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1: The Nursing and Midwifery Board of Australia have put forward certain guidelines in the form of Code of Professional Conduct for Nurses. In the guidelines, the decorum of practicing nursing in a secured and competent way abiding by the professional and extended health system standards as well as the laws pertinent to the occupation and nursing care have been proposed (www.nursingmidwiferyboard.gov.au, 2016).
In the given case study of Conyard, 2015, the nurse was alleged of being guilty of unsatisfactory professional conduct applicable under the Section 139B of the national law (NSW). As per the stated law unsatisfactory professional conduct may be referred to as the demeanor on the part of a registered health personnel possessing adequate experience and training that is not in conformity or is substantially below the expected, reasonable standard (Staunton & Chiarella, 2012, Pairman et al., 2015). The course of action that followed in this particular case stem out of the fact that the nurse was unable to ascertain and react appropriately to the patient A’s declining health status and consecutively failed to document her observations and improvise a proper working modality accordingly. The circumstantial evidences that lead to the prosecution as reported is as follow.
Proceedings on 11th January, 2013 for patient A
Observations & Activities
Significant health deterioration
· Blood Pressure- 89/53
· Respiratory rate- 40-44 bpm
· Abdominal pain
Post 1810 hours
· Nurse made personal observations
· Observations undocumented
· Doctor uninformed
Locum doctor arrived
Patient critically ill
Morning of 12th January
The loophole in the nurse’s conduct identified under the given context was that she failed to inform a doctor on time although that was essential. Moreover she did not keep record of the personal observations. All these breaches favored the assessment of the case under the conduct pathway for the Nursing and Midwifery Council of NSW.
2: Individual professional accountability in the context of the nurses is in accordance with the Registered nurse standards for practice. The standardized nursing practices encompass a wide range of activities such as critical thinking and analysis, engagement in an integrated palliative care, assessment, improvisation, maintenance of a proper nursing regime and ensuring suitable nursing practice. Accountability implies that the nurses address and cater to the needs and requirements of the patients receiving care under their supervision as well as inform and report to the competent authorities such as their employers, the nursing regulatory body and also the public at large. The nurses themselves are held responsible for performing their duties, roles and responsibilities, making the decisions in addition to documenting the experience and observations (Krautscheid, 2014). Accountability as per general perception cannot be delegated and in case that is done, then also the nurses continue to be accountable for the decision to delegate, supervising the task of the relevant person and estimating the results including risks and benefits of the delegated activity (www.nursingmidwiferyboard.gov.au, 2016). An essential component of the accountability for the registered nurses is the ability to undertake a coordinated care approach of treatment involving the delegates such as an enrolled nurse, a student nurse or an individual outside the nursing profession (Savage, 2015).
In view of the Conyard, 2015 case certain mitigating factors reduced the personal accountability of the nurse. As per the available information, lack of documentation and failure of timely referral and communication with the immediate higher authority or the concerned physician may be regarded as the possible causes.
3: In the discipline specific case study, the following standards are identified to be relevant with the codes and standards as put forward by The Nursing and Midwifery Board of Australia for the registered nurses. As per their guidelines:
Standard 2 implies engagement in therapeutic and professional relationships.
This overall includes the definite engagement in holistic clinical and professional relationship through collegial generosity, mutual trust and respect within a congenial, healthy working atmosphere. Utilization of consultation, delegation, supervision, coordination and referral as a part of the collaborative work plan are carried out in this respect to optimize the patient well-being (Chang & Daly, 2016).
Standard 4 consist of comprehensively conducting assessments.
It refers to the usage of appropriate assessment techniques in conjunction with an inter-professional partnership to procure and acquire accurate, relevant knowledge in addition to evaluate the resources to inform future planning and nursing practice.
Standard 5 includes developing a plan for nursing practice.
This standard takes into consideration the assessed data for drawing effective plan in partnership through proper communication. Additionally, documentation, evaluation and plan modifications are executed as part of the commitment to the agreed outcomes. Planning and negotiation to achieve the desired benefit within stipulated time duration are other important aspects of this standard.
Standard 6 highlights the necessity of providing safe, appropriate and responsive quality nursing practice.
It deals with the provision of safe, quality care nursing practices complying the relevant regulations and legislations. Identification, assessment and scrutiny of both assumed and real risks and report of the practice below the standards are done in this case (www.nursingmidwiferyboard.gov.au, 2016).
Breach of Standard 2- On 11th January the nurse failed to recognize and act accordingly to the debilitating health condition of the patient. No consultation, delegation or referral was made.
Breach of Standard 4- No assessment regarding patient A’s health from the available data and observations were done, starting from the day of hospitalization till the taking over by the nurse. Thus scope for future planning strategy was reduced.
Breach of Standard 5- There was dearth of documentation from the nurse to assess the health status of the patient thereby eliminating the chances for suitable clinical interventions in the near future.
Breach of Standard 6- Lack of suitable intervention even after observing the deterioration in the patient A’s vital signs was a major mistake on the nurse’s part. She failed to assess her risks and arrange for appropriate treatments or medications. Thus the standards code of conduct as laid down by the concerned authority was breached.
