care, she would have been aware of the fact that a patient in the red zone requires prompt medical attention and should be immediately seen by a medical officer within 10 minutes (Johnstone, 2015). It should be discussed beforehand that the respondent was in charge of the afternoon shift, when there was no nurse manager in the hospital. It has to be remembered that part of the respondent’s role is to escalate issue to the nurse health manager, but it can be found that the respondent did not raise the condition of Patient A to Ms Jones (the clinical nurse manager).

Breaches of NMBA Standards in the Case Study


Thus it can be seen that standard 1,4,6 had been breached.

There are certain codes of ethics, each nurse is entitled with, and that is commitment with the patient and staffs. The codes of ethics also include honesty, professional responsibilities and self integrity (Johnstone, 2015).

It was reported that the hospital did not contain advanced facilities that were needed for the patient. Therefore it was required to shift the patient to some other improved healthcare setting, but it was a delayed decision. Awareness in part of the registered nurse in charge might have saved the life of the patient (Chadwick & Gallagher, 2016). It should be remembered that a proper clinical handover can mitigate the risks of deterioration in patients, as it helps the nurses and the health practitioners to save time and give a quick idea about the background of the patient (Chadwick & Gallagher, 2016).

All these activities of the concerned nurse amounted to the unsatisfactory professional conduct of nursing. In a nutshell the factors that could have addressed in this case study are better monitoring of the vital signs, assessment of the signs, proper communication with the doctors via good clinical handovers, early detection of the risks of deterioration and provision of holistic care of approach to the patient (Chadwick & Gallagher, 2016).

There are certain codes of ethics that I should uphold as a nurse. These codes of ethics would act like yardsticks to measure the nurse’s conduct (Chadwick & Gallagher, 2016). The code of ethics consists of trust, respect, partnership, honesty and integrity towards the patient. Although a nurse should perform duties based on the directives of the physicians, but it is also required to implement evidence based approach of care depending upon researches (Chadwick & Gallagher, 2016).


As nurse I should be able to assist a patient in dong his simple tasks. Unlike the concerned respondent in the case, I should be able to support the nurses on the ward and escalate the care when I see that the patient is deteriorating. It is to be noted that the patient is noted and was already suffering from various physical ailments (Fisher & King, 2013). It should be noted that physical problem in elderly patients may lead to the dysfunction of his cognitive values. Thus, it is necessary that I provide a holistic care approach to the patients. It was written in the case study that the patient was unable to mobilize, as he was lacking energy. As a nurse I would have allowed some other methods of feeding.   Advocacy, promotion of a safe environment, research, participating in shaping health policy and in patient and health systems management, and education are the key nursing roles that I would have incorporated in my profession. As a nurse I should have the power to understand the deteriorations in patients via my intuitions or evidence based research knowledge (Christensen & Kockrow, 2013).  Concern, worry in combination with the rapid response system often helps the nurses to believe on their intuitions and seek prior help from the doctors. Such a practice can largely reduce the recurrence of the sentinel events in a health care setting.  Responsibility, attentiveness, competence and responsiveness are some of the principles that have to be maintained.

Hence forth it can be concluded that the concerned nurse failed assess the patient properly which catalyzed the death of the patient. As a registered nurse, she should have addressed all the NMBA standards, but it can be clearly seen that she could not meet up to the professional code of conduct. Finally it can be said that as a nurse I should be able to conduct a systematic assessment and provide a safe, appropriate and responsive quality of nursing practice.

References

Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., ... & FIRST2ACT™ Research Team. (2014). Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study. Nurse education today, 34(5), 691-696.

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.

Christensen, B. L., & Kockrow, E. O. (2013). Foundations of Nursing-E-Book. Elsevier Health Sciences.

Dawson, S., King, L., & Grantham, H. (2013). Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia, 25(5), 393-405.

Fahlberg, B. (2014). Promoting patient dignity in nursing care. Nursing2016, 44(7), 14.

Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 2375-2388.

Gastmans, C. (2013). Dignity-enhancing nursing care: a foundational ethical framework. Nursing ethics, 20(2), 142-149.

Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing Regulation, 3(3), 36-42.

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