1. The case study depicts the clinical scenario of 81 year old, patient A who had initially complained about shortness of breath while lying flat on the bed on 5th of January. She was recommended oral Lasix and was asked to report again after two days. However, the patient did not find much relief with the use of oral Lasix and reported the very next day to a rural hospital. On January 9th, the patient complained of dizziness with an increased heart-beat. The patient further refused food and also stated to have severe abdominal pain. On reviewing the patient, the VMO concluded the patient to have been feeling depressed and at the same time analysed the condition of the patient on the ECG report and prescribed Digoxin and Valium to control the accelerated heart-beat of the patient. Later during the day the progress notes revealed the patient to be tachycardiac, with cold and clammy skin and back ache. The VMO diagnosed the patient again and the progress notes mentioned Patient A to have an increased WBC count despite having fever, with urinary tract infect ions, severe abdominal pain and administered antibiotics intravenously (National Safety and Quality Health Service Standards, 2018). Gradually the patient developed diarrhoea and ultimately due to critical weakness passed away on 11th January. The identified reason for death was septicaemia.
2. According to the NMBA standard guidelines that are followed on a mandatory basis in nursing a number of measures could have been adopted that would have helped in preventing the deteriorating condition of the patient (Andrew, 2015). The first and foremost measure that could have been taken was an elaborate documentation (Boyd & Sheen, 2014). The case study reveals that a number of observations were not taken note of and also the casual approach of RN John led to the worsening of the health condition of patient A. Registered nurse John could have immediately informed the clinical manager MS. Sophie Smith and requested her to urgently design a course of action. It should be noted that RN John despite being informed by the enrolled nurses about the worsening condition of the patient did not review the patient and waited for the locum to arrive. Further, the case study also states that RN John did access patient A but did not document the observation (National Safety and Quality Health Service Standards, 2018). It is also mentioned that he telephoned the clinical manager and asked her to arrange medication for another patient other than patient A. Even when Ms. Smith had arrived with the medication, RN John did not convey any information regarding the degrading medical condition of patient A. Also, it is stated that the after the successful completion of ISBAR evaluation, the documentation by RN John and another fellow nursing professional it was recorded that patient A’s medical condition was worsening and that her family members had been contacted. Although, the nurse had mentioned these characteristics in the ISBAR evaluation form he had absolutely taken no initiative to prevent the condition from deteriorating 9 National Safety and Quality Health Service Standards, 2018). Patient A constantly complained of back pain and the progress notes that were handed over to RN John on commencement of his shift stated that the patient had clammy skin and found it difficult to mobilise. RN John did not take note of the crucial observations. He failed to identify the symptoms of septicaemia. The progress notes also mentioned the patient had been refusing meals and was severely dehydrated. RN John as a responsible professional must have proactively administered medication to combat dehydration and must have checked the vital signs of the patient and recorded the detailed observation Aebersold & Tschannen, 2013). RN John and the enrolled nurses must have taken an immediate clinical decision based upon the urgency of the situation and arranged for an emergency MET call (Cusack, 2015).
3. Professional approach that could have been incorporated in order to avoid the fatal situation could be proper documentation of observation, effective communication and better decision making ability. The nurse could have recorded the patient observation on hourly basis. According to the NMBA standard recording observations on hourly basis helps in being able to monitor the condition of the patient in a detailed manner as it provides an over view about the deteriorating or improvement health status of the patient in a concise and accurate manner (Keast,2015). Also, RN John could have checked vital signs which was not done by him. Further, when the patient repeatedly complained about back pain and the progress notes revealed restricted mobility due to back pain and pain in the abdomen, the RN could have arranged for physiotherapy so as to help the patient with mobility (National Safety and Quality Health Service Standards, 2018). The progress notes also revealed that the patient had refused meals. It should additionally be stated that there was no documentation about the bowel movement of the patient Aebersold & Tschannen, 2013). It might have been possible that the patient was constipated before. The case study does not mention any documentation of the dietary or the fluid intake of the patient. RN John prior to the arrival of the locum could have organized for fluids that would have helped the patient with dehydration and would have helped the patient in urinating frequently. This would have helped the patient in getting relieved of the urinary tract infection. Further, it is important to consider here that the patient with proper assistance of fluid intake would have not been dehydrated and would not have refused meals. It can be said that the refusal of the meals was primarily due to severe dehydration (National Safety and Quality Health Service Standards, 2018). Further, as supported by the patient safety guidelines it should be stated that the registered nurse should have immediately arranged a MET call or consulted with the clinical manager so as to improve the deteriorating health of the patient (Scanlon et al., 2016). Hence, it can be said that comprehensive documenting is described as a pivotal tool that determines best nursing practice (Levada et al., 2015). It is highly recommended to the nursing professionals to document the observations in a detailed manner in the progress notes in order to ensure that every significant information of the medical status of the patient is recorded in a detailed manner (McCabe & Timmins,2013). RN practise requires a comprehensive thinking and efficient decision making so and deliver the medical services with close association to the safety standard of the patient.
4. According to my understanding and critical evaluation of the case study, I believe that I am not yet entirely prepared for my professional practice. In order to improve my preparedness for professional practice, I would like to develop my decision making ability complying with the reflective framework of Rolfe’s reflective framework (National Safety and Quality Health Service Standards, 2018). This framework is primarily based upon the three vital considerations that accesses what is the situation, what can be done according to the theoretical and practical experience in the situation and finally the attempt that can be taken to improve the situation (Rolfe, 2014). It has been stated as per the facts furnished by scholarly references that the third aspect is the most critical aspect of Role’s reflective framework (Heckemann et al., 2015). Therefore, the efficient use of Rolfe’s reflective framework would help in successfully evaluating the course of actions undertaken by me to serve the patient in with respect to the social policy, legislative policies and my personal attributes (National Safety and Quality Health Service Standards, 2018). Further, I would make use of these considerations and address the third and the most vital part of the reflection framework that would help me judge my own course of action and help me design better intervention strategies. Also, I believe that on working with my supervisors I would be able to develop my professional skills on the basis of the knowledge gathered through observation and their experience of dealing with patients over a considerable time period.
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Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), 129-142. DOI: https://doi.org/10.1016/j.colegn.2014.09.009