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Introduction to Nursing

Question:

Discuss about the Critical Analysis Of Nursing Care.

Nursing can be defined as a noble profession within the Health Care Sector that comprises of caring for different patients, families or communities regardless of contributing factors like race, gender, religion and socioeconomic status, in order to ensure providing optimal health care to each and every sector of the society.  Nurses can be differentially recognized from the rest of the allied health care staffs in regard of their specialized training, codes of conduct and practice, and the scope of the service. Along with that, the registered nurses are also entrusted with the task of administering medication to the patient during urgencies given the fact that they are trained and hold certified registration for medication administration (Blegen et al., 2013). Along with that another very important fact is that nursing profession and the job roles come with it are very multifaceted, there are various dimensions to the responsibilities that a nursing professional has to fulfill. For instance, along with patient assessment, care planning and implementation, a very important aspect of nursing profession is establishing a mutually respectful therapeutic relationship with the patient. It has to be understood that the patients and their family members spend most of the time in the health care facility with the nurses; hence nurses are the most approachable personnel for the patient and their family members to share their preferences or grievances. Hence, with the importance of the nursing professional so grave, unsatisfactory professional conduct can be extremely detrimental to the health and safety of the patient under consideration. It has to be understood that nurses play the role of a moderator, bridging the gap between the treatment decisions from physician, therapists or dietician and the perception and needs of the patient and his or her family. It has to be understood that in certain cases, the nurses might need to take full responsibility of taking critical clinical decision in emergencies on their own and save the life of their patient, and the nurses are trained and skilled to take up this responsibility (Butts & Rich, 2012). Hence, professional ethics mandate the nurses to take adequate clinical edcisions and implement emergency care protocols in case of any emergency deteriorating in the condition of the patient, and any nursing professional not abiding to this protocol violates a number of key codes of conduct of nursing ethics. This assignment will attempt to incorporate nursing roles and practice guidelines from NMBA in hopes of exploring the impact of unsatisfactory professional conduct from nurses in case4 of emergencies taking the help of a case study.

Nurse-Client Interaction

Nurse-client interaction is the main region in cooperative nursing hypotheses. These speculations are focused on enhancing medical attendant customer relationship, considering the qualities in nursing like respectability of human and the need of sensitivity and human associations. From their perspective, nursing care is a human procedure instead of a mechanical practice and it will build the wellbeing and feeling of prosperity in customers (Chiarella & White, 2013). An appropriate and viable human collaboration has been one of the basic necessities for nurture graduates up until this point, yet overlooking the customer as a care design member and showing standard and programmed nursing care rather than an expert minding have been left as one of the primary difficulties in nursing training. In an immediate situation, a succession of exchanges including understanding conduct and medical caretaker response happens until the point when the patient's requirement for help, as he sees it, is illuminated. The medical attendant at that point settles on a proper activity to determine the need in collaboration with the patient. This activity is assessed after it is completed. In the event that the patient conduct enhances, the activity was fruitful and the procedure is finished. In the event that there is no change or the conduct deteriorates, the procedure reuses with new endeavors to illuminate the patient's conduct or the suitable nursing activity. In the emergency of nursing situation, every patient's conduct must be surveyed to decide if it communicates as requirement for offer assistance (Colvin et al., 2013). Moreover, indistinguishable practices by a similar patient may demonstrate distinctive requirements at various circumstances. The nursing activity should likewise be particularly intended for the prompt experience.

Nursing and Nursing Board of Australia or NMBA have several statements or guidelines in order to ascertain the ambit and responsibilities of the registered nurses in Australia. Registered nurse (RN) practice is person centered and proof dependent with deterrent, remedial, developmental, steady, remedial and end of life components. The RNs perform in remedial and proficient relations with different people, be it patients or their families, gatherings and groups. These individuals might have medical complications manifested as physical or psychological instability along with wellbeing challenges. These challenges can be represented by physical, mental, formative and additionally intelligent handicaps. As controlled wellbeing experts, RNs are capable and responsible to the Nursing and Midwifery Board of Australia (NMBA). The above mentioned are considered the National Registered medical attendant norms for training for each and every RN (Dinç & Gastmans, 2013). Simultaneously with NMBA benchmarks, codes and rules, these Registered medical caretaker gauges for training ought to be clear in present practice, and advise the improvement of the extents of training and goals of RNs. The Registered medical attendant norms for training comprise of the accompanying seven measures:

  • Critical and analytical thinking for nursing practice
  • Building mutually respectful and therapeutic relationship
  • Maintaining and broadening the practice scope and competence
  • Comprehensive and realistic patient assessment
  • Devising scientifically reasonable nursing care plans.
  • Providing safe, suitable and receptive quality nursing care.
  • Evaluating patient outcome to improve quality of care (Johnstone, 2015).

