Nursing Services to the Patient & Service-User - Case Study Example

CRITICAL ANALYSIS OF NURSING PRACTICE by Student’s name Professor’s name University name City, State Date Introduction     Mrs Elizabeth Rose Green is a retired widow who is 78 years old. She lives alone in her own ground floor unit and uses a Webmaster pack for medication. She employs a private cleaner once a week. Mrs Elizabeth has one daughter referred as Rose and one son known as James who supports her in all ways and pays for the cleaner. Both her two children live a little far away and visit her only on weekends. Elizabeth has five grandchildren and her loved pet is known as Matilda, a terrier cross.  Mrs Elizabeth prefers using a taxi for transport rather than driving. Last month when washing dishes at her home, Elizabeth experienced 10 minutes of unrelieved central chest and left shoulder pain. After calling an ambulance, Elizabeth was admitted to the emergency department (ED) and after review by the medical team; she was admitted for an angiogram plus or minus stenting. Elizabeth was a former smoker but quitted smoking 5 years ago.     She also had GORD, HT, hypercholesterolemia, osteoarthritis, type 2 diabetes (diet controlled). She had also undergone hysterectomy 30 years ago. Elizabeth’s mother (deceased) had cardiac disease, her father (dead) had rheumatic fever when young which contributed to long term problems and her sister (deceased) had breast cancer. Her prescription was Esomeprazole 20mg nocte, Metoprolol 25 mg mane, Simvastatin 20mg nocte, vitamin D and calcium tablet I daily and Paracetamol 1g 6/24 prn no more than 4g per day. Therefore, this paper discusses the best manner a nurse should provide  healthcare services to any patient or to him/herself in the health facility the nurse is providing health care services.   The Responsibility of Nurses in Prescription     As a matter of fact, Elizabeth was admitted to hospital being sick. After being reviewed by the medical practitioners, she was admitted for an angiogram. On the day of discharge Elizabeth was given the following prescription: Discharge medication list: PO Esomeprazole 40mg nocte, PO Metoprolol 25mg mane, PO Simvastatin 20mg nocte, PO Vitamin D and calcium tablet 1 daily, PO Paracetamol 1000mg TDS, PO Clopidogrel 75mg mane. In point of fact, Elizabeth is supposed to strictly follow the recommendations on how to take the medicines given by the nurse. Equally important, the prescription should be correct as they have been offered by a qualified nurse. As a matter of fact, nurses turn to be responsible for sustaining their professionalism for medication management which comprise of understanding of prescriptions which they are administering or supplying to patients.     On the other hand, the legislation of  medicinal products   gives nurse or medical practitioner authority of prescribing prescription via the Medicinal Products  (Prescription and Control of Supply) Regulations, 2003 (Statutory Instrument (SI) 540 of 2003) (Guidance to Nurses and Midwives on Medication Management 2007). In fact, activities of medication management that are executed by the nurse might vary depending on the setting of the healthcare, personal service-user/patient situation, its protocols and policies together with practice’s capacity of the nurse. The major factors being born in mind during determining the practice’s scope for nursing are also the ones applicable for the medication management practice’s scope.     The first factor is competence (Nursing and Midwifery Board of Australia 2006). In this scenario, a nurse is anticipated to build up and retain proficiency with respect to the entire medication management features, making sure that his/her skills, knowledge together with clinical practice turn to be updated. It is a requirement of the medication management’s activities for nurses to be held responsible for the public, his/her employer, patient/service-user, regulatory body together with whichever pertinent administrative authority. This correlates to both omissions and actions. In this regard, it is the nurse’s responsibility of ensuring his/her continual professional advancement that is essential for competence maintenance, especially in medicinal products concern.  As such, the nurse ought to demand support and assistance from health services provider when appropriate regarding continued career advancement.     On the other hand, nurses who want personal heath medication ought to obtain it through suitable means for instance, over the counter if in a pharmacy; on foot of medication from the registered nurse or medical practitioner prescriber who has examine that need. In point of fact, it is unacceptable practice for the nurse to tackle or remove prescription from his/her place of work for individual consumption or for taking to his/her friends, family use or for whichever other reason (Nursing and Midwifery Board of Australia 2006). This turns to be applicable to the entire kinds of medicinal products for example, prescription medication comprising of antibiotics, analgesia, together with over the counter/non-prescription medication. In this scenario, it is inappropriate for the nurses to persuade her workmate having prescriptive power to write for them prescriptions.     