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Negligence of care

Discuss the Nursing Assignment Based on a Case Study.

The advancement of the medical science with simultaneous rise in the impacts of globalization in every sphere of life has hugely affected the healthcare service as well. The changes and modifications existing in the healthcare sectors are evident through references available from evidence based practices. The healthcare working community recognizes the importance of a co-operative and well equipped infrastructural setting to impart improved healthcare access to persons in need. Clinicians, medical practitioners, surgeons, specialized physicians, registered and enrolled nurses along with other medical support staff comprise the basic structural organization within a healthcare facility. The role of the nurses are vital in ensuring speedy recovery of the patients through provision of person centered care, suitable therapeutic intervention suited to specific case situations. The duties and responsibilities expected out of practicing nurses are guided by relevant code of ethics, policies and legislations as put forward by the competent authorities. Case study evaluation following definite analytical and reasoning skills might provide an overview into the actual scenario that resulted in repercussions. In view of this fact, a case study as reported in case of a 64 year old male patient named Jon Lee who underwent laparoscopic cholecystectomy surgery in a hospital and the consecutive events and complications that followed post surgery will be discussed in order to assess and review the situational demands and loopholes in the healthcare service that prompted such consequences. The roles performed by the nurses in this specific case are also scrutinized to understand the limitations and fallacies that underpin the healthcare service. Guidelines for nurses employed in the gastroenterological wards may be considered for examining their practice modalities (Nuutinen and Rannos 2013). The discussion carried hereafter will be based upon the legal, ethical and professional practice issues. The vital issues as detected through insightful analysis revealed three key aspects that culminated in negative health outcome in the concerned patient. Negligence of care, faulty hospital operational policy and lack of culturally safe nursing practice were found to be the prime causative factors. Therefore, the assessment referring to the case study will discuss on the ethical, legal and practice methods for the nursing professional so as to get an overview of the working modalities in a healthcare setting.

According to the case study observed for Mr. Lee, certain breach of practice was observed on the part of the registered nurse (RN), Ms. Colleen Price who was assigned to look after him in the night shift at the extended day unit (EDU) of the hospital. Mr. Lee was subjected to a laparoscopic cholecystectomy operation on the same day, when the RN took over his case and therefore demanded undivided attention from the nursing professional’s ends to cater to his medical demands. Post operation, Mr. Lee reported of experiencing abdominal pain and distension. In response to the patient’s concern and routine examination by the attending medical officer (MO) at the hospital via consultation with the authoritarian surgeon prescribed analgesia (10 mg Morphine SC) to be administered on a pro re nata basis 6 hourly to ameliorate the reported symptoms. However, the RN having professional experience of five years was found to not document the administration of any such analgesia during her shift hours. During her shift timing tenure, RN documented the vital signs of the post operative care patient, Mr. Lee comprising of the note of parameters such as body temperature, pulse count and blood pressure at only one instance. No other follow up of the vital sign variables were documented during the entire night by the RN. Moreover, the RN was found faulty of not seeking any sort of assistance from the Post Anesthesia Care Unit (PACU) when required, located adjacent to the EDU, although the hospital decorum and guidelines provided enough scope to do so. Unfortunately, these breach of conduct and failure to apply experienced nursing knowledge into proper practice as evident in case of Ms. Price to address the conditions of Mr. Lee harbored negative implications and the limitations of the nurse may be identified through the following discussions and analysis. Nursing and Midwifery Board of Australia (NMBA) has developed Code of Ethics for Nurses in Australia that provides uniform guidelines for the nurses to uphold the fundamental human rights standards and ethical values in their professional practice by virtue of ethical decision making ability. The codes outlines the ethical virtues that are expected out of a nurse and primarily emphasis is laid on valuing quality nursing care for everyone alike, respect and kindness for self as well as others, diversity among people, accessibility to proper nursing and healthcare service, concept of informed decision making, culture of safety within healthcare and nursing facility, ethical maintenance of information ensuring privacy and confidentiality of the data procured and finally valuing a socio-economically and ecologically sustainable surrounding to foster well being and healthy life (NMBA 2007). A nurse attaining a level of expert clinical competency through proper training and acquired knowledge base supported by enough experience and critical decision making skills is bound to work in compliance with the context or the country where she has been appointed (Grace 2013). The four pillars of bioethics consisting of the vital components of justice, autonomy, non-maleficence and beneficence also enlighten the nursing ethical practice (Butts and rich 2012). Another crucial part of the nursing job that is often overlooked or undermined during practice is that of integrated record keeping and documentation of the patient data conforming to confidentiality, authenticity, durability, accessibility, relevance, completeness and comprehensiveness (Staunton and Chiarella 2012). Need for highly sophisticated and round the clock monitoring specifically for post operative patients have been highlighted in studies to aid in risk assessment and plan future intervention accordingly (Rothrock 2014). Reports suggest following of three basic theories of descriptive, predictive and explanatory types in nursing practice to facilitate good understanding of the patients’ situations (Parahoo 2014). Breach of conduct in standard practice in terms of not abiding by the Standards 1, 4, 6, 7 and 9 as put forward by the NMBA was observed in the particular case with respect to the RN’s attitude towards the patient care (NMBA, 2016). Negligence is normally associated with civil law and criminal prosecution follows in cases where indifference, inattention or failure from the nurses ends towards an obvious risk to injury of the patient are established (Griffith and Tengnah, 2014). Further, knowledge in nursing practice has been interrelated to four key sects such as empirical, aesthetic, personal and ethical that paves the way for reflective service outcomes in clinical setting (Heaton 2014). However, in the referred case study all these ethical and legal issues pertinent to nursing was not stringently complied that might have lead to exacerbation of the patient condition.

