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Discussion

The case is of a young six-year-old boy who passed away due to the complication of melioidosis. He was noted to be a healthy and happy child. However, as the melioidosis propagated, the boy’s condition deteriorated, leading to death. Melioidosis is a well-known complication that is caused due to bacterial infection (Zakharova et al., 2021). Most number of Melioidosis cases are found in tropical areas such as Southeast Asia and tropical Australia (Mukhopadhyay et al., 2018). The infection for melioidosis is caused due to the untreated open wound, and the cause of death is due to the lowered immunity which further causes sepsis. Most cases are found in adults (Fong et al., 2021).

Child death caused due to melioidosis is quite a rare scenario, which is why the doctors and registered nurses are unable to give proper diagnosis and treatment to the children (Aziz et al., 2020). Hence, the response to the acute deterioration parameter is heavily ignored in the case of C. It is was noted that C’s medical case presentation wasn’t prepared throughout his admission to the remote hospital. Hence the registered nurses and the physicians did not adhere to the effective communication guidelines. The vital signs of the development of sepsis were also ignored in the C case. The handover procedure to the regional hospital was also poorly outlined and mismanaged, which caused unnecessary delays in understanding C’s condition and incorporating proper evidence-based treatment. The CWET report prepared by the regional centre also showed incomplete analysis. In the intervention and the clinical comments, as the test conducted on the C was not highlighted properly, the time of C conduction deterioration was not captured properly, and the patient’s medication was also not highlighted. Hence the registered nurse failed to show accountability and responsibility while handling C’s case. Additionally, one point it was mentioned that discrepancies were noted in the medical records of the remote hospital and the information provided to the C’s parents. Again, failing to meet the patient are guidelines.

In terms of professional nursing, accountability plays an integral part as accountability is referred to as the “Hallmark of professionalism” (Spears & Allen, 2018). As per the accountability definition in the medical setting, the nurses are required to answer for their actions which are also mentioned in the code of conduct: ethical guidelines (Fawaz et al., 2020). Several studies show that professional conduct affects all elements of treating patients, including daily life activities, promotion of health, clinical education, counselling services, and communication with multidisciplinary teams (American Diabetes Association, 2022). Although some information, such as flexibility activities from physiotherapy, may not be offered by nursing professionals, it should be the nurse's obligation to assure that all treatments and diagnoses are in the medical setting are maintained throughout treatment. Accountable nurses will work hard to earn the respect of their patient populations, not only in themselves but in the nursing profession as a whole (Roth et al., 2022). Whenever patients see teamwork, cooperation, and nursing assistants together achieve a shared goal, they might gain faith in the field. The standard of practice in a medical setting is to ensure the best possible treatment for patients and to improve their medical results (Kelly et al., 2019). Responsibility to themselves, the patient/family, superiors, the organization, and the community is jeopardized when nurses practise outside their scope of practice.

Coroners Case Report

In C’s case, it was highlighted that the registered nurse in the remote hospital did not present C’s case properly, which caused significant issues in the patient’s discharge and also did not connect with the physicians and other employees to work as a multidisciplinary team. If properly analysis and care could be given, the condition could have been improved. Similarly highlighted in the Coroners Court of Queensland report that a range of systemic issues at the remote hospital was observed, which severely impacted the care offered to C. According to an independent clinical evaluation, viral gastroenteritis is the greatest prevalent cause of influenza and dysentery in children; although melioidosis is a source of sepsis in children is extremely unusual, and it would not be identified by most doctors as the potential explanation of C's hospitalization. However, if the evidence-based practice would have been carried out, the detection of issues could be a lot faster than usual. It was also noted that there was an absence of proper clinical documentation, which makes it difficult to analyse if the patients were provided proper diagnosis as the patient’s case escalated to SEPSIS.

In the inquest report of patients, C report identified “The formation of sepsis from the complication of melioidosis, the failure of recognition of the clinical deterioration and on-compliance with the early warning and vital signs of the patient” (Coroners Court of Queensland, 2020). The case of patient C indicates that there are several miscommunications, documentation errors and mismanagement of escalation. The coroner’s report highlighted that the clinical presentation was inconsistent and further there was a range of systematic issues in the remote hospital (s45). The report further highlighted that the sepsis pathway is not common in children which is why the remote hospitals could not understand the vital early signs and symptoms. Throughout the Inquest, ineffective communication was evident on many occasions from the registered nurse and the physicians. An example of this is detailed in the Inquest on page 4, where the physicians failed to understand the cause of the issue is what propagated to the development of sepsis, and as well the registered nurse failed to present the case of the patients which caused mismanagement in the handover of the patients (Queensland Courts, 2020).

Therefore, from the above analysis, three major safety concepts are highlighted, which are: 1. If a proper diagnosis is followed or there are errors in such, 2. The patient’s discharge was not carried out properly, and 3. Development of sepsis.