Additionally, nurses who take prescriptions from their workplace for individual consumption might be subject to practice inquiry by the relevant authority for criminal charges, employment punitive processes and/or professional misconduct. Equally important, medication management have got guiding principles that are required to be adhered to by all nurses when delivering care correlated to curative products (Murphy, TE, Agostin, JV, Van Ness, PH, Peduzzi P, Tinettie, ME & Allore, HG 2008 ). As a matter of fact, the medication or prescription order correctness ought to be verified before administering the curative product. At this moment, the suitable professional of healthcare should clarify any questions concerning medication/prescription order. Additionally, the date of expiration ought to be checked ahead of administration.     In point of fact, out of date medications should never be administered (Murphy, TE, Agostin, JV, Van Ness, PH, Peduzzi P, Tinettie, ME & Allore, HG 2008). Equally important, five rights regarding medication administration that exists require being applied for every patient/service-user encounter. The first right consideration turns to be right medication (Guidance to Nurses and Midwives on Medication Management 2007). This involves corresponding the medication/prescription order against dispensed label, being familiar with similar and look-alike sounding prescriptions and best practice signifies utilizing generic mediations’ term every time possible. The other consideration turns to be the precise patient/service-user. This entails being sure of the individual’s identity who is obtaining the prescription, verifying the identification band and or the number of medical record, asking the service user/patient to state his/her name, ascertaining that the age and name are ways of guaranteeing the accurate identity and maintaining an individual’s photo on the record of administration record.     This right has been ensured in Elizabeth’s case. The other consideration right is the right dosage. This right entails bearing in mind the appropriateness of the board grounded on vital signs, size, age or other changeable, provided there is necessity of measuring the dose for instance, in liquid form, use of the appropriate equipment is ensured. The other consideration is the right form. This involves guaranteeing that the precise administration method, route and form of the prescription turn to be the way they are prescribed and if that information turn not to be specified on the label or prescription of the medication, the prescriber should clarify it, because several prescriptions can be offered through different ways.  The other consideration is right time. As a matter of fact, right timing entails guaranteeing the exact duration, frequency and timing of the medicated order, the medications doses timing for sustaining particular levels of therapeutic blood-drug for instance, antibiotics and shunning relations with other prescriptions and precisely documenting times of medication administration (Guidance to Nurses and Midwives on Medication Management 2007).     On the other hand, nurses have an important role of monitoring the health of a patient/service use on noting any medication error that might have occurred. Thus, the moment medication error gets recognized, nursing and medical interventions requires immediate implementation in order to restrict potential undesirable reactions or effects. In a word, patient/service-user turns to be paramount in nursing’s medication management. Culture to be embraced by Nurses in Medication management     As a matter of fact, it is possible for individual nurses to achieve the client centered care in interactions with their clients, by whole work groups or units, by organizations of healthcare, and by the entire health care system. Equally important, nurses via their practices and actions possess the capability of influencing their colleagues’ practice together with system and organizational policies toward that end.  Since nurses turn to be instrumental to client centered care, they ought to fully embrace the following culture: consistency and continuity of caregiver and care; human dignity; clients as the leaders; clients are professionals for the personal lives; responsiveness; common care access; and timeliness (Cowen & Moorhead 2014). That culture requires being integrated into and revealed all through, each aspect of client services and care.     The following is an explanation of cultures that this paper has identified as being instrumental to client centered care. First and foremost is respect. In this scenario, nurses ought to respect the strengths, priorities, wishes, perspectives, values and concerns of clients. Respect can be exemplified in Elizabeth’s case when she was told by the doctor that she required an angiogram performed on her, and that an additional procedure was to be carried out if a blockage was discovered. Elizabeth told the doctor to hurry up and do what was necessary. In this scenario, the doctor respected Elizabeth’s wish by first asking her whether it was appropriate performing an angiogram on her. Then, her wish was respected by continuing to perform the angiogram and further tests in her body. The other culture is dignity. In this case, clients’ care ought to be taken as unique and whole human beings not as diagnoses and problems.     This can be seen by the way Elizabeth was attended fast by the doctors upon arrival at the hospital. The other culture is that clients turn to be professionals of their personal lives. In this scenario, clients acknowledge their individual problems more than anybody else. The other culture is client’s being leaders. In this case, client’s lead ought to be followed relative to offering information, making of decisions, general care and others’ engagement. Clients’ as leaders can be evidenced by the Elizabeth’s case in that; the family information had to be examined to determine her past general health together with that of her relatives and determine the next step to take in further tests medication. The other culture is goals of clients in coordinating care of the heath care group (Vincent 2010).  