Nursing Roles and Practice Guidelines from NMBA

There are in total ten codes of professional standards for registered nurses. According to these codes, there are some guidelines nurses are required to follow when working which include nurses must practice in safe and competent manner; the professional approach should always be given the highest importance; the laws relevant to nursing practice should be kept in mind while practicing; nurses should maintain the confidentiality factor in regard of the identity and disease condition of the patient. Now it has to be understood that the illustration of any standards is governed by the criteria mentioned in the standard itself. These criteria require being deciphered in accordance to the training received by the RNs. It can be further explained by the fact that all the registered nurses have to work in collaborative manner and delegate obligations, however only one out of each odd RN will employ any medical caretaker for the practice if need be. In case the criteria lack comprehension and empower and facilitate for the RNs to achieve absolute advancement in their professional expertise (Levett-Jones & Bourgeois, 2015).

The Registered medical attendant guidelines for training involve all training ranges for all RNs. However the standards mandates these principles to be followed in coordination with applicable NMDA buddy archives, for instance, the gauges, codes and regulations, such as the Code of expert refers to medical attendants, Code of morals involves the medical caretakers, most basic nursing care leadership devices are addressed and improved by National system, Supervision rules assist in maternal nursing care, and Guidelines for compulsory notices.


The professional boundaries of nurses are mentioned in different set of guidelines. A nurse enters into a therapeutic relationship with the patient and they do get access to voluminous amount of personal information with respect to the patient and the concerned family. The imbalance in command will result in poor quality of service putting the lives of the vulnerable patients at risk. The professional standard requires the best outcome to be met by the nurses in regard of the therapeutic fate of the patients. There is another accountability of helping other colleagues in the same profession and all of these actions are to be executed within the set limit.  Professional boundary in nursing is defined as limits that protect the freedom between occupational power and the naiveté of patient (McGowan, 2012). This means there is a margin that marks brinks between an occupational, therapeutic relationship along with an attachment involving nurse and a diseased person. When a nurse transcends a guideline, usually behaving in a manner that is not coherent to the norms the misuse of power is to be perceived as a breach of NMBA statement.

Professional Standards for Registered Nurses

                               Figure 1: Professional Boundaries of nurses

                                 Source: (Nursingnursingboard.gov.au 2017)

There are guidelines for registered nurses providing suitable framework and scaffolding for the actions to be taken up by them. They work in a more person-centered atmosphere and now a days the evidence based practice has turned the contribution by registered nurses more effective and fruitful (McGowan, 2012).

The concerned patient in the case study is an old patient who is 81 years old and was admitted in the hospital on 6th January, 2013 with gasping for breath symptom along with other complications. These complications include diabetes, leg edema, tachycardia and hypotension. The patient was a female patient and her condition did not improve over a period of time after the admission. Her condition was aggravated in the afternoon on 11th January, 2013 and her blood pressure and respiratory rate were abnormal and the concerned respondent nurse was called in to the picture at this instance of time. There are various aspects associated with this case study has been discussed in the following section (Moxham, 2012).


The accountability of the concerned nurse cannot be overlooked in this particular case. The nurse herself has also accepted the fact that duty derelictions have happened on her part. Nurses are usually given appropriate training and clinical internship provision in order to enable them to handle the work pressure in real life situation. Hence, it is expected that there should be a clear conscience on the part of the concerned respondent or the nurse regarding the fact that professional responsibilities have been breached on several occasions (Moxham, 2012).