RN’s Role in the Escalation of Care

The escalation case is when health professionals, health care workers, family and friends, or caregivers are highly involved in a patient condition that intensely declines and advocate contacting the available medical assistance in order to provide immediate assistance (Kodankandath, 2021). The escalation procedures focus on providing clear, objective standards that stimulate them to call emergency services. In the case of C’s case, it is observed that in the remote hospital, the escalation case was not handled properly by the registered nurses, which is during the swelling of hands and joints; no activity highlighted the implementation of the immediate assistance. This caused a restriction in C’s mobility which ultimately led to the death of C. Effective communication in the field of healthcare is extremely necessary as it mitigates discrepancies in medical treatment. In C’s case, multiple discrepancies were noted, which led to ineffective communication between the parents of the child and the hospital. In the remote hospital setting, teamwork was not observed at the beginning, which led to improper management of the patients in terms of providing care. All these factors terribly affected the effective decision-making, communication and documentation of a patient’s ongoing condition and care. Hence, it can be evaluated that the registered nurse did not properly follow the roles and responsibilities in order to provide patient-centric care.

A suitable strategy could have been incorporated to mitigate the risks and adhere to the opportunities in the Implementation of Evidence-based practice. Evidence-based practice is an arduous task that entails merging study information to create the strongest scientific proof and correlating concepts to create a diagnostic response with the help of practical information.

Evidence-based practice is critical for nurses to provide elevated treatment, boost experiences of the patient and family, and manage a productive healthcare system (Chien, 2019). As a result, when treatments and services are backed up by evidence, it directly impacts the condition of the patients. According to the Nursing and Midwifery Council (NMC) code of ethics, it is a duty of a registered nurse to provide high-quality treatment and care to the individuals of the community; therefore, it is integral that such professionals reflect, review their work, and stay current on new research and evidence (Ross et al., 2021). Delivering a simplified, cost-effective solution based on existing evidence-based practice has been found to minimize costs while simultaneously improving patient outcomes provided to patients (Norhayati & Nawi, 2021). The patient can engage in choices that influence their treatment by collaborating with the registered nurses (Connolly et al., 2018).  This is advantageous to the patient and benefits the registered nurse who is administering the client. In addition, evidence-based treatment is a problem-solving aspect of health provision (Son?ur et al., 2018). The nurse uses various problem-solving strategies to deliver personalised patient-centred treatment appropriate for the patients.

Evidence Based Practice

The evidence-based or the findings-based practice encourages the use of scientific evidence as a foundation for making healthcare recommendations, so it's critical to look for the facts and information in a reasonable manner. Owing to the discipline engaged, comprehensive research that may depend on skill and understanding represents a higher degree of proof. With the help of the strength of knowledge that is gained from available information hierarchy of evidence is created. The hierarchy of credible evidence can help clinicians determine which data would be most probable to provide the greatest impact on therapeutic choices (Löscher et al., 2020). Establishing evidence-based theory and practise is fraught with difficulties. However, this approach has severe drawbacks, which are, a lack of employee knowledge and skills. Healthcare practitioners' lack of information in relating results of the diagnostic and therapeutic investigation of contemporary suggestions might not have had the appropriate professional education experience to accomplish change. Registered nursing professionals have also identified time constraints as a challenge in implementing a study to operation. As the percentage of patients rises, doctors experience difficulties in creating a secure, high-quality treatment within a limited time span. A "toolkit" is an essential module that is developed by the researchers so that the nursing professionals can enhance their knowledge regarding the evidence-based practices and their benefit (Kilbourne et al., 2019).

Conclusion

From the above analysis, it can be concluded that the C was a young six-year-old boy who passed away due to the complication of melioidosis. Melioidosis is a well-known complication that is caused due to bacterial infection. Most number of Melioidosis cases are found in tropical areas such as Southeast Asia and tropical Australia. The infection for melioidosis is caused due to the untreated open wound, and the cause of death is due to the lowered immunity. Most cases are found in adults. Child death caused due to melioidosis is quite a rare scenario, which is why the doctors and the registered nurses are unable to give proper diagnosis and treatment to the children. In terms of professional nursing, accountability plays an integral part. The nurses are required to answer for their actions which are also mentioned in the code of conduct: ethical guidelines. Accountable nurses will work hard to earn the respect of their patient populations, not only in themselves but in the nursing profession as a whole. In C’s case, it was highlighted that the registered nurse in the remote hospital did not present C’s case properly. The escalation procedures focus on providing clear, objective standards that stimulate them to call emergency services. The evidence-based practise offers elevated treatment, boost the experiences of the patients and family members, and manage a productive healthcare system. According to the Nursing and Midwifery Council (NMC) code of ethics, it is the role of the registered nurse to provide high-quality care to the individuals of the community. Delivering a simplified, cost-effective solution based on existing evidence-based practice has been found to minimize costs while simultaneously improving patient outcomes provided to patients.