Faulty Hospital Policy

Referring to the cases study of Mr. Lee, it was inferred that the EDU on the day of the happening was not sufficiently equipped in terms of engagements of the healthcare staff in the concerned ward of 12 bed capacity. One RN and another enrolled nurse (EN) only were in charge of the ill patients of variable distress levels and complexities. Thus the patient to healthcare provider ratio was insufficient to meet the workload. The condition of two of the patients out of the total number of 12 patients were found to be quite critical as well when one was continuously vomiting post appendectomy and the other was experiencing urinary retention following Transurethral Resection of the Prostate (TURP). Moreover, a sole female patient admitted in the same ward, possessing certain religious notions and prejudices as well as inadequate English language proficiency added to the complexity of the situation in the EDU on that night when Ms. Price and the other EN was on duty. Yet another drawback in the functioning of the hospital policy was noticed as the PACU RN made futile attempt to check and make contact with the ED nurses for any assistance when the EDU nurses themselves were overburdened with severe work pressure thereby unable to communicate effectively with the PACU nurses over telephonic conversations. Thus telephonic mode of communication was found to be inappropriate in demanding situations. Additionally the patient handover technique during the change of shift for the nurses was detected to be erroneous and unsatisfactory as no evidence supported the smooth transfer of duty from Ms. Price to the morning hour nurse due to lack of awareness regarding the deteriorating health status of Mr. Lee during the immediate phase that preceded the later events. Hence these inherent flaws that affected the reputation of the relevant hospital due to defective operational strategy applicable to the hospital failed to fulfill the immediate requirements and assess the futuristic outcomes of patient named Mr. Lee in his post operative sessions. The limitations, thus identified may be re-examined under legal and organizational operational framework contexts. Bettering the Evaluation and Care of Health (BEACH) program conducted in the Australian domicile aimed to provide insight into the various reliable and valid data collection procedures to cater the ever-changing needs of the diverse patients pertinent to their health states through general physician (GP) and patient interactive encounters, evaluate the patient risk factors and health conditions as well as propagate an ongoing database information for GP-patient encounter. An overall well coordinated and equipped infrastructure is imperative to serve quality service to the sick patients (Britt et al. 2013). Education, clinical experience and competence resulting in endorsement and straightforwardness determine the nurses’ scope of practice within the Australian region. However the situation of clinical practice constrained by jurisdictional and regulatory restrictions are found to hinder the scope of nursing practice to its full capacity (Scanlon et al. 2016). Lack of effective communication among the nursing and associated staff within a hospital facility have been found to impair the teamwork output thereby obstructing the holistic mode of care (Masters 2015). The standards of practice for the nurses in Australia have fore grounded the relationship between the ethical and nature of nursing and the importance of translating evidence into actual practice as per the situational necessity (Cashin et al. 2016). Share of duty and excessive workload are found to impact the patient outcomes declining the quality of service offered to them (Chang and Daly 2015). Extensive literature reviews defined the professional nursing accountability in a comprehensive and reliable manner where the nurses are entitled to perform their assigned jobs in a legally and ethically suitable manner (Krautscheid 2014). Inter-professional collaboration and clinical decision making has been found to potentially enhance through adequate teamwork and exchange of views among colleagues in a healthcare facility (Lapkin, Levett-Jones and Gilligan 2013). The national principles for development of decision making tools as put forwarded by NMBA may be helpful in this regard (NMBA 2010). Thus in view of the facts and information acquired through literatures, books and published articles and referring to the mentioned case study a congenial atmosphere with sufficient provision for all facilities are vital to improved healthcare service in a hospital setting.

