NURSING 7203 Professional Nursing

The happenings in this clinical Incidence

Patient A whose treatment procedure started on 5th January 2013 visited GP clinic and was diagnosed with fine creps at the base of both lungs and slightly elevated jugular venous pressure. Oral Lasix was administered, but the patient didn’t improve. The patient later visited a local hospital with shortness of breath and was admitted. The situation became compounded. There was dizziness, atrial fibrillation (AF) at the rate of 120/min, challenge to eat and drink, feeling weak and experiencing abdominal pain. A second review by the same Visiting Medical Officer (VMO) concluded that the patient was depressed and anxious. He recommended for a mobilisation of the patient by the nurses and planned for discharge at 1021 hours.

Comments at 1315 hours from the nurse read that the patient felt unwell, had not taken breakfast and lunch, was weak, and required mobilisation. The respiratory rate was 28- 30/ min, everything else was normal.  At 1820 hours, she didn’t take dinner.  In less than an hour after this, the respiratory rate had shot to 40/ min and tachycardic at 122/ min. At 1930 hours the patient felt dizzy, cold, sweaty and experienced some severe back pains. BSL was at 16.1mmmoI/l, and heart rate was at 168/min. VMO recommended the administration of Digoxin and Valium. However, at 2110 hours the respiratory rate was still 40/ min.     

On 11 January 2013 at 0530 hours, the patient was unable to void, pale and grey had clammy skin and nausea.  Three hours later the VMO reported that the patient had “significant medical illness”. An abdominal x-ray and pathology are ordered. Then the VMO at 1330 hours indicated that the patient could not mobilise, her white cells count had risen to 17.5, urinary tract infection diagnosed, and intravenous antibiotics were recommended and administered.

Registered Nurse John commenced his shift at 1430 hours. On reading the patients nursing notes, he became concerned. She reported at 1720 hours of feeling dizzy and had abdominal pain. The nurse observed that the respiratory rate had risen, while the blood pressure and heart rate had lowered. Later an enrolled nurse informed the RN John of patients A’s condition. RN John promised that the Locum would address the situation upon arrival. Then the patient had persistent diarrhoea. RN John assessed the patient without documenting. An hour later RN John arranges for an ECG to be carried out.

 At around 2020 hours, RN John called Clinical Nurse Manager (Ms. Sophie Smith) to arrange for medication to be obtained from the drug safe. Ten minutes later Ms. Smith signs for medicine.  RN John did not address patients A’s issue with Ms. Smith. At 2100 hours RN John and a colleague, a registered nurse completed an ISBAR (Introduction Situation Background Assessment Recommendation) form.  The respondent described patient A’s condition as deteriorating and recommended for an ASAP review. He also stated that the family was contacted.

VMO came at 2200 hours. The patient’s condition was critical. Emergency on-call doctor arrived later and tried to treat severe dehydration. There were also attempts to transfer the patient to a referral hospital. The attempts were challenged by the critical condition of the patient. The patient, unfortunately, succumbed the following morning while being assessed by the air evacuation team. It was concluded that the primary cause of death was Septicaemia.

The activity the nurse or midwife needed to complete in the immediate situation

The patient was finally diagnosed with Septicaemia (ten Cate et al., 2015). Since this disease is life-threatening, treatment comes before diagnosis. Furthermore, the patient was at high risk because of her old age compounded by her diabetic condition. Banks (2016) notes that high health risky situation calls for urgent attention.  With the symptoms that the nurses  had observed from the patient, they needed to start treatment immediately as follows: – the nurse should have administered antibiotics in order to manage the most likely infection from bacteria, then do a test to establish out which infection is involved, withdraw the oral Lasix that the patient was using before and change the prescription appropriately.

