Nursing case study

This assignment will critically analyze a case that represents the unsatisfactory professional conduct performed by a Registered Nurse during the care of a Patient that leads to a patient loss. The case study contains several aspects that is determining the actions taken by the nurse deliberately or undeliberate regarding her professional practice in lieu of the patient care. The other significant aspect is representing the breaching of professional codes and standards of the Nursing and the Midwifery Board of Australia (NMBA). Also, represent the aspect related to new graduate nurse professional practices.

In relation to the HCC v Youssef & McArthur case, both the nurses in question failed to act appropriately as expected of an RN and a health care professional on two occasions. First, the RN Youssef intended to delegate her task to her colleague by providing her Mepilex dressing to cover the stoma of the patient during shower not knowing that the stoma was the patient’s sole airway, which determines that she had a lack of knowledge of the underlying anatomy and clinical history of the patient. Second, the RN Youssef failed to remove the dressing when she found the patient’s unresponsiveness and failing to ensure resuscitation.

In response to this, RN McArthur applied inappropriate occlusive dressing without knowing the underlying anatomy and history of the patient and did not stay with the patient for a period of 5 minutes after application of the dressing.

The poor actions or inaction of the RN had led to the blockage of patients’ airways which ultimately resulted in the patient’s death. It is noted that the actions or inaction of both RN was related to their individual professional accountability and the accountability to coordinate the care of the patient. The RN is overall responsible for the health of the patient, as the RN was responsible to provide patient care she/he is accountable for the health of the patient during that shift.

Accountability is an essential component of professional nursing practice and nursing safety (Battié et al .2014).It allows the nurses to meet the healthcare needs of the patient with chronic illness and complex disease processes. Nurses are professionally accountable for adhering to the gold standards of evidence-based practices as well as expanding their clinical settings. Nurses as a mentor should offer assistance to peers performing a new task in order to build their confidence as well as also validate their practices that whether it is in compliance with the organizational standards or not (Davis & C .,2017).

According to complain one, Nursing and Midwifery Board of Australia; Registered Nurse practice standard 6.2 implied which suggest that practices within the scope of practice. This lacks one of the abide rule implementation where the Nurse are expected to work under their own learned capacity and are allow to refuse for the skills which he/she is not competent enough, either the skill has not learned or they are not confident enough to perform such skill .This over doing of task represents failure to meet the standard of working within the professional framework environment. These are the legal attributes toward the professional working environment, especially in the hospital (Nursing and Midwifery Board of Australia [NMBA], 2016, Standard 6.2).

Standard 6.1 suggested that providing comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of the people. In this case the nurse failed to achieve provided patient care and ensure safe practice. This requires potential standards to be followed before the nurses’ registration, not following one may cause the serious harm to the patient’s overall health. As safety of the patient is one of the key components which is expected to be followed in the facility, it is necessary for a nurse to provide public safety. The topmost priory of the nurse is to follow Safe practices in order to provide effective patient care. (Nursing and Midwifery Board of Australia [NMBA], 2016, Standard 6.1)

In this case the Nurse delegated her task to other RN without determining the need for supervision and instructions, for delegation of tasks NMBA has provided the Frameworks of assessing standards for practice for registered nurses, enrolled nurses and midwifery which suggest the principles of performance-based assessment for delegation. It is always necessary to supervise the nurse whose competency is still in doubt, this model focuses more on the knowledge and performance. Lack of knowledge of anatomy and physiology before proceeding with any kind of skills, especially those of sole stoma is considered to be dangerous and life-threatening. Stoma care is relatively be done by the senior registered nurse, even if it requires assistance from the colleagues whose competency is below of what expected, then it is always ought to supervise the subordinate.

This case also indicating the misconduct of Standard 5 NMBA which determines that enrolled nurses standard who have been assigned by their senior nurse are always required to seek supervision or asking for direction, it is always better to discuss with the senior colleague and when the skills are not in the scope of one’s practices they can always seek help and advice from the senior nurse. Any skill or procedure which is not a standard of practice can always be questioned to the delegation. However, delegating a task is a responsible judgment, a senior nurse should also know the range of work skills that a subordinate or enrolled nurse can do or not. (Nursing and Midwifery Board of Australia [NMBA], 2016, Standard 5).

Such incidence can be avoided in future by implementing and adhering to governance policies and procedures. A nurse should ensure that all patients received the best care. According to the Australian Commission on Safety and Quality in health care - Clinician governance is an important aspect to optimize patient care by taking part in the patient safety process. A nurse should report any such incidents and near misses immediately to avoid any delay in the treatment, also a nurse should provide proper supervision of the junior member and workforces which could prevent any future miscommunications. (Australian Commission on Safety and Quality in Healthcare, 2019).

The Standard 6 of Australian Commission on Safety and Quality in health care- Communicating for safety allows effective communication, by adhering to such practice a clinical nurse should ensure effective communication when critical information emerges, as in this case the critical information was the stoma covering which could block the patient sole airway. Communication among the health care professionals should be ensured to provide correct procedure matching. (Australian Commission on Safety and Quality in Healthcare, 2019, Standard 5).

Future practices should also ensure that nurses should discuss delegation and scope of practice, in particular how changing models of care impact how care is managed.  The nurse should assess and plan the care of the patient in charge, she should ensure that assessment is done correctly, taking a patient medical history and knowing the clinical background before performing any task and procedure on the patient, she should ensure that the treatment provided is appropriate and within the scope of practice and should be solely performed by those nurses that are adequately and comprehensively qualified and trained.  Considering patient history before any procedure is an important aspect to avoid future hamper or negative impact on the quality of basic nursing care (Lubbe et al., 2014).

A nurse should provide supervision efficiently while delegating any of the tasks to team members or other RN nurses, she should communicate properly and clearly while providing instructions and ask for validation with the RN nurse to repeat the instructions given before performing the task, this will reduce the chances of any miscommunication between the both RN nurses. (Duarte et al.2018). This determines a nurse to follow Standard 6.3 of Nursing and midwifery board Australia indicates to appropriately delegates aspects of practice to enrolled nurses and others, according to enrolled nurse’s scope of practice or others’ clinical or non-clinical roles must be ensured, and standard 6.4 indicates to provide and ensure the effective direction and supervision for safe and correct practice to avoid future misconducts. (Nursing and Midwifery Board of Australia [NMBA], 2016, Standard 6).

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