The NMBA standards or codes or statements which have been violated in this context include the codes of ethics. Ethics direct a nurse to always put the well being of patient as the prime priority. That has not been met here. The statements of professional standards and boundaries have also been violated when the nurse was indifferent to the first instance of aggravation of patient’s condition and later reluctant when doctor was expected to be called. The first guideline in the NMBA standards deals with the laws and regulations which have been violated in this regard. The laws identify legislation that governs different nursing practices; explains nursing practice standards in accordance with the common law; explains medication administration protocols in regards with the legislative requirements; recognizes the legal implications of providing nursing care; intervention actions express the level of awareness of the said lawful implications of nursing practice along with explaining effects imparted by the legislation upon the caring procedure of patients, and lastly it also uncovers  unethical practice which relates to confidentiality and privacy legislation (Nursingnursingboard.gov.au., 2017).

Professional Boundaries of Nurses

The policies of registered nurses ensure that the interests of the patient and his or her families are always addressed properly which has not been followed in this particular case study pertaining to the flag policy. That means when vital status of the patient was in red zone after 17:20 hrs, emergency action was not taken up.

Some contributing factors in the professional behavior of the concerned nurse could have been changed; the outcome of the patient could have been different. These action points include the first occasion when the respiratory rate and blood pressure level showed the primary concern; the time when doctor should have been called which was not performed and a local doctor accidentally came at 2200 hrs. The nurse did not document the aggravation of symptoms at 1820 hrs. The fatal outcome of the patient could have been avoided in case the first time reading abnormality could churn the nurse to pay heed and doctor or specialist was called immediately (Powell & Davies, 2012).

The example care at par the graduate training in the nursing school should include an immediate care plan right after the admission of the patient and the abnormality in respiratory rate and blood pressure readings would have been informed to doctor. The onset of abdominal pain and diarrhea should have been treated with specific medication, rehydration and care plan. The red zone readings of vital statistics should prompt the nurse to inform the physician further along with checking the care plan and attached installations again. These exemplary actions could have been able to avoid the fatal consequence or death of the patient on the next day (Ross, Barr & Stevens, 2013).

The profession of nurses and midwives consists of tremendous responsibility regarding the health of the patients and their general well being and hence, a sense of duty should always prevail among the professionals in this field. The concerned respondent or the nurse has been proven to be guilty of dereliction of duty as a nursing care specialist on several occasions and thus the applicable regulations should be implemented in this regard. The patients are usually vulnerable in most of the cases not being aware of their actual health condition and nurses are the primary set of people who come in contact with these naïve sufferers. They need to be adequately aware in order to serve in an infallible and efficient way (Chiarella & White, 2013).

Reference:

Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration, 43(2), 89-94.

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

Chiarella, M., & White, J. (2013). Which tail wags which dog? Exploring the interface between professional regulation and professional education. Nurse education today, 33(11), 1274-1278.

Colvin, C. J., de Heer, J., Winterton, L., Mellenkamp, M., Glenton, C., Noyes, J., ... & Rashidian, A. (2013). A systematic review of qualitative evidence on barriers and facilitators to the implementation of task-shifting in nursing services. Nursing, 29(10), 1211-1221.

Dinç, L., & Gastmans, C. (2013). Trust in nurse–patient relationships: A literature review. Nursing Ethics, 20(5), 501-516.

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

Katsikitis, M., McAllister, M., Sharman, R., Raith, L., Faithfull-Byrne, A., & Priaulx, R. (2013). Continuing professional development in nursing in Australia: Current awareness, practice and future directions. Contemporary nurse, 45(1), 33-45.

Levett-Jones, T., & Bourgeois, S. (2015). The Clinical Placement-E-Book: An Essential Guide for Nursing Students. Elsevier Health Sciences.

McGowan, C. (2012). Patients’ confidentiality. Critical care nurse, 32(5), 61-64.

Moxham, L. (2012). Nurse education, research and evidence-based practice.

Nursingnursingboard.gov.au. (2017). Nursing and Nursing Board of Australia - Professional standards. Nursingnursingboard.gov.au. Retrieved 7 September 2017, from https://www.nursingnursingboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Powell, A. E., & Davies, H. T. (2012). The struggle to improve patient care in the face of professional boundaries. Social science & medicine, 75(5), 807-814.

Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC nursing, 12(1), 9.

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