Critical Analysis Of A Case Study On Unprofessional Conduct In Nursing

Question:

Discuss about the Evaluation Of The Unsatisfactory Professional.

Nursing is considered as a noble profession in which apart from professional competence and essential skills, the nursing practitioners are to work in compliance with the professional standards and principles as laid down by the concerned authorities. It is imperative for the nurses to abide by these guidelines for ensuring appropriate professional conduct, accountability and ensuring so that there is no violation of the accepted norms and regulations (Masters, 2015). In the following essay, critical analysis will be performed with respect to a chosen case study whereby evaluation of the unsatisfactory professional conduct as performed by nurse will be conducted. The relevant professional standards as applicable to the case scenario will be identified. Discussions will be made in terms of professional behaviors that could have made a difference to the case. Further, evaluation of self-preparedness for professional practice will also be carried out to offer deeper probe into the matter.

As per the given scenario, the nurse was found guilty of unsatisfactory conduct with respect to her failure in acknowledging and responding to the deteriorating health status of the patient. Moreover, she was also declared guilty of not documenting her assessments and subsequent plan of action for the patient. Thus, in conformance with the give situation it is evident that the nurse did not act up to the mark in performing her duties. It has been stated that the nurse after being informed about the observations with respect to the vital signs, did not take appropriate actions in managing the ensuing situation. Patient was left without any proper medical review or intervention until a long period of time even though her vital parameters were found to be within the ‘red zone’ as depicted in the Hunter New England NSW Health Policies. As per the governing policy, a patient exhibiting such symptoms call for ‘rapid response’ in which the patient is to be attended by either a medical officer or a rapid response team within 10 minutes. Further, it is expected that in absence of all these facilities, the patient’s general practitioner or the on-call visiting medical officer be immediately notified to undertake prompt therapeutic actions. In this respect, lack of critical reflection on the part of the nurse may be indicated as she failed to recognize the deteriorating health status of the patient. Empirical evidences have cited that critical thinking skills and its integration into nursing practice is vital in facilitating proper planning and implementation of strategies for ensuring speedy patient recovery (Burrell, 2014). Moreover, the nurse did not document the patient’s medical record that is crucial to her assessment, plan of action and rationale behind selection of undertaking a particular course of treatment. Neither did the nurse escalate the situation to the concerned authority of the clinical nursing manger for proper intervention. Documentation in the pursuit of nursing is vital for smooth operation of the nursing practice as it is indicative of the prospective course of treatment to ensure positive health outcomes for the patient. Staff competency and education are two prerequisites that account for improved documentation in nursing practice (Okaisu et al., 2014). Hence, correct following of appropriate actions in immediate situation would have averted the negative repercussions.

Compliance with Professional Standards and Principles

It is imperative in nursing practice to abide by the professional standards for ensuring the safety and provision for optimal healthcare service for the patient, the end user of the healthcare service facility. These standards are responsible for governing the professional nursing practice and dictate the professional accountability in the vocation. A foundational framework is rendered by compliance to these standards and ensures so that optimal outcomes may be achieved for the patient population (Krautscheid, 2014). In the given scenario, it has been reported that the nurse was guilty due to unsatisfactory professional conduct. A strict violation of the professional standards as lay down by the concerned authority consisting of the Nursing and Midwifery Board of Australia was evident in the given scenario. Breach of standards has occurred pertaining to the given condition whereby the nurse has failed to accurately recognize the deteriorating health condition of the patient and did not even document the medical record of the patient. Standard 1 was breached because as per the statement, a nurse must think critically and analyze the situation in course of nursing practice. Further, standard 5 was breached, as the nurse did not develop a plan for nursing practice. Lack of documentation has been observed, as the nurse did not take appropriate actions in terms of harboring positive outcomes for patient. Moreover, breach of Standard 6 is also noted as the nurse failed to provide safe, appropriate and responsive quality nursing practice (Nursingmidwiferyboard.gov.au, 2017). According to the Code of Professional Conduct for Nurses, the nurses must practice in a safe and competent manner, in conformance with the standards pertinent to the profession and broader health system. Reflective and ethical consideration in nursing is also an important virtue as stated in code of professional conduct for nurses. However, all these codes were violated in given context thereby culminating in unprofessional conduct as it opposed the agreed and accepted practice standards (Nursingmidwiferyboard.gov.au, 2017).

