Patient Safety and Ethical Issues - Assignment Example

assigment 3030 2016: Assignment One Section One: Patient Safety Ineffective communication Evidence shows that ineffective and inadequate among healthcare team members is a major contributing factor to medical errors and adverse events (Daugherty et al, 2010). In the acute setting, ineffective communication result to increased cases of patient harm (Daugherty et al, 2010). In this case, there are various incidents of ineffective communication during delivery of nursing and medical care to Mr. Hammett. First, during handover of the patient from PACU to RN Manton, there was inadequate communication since RN Turrell didn’t inform him regarding the desaturation event in PACU during handover. This contributed to patient’s harm since as nurse Manton testified, if he was informed of the desaturation event during handover he would not have accepted the patient in the ward because of lack of medical cover overnight. Evidently, ineffective communication contributed to the patient’s harm. This is supported by WHO (2007,) who explains that the hand-over miscommunication can lead to serious breakdowns in the continuity of care and harm to patients and that inadequate communication is among the key contributing factors to sentinel events in healthcare. Another problem in communication in the case study is evident where RN Manton failed to inform Dr. Wooller regarding the patient’s worsening oxygen saturations which were only maintained through an increase flow. As the doctor testified, if the nurse had communicated this to him he would have known that there was an underlying problem with the patient. In addition, EN Valentine also made errors in writing when he overwrote entries in the patient’s chart. All these errors in communication contributed to Mr. Hammett’s harm. Daugherty et al (2010) explains that poor communication between healthcare providers can result to patient’s not receiving the appropriate treatment and adverse events. Just like evident in this case study, Daugherty et al (2010) emphasizes that risk for communication breakdown increases where numerous healthcare providers interact with one patient. Ineffective Monitoring In the case study, there was ineffective monitoring of the patient by the nurses and physicians. According to Armstrong (2009) healthcare providers should constantly monitor conditions of their patients and intervene in order to avoid development of complications, worsening of the condition as well as promote recovery. While EN Valentine constantly monitored Mr. Hammett, RN Gibbons never assisted her in conducting observations with any patient. In addition, when the patient entered the PACU observations took minutes to be taken instead of being taken about 30 seconds. The testimony indicated that the patient was not under constant observation by the nurses. Similarly, Dr. Wooller did not monitor the patient appropriately, for instance where he never physically examined Mr. Hammett as required. It is obvious that ineffective monitoring led to the patient’s harm. Basically, omitting crucial monitoring can result to adverse health outcomes. Additionally, nursing and midwifery standards require ongoing data collection and regular and rigorous monitoring and evaluation of patients to enhance evidence-based decision making (Armstrong, 2009). Knowledge-based errors There are several knowledge-based errors in the case study. One example is where in spite of the patient’s alarming oxygen desaturation Dr. Wooler suggested the patient could be discharged to the recovery ward. According to the doctor, the oxygen desaturation event resulted from airway obstruction and in spite of the aspiration could have been a possible cause the doctor never examined the patient about it. Evidently, Dr. Wooler failed to take in consideration all possibilities during Mr. Hammett’s management. Another example is where Mr. Hammett’s oxygen saturations were maintained up by increasing in flow yet this did not inform RN Manton of the patient’s deteriorating condition. All the nurse did was turning on oxygen and did not even inform the doctor about it. RN Manton also ignored the doctor’s prescription in regard to oxygen therapy an applied his own oxygen therapy that was erroneous. According to Ballard (2006), knowledge-based errors are a major source of errors and can be avoided if healthcare providers make well-informed decisions when delivering nursing and medical care. Accountability and Responsibility Nurses can enhance safe care by being competent team leaders. Generally, delivery of nursing care is normally a team efforts where Registered Nurses guide and direct non-registered nurses. RN should offer the suitable levels of direction and supervision when care is being delivered by unregistered nurses to ensure that patients get safe and competent care (Ballard, 2006). Nurses have the responsibility to ensure that the standards of their practice is in accordance with the professional standard in order to enhance safety of the patients (The Nursing and Midwifery Board of Australia, 2010). In this case study, RN Gibbons did not fulfill this responsibility as a registered nurse. “While in the care of RN Gibbons and EN Valentine, RN Gibbons did not check the patients; he relied solely on EN Valentine to check on all the patients while he remained at his