4: Unlike every other profession that demands certain amount of knowledge, expertise, personal attributes and prior experience to satisfy the needs of the client, the professionals engaged in the noble profession of healthcare like nursing require to have much more than these basic qualities. It is expected that the nurses must be thorough about their understanding of the nursing practice by virtue of their knowledge foundation related to clinical reasoning cycle and clinical actions and duties. Clinical reasoning, as described by Levett-Jones et al., (2013) is a complicated cognitive process that require the personnel to utilize several thinking strategies to ably collect and analyze information of the patients (Lapkin, Levett-Jones, & Gilligan, 2013). The professional should think beyond the convention and apply their intuition and insights to influence the decision making pertaining to the individual patient’s situation. A person’s attitudes and perspectives, assumptions and preconceptions majorly impact the critical thinking modality (Blondy et al., 2015). The clinical reasoning skill adds to the efficiency and professionalism of the nurse and the cycle involves certain major steps. Among them considering the patient’s situation, collecting cues or information, processing those information, identification of the issues, establishment of suitable goals, taking proper actions, evaluation of outcomes and finally reflection regarding novel processes and new learning are the essential steps (Dempsey et al., 2009). The careful following of all these steps enable a nurse to perform her duty competently.
In the context of the Conyard, 2015 case study a distinction would have been possible if certain aspects of the professional behaviors could be altered after insightful consideration of the patient situation. As stated in the complaint the nurse in charge of the patient A on 11th January 2013, could not assess and thereby act accordingly to the deteriorating clinical condition between 17:10 and 21:00 hours. Simultaneously, a failure to organize a medical review of the Patient A’s declining vital signs despite falling under the ‘red zone’ category was considered as a major breach of conduct and thus was liable to prosecution. Moreover, the nurse did not document her observations and successive failure to assess the patient’s critical condition thereafter followed this missed conduct. Subsequent failure to implement a suitable plan of action for the patient A was also not executed and all these consecutive incidences and conducts of the nurse contributed to further worsening of the patient circumstances. A proper professional approach could have made a difference in this case study if the nurse strictly complied by the standards and established regulations. The nurse could have carried out the clinical reasoning process to critically analyze the patient’s condition. A little prudence and foresight on her part could have provided some respite to the patient and spare her the trauma of the legal prosecutions as well. Timely intervention and communication with the persons in higher position, an important responsibility of the nurse could be beneficial in the said circumstances. A nurse of her order and experience who was into the job for a period of over 14 years till 2013 should have been more careful and conscious in executing her duty.
5: Preparedness for professional practice is a real time necessity particularly for healthcare providers. Considering the Conyard, 2015 case study the role of the nursing accountability may be discussed in this context. As per my understanding, I learnt that to be accountable, the nurses must be able to perform the desired task or therapeutic intervention, accept the responsibility of doing the duty and lastly must possess the requisite expertise and qualification to perform the activity and delegate in compliance with the protocols and policies of the working organization. Referring to the case studied, I found that the lack of documentation from the nurse was a hindrance to the personal accountability. Therefore in my opinion this specific task of documenting each and every encounters and clinical observations by the nurses are of immense importance in the nursing practice for safeguarding the health of the patients undergoing treatment module in a hospital framework. I believe this practice of documentation might also be of immense help for future references as well as for keeping personal records. However trivial or unnecessary the observation might seem to the nurse, yet it must be well reported in paper to avoid any near misses and appreciate new findings. The healthcare personnel are subjected to the criminal and civil courts in case their duties do not conform to the legal requirements, hence they must be extremely cautious and aware about their norms of practice and patient care. As a new graduate nurse, in fine I would like to comment that taking legal liability of a patient following strong professional ethics and morale are imperative to the professional accountability of the nurses and under no circumstances should be undone.
Blondy, L. C., Blakeslee, A. M., Scheffer, B. K., Rubenfeld, M. G., Cronin, B. M., & Luster-Turner, R. (2015). Understanding Synthesis Across Disciplines to Improve Nursing Education. Western journal of nursing research.
Chang, E., & Daly, J. (Eds.). (2016). Transitions in nursing: Preparing for professional practice (4th ed.). Chatswood, Australia: Elsevier.
Dempsey, J., Hillege, S., French, J., & Wilson, V. (2009). Fundamentals of nursing and midwifery: a person-centred approach to care| NOVA. The University of Newcastle's Digital Repository.
Krautscheid, L. C. (2014). Defining professional nursing accountability: A literature review. Journal of Professional Nursing, 30(1), 43-47.
Lapkin, S., Levett-Jones, T., & Gilligan, C. (2013). A systematic review of the effectiveness of interprofessional education in health professional programs. Nurse education today, 33(2), 90-102.
Nursing and Midwifery Board of Australia (2010) ‘A nurse’s guide to professional boundaries’. Retrieved 15 September 2016, www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2015) ‘Supervision guidelines for nursing and midwifery. Retrieved 15 September 2016’, www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/reentry-to-practice.aspx
Pairman, S., Pincombe, J., Thorogood, C., & Tracy, S. K. (2015). Midwifery: Preparation for practice (3rd ed.). Chatswood, Australia: Churchill Livingstone.
Savage, P. (2015). Legal issues for nursing students: Applied principles (3rd ed.). Frenchs Forest, Australia: Pearson Australia.
Staunton, P. J., & Chiarella, M. (2012). Law for nurses and midwives. Elsevier Australia.
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