Nursing practice demands for prudent ad pragmatic approaches in terms of conducting professional behaviors that are essential to ensure safe and quality healthcare services to the patient. As per the given scenario, the nurse exhibited lack of professional approach that ultimately resulted in death of the patient following progressive deterioration of her health status. It has been clearly stated in the case study that the nurse was informed about the declining health status of the patient evident through clinical manifestations of hypotension, tachypnoea in addition to abdominal pain and diarrhea upon her arrival to the ward. However, the nurse failed to acknowledge the criticality of the situation and did not resort to undertake prompt actions that were required of her. She could not fathom the urgency of therapeutic treatment intervention and hence did not perform the necessary actions that would have altered the situation for good. No doctor was summoned at that hour although her vital signs observations clearly indicated debilitating health status of the patient.  The locum doctor appeared at the scene approximately three and half hours later.  Moreover, she did not record her personal observations on arriving at the scene. However, the early presence of the doctor would have been of utility in terms of gauging the relative urgency of the situation and implementing suitable therapeutic actions. Further, documentation of valid observations would have aided in framing the nursing care and plan as suitable for the patient. Possession of the essential nursing skills such as that encompassing critical reflection and analysis would have generated positive outcomes. These virtues would have upheld competency and safe practicing norms for the nurses (Missen et al., 2016). Moreover, apart from these personal attributes, prior clinical experience to similar setting would have made difference. As far as critical care nursing is concerned, research has revealed that experience across the nurse practitioners is majorly responsible for inducing positive outcomes (Morton et al., 2017). Hence, it may be commented that a more professional approach would have reversed the given context and culminate in generating positive outcomes for the intended patient.

Importance of Professional Behaviors

Reflecting on the case study, I became aware about my own professional preparedness. I came to acknowledge the usefulness of biding by the professional standards and code of conduct in professional practice. Further, significance of lawful and ethical compliance to nursing practice became clearer to me. Codes of ethics as suitable to relevant situation was clearly elucidated to me as I perceived that keeping aside the safe and quality practice in nursing, the ethical virtues must also be maintained in due course to account for optimal outcomes for the patient (Nursingmidwiferyboard.gov.au, 2017). Reviewing the content of case study, I feel enlightened in terms of knowing the pivotal role of documentation in nursing practice. I believe, as an integral part of nursing care, the nurses should strive to document their observations explicitly even though it might appear trivial a times. Correct documentation would account for indicating the course of appropriate therapeutic practice thereby aiding in formulation of an appropriate care plan directed to the patient (Woods et al., 2015). As a new graduate nurse, I think it is within the scope of practice to undertake the actions that might ultimately result in rendering safe and competent care services to the patient.

Nurses must be proactive in their efforts and thorough about their knowledge regarding their professional conduct and work in alliance with the professional standards and code of ethics as fostered by competent authorities. In case of deviation from these ideal behaviors, they are liable to be prosecuted under the court of law. Gross violation of accepted protocols and practices would account for proceeding with necessary actions that might be leading to legal trials and appropriate actions as applicable in particular case scenario. Moreover, nurses must take responsibility or be accountable for their behaviors. Critical reflection to a specific situation is necessary to strategize suitable actions in favor of holistic outcomes for the patient. Prudent insight into a given scenario is vital to acknowledge the specific condition of patient. Therefore, nurses must be well versed and aware about their professional accountability to ensure safe and optimal healthcare service for the patients.

References

Burrell, L. A. (2014). Integrating critical thinking strategies into nursing curricula. Teaching and Learning in Nursing, 9(2), 53-58. doi: 10.1016/j.teln.2013.12.005

Krautscheid, L. C. (2014). Defining professional nursing accountability: a literature review. Journal of Professional Nursing, 30(1), 43-47. doi: 10.1016/j.profnurs.2013.06.008

Masters, K. (2015). Role development in professional nursing practice. Jones & Bartlett Publishers.

Missen, K., McKenna, L., Beauchamp, A., & Larkins, J. A. (2016). Qualified nurses' rate new nursing graduates as lacking skills in key clinical areas. Journal of clinical nursing, 25(15-16), 2134-2143. doi: 10.1111/jocn.13316

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 7 October 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Professional standards (Code of professional conduct for nurses). Nursingmidwiferyboard.gov.au. Retrieved 7 October 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Professional standards (Code of ethics for nurses). Nursingmidwiferyboard.gov.au. Retrieved 7 October 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Okaisu, E. M., Kalikwani, F., Wanyana, G., & Coetzee, M. (2014). Improving the quality of nursing documentation: An action research project. curationis, 37(2), 1-11. doi: 10.4102/curationis.v37i1.1251 

Woods, C., West, C., Mills, J., Park, T., Southern, J., & Usher, K. (2015). Undergraduate student nurses’ self-reported preparedness for practice. Collegian, 22(4), 359-368. doi: 10.1016/j.colegn.2014.05.003