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Case Study: Responding and Communicating Appropriately to Patient Deterioration

Nursing and paediatry are professions which are part of the health sector that is involved in the provision of health care to individuals and families, and children respectively. The professions involves the attendance, maintenance and recovery to optimal life of sick people and children so that they can have quality life. A primary mission of the Professional Standards Committee is to ensure that the best practices in nursing are exercised by nurses as they provide day-to-day care to individuals with a clear focus on nursing that is evidence-based as stipulated in the nursing research (Kurtz, Silverman and Draper, 2016). This means that quick response and communication about a patient’s status once they are admitted to a health facility is a prerogative that nurses should not compromise. As per the case study, it is noted that the profession of nursing did not take into account the urgency and need of quick response, clear communication, right diagnosis of disease, clear observation of the nursing codes of conduct, strict adherence to nursing policies, proper maintenance of nursing records, and the general observation of the requirements of a professional career in nursing. This paper assesses the requirements of a proper nursing career, and the legal and professional implications that arise once a patient is mishandled by a nurse leading to death of a patient (Cherry & Jacob, 2016).

Professionalism in Nursing

Countries all over the world have professional standards committees and professional bodies that handle issues arising from various professional practices. Apart from that, governments also have the professional codes of conduct that guide professionals in their delivery of service which are clearly enacted in law (Olsen, Mooney and Evans, 2016). Nursing as critical professions as compared to paediatryis not an exception in receiving proper guidance from the government and professional bodies, and should therefore provide proper first-hand services to its clients. Professionalism in nursing leads to the development of a healthy working environment for all other practitioners in the health sector as well as those seeking services from a health facility. Best practices in nursing must be seen in form of activities and methods that nurses apply in delivery of service through identification of a health problem, implementation of a health procedure, and monitoring of the response after the procedure (Urdenet al, 2015). By having evidence-based practice of nursing, it means that all techniques and methodologies together with experience and research are applied to offer the best care possible leading to achievement of a desired result. The following are some of the requirements for best practices in nursing that should be adopted in order to avoid unsatisfactory professional conduct by practitioners as was noted in the case study; the patient in this case will be excluded from failure to observe proper nursing principles as this was solely a problem emanating from the nursing staff;

Proper understanding of patients – The Nursing staffs are the first people in a health facility that patients always encounter when they report to any health facility. The nurses are assigned to various departments including the emergency department. As per the case study, the patient who was a six month old baby was in critical condition and was therefore admitted to the emergency department of the hospital. This was a matter of high sensitivity and urgency. Nurses should ensure that initial indications shown by the patient, once they are brought to a health facility, should be noted. This is because by showing respect to all patients, nurses adhere to the fundamental need to understand individual needs, apply compassion, show sensitivity of the matter, and provide the best care that patients need. From the case study, it was noted that nurses did not take into account the seriousness of the situation thus leading to wrong diagnosis (Urdenet al, 2015).

Responsibility – It is prudent for nursing staff to be responsible for their actions as they discharge their mandate. Once a patient is brought to a health facility, the patient’s responsibility is handed over to the receiving nurses who will immediately give an initial diagnosis (Coleman and et. al., 2017). The judgments and actions taken by nursing staff should be in line with the descriptions given by the parents or guardians of the patient. Note that failure to follow instructions, codes of conduct, requirements by law, and nursing procedure will lead to breach of duty which is chargeable by law. The nurses in our case should take full responsibility for failure to adhere to basic nursing procedures and be subjected to the full force of the law.

Decision making –Decisions are determinations that arise after a person makes a judgment. Proper and quick decision making constitute a nurse’s practice in the daily delivery of service. The quality, time, and effects of the decision are weighed based on procedure, experience and resource availability. Nurses are required to convey the decisions they make based on judgment of the situation at hand to both the other medical staff and patient’s family. This means that the initial diagnosis results of a medical condition done by a nurse will be used by the pediatrician and patient’s guardians to make a clinical and financial decision respectively. If the nurses in the case study would have done a proper initial diagnosis, which involves first aid, incident categorization, incident prioritization, and incident identification, they would have given out the right information and decisions to the pediatrician and the family members. Instead, the nurses failed to appropriately manage or communicate with the other medical staff as well as issuance of poor clinical records of observation (Parahoo, 2014).