Lack of Culturally Safe Nursing Practice

In context to Mr. Lee’s case, the RN Ms. Price failed to consider the clinical consequences of the deteriorating health condition of the patient evident from the observations obtained via the vital signs that belonged to the yellow zone of clinical implications. Case appropriate decisions were not followed subsequently that lead to further decline in the health condition. Lack of analytical reasoning and inability to predict the futuristic mode of treatment to assess Mr. Lee’s condition harbored negative implications. Further the night on which the RN and EN were engaged in their respective duties in the EDU indicated acute and stressful situations. Ms. Price was reported to be exhausted to address Mr. Lee’s situation in addition to other patients demanding circumstances. Thus person centered care was compromised due to severe workload and inadequate supporting staff. Moreover, evidences from the following day after the transfer of duty from the night shift nurses to morning shift nursing professional revealed that after documentation of the vital parameters of Mr. Lee that belonged to the red zone, the morning shift nurse failed to immediately assess the gravity of the situation. Approximately after a lapse of 45 minutes a PACE phone call was made to report the debilitating health condition of the patient. Thus this delay in making contact with the appropriate authority to seek medical help and guidance breached the safety standard of professional nursing practice that lead to negative outcomes in the patient. Dearth of competency, lack of professionalism and unstable case related evaluation failed to assess the risk pertaining to ensuing bowel obstruction through increased pain levels. Therefore, paucity of culturally congruent safe practices was found to hinder the patient’s recovery process in the case of Mr. Lee and the effects may be discussed thoroughly with reference to the various codes of conduct and legal frameworks applicable to healthcare setting. Studies emphasize on the investment in evidence based and contemporary education by virtue of a competent, capable and resilient workforce deployment. The roles of coaches and educators are found to be pivotal in imparting knowledge to the nursing practitioners in course of their continuous development process in this regard. Absence of competency may lead to serious errors thwarting the patient’s health status (Duff 2013). Utilization of just culture principles through case based nursing peer review emphasized on medication reconciliation process, identification of deep tissue injury and bowel management regimes as the recognized educational necessities to address the patient’s health condition. Screening of surgical patients for opioid tolerance that may be corroborated in the given case study has also been emphasized in relevant studies as well (Jochem, Scott and Stuckman 2015). Handoff functions following verbal as well as sophisticated experimental techniques have been recommended in relevant studies to foster quality healthcare service to patients suitable for medical and surgical settings (Staggers and Blaz 2013). NMBA has proposed national competency standards for registered nurses including certain specific domains to ensure safe and culturally congruent integrated nursing care practice. The domains mentioned considers professional practice, critical thinking and analysis, provision to coordination of care and collaborative, therapeutic practice as the key aspects to maintain professional competency and retain the accountability of the nursing professional in the job (NMBA 2015). Literature review regarding patient-centered care revealed three core themes ensuring patient safety which include patient participation and involvement, the association between patient and healthcare provider, and the situation in which the care is delivered (Kitson et al., 2013). Forecasting the patient outcomes beforehand and taking precautionary measures in accordance with the existing guidelines and policies relevant to the specific patient situation within an ethically and legally sound healthcare infrastructure was thus found to generate positive results in the patients and ensure quicker recovery.

