Nursing Case Study Patients Treatment

Question: Describe the Nursing Case Study for Patients Treatment. Answer: Section 1: Clinical decision making and care provision The decisions taken by the nurses have immense implications on the patient outcomes. They take an active participation in the clinical decision in healthcare system regarding the patients treatment. It is the process of gathering and evaluating the information to make decisions regarding patient care (Barry Edgman-Levitan, 2012). It includes the various cognitive processes, skills, and the freedom to make decisions, education, knowledge, communication, monitoring and accountability to make the best clinical judgment for the patient (Hoffman, Aitken Duffield, 2009). If the patient related safety problems are solved, then there would be fewer chances of errors made in healthcare industry. The nurses have a duty to report for the findings and take necessary clinical decisions. The clinical decision-making by nurses involves the knowledge, evidence-based practice to critically appraise and scientifically prove to ensure quality patient safety and care (Cranley et al., 2009). The clinical decision-making also includes the education and technological resources, nursing practice and training. In order to provide the best quality of care and safety to the patients, a nurse needs to clinically think, judge and act accordingly to the situation. The use and implementation of scientific knowledge is important in the critical decision making process (Simmons, 2010). The implementation of current knowledge by nurses to ensure patient safety and care is crucial in decision-making process (Lake, Moss Duke, 2009). Apart from knowledge and evidence-based practice, the communication skills are also important. The communication skills focus on delivering and receiving information to the patient and their family members and information about the risks and benefits about different prognostic or intervention processes (Parker et al., 2009). The active listening towards the patients and their families to ensure the patient centered safety and care. The decision-making process also involves the patients and their family in decision-making process (Mullan Kothe, 2010). The monitoring and reporting by the nurses have a great impact on the clinical decision making for the patients safety. There was no proper monitoring by the Hospital at Night team and he was not escalated as a patient of concern in emergency treatment. The improper documentation would give lack of data for comparative study and treatment of the patient. The documentation and reporting helps to generate awareness about the situation of the patients and to raise flag in case of emergency. It also accounts for the safe decision-mak ing and reduce the chances of errors in the decision making process. The practice of safe-decision making includes integration of scientific knowledge, experiences to anticipate the situations that are likely to happen in the future. In the Inquest into the death of SM, there was failure of documentation and reporting of the patient. There was lack of documentation and reporting of the low oxygen saturation levels in SM. There was no reporting of the continual and unrestricted use of oxygen in the patient. The monitoring of the patient to look for any abnormal findings and well documentation and reporting is required to provide the patient care and safety. The correct monitoring would help to prevent medication errors and rate of death in hospitals (Mitchell et al., 2010). There was no review or assessment of the low oxygen saturation levels and hypoxia throughout his admission except for only one occasion. There was no proper documentation of the scores on the Q-Adult Deterioration Detection System (Q-ADDS). There was failure in the addition of the s cores on the early warning observation form. There was incorrect scoring of the patient and so SM was never escalated as a patient of concern. There was improper documentation in the scoring of the early warning observation form and when SM was escalated as a patient of concern, it was not well documented. On 2nd July, scores of two were not documented properly and seven was added correctly. SM also scored 4-6 around thirteen times in the 24 hours, and the root cause analysis team reported that the case required the higher levels of action including the involvement of the consultants. To provide the patients with the quality ensured care and safety, proper reporting about the findings to avoid errors in ensuring quality care. For the proper reporting, monitoring and documentation is important about every physical parameters of the patient (Jones, King Wilson, 2009). On 3rd July, SM flagged four on two occasions but he was not recorded on the Q-Adult Deterioration Detection System. As a result, the Hospital at Night (HAN) did not escalate SM. There was no medical documentation of SM for the persistent low oxygen saturation levels. The accountability and responsibility also accounts for patients safety and care provision. Nurses are responsible for ensuring safety of the patient and are held accountable for the actions. The failure of the reporting nursing staff to investigate the persistent low oxygen saturation levels showed the lack of responsibility by the nurses that might have escalated SM for emergency treatment. Nurses are held answerable for their actions and responsible in performing their duties. The proper reporting about a patients condition is important for the appropriate treatment (Kelly Ahern, 2009). The Hospital at Night reviewed SM and flagged as an outlier during his admission. However, SM received the appropriate prophylaxis for the venous thromboembolism (VTE). He also received the proper treatment for the VTE by the surgical team. The findings of the chest X-ray showed a collapsed area in the lung that explained SM high oxygen demand and his persistent low oxygen saturation levels. There was no analysis of the blood gas to check for the possible cause of his low oxygen saturation levels. Moreover, SM did not receive the chemical prophylaxis as the first dose but that was not considered as the contributing factor for his death. The nursing staff reported the patients requirement for oxygen but did not raise any flag for his abnormal oxygen saturation levels. The incidence reporting is important to know what actually happened in a case and helps in legal documentation and fulfilling of formalities (Kirwan, Matthews Scott, 2013). There was also reduced mobility that accounted for the SM venous thromboembolism (VTE) after his surgery but there was no assessment regarding his restricted mobility. Despite of his continuous hypoxia, tachycardia and high oxygen demand, there was no raised flags and considered