Communication – The nurses and nursing staff are at the center point of communication in a health facility. This is because they are involved in assessing, recording, reporting to other medical staff, handling sensitive and confidential medical information, handling patient complains, among other duties that are specific to their practice. The nurses in the case study did an initial diagnosis of the patient’s condition and found out that it was suffering from gastroenteritis. The information about the condition was recorded, signed, and reported to the pediatrician (Bucknall and et.al., 2016). On handling the matter, other medical staff started giving treatment for gastroenteritis for a specified period of time. The condition was realized that it was not improving and that is when a further diagnosis was done which indicated that the patient was suffering from a bowel obstruction. Attempts to transfer the baby to a better facility did not bear fruits as the baby was pronounced dead on arrival. Had it not been wrong diagnosis and communication from the nurses, the baby could have been transferred to a tertiary hospital where they could have given the right treatment and saved the baby’s life (Cherry & Jacob, 2016).

Possession of relevant skills and knowledge – nursing staff are required to have applicable knowledge and skills in their profession. The skills must be up-to-date, used intelligently, and must conform to the needs of the practice. These skills and knowledge must be applicable to the current time and circumstances (Binder, Huang and Buss, 2016). Some of the attributes include good communication skills, problem solving skills, interpersonal skills, attention to detail, flexibility skills, emotional stability, and empathy. According to the case study, nurses failed to apply proper communication skills, attention, and empathy skills thus resulting to quick judgments and wrong diagnosis (Parahoo, 2014).

Team work – this principle is a necessity in any organization that consists of high number of employees assigned to different linked departments. In a health facility, there are several departments which include emergency, neonatal, neurology, occupational therapy, pharmaceutical, dental, surgery, and maternity, among many others. These departments consist of medical staff who cannot work without others. By initiating team work in the execution of their duties, nurses and other staff will ensure that patient’s care and treatment is properly coordinated and will lead to a positive outcome.

Adherence to professional nursing standards – nurses and other medical practitioners are subject to standards set out by their relevant regulatory bodies. These standards are in conformity with the requirements of the government, the professional practice itself, and the general health requirements. These standards set out the codes of conduct, codes of ethics, professional boundaries, and competencies. Professional nursing standards include critical thinking and analysis in the practice, engagement in proper therapeutic and professional relationships free from compromise, comprehensive assessment ability, and provision of safe and responsive nursing practice, among many others. Proper adherence by registered nurses to these standards will yield to the development of a vibrant healthcare system as well as achievement of aspirations of all registered nurses (Parahoo, 2014).

Finally, other relevant professional requirements that need to be held by medical practitioners including nurses are possession of leadership skills, need to embrace safety in delivery of service, and proper client feedback processing. Keeping all the necessary requirements of a nursing profession in mind, practitioners in their discharge of duties will realize the need and importance of response and communication to avoid patient deterioration. 

Professional Misconduct in Nursing

Nursing is a self-regulating but sensitive profession. Various ministries of health and regulatory agencies have put in place enforceable standards that medical staff must adhere to in order to provide the general public with safe, timely, effective, and ethical medical care. Failure to adhere to one or more of the standards set out will be treated as breach of duty and charged as a professional misconduct (Oermannet al., 2017). The following scenarios, as portrayed in the case study, are considered as forms of professional misconduct in nursing;

o   Delegation of personal nursing duties to medical staff or practitioners who are considered incompetent to discharge sensitive services to clients. These may include directing students on internship to do initial diagnosis of patients without their presence as a guide.

o   Failure by registered nurses to give accurate information as pertains to their profession such as areas of competency and weakness should be discussed with the employer. If a nurse feels that they are not capable to perform certain functions, and they go ahead and execute it, they should be excluded from performing such functions immediately. These functions may include the right to write a diagnosis report of a particular patient and handing it over to the next step.

o   Practicing the profession while under the influence of certain drugs and substances. The ability to determine the cause of a medical condition requires that nurses are sober and of sound mind during the judgment. Clinical reasoning ability should be applied at first instances when a patient is admitted to a health facility. In our case, nurses failed to apply this standard resulting in the loss of the patient.

o   Abusing a client during the discharge of professional services. Abuse in this case amounts to emotional and physical torture. In our case, serious omissions made by nurses during the initial diagnosis of the patient ultimately led to the physical harm of the client and emotional harm to the client’s family.

o   Failure to keep records as required. Health care practitioners must maintain accurate and adequate records of patients. This is because the recordings are communicated to other users for further actions. The case study is a classic example of nurses’ failure to properly maintain client’s records resulting in wrong diagnosis and treatment.

Professional Misconduct in Paediatry

Pediatricians are doctors who are tasked with provision of medical care to children. They are trained to diagnose and treat ailments among children with minor disorders to serious diseases. Like many other health professionals, pediatricians work with nurses and other health care workers to assess the conditions of sick children and offer them treatment (Olsen, Mooney and Evans, 2016). This profession has set out standards of practice which include; possession of relevant knowledge and skills in handling children’s health complications, provision of services that are consistent with pediatricians education, and adherence to professional practice. Failure by pediatricians to discharge their mandate as required by governing bodies will lead to professional misconduct (Persechinoet al., 2015). This can be though;

o   Wrong assessment of the signs and symptoms portrayed by a sick child.

o   Failure to report to heads of hospitals on a misdiagnosis done by other medical practitioners such as nurses.

o   Neglect of duty through assignment of tasks to unqualified staff and students.

o   Failure to follow up on treatments prescribed to infants for various medical complications.

