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Violations in Patient Care

Nurses play one of the most significant as well as crucial roles within healthcare sectors where their priority is to offer quality healthcare services and treatment to patients. While delivering care to patients, nurses are expected to demonstrate professionalism, adhere to nursing standards, values, and practices to perform both ethically and legally (Roulin et al., 2020). However, when nurses violate or breach these standards it is not only unethical but also puts patients and colleagues at risk (Roulin et al., 2020). Hence, the primary aim of the paper is to discuss the violations made by the nurse within the healthcare sector while being engaged in patient care and relate it with the registered nurse and RN sub-standards for Practice as well as highlight the implications for the same along with a solution.

From the case study, a number of violations have been identified that have been committed by both the registered nurse Dan and Abi. The first violation or breach is RN Abi coming to work with a hangover which is both unethical and illegal. The second violation is RN Abi’s disrespect and disregard towards the family members of a patient, where nurses are expected to show complete respect and support to both patients and their family members.

The third violation was that RN Abi promoted patient harm, instead of offering quality care and dressing to one of the blind patients, clearly overlooked the bad dressing accompanied by an odour. Instead of immediately addressing the issue, RN Abi tends to ignore it which could have a tremendous impact on patient health and safety and could also aggravate the condition of the wound.

Fourth, a violation is committed by RN Dan, who without the consent of the patient clicks a picture of her wound.

This is followed by a fifth violation, which was related to patient confidentiality and privacy, where without consent and breaching privacy concerns of the patient, her photo of the wound is posted on social media with an anonymous name with the name of the hospital is mentioned clearly in the post which is unethical and might even be quite uncomfortable and embarrassing for the patient.

 The last violation is regarding the violation of the social media policy of the healthcare organization committed by RN Dan, who instead of informing the authorities regarding the hangover of RN Abi or advising her to take a day off, assists her in her work throughout the day and goes on to mention the hangover on a social media site that can have a tremendous impact on the reputation of the hospital.

The first violation that will be discussed is RN Abi coming to work with a hangover which makes her feel unwell. It is completely unethical for nurses to come to work with a hangover or drunk since it might put the patient health and safety at great risk and also hamper the reputation of the healthcare sector (Schneider et al., 2019).

 By coming to work with a hangover, RN Abi has violated the RN 3.1 sub-standard of considering and responding in a timely manner to the health and wellbeing of self and others. Under this sub-standard, nurses are responsible for not only taking care of patients but also of themselves, ensuring they are safe and capable of practice (NMBA, 2017). They are responsible for responding to the health and well-being of self and others, using a lifelong approach for professional development of self and others, being accountable for decisions and actions, and influencing better health outcomes (NMBA, 2017).

Registered Nurse Standards for Practice

Hence, the above nursing standard for practice has been chosen because it clearly shows that RN Abi has completely violated this standard of nursing practice where coming to work with a hangover she did not effectively respond to her health concerns which could affect her and put patients’ safety and quality care at risk that is clearly aligned to the code of professional conduct of preserving patient safety (NMBA, 2017). Due to her hangover, she was also unable to show professionalism at work and did not show accountability while making decisions and taking actions where she depended on other RN to make decisions and take actions (NMBA, 2017).

 Apart from this, due to her unethical behaviour she was also unable to promote an effective and ethical nursing practice, decisions, and values, and her hangover clearly affected her decision-making abilities thereby hindering better health outcomes for patients (Attenborough & Abbott 2019). Apart from this, due to hangover and being unable to effectively make quality decisions for patients and ensure their health safety, RN Abi was also unable to professionally develop herself and at the same time, was unable to influence the professional development of her colleague Dan who is likely to learn and be influenced from her casual and unethical behaviour which might further lead to greater risk for the patient (Attenborough & Abbott 2019).

Literature evidence clearly indicates that when RNs portray unethical behaviour and attitude, and do not abide by the policies of the organization then it has a direct impact on their decision-making process, leads to ineffective and inappropriate decisions, and thereby promotes patient harm and unsafe medical practices (Lee et al., 2021). This also hinders the professional development of subordinate nurses since their growth, skills, and knowledge becomes limited due to a lack of RN responsibility and accountability (Lee et al., 2021).

Thus, it should be noted that some of the implications that might arise from the unethical behaviour of RN Abi are that while working under a hangover, her decision-making regarding patient health and safety might be completely impaired which will pose a high risk to patient safety and quality and might also aggravate their health condition (Perry et al., 2018). It will also place peers in difficult situations where they might be in a dilemma of whether to inform the authorities or supervisors regarding the same leading to termination (Perry et al., 2018).

Another implication of the same is that the nurse can be subjected to lawsuits in courts and might have to bear legal consequences due to breach of nursing standards and practices since it is illegal to attend to patients under the influence of alcohol or with a hangover because it puts patient safety and security at stake (Dotinga, 2019).

Working under hangover, mismanagement of medications of unsafe and negligent practices will also be promoted by the nurse, which has happened in the case of Abi where she was unable to take corrective action regarding wound dressing and overlooked future harm and complications for the patient (Perry et al., 2018). It will also affect their relationship-building capacity with the patient.