Guidelines for Nurses Employed in Gastroenterological Wards

Conclusion

Drawing evidences from the given case study it was revealed that Ms. Price, the RN on duty in charge of Mr. Lee undergoing post operative care in the hospital EDU was guilty of breaching her sense of responsibilities and professional competency standards due to inappropriate and inadequate code of conduct at various instances. Other issues pertinent to hospital operational policies were found to affect the patient’s declining health status. Hospital staffing ratio again interrupted the normal functioning of the hospital setting. Lack of culturally safe and acceptable working modality was another crucial factor harming the patient and causing severe distress. All these crucial aspects and nagging problems added to worsening of Mr. Lee’s condition in the given scenario. In the Australian context, specific codes and guidelines associated to legal and ethical grounds have been improvised and implemented by the NMBA to aid in the nursing practice and foster quality healthcare service to the persons in need. Summarizing the information procured from the published articles and books it is opined that the healthcare professionals particularly the nursing staff who remain in active contact with the patients during their care delivery process must maintain optimum level of competence conforming to the prevalent legislations and ethical codes through enough prudence and pragmatism. Awareness regarding the current and existing laws and practices relevant to nursing practice has also been assigned as pivotal prerequisites to continue professional practice. However, competent authorities should also make effort to arrange for programs and training sessions to impart substantiate knowledge and evidences regarding specific case situations for enhancing the nursing skills among the practicing nursing personnel. In fine, it is suggested that a holistic approach through effective collaboration from all ends of working healthcare personnel be upheld to facilitate quality healthcare service for patients in dire crisis and ensure improved state of living.

References:

Britt, H., Miller, G.C., Henderson, J., Bayram, C., Valenti, L., Harrison, C., Charles, J., Pan, Y., Zhang, C., Pollack, A.J. and O'Halloran, J., 2013.General Practice Activity in Australia 2012-13: BEACH: Bettering the Evaluation and Care of Health (No. 33). Sydney University Press.

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

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., Kerdo, E., Kelly, J., Thoms, D. and Fisher, M., 2016. Standards for practice for registered nurses in Australia. Collegian.

Chang, E. and Daly, J., 2015. Transitions in nursing: preparing for professional practice. Elsevier Health Sciences.

Duff, B., 2013. Creating a culture of safety by coaching clinicians to competence. Nurse education today, 33(10), pp.1108-1111.

Grace, P.J., 2013. Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Publishers.

Griffith, R. and Tengnah, C., 2014. Law and professional issues in nursing. Learning Matters.

Heaton, L., 2014. Legal aspects of nursing. Kozier & Erb's Fundamentals of Nursing Australian Edition, 3, p.57.

Jochem, K., Scott, C.A. and Stuckman, C.L., 2015. Case-Based Nursing Peer Review Using Just Culture Principles.

Kitson, A., Marshall, A., Bassett, K. and Zeitz, K., 2013. What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of advanced nursing, 69(1), pp.4-15.

Krautscheid, L.C., 2014. Defining professional nursing accountability: A literature review. Journal of Professional Nursing, 30(1), pp.43-47.

Lapkin, S., Levett-Jones, T. and Gilligan, C., 2013. A systematic review of the effectiveness of interprofessional education in health professional programs. Nurse education today, 33(2), pp.90-102.

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L. and Reid-Searl, K., 2015. Medical-surgical nursing. Pearson Higher Education AU.

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

Nursing and Midwifery Board of Australia, 2007. ‘National framework for the development of decision-making tools for nursing and midwifery practice’. Retrieved on 15 October 2016 from www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx

Nursing and Midwifery Board of Australia, 2010. ‘A nurse’s guide to professional boundaries’. Retrieved on 15 October 2016 from www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing and Midwifery Board of Australia, 2015. ‘Supervision guidelines for nursing and midwifery. Retrieved on 15 October 2016 from www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/reentry-to-practice.aspx

Nursing and Midwifery Board of Australia, 2016. ‘Standards for Practice: Enrolled Nurses’. Retrieved on 15 October 2016 from www.nursingmidwiferyboard.gov.au/Nursing-and-Midwifery-Board---Standards-for-Practice---Enrolled-Nurses.PDF

Nuutinen, T. and Rannos, S., 2013. Welcome to practise in gastroenterogical wards: An Orientation Guide for Exchange Nursing Students.

Parahoo, K., 2014. Nursing research: principles, process and issues. Palgrave Macmillan.

Rothrock, J.C., 2014. Alexander's Care of the Patient in Surgery. Elsevier Health Sciences.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J.G. and Buckely, T., 2016. The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), pp.129-142.

Staggers, N. and Blaz, J.W., 2013. Research on nursing handoffs for medical and surgical settings: an integrative review. Journal of Advanced Nursing, 69(2), pp.247-262.

Staunton, P.J. and Chiarella, M., 2012. Law for nurses and midwives. Elsevier Australia.

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