Legal Implications of Professional Misconduct in Nursing and Paediatry

The role of law makers and regulatory bodies in various professions is to ensure that set standards of practice are adhered to, and any breach of it must be accompanied by a remedy. Legal implications in the nursing practice, for example, are specific to existing licenses, existing laws of a country, scope of practice in nursing, and public demand. The professional standards, experience and education of staff, and health laws form the basis of good practice by both nurses and pediatricians (Urdenet al, 2015). Once the discharge of duties by nurses and pediatricians fall below the required professional standards, the following bases for litigation will be followed;

o   Professional negligence – This form of professional misconduct may be subjected to a legal process leading to administration of justice in form of fines, jail terms, and other remedial measures as determined by a jury.

o   Malpractice – This relates to inability to deliver services as stipulated and agreed during signing of contract (Greenfield and Jensen, 2016). A legal process may suggest correctional measures to include fines, jail terms, among others depending on the level of malpractice.

o   Failure by pediatricians to exercise a certain level of care to infants – the basis for litigation for this kind of professional misconduct may be in form of license review, jail terms and corporate fines as stipulated in existing health laws.

Regardless of the method used to offer legal redress for both medical practitioners and clients, both parties have the opportunity to respond to each of the charges. Committees can also be set to determine the extent of each case through conduct of an inquiry; this will ultimately offer all parties a proper hearing.

Professional Implications of Professional Misconduct in Nursing and Paediatry

The following will be considered as remedies for professional misconduct for both nurses and pediatricians once they have breached standards of practice, and have been found legally improper in the conduct of their practice;

o   Immediate termination from duties as a practicing or registered nurse and pediatrician.

o   Correctional measures such as suspension from duties pending investigation by agencies set by the government and regulatory bodies. 

o   Registered nurses will have their licenses of operation withdrawn or suspended until an inquiry into their conduct is determined by the right agencies.

o   Serious violation by a team of nurses in a health facility, for example mass neglect leading to mass deaths of patients, will lead to subsequent termination of an operation permit and business license of the hospital

o   Closure of a health facility until further notice and the immediate suspension of all members of staff. The government in this case will be tasked with the authority to determine best operational procedures for other facilities to avoid total public disregard.

In conclusion, as per the case study, it is important to note what is required of a nursing professional, its professional standards of operation, skills and knowledge for operation, areas of possible failure in discharge of duties as well as existing legal and professional remedies available for all parties to a process.

Reference List

Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Oermann, M.H., Shellenbarger, T. and Gaberson, K., 2017.Clinical teaching strategies in nursing. Springer Publishing Company.

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

Persechino, S., Persechino, F., Romano, I., Di Vito, E., Giulianelli, V., Parisella, F.R., Parisi, P. and Tammaro, A., 2015. Unusual clinical case in pediatry. Journal of the American Academy of Dermatology, 72(5), p.AB205.

Urden, L.D., Stacy, K.M. and Lough, M.E., 2015. Priorities in critical care nursing. Elsevier Health Sciences.

Kurtz, S., Silverman, J. and Draper, J., 2016. Teaching and learning communication skills in medicine. CRC press.

Bucknall, T.K., and et.al., 2016. An analysis of nursing students’ decisionmaking in teams during simulations of acute patient deterioration. Journal of advanced nursing72(10), pp.2482-2494.

Olsen, M., Mooney, K. and Evans, E., 2016. Implementation of an Early Warning Scoring System to Identify Patients With Cancer at Risk for Deterioration. Clinical journal of oncology nursing20(4).

Greenfield, B.H. and Jensen, G.M., 2016. Understanding the lived experiences of patients: Application of a phenomenological approach to ethics. Physical Therapy90(8), pp.1185-1197.

Coleman, K.J., Caparosa, S.L., Nichols, J.F., Fujioka, K., Koebnick, C., McCloskey, K.N., Xiang, A.H., Ngor, E.W. and Levy, S.S., 2017. Understanding the capacity for exercise in post-bariatric patients. Obesity surgery27(1), pp.51-58.

Binder, A.F., Huang, G.C. and Buss, M.K., 2016. Uninformed consent: Do medicine residents lack the proper framework for code status discussions?. Journal of hospital medicine11(2), pp.111-116.

 

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