him as a patient for emergency treatment. There was failure to complete the early warning observation form despite of the recording of his scores. There was also failure of the treating team to identify the deterioration in the SM condition. They did not made an emergency call after the reporting of the nursing staff that SM is on oxygen demand for last six days. The Australian government has established many policies and processes to increase the proper reporting of the event, assure quality mechanisms and open disclosure in the adverse events in patient care and safety. Section 2: Tort of Negligence The tort of negligence in nursing is failure to act and take appropriate steps to avoid or prevent the loss or injury to the patient (Huang McLean, 2010). A nurse is capable of caring for the patient but does not care for and as a result, the patient has to suffer unnecessarily. The malpractice and professional negligence by the nurses and the hospital staff that cause emotional and physical damage to the patients (Mair, 2014). The hospital staff, physicians, nurses and healthcare professionals involved in the medical malpractice. The nurses neglect the patients generally face the tort of negligence. The tort of negligence is applied to the nurses who are negligent towards ensuring patient care and that have posed a threat to the life of the patient. The nurses were negligent in the case of SM. They would have been more careful and less negligent regarding the reporting and documentation of his condition. The negligence was also seen regarding the continuous low oxygen saturation le vels of SM. The negligence in nurses to record, document and report to the concerned authority could cause breach of duty. The quality of patient care is hampered and the patient could file a lawsuit against that particular nurse (Staunton Chiarella, 2012). The wrong recording of the scores was also under the tort of negligence. The persistent low oxygen levels in the patient were continuous but the nursing staff and the Hospital at Night was negligent and did not escalate him as a patient for emergency treatment. They were not bothered to investigate and find out the possible outcome of the low oxygen saturation levels in the patient. The reduced mobility in the patient was a matter of great concern but the medical staff was negligent in reporting and raising flag for the emergency treatment. The further reduction in mobility after the surgery should have been a matter of concern and triggered for the assessment but the treatment team was not concerned about the issue. The claim o f negligence contains the negligence arising due to the duty and care by the doctor owed towards the patient, breach of duty by the nurse and a direct implication of the negligence that harm a patient causing him injury or loss (HEATON, 2014). The continuous hypoxia, tachycardia and low oxygen saturation levels demanded immediate investigation and questioning and the arterial blood gas analysis but the medical team was negligent and did not concern to look into the matter. The nursing staff documented and reported the significant periods of hypoxia and low oxygen saturation levels but the medical team did not raise any flag or concern and took immediate steps to make the situation under control. The tort of negligence includes the poor documentation, proper reporting and monitoring of the patients condition that would increase the duration of stay (Atkins, De Lacey Britton, 2014). The X-ray of the chest showed a collapsed area in the lung that explained SM high oxygen demand and hi s persistent low oxygen saturation levels but the medical team was negligent about this major finding. There was no one person who was responsible for the death of SM, the medical team, the nursing staff, the Hospital at Night team and the surgical team were negligent and careless towards SM. Section 3: Ethical Issues In patient centered care, there are many ethical issues in nursing practice. The clinical decision-making involves guidelines for ethics that are intended to provide patient centered care. The nurses have to follow the professional ethics guidelines that are necessary to provide the best quality of care to the patients. The patient has the right to control his or her life and the nurses have to make decisions according to the circumstances. The act of beneficence and non-malfeasance also accounts for the ethics in nursing practice. These ethics are quoted to provide patient care, respect human dignity and to work in collaboration to provide the best quality and high standard care by the healthcare system. The act of beneficence and malfeasance is aimed at providing the best care with an aim to work for the welfare of the patient and cause minimum harm (Yeo et al., 2010). The code of ethics in Australia aimed to identify the standard ethics and principles in nursing practice and to in corporate them in their nursing practice. The code of ethics also guides the nurses to make decisions that are ethically correct and implement them in their nursing practice. The ethical values also safeguard the rights of the patients and ethical values for the nurses (Johnstone, 2015). The surgical team ignored the reduced mobility in SM post-operative. The patient required the immediate treatment for the persistent low levels of oxygen saturation but they ignored the condition and did not raise any flag for the emergency. It was unethical and unfair on the part of the nurses that they did not report or document his hypoxia, tachycardia and persistent low oxygen levels. The ethical code of conduct also demonstrates that the justice is ensured for every patient providing the patient the right to refuse or accept treatment (Burkhardt Nathaniel, 2013). The nursing team did not add and document the scores on the early warning assessment warnings. They also raised flags but the medica l team did not bother to look into this matter and act accordingly. The SM care was ethical at some stances but was unethical under the breach of duty, tort of negligence and dereliction of duty. The patients capability in decision-making along with the refusal to treatment and the involvement of the patients family in the decision-making constitutes the respect for autonomy (Izumi et al., 2012). The nurses reported about the persistent low levels of oxygen in SM but in several situations were negligent about his continuous demand for oxygen. Despite of the raised flag, SM was not documented under the Q-ADDS form as a patient of emergency rather he was treated as an outlier from the time of his admission. The nursing staff did not respect the act of autonomy in case of the patient in providing and meeting the requirements of the patient. 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