Nursing profession is one of the largest healthcare related workforce. Nurses analyse a patients’ needs and health demands, they execute care plans, and maintain medical records (Lindrooth et al. 2015). While working as an associate nurse, I was directly involved with the delivery system of the hospital, focused on caring for my patients and their family. This essay will present a reflective overview of an incident which occurred and will analyse the possible methods of clinical governance that could have produced a better patient outcome in the incident. I will use the Driscoll’s reflective framework to narrate the incident.
The situation, which I will explore, occurred during my work as an associate nurse in India. The patient was Jyoti (name changed) had been admitted to the emergency department after complains of nausea, chest pain, palpitations, trembling and dizziness. On assessing her medical records I realized that she was on medications, for anxiety disorder prescribed by the GP. She was also suffering from depression. Her mother accompanied her and was extremely distressed and for not being able to protect her daughter from mental issues. As a young girl she was diagnosed with anxiety and oppositional defiance disease which often made her aggressive. Owing to the severity of her symptoms, I was immediately advised by the doctor-in-charge to keep in a seclusion room. Seclusion and restraints should be the last resort of intervention to manage behavioural emergencies in mentally ill patients. However, the doctor adopted that measure to immobilize her (Sherwood and Barnsteiner 2017). She was confined in a room, which was poorly lit and drab. I was instructed to go there and introduce myself to her. I approached the room where she was and introduced myself. I tried to explain about her mental health condition and assessment. However, she began to shout ' get out, go away'. I was uncertain regarding my proceedings this response was completely unexpected. I therefore returned to my senior to report the incident. There was miscommunication between the two graduate nurses attending the incident and they failed to inform the doctor about her current state of mind. An hour later when I was again instructed to go to her room along with one of the two nurse trainees, to give him medicines, she escalated into a meltdown. She did not want to take those medicines. The nurse talked to her in some language, unworthy of respect and made fun of her mental state. I was agonised. Jyoti became aggressive and punched and hurt the nurse. We alerted the staff to control her. They grabbed her and threw her to the bed. She wailed and howled and gasped for breath. While shouting at the staff, she fell from the high bed and suffered injuries in the head. I ran to call the doctor and informed her mother as well. She became calm after taking pain killers and dressing the wound . My mentor returned after speaking discreetly to her and for an hour and disclosed that she had experienced a panic attack which made her agitated. She felt isolated and traumatised inside the dark room. Moreover, while being brought to the seclusion room, she had received lewd remarks from some of the staff members regarding her health. When the nurse talked to her inappropriately, it caused her meltdown and she attacked the junior nurse. I felt relieved that she was ready to allow me complete her mental health analysis (Miraglia and Asselin 2015).
I was horrified with what had just happened. From my nursing knowledge I knew that clinical excellence and patient safety promote high quality healthcare practice. Clinical excellence encompasses different aspects of proving patient centred quality care like clinical knowledge, humanism and professionalism, diagnostic acumen, interpersonal skills, skilful negotiation and having a scholarly approach to the situation (McCaughan and Kaufman 2013). My view on clinical excellence was influenced by my philosophical approach to nursing, my education, background and nursing experiences. However, this particular incident failed to provide quality care to Jyoti owing to lack of participation, clinical effectiveness, risk management strategies and effective workforce. I was able to recognize the aspects that needed greater emphasis for effective patient care (Taschuk et al. 2017).
Consumer participation, effective workforce, clinical effectiveness and risk management procedures could have helped in improving the care provided to the patient.
Impact of consumer participation- Consumer participation includes involvement of patients with the care givers in the design, development and implementation of their own treatment. The inclusion of consumers in their mental healthcare services as co-investigators likely enhances the effectiveness of the service (Byrne et al. 2014). Jyoti and her mother needed to be involved and engaged from the beginning with the physicians and nurses who were looking after her. It is the legal right of a consumer to have knowledge into how the programs and services are run. The doctors should have acknowledged the benefits of the patient’s participation in formulating an effective therapeutic strategy. Organizing open meetings where the patient could express her views on the service could prove beneficial (Tobiano et al. 2015). It also ensures appropriate training for staff. Well trained staff would not have passed lewd remarks against Jyoti. This could have prevented her meltdown.
Impact of clinical effectiveness- Clinical effectiveness is the application of best knowledge, derived from clinical experience, research and patient preferences used to achieve best outcomes for patients. The staffs are provided support to focus on their team effectiveness and patient outcomes. The staff works to deliver excellence when their efforts are recognized (DiCenso, A., Guyatt and Ciliska 2014). Recent research and developmental strategies should have been studied by the staff members and physicians to deliver proper care to the patient. Recent research suggests minimizing the use of seclusion rooms. They make a patient more violent and traumatized (Johnson et al. 2017). The staff should have adequate knowledge on the possible ways to avoid such trauma incidents. Jyoti should have not been kept in isolation, had the staff been aware of the harmful effects of their approach. Evidence based treatment strategies should have been followed from translational research. Implementing basic science findings on practical applications while designing a care for the patient would have enhanced her wellbeing (Kirkman 2013). All students and staff should have been able to access best evidence to support efficient clinical trials and policy making.
Impact of effective workforce- A workplace has an overarching culture along with a plethora of sub-cultures. Each culture is represented by a set of beliefs, values, attitudes, social customs and professional norms (Triolo 2012). Efficient workplace practices can enhance mental healthcare provisions. Regular surveillance on the competency of the workforce would have prevented any form of miscommunication. Effectiveness of a healthcare organization involves optimal performance of the staff, avoidance of any stigma related to mental health, encouragement of recovery and good partnership between the staff allocation system. This would, help in meeting the patient’s needs. A good workforce effectively works together to promote mental health prevention, and rehabilitation. There should have been a leadership and collaboration focused on the state of anxiety and depression. Staff retention to ensure practice excellence and proactive risk management would have proved useful in pacifying her and reducing her agitation.
Impact of risk management- Patients suffering from mental illness should receive care in a safe environment. However, several risks like suicide, falls, injuries and violence occur. Clinical risk management relies on effective treatment that studies a patient’s history and tries to prevent adverse effects while proving potential treatment opportunities. Recently, emphasis has been laid on patient safety measures across the world through different legislative changes, policy reforms and standard care development (Cole, Chaudhary and Bang 2014). Four main risk factors that need to be considered are vulnerability of the patient to external factors, intentional injury, suicide, hallucinations or psychotic phenomena, causing harm to others and risk form falls. Her health demands needed to be balanced with public and personal and safety issues. Healthcare providers should have balanced decision making according to Jyoti’s personal demands. The service users should have taken support from her mother to comply with their duties. Some interventions can present a risk to service users, such as some types of medication which may have unwanted side effects. So the concept of risk is much broader than often portrayed or acknowledged. Inpatient falls are a matter of concern for patient safety issues. Increased surveillance, increased funding for bed alarms and construction of low beds can eliminate chances of such falls and related consequences.
A detailed investigation of the study has been carried on the importance of health and safety of patients and the responsibility of the medical practitioners. Patient safety is a fundamental healthcare principal and refers to the ways by which hospitals and healthcare centers protect the patients from medication errors, fall risks, accidents, injuries and infections. In carrying out such activities, risks are inevitable. Managing risk should not just focus on eliminating risk, it is about Risk management generally provides a process that ensures identification of potential benefits which reduce the likelihood of harms. The health professionals should have taken reasonable care to protect her safety and welfare along with the safety of the other persons involved. Thus, it can be concluded that application of clinical knowledge, empathy and risk management strategies help in improving patient outcomes.
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