Critical Response To A Clinical Incident

Students are to draw on the National Safety and Quality Health Service Standards and the NMBA professional practice documents to develop critical responses to the clinical incident. The following questions are required to be answered for this assessment:

1. What happened in this clinical incident?
2. What activities did the nurse or midwife need to complete in the immediate situation?
3. What professional behaviours may have made a difference in this situation?
4. What do you learn from this case study about your own preparedness for professional practice?

Support your answers with reference to the relevant clinical and professional standards that apply to professional practice.

Clinical Incident

An 81 year old patient A, had been taken to a GP clinic with the complain of spending two nights of breathlessness when lying flat as well as shortness of breath all the time. In the primary investigation it was found that she was having fine crep at the base of both of the lungs and simultaneously elevated jugular venous pressure. Due to that, the medical practitioner gave her an oral Lasix and recommended for a clinical review two days later.  But, on the next day which is 6^th of January, she was admitted to local hospital with no improved condition. But, on 9^th January, she was diagnosed with a more than normal arterial fibrillation rate of 120/min. She felt dizziness, weakness and abdominal pain and she also refused food and liquid. Her VMO reported that she was depressed and anxious and encouraged to mobilise the patient, but she was not courageous and willing and also refused food. Her respiratory rate was high above the normal range and it was going very high at a faster rate. With a severe back pain her skin started getting cold. Her heart rate went extremely high and the VMO prescribed Digoxin and Valium to control the heart rate. In the assessment of 11^th January, the VMO declared “Significant medical illness” as she had grey, pale and clammy skin with nausea. Abdominal x-ray was ordered and a urinary tract infection also occurred for the patient with a rise of white blood cell count. To control infection, intravenous antibiotics were commenced.     

Registered Nurse (RN) John was commenced to assist Patient A in his afternoon shift. Reading the issues of the patient, RN John got concerned however, he waited for the locum to arrive and review the patient. The patient was observed to have a much higher respiratory rate, low blood pressure but a normal heart rate as Digoxin had been provided to her previously. The patient had continual diarrhoea. An enrolled nurse advised to review patient’s condition but John said he would have reviewed the patient once the locum arrives. Although, John did the assessment of the patient but did not note down anything regarding the observations. John arranged a further ECG for the patient A. Meanwhile he got busy with other patients’ medication and called Clinical Nurse Manger Ms Smith for issues not related to Patient A. When Ms Smith arrived, John did not raise any issue of concern regarding the condition of patient A.  Approximately after two hours of the ECG done, John was informed that patient A was deteriorating and she require immediate review and her family was contacted also. In that night an emergency on-call doctor came and inserted a large bore IV Cannula to treat the dehydration of the patient. Even, attempts were made to transfer the patient to the referral hospital but her physical condition did not favour mobilization and the patient tragically died. On the following morning the cause of death was stated septicaemia.

The roles and responsibilities of nurses are very much essential in achieving the goals for better health of every individual (Romano, Guizzi & Chiocca, 2014). During emergency situations, each and every step of nurse is associated with the life of the patient. Nurses’ medical knowledge, quick thinking and assessment also assist the medical procedure (Regan, Laschinger & Wong, 2016). Nurses are responsible for overseeing the patient and according to their observation doctors prescribe medicine and proceed for further treatment as per the requirement. Nurses are meant to watch all the signs and symptoms and they should inform the doctor about that in order to avoid side effects of medicinal overdose (McInnes, Peters, Bonney & Halcomb, 2015). Monitoring and preparing charts and observation tables is necessary to keep record of each and every detail of the patient. Apart from that, the immediate action of nurses and midwife can be life saviour also. In case of emergency, nurses should not wait for the doctor to arrive and instead of that they should call in a doctor to take immediate action according to the requirement (Anquinet et al., 2015). Every second is important for a nurse to provide care for an emergency patient (McDonnell et al., 2015). In case of patient A, the registered nurse was concerned about the patient’s condition but he did not take any prompt action and depended on the review of the locum.   

Nurse's Intervention

According to the national safety and quality health service standards, professional behaviour in nursing practices is most essential (Boyd & Sheen, 2014). In the case of patient A, the registered nurse John, could not play the role of a professional nurse. First of all, John should not wait for the locum to come for reviewing the patient when he knew that patient was in serious condition. Secondly, the most important mistake of John was not recording each and every detail of the observational data of patient A in any paper. The patient was having continual diarrhoea but the nurse did not take much action on that. Along with it, John went busy with the issue of other patients and when he met the Clinical Nursing manger, he did not raise a single word of concern on the issues of patient A. Nurses cannot waste a single moment of time while handling serious patient and they are always required to take immediate action (Steinemann et al., 2016). But, John wasted valuable time on other tasks without keeping attention to patient A’s condition. If John was not able to handle the patient’s condition alone, then when the Clinical Nursing Manager came, he would have present his concern to her regarding the patient’s condition. Considering the seriousness of the patient’s situation, he should call in the doctor on an emergency-basis. The medicines provided to the patient must have been reviewed to be sure that those are not responsible for the deterioration. Even, John did nothing to saturate the anxiety and depression of the patient. However, the patient was very serious but if the nurse would be more active and if he should have maintained a professional behaviour while dealing with the patient, then this patient might have lived for few more days.   

This case study provided me an opportunity to learn how a lack of professional behaviour can be disastrous for any patient. It made me learn that, keeping record of patient’s data is extremely important and time plays the most valuable role which should never be wasted in case of such serious patients (Conard & Pape, 2014). If the actions were taken on time without any delay or negligence, then it would have created a difference in the result. So, prompt and immediate action and quick decision making of nurses are most important in this profession (Sherwood & Zomorodi, 2014).  

References:

Anquinet, L., Rietjens, J. A., Mathers, N., Seymour, J., van der Heide, A., & Deliens, L. (2015). Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries. Journal of pain and symptom management, 49(1), 98-109.

Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management, 9(3), 31-37.

Conard, P. L., & Pape, T. T. (2014). Roles and responsibilities of the nursing scholar. Pediatric nursing, 40(2).

McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K., & Smith, C. (2015). An evaluation of the implementation of advanced nurse practitioner (ANP) roles in an acute hospital setting. Journal of Advanced Nursing, 71(4), 789-799.

McInnes, S., Peters, K., Bonney, A., & Halcomb, E. (2015). An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of advanced nursing, 71(9), 1973-1985.

Regan, S., Laschinger, H. K., & Wong, C. A. (2016). The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. Journal of nursing management, 24(1), E54-E61.

Romano, E., Guizzi, G., & Chiocca, D. (2014). A decision support tool, implemented in a system dynamics model, to improve the effectiveness in the hospital emergency department. International Journal of Procurement Management, 8(1-2), 141-168.

Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: the QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15-22.

Steinemann, S., Kurosawa, G., Wei, A., Ho, N., Lim, E., Suares, G., ... & Berg, B. (2016). Role confusion and self-assessment in interprofessional trauma teams. The American Journal of Surgery, 211(2), 482-488.