In this scenario, clients are supposed to identify the goals that integrate health care group practices.     In order for such goals to be achieved, all team members ought to work towards their achievement. The other culture is that nurses should consistently and continuously provide care to all people irrespective of sex, age, color, ethnicity, and tribe among others. The other culture is timeliness. As such, the patients and nurses need a timely reaction. This can be seen in Elizabeth’s case in that; upon being received in ED, the doctors began instantly conducting reviewing her to diagnose what might have been disturbing her. Additionally, when the people with the ambulance phoned the doctors that they were on the way taking a patient who demanded immediate attention, the nurses begun preparing the emergency department to admit her. The other culture is universal access and responsiveness (Vincent 2010). In this case, care which is provided to clients ought to be generally reactive and accessible to their concerns, priorities, wishes, perspectives and values.     Care that is generally reactive and accessible to client’s concern can be exemplified in Elizabeth’s case when she asked John to disconnect her GTN since it was restricting her arm movement. Though John had not received handover yet, he agreed to disconnect it in order to cater for her concern. On the other hand, nursing in medication management follows the law and medical ethics in executing duties. First, nurses are required by medical ethics to seek the informed permission from their patients ahead of starting treatment (Applebaum 2007). In fact, legitimate informed permission is based on the suitable information disclosure to the qualified patient who has the capacity of making choices. Thus, in Elizabeth’s case ethics was followed by the cardiologist as he sought consent from Elizabeth of performing angiogram and continuing with extra procedure if found necessary.     The other ethical issue is justice (American Nurses Association 2005). Justice involves the duty of health professional to care for persons fairly, prejudice free and on medical need’s ground. Justice turns not to be reliant on subjective factors, like, age, race or gender. Whichever age-oriented allotment of health resources breaches the equality principle. Therefore, justice was adhered in Elizabeth’s case as she was fairly treated, without prejudice and on her medical need’s grounds. The other ethics is autonomy. Autonomy is duty of health professional to give respect to people together with their self-determination rights (Couteur, Ford & McLachlan, 2010). As such, Elizabeth’s case followed the autonomy principle since her right of giving consent to receiving treatment was highly considered. On the other hand it is a legal and ethical duty for the nurse to react to the demand for care (Osborn, Day, Komesaroff & Mant 2009). Therefore, it is the responsibility of the nurse to examine the patient for the purposes of evaluating that patient’s health needs and make decision of the echelon level demanded.     The ANMC competency elements have in fact been achieved due to various reasons.  First, the nursing team is capable of working in collaboration with one another thus, making the progress of their team successful. For example, during the treatment of Elizabeth, the nurses and cardiologists worked in unison and succeeded in their operation. In addition, the nursing team approach of medication is immeasurable. In this case, nurses offer prescription using their advanced and best knowledge that they have gained. Therefore, there are no or limited cases of wrong prescriptions. On the other hand according to ANMC competencies, nursing in medication management has succeeded in producing expected outcomes through making thorough revision on the care plan, and making important communications between teams of health care and patients/service-users which totally improves the expected outcomes. Conclusion     In fact, it is a requirement by medication management that all nurses should provide standard services to the patient/service-user always. As such, nurses who do not offer standard services are likely to face actions against them for not complying the nursing medication management laws and ethics. Maintenance and advancement of the appropriate skills is significant within nurses in medication management and makes nurses to offer suitable services to patients. The ethical issues in nursing in medication management include seeking informed permission, autonomy, and   justice among others. Since nurses turn to be instrumental to client centered care they ought to fully embrace the following culture: consistency and continuity of caregiver and care; human dignity; clients as the leaders; clients are professionals for the personal lives; responsiveness; common care access; and timeliness Bibliography 2007, Guidance to Nurses and Midwives on Medication Management. Available from . [2nd May 2015] American Nurses Association 2005, Code of Ethics for Nurses with Interpretive Statements, Silver Spring, MD, Nursesbooks.org/American Nurses Association. Applebaum, PS 2007, Assessment of Patient’s Competence to Consent to Treatment, The New England Journal of Medicine, 357, 1834-1840. 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