Implications of Violations

The correct action in the case of RN Abi would be to take a day off from work and effectively manage her health and come back to work the next day where she would be able to make efficient decisions that would prioritize and guarantee patient health and safety and at the same time, would also not place her peer in an unlikely or uncomfortable situation (Schmidt & McArthur 2018).

Another course of corrective action that could be ensured was RN Dan’s duty to inform the supervisors about the ill-health of RN Abi, while not disclosing the real reason for the hangover which would have helped in giving her a day off or required health attention to RN Abi for the day (Chehab et al., 2018). Provisions to replace her with another experienced RN would have helped in ensuring patient safety and quality, would have helped in the professional development of other nurses and at the same time, would also help in ensuring ethical and legal practice within the healthcare sector (Schmidt & McArthur 2018).

The second violation that has been committed by RN Abi, as well as Dan, is not prioritizing patient care, quality, and treatment. Under the hangover, RN Abi was unable to make an effective and efficient decision regarding the wound that had aggravated which looked both purulent and odorous. Instead of addressing the wound with professional expertise and knowledge, Abi ignored the complications and complexities that might arise from the wound and asked Dan to do the same dressing without effectively treating the wound, where the nurse failed to do the dressing appropriately.

Similarly, instead of raising concerns regarding the wound being aggravated with a foul smell, the nurse simply overlooked the vital signs of deterioration thereby increasing the risks of harm. This clearly shows that her decision-making abilities were impaired due to the hangover and she was acting unethically at work.

This clearly shows that both nurses Abi and Dan did not follow the 1.1 sub-standard of accessing, analysing, and using the best available evidence which includes research findings for safe and quality practice along with the 6.1 sub-standard of providing safe, responsive, and appropriate along with quality nursing practice respectively (Dearnley et al., 2018). Under the first sub-standard, nurses are expected to make use of research findings that will promote quality practice, incorporate laws, policies, and ethics while making decisions, which also includes the 4.1 sub-standard of maintaining accurate and timely documentation of medicines and actions that will ensure quality care for patients (NMBA, 2017).

Thus, the above sub-standard has been chosen because none of the expectations from a nurse as mentioned in the first standard have been fulfilled by either of the nurses mentioned in the case study. Neither RN Abi nor Dan was able to think critically and analyse the nursing practice that would have helped them to realize the implications of their casual attitude on the health and safety of the patient (NMBA, 2017).

Both the RNs did not make use of research findings while treating the aggravated wound that would have helped in ensuring safe quality practice. RN Abi’s decision to do the same dressing on the aggravated wound again clearly showed that she did not comply with policies, and standards while making decisions that might put patient safety and health at risk.

Conclusion

The 6.1, 6.3, 6.5, and 6.6 sub-standards of providing appropriate, responsive, and quality nursing practice states that nurses’ primary duty is to offer safe and quality treatment to patients, delegate aspects of practice to other nurses according to their expertise, align their actions with nursing guidelines, regulations, and legislations and identify potential for risks respectively which helps in ensuring safe and quality care (Davidson et al., 2018).

These sub-standards have been chosen because both RN Abi and Dan were incompetent in demonstrating them by not critically analysing the complications that might arise from the aggravated wound and by dressing the wound inappropriately it can clearly be said that both Dan and Abi were not adhering to safe quality practice (Davidson et al., 2018). She was also ineffective in delegating effective roles and responsibilities to other enrolled nurses like Dan, where she could have successfully supervised both wound dressing and treatment of a wound to Dan would have helped in enhancing the professional competency of both nurses (Shinners, 2019).

The attitude of the nurses toward the aggravated wound of the patient clearly showed that they were not acting in accordance with nursing guidelines, ethics, legislation, and regulations because according to these, the role of every nurse is to effectively respond to patient safety concerns and prioritize their health (Shinners, 2019). Apart from this, they were also unable to report and respond to the potential risk of aggravated patient wounds and did not effectively analyse its related issues that had put the patient health and safety at risk (NMBA, 2017).

Thus, it should be noted that the behaviour and attitude of the nurses would have tremendous implications and the first is that it would put the safety of the patient at risk. Unaddressed wounds can lead to several infections and health risks that might put patients at risk (Younas, 2020). A second implication is that it might affect the relationship between patient and nurse since these types of discrepancies and health outcomes are bound to dissatisfy patients and their family members and lose trust in the services of the healthcare sector (Younas, 2020).

In addition to this, the nurses would also be subjected to a nurse tribunal where the members of the tribunal would address the safety issue that was put at stake by the nurses. The tribunal would be responsible for giving notice to the concerned nurses for their violation and would also decide the consequences that would be borne by them (Hodson, 2020). It has been suggested by literature and evidence that when the above instances are noticed or complained about, then the nurses are either suspended from their duty until called back or directly terminated since this tends to have a direct impact on patient safety and organizational reputation (Hodson, 2020).