 If a particular source is identified to be the cause of the infection, efforts should be made to remove it. This can include the removal of the infected tissue, draining of abscess, and taking away of any foreign materials that may have been infected such as catheters. Further life support measures should have been employed such as the introduction of machine-assisted breathing, use of intravenous fluids which go directly into the patient’s bloodstream (Nursing and Midwifery Board of Australia [NMBA], 2015). Such interventions will protect the patient from further deterioration and ensure that body organs are working even as the blood pressure is being stabilised.

Professional behaviours that may have made a difference in the situation

Documentation of the patient’s medical history, the diagnosis carried out and the medication prescribed. Banks (2016) observes that there is need for reference to a patient’s medical history by the health care centre attending to the patient. For example, if the local health facility had enquired of the previous treatment offered by the GP clinic, they may not have gone ahead and treated the patient. Actually, on this day of therapy, the patient’s time under review had not elapsed. Considering the age of the patient, it was advisable for the health centre to advice her to be accompanied by a family member next time she visits a health facility (Leventhal, Jessica, Leventhal & Bodnar-Deren, 2016).  This family member should be one who is in a better position to take care of the patient once outside the health facility.

The VMO upon the review would have accorded the patient more time for further investigation within the premises of the health facility. This degree of insensitivity can only worsen the situation (NMBA, 2015).  Actually, within 4 hours and 45 minutes, the patient’s condition had deteriorated. The health facility should have engaged a competent VMO. Upon review of the patient, the medication suggested by the VMO was not yielding results. Therefore, there is a need for comprehensive diagnosis and proper medication. The professionals should not be negligent to duty. There is time wastage in the treatment process. When nurses are ordered to help mobilise the patient, this is not done.

Teamwork should be encouraged, and every employee is significant in the health management process. The health centre should engage at least a qualified personnel. If it depends on external staff, should be available upon call. Kitto et al., (2015) contends that only a competent person should be in charge of what is happening in the health facility. Cultural sensitivity should be at the core of health management. Patients come from diverse backgrounds, and this affects their interactions. They should, therefore, be handled with care.

Lessons learnt regarding my preparation for professional practice

This incidence challenges me that there is a need for in-depth learning to acquire the relevant skills that I need to deliver in my profession. In the workplace, I will encounter different personnel with different personalities. The personalities should not be barriers to the execution of my duties. In spite of the various characters, I should foster teamwork in the working environment and treat every colleague with honour. I should learn from my seniors and my juniors alike as I endeavour to deliver quality services.  I will strive to offer the professional services sought by patients in the most dignified way, the culture of the patients’ notwithstanding. All my services shall be provided in strict conformity to the guidelines in the Code of Professional Conduct for Nurses in Australia as published by the Nursing and Midwifery Board of Australia as well as the National Safety and Quality Health Service Standards.

References

Banks, M. (2016). ISQUA16-2476 IMPROVING THE SAFETY AND QUALITY OF HEALTH CARE FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE USING THE AUSTRALIAN NATIONAL SAFETY AND QUALITY HEALTH SERVICE STANDARDS. International Journal for Quality in Health Care, 28(suppl_1), 55-55.

Kitto, S., Marshall, S. D., McMillan, S. E., Shearer, B., Buist, M., Grant, R., … & Wilson, S. (2015). Rapid response systems and collective (in) competence: An exploratory analysis of intraprofessional and interprofessional activation factors. Journal of interprofessional care, 29(4), 340-346.

Leventhal, H., Jessica, S. Y., Leventhal, E. A., & Bodnar-Deren, S. M. (2016). Cognitive Mechanisms and Common-Sense Management of Cancer Risk: Do Patients Make Decisions?. In Handbook of Health Decision Science (pp. 87-108). Springer, New York, NY.

Nursing and Midwifery Board of Australia. (2015) ‘Supervision guidelines for nursing and midwifery.Retrieved25September2015’,www.nursingmidwiferyboard.gov.au/Registration-and Endorsement/reentry-to-practice.aspx

ten Cate, O., Chen, H. C., Hoff, R. G., Peters, H., Bok, H., & van der Schaaf, M. (2015). Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Medical teacher, 37(11), 983-1002.