References

American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers. Clinical diabetes, 40(1), 10-38. https://doi.org/10.2337/cd22-as01

Aziz, A., Currie, B. J., Mayo, M., Sarovich, D. S., & Price, E. P. (2020). Comparative genomics confirms a rare melioidosis human-to-human transmission event and reveals incorrect phylogenomic reconstruction due to polyclonality. Microbial genomics, 6(2), e000326. https://doi.org/10.1099/mgen.0.000326

Chien L. Y. (2019). Evidence-Based Practice and Nursing Research. The journal of nursing research : JNR, 27(4), e29. https://doi.org/10.1097/jnr.0000000000000346

Connolly, M., Jacobs, S., & Scott, K. (2018). Clinical leadership, structural empowerment and psychological empowerment of registered nurses working in an emergency department. Journal of Nursing Management, 26(7), 881-887. https://doi.org/10.1111/jonm.12619

Fawaz, M., Anshasi, H., & Samaha, A. (2020). Nurses at the Front Line of COVID-19: Roles, Responsibilities, Risks, and Rights. The American journal of tropical medicine and hygiene, 103(4), 1341–1342. https://doi.org/10.4269/ajtmh.20-0650

Fong, J. H., Pillai, N., Yap, C. G., & Jahan, N. K. (2021). Incidences, Case Fatality Rates and Epidemiology of Melioidosis Worldwide: A Review Paper. Open Access Library Journal, 8(6), 1-20. https://doi.org/10.4236/oalib.1107537

Kelly, C. J., Karthikesalingam, A., Suleyman, M., Corrado, G., & King, D. (2019). Key challenges for delivering clinical impact with artificial intelligence. BMC medicine, 17(1), 1-9. https://doi.org/10.1186/s12916-019-1426-2

Kilbourne, A. M., Goodrich, D. E., Miake-Lye, I., Braganza, M. Z., & Bowersox, N. W. (2019). Quality Enhancement Research Initiative Implementation Roadmap: Toward Sustainability of Evidence-based Practices in a Learning Health System. Medical care, 57 Suppl 10 Suppl 3(10 Suppl 3), S286–S293. https://doi.org/10.1097/MLR.0000000000001144Immunity, 11(3), 409-422. https://doi.org/10.15789/2220-7619-MIA-1584

Kodankandath, T. V. (2021). Delayed Thrombus on Carotid Web: Case Report With Escalation of Treatment. The Neurohospitalist, 19418744211058940. https://doi.org/10.1177%2F19418744211058940

Löscher, W., Potschka, H., Sisodiya, S. M., & Vezzani, A. (2020). Drug resistance in epilepsy: clinical impact, potential mechanisms, and new innovative treatment options. Pharmacological reviews, 72(3), 606-638. https://doi.org/10.1124/pr.120.019539

Mukhopadhyay, C., Shaw, T., Varghese, G., & Dance, D. (2018). Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan). Tropical Medicine and Infectious Disease, 3(2), 51. https://doi.org/10.3390/tropicalmed3020051

Ross, L., Holt, J., Kuven, B. M., Ørskov, B., & Paal, P. (2021). Educational Context, Evidence and Exploration of Professional Fields of Nursing and Midwifery. In Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care (pp. 39-56). Springer, Cham. https://doi.org/10.1007/978-3-030-65888-5_3

Roth, C., Wensing, M., Breckner, A., Mahler, C., Krug, K., & Berger, S. (2022). Keeping nurses in nursing: a qualitative study of German nurses’ perceptions of push and pull factors to leave or stay in the profession. BMC nursing, 21(1), 1-11. https://doi.org/10.1186/s12912-022-00822-4

Son?ur, C., Özer, Ö., Gün, Ç., & Top, M. (2018). Patient safety culture, evidence-based practice and performance in nursing. Systemic practice and action research, 31(4), 359-374. https://doi.org/10.1007/s11213-017-9430-y

Spears, T. L., & Allen, L. (2018). EVIDENCE-BASED CARE SHEET. https://www.ebscohost.com/assets-sample-content/NRCP_EBCS_Accountability-in-NursingPractice.pdf

Zakharova, I. B., Toporkov, A. V., & Viktorov, D. V. (2021). Melioidosis in aspects of epidemiology, clinic, and laboratory diagnostics. Russian Journal of Infection and Norhayati, M. N., & Nawi, Z. M. (2021). Validity and reliability of the Noor Evidence-Based Medicine Questionnaire: A cross-sectional study. PloS one, 16(4), e0249660. https://doi.org/10.1371/journal.pone.0249660

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My Assignment Help. Child Death Due To Melioidosis: A Case Study Essay. [Internet]. My Assignment Help. 2022 [cited 12 July 2024]. Available from: https://myassignmenthelp.com/free-samples/nur3201-quality-safety-and-risk/evidence-based-practice-file-A1DCAB2.html.

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