 Apart from this, by not following or complying with the two standards, the job of both the nurses might come under the scanner since their unethical behaviour and decisions might put patients’ lives at risk. Furthermore, unethical decision-making may also tremendously affect the reputation of the healthcare organization (Younas, 2020).

The correct action in this situation would be for Dan to inform the supervisors regarding the aggravated wound which would help him to realize the complications and complexities which might arise in patient health due to this issue (Poorchangizi et al., 2019). Informing relevant clinical supervisors regarding the health risk in concern would have helped in treating and addressing the complexities of the wound in time and thereby would have helped in ensuring safe and quality healthcare practices and care for the patient (Poorchangizi et al., 2019).

Another correct action would be Dan’s role in advising and guiding Abi to treat patient wounds effectively and understand the issues related to the same which would make Abi realize her nursing roles and responsibilities and thereby provide quality and safe treatment and care to the patient.

Conclusion

To conclude it should be noted that the unethical and sub-standard nursing practice followed by RN Abi and Dan has put the patient health and safety at risk. Therefore, to avoid these kinds of situations, it is expected the nurses to effectively comply with nursing legislations, ethics, practices, regulations, and values that will not only help in prioritizing patient health and safety but will also help lead to nurses’ professional development.

References

Attenborough, J., & Abbott, S. (2019). The impact of Nursing and Midwifery Council revalidation on the professional identity of academic staff in a higher education institution: A qualitative study. Nursing Open, 6(2), 434-442. https://doi.org/10.1002/nop2.224

Chehab, M. A., Thakor, A., Tulin-Silver, S., Connolly, B. L., Cahill, A. M., Ward, T. J., & Venkatesan, A. M. (2018). STANDARDS OF PRACTICE. J Vasc Interv Radiol, 1, 19. https://doi.org/10.1016/j.jvir.2018.06.007 

Davidson, P., Rushton, C. H., Kurtz, M., Wise, B., Jackson, D., Beaman, A., & Broome, M. (2018). A social–ecological framework: A model for addressing ethical practice in nursing. Journal of clinical nursing, 27(5-6), e1233-e1241. https://doi.org/10.1111/jocn.14158

Dotinga, R. (2019). 8 Tips to Avoid Being Sued in the Nursing Home: Attorneys Offer Expert Insight on Improving Care and Avoiding Lawsuits. Caring for the Ages, 20(5), 6-7. https://doi.org/10.1016/j.carage.2019.05.001

Dearnley, C., Rhodes, C., Roberts, P., Williams, P., & Prenton, S. (2018). Team based learning in nursing and midwifery higher education; a systematic review of the evidence for change. Nurse Education Today, 60, 75-83. https://doi.org/10.1016/j.nedt.2017.09.012

Hodson, N. (2020). Regulatory justice following gross negligence manslaughter verdicts: Nurse/doctor differences. Nursing ethics, 27(1), 247-257. https://doi.org/10.1177/0969733019833124 

Lee, C., Kim, S., Choe, K., & Kim, S. (2021). Effect of ethics seminar on moral sensitivity and ethical behavior of clinical nurses. International Journal of Environmental Research and Public Health, 18(1), 241.

NMBA (2017). Professional Standards. Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx 

NMBA (2017). Registered Nurse Standards for Practice. Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx 

Perry, L., Xu, X., Gallagher, R., Nicholls, R., Sibbritt, D., & Duffield, C. (2018). Lifestyle health behaviors of nurses and midwives: The ‘fit for the future’study. International journal of environmental research and public health, 15(5), 945. https://www.mdpi.com/1660-4601/15/5/945 

Poorchangizi, B., Borhani, F., Abbaszadeh, A., Mirzaee, M., & Farokhzadian, J. (2019). The importance of professional values from nursing students’ perspective. BMC nursing, 18(1), 1-7. https://doi.org/10.1186/s12912-019-0351-1 

Roulin, M. J., Jonniaux, S., Guisado, H., & Séchaud, L. (2020). Perceptions of inpatients and nurses towards the importance of nurses' caring behaviours in rehabilitation: A comparative study. International Journal of Nursing Practice, 26(4), e12835. https://doi.org/10.1111/ijn.12835

Schmidt, B. J., & McArthur, E. C. (2018, January). Professional nursing values: A concept analysis. In Nursing forum (Vol. 53, No. 1, pp. 69-75). https://doi.org/10.1111/nuf.12211

Schneider, A., Bak, M., Mahoney, C., Hoyle, L., Kelly, M., Atherton, I. M., & Kyle, R. G. (2019). Health?related behaviours of nurses and other healthcare professionals: A cross?sectional study using the Scottish Health Survey. Journal of Advanced Nursing, 75(6), 1239-1251. https://doi.org/10.1111/jan.13926

Shinners, J. (2019). Nursing professional development and continuing education in 2019: Organization, assessment, and evaluation. The journal of continuing education in nursing, 50(1), 6-8. https://doi.org/10.3928/00220124-20190102-02

Younas, A. (2020). Operationalist and inferentialist pragmatism: Implications for nursing knowledge development and practice. Nursing Philosophy, 21(4), e12323. https://doi.org/10.1111/nup.12323

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