station”. This statement indicates that RN Gibbons did not guide, direct and supervise the Enrolled Nurse Valentine as per the requirement. Additionally, nurses are required to always fulfill their duty of care. According to The Nursing and Midwifery Board of Australia (2010), nurses should perform nursing interventions according to the recognized standards of practice and recognize the responsibility to prevent harm. RN Gibbons did not check on Mr. Hammett as required and hence breached the duty of care. Nurses are also required to clarify responsibility for aspects of care with other healthcare team members (The Nursing and Midwifery Board of Australia, 2010). On the contrary to this requirement, RN Manton did not clarify with Dr. Wooller regarding the patient but instead ignored the doctor’s prescription and applied his own oxygen therapy. Nurses are also required to exhibit empathy and respect for the dignity while delivering nursing care and also interact with their patients in a supportive manner (The Nursing and Midwifery Board of Australia, 2010). Nurse Manton constantly ignored Mr. Hammett’s request for pain relievers and even referred to him as a “whimp”. This clearly indicates that RN Manton did not handle the patient with empathy as required. Section Two: The Tort of Negligence Duty, breach of duty, causation and damages are the four elements of negligence that need to be proved before any malpractice suit against the nurses to advance for a successful claim for negligence (Wade, 2015). Duty Duty refers to the legal responsibility to conform to the predetermined standards of care. Every healthcare provider is obligated to exercise ordinary care and avoid harm (Hughes & Clancy, 2005). Therefore, when nurses are performing actions that directly relate to their professional nursing duties, they are legally obligated to adhere to the predetermined standards of care. Tingle (2013) further explains that duty includes; a relationship between the involved parties (in this case a legal nurse-patient relationship and the standard of care. In this case, Nurse Dean Manton owned a duty of care to Mr. Hammett because when the patient was transferred to the Accommodation Ward, he was placed in the care of RN Manton and there was a nurse-patient relationship. Breach of Duty An individual is liable for negligence when one breaches the duty that he/she owes to the claimant. Such duty is breached when an individual does not exercise reasonable care to fulfill the duty. In addition, a nurse who fails to conform to the recognized standards of care is deemed to breach the duty. Nurse Manton breached the duty of care by not ignoring Dr. Wooller’s prescription in regard to oxygen therapy and in place used his own oxygen therapy without consulting Dr. Woller. According to Wade (2015) RN Manton also breached the duty when he did not attend the patient when he complained of pain. The nurse owed the duty to administer the required analgesics to the patient or inform the doctor regarding the patient’s considerable pain so that the doctor can diagnose the cause of the pain. Therefore, by not ensuring that the patient’s pain was addressed, RN Manton breached the duty of care. Causation This is the connection between the negligent act and the resulting damage/injury (Wade, 2015). Therefore in this case it must be proved that the nurse’s negligent act was a significant factor in causing harm to the patient. In this case, RN Manton’s act contributed in causing harm to the patient. Had the nurse informed Dr. Wooller about the patient’s oxygen saturations, the doctor would have known that there was an underlying problem; therefore he would have assessed the patient to find out the problem and the underlying problem would have been identified and treated promptly and probably the patient would not have died. Damages Damages refer to the physical outcome of an injury or harm that occurs due to breach of duty (negligent act). Tingle (2013) explains that it is not enough that the defendant breached the duty: breaching the duty should result to actual damages to the individual whom the defendant owed a duty of care. Evidently, RN Manton’s breach of duty resulted to harm (death of Mr. Hammett) on the patient who he owed a duty of care. Therefore, it is possible to advance to a successful negligence suit against nurse Manton because all elements of negligence have been proved in the nurse’s negligent acts. Assignment Section Three: Ethical Issues There are several ethical issues in the case study. Nursing ethics involves moral judgment and standards of conduct and nurses are required to adhere to the nursing ethics in every situation. Non-maleficence Nurses are obligated to stay competent in their field to avoid harming the patients (Ulrich et al, 2010). In addition, non-maleficence also involves nurses reporting any suspected abuse or incompetence by the healthcare providers (Ulrich et al, 2010). One example where a nurse did not hold this principle is where RN Manton was not competent in the situation. Mr. Hammett’s oxygen saturations were kept up only by increasing the in-flow. Had the nurse been competent in his field, this should have informed of the patient’s deteriorating and serious condition. Therefore, RN Manton did not uphold the principle of non-maleficence because his incompetence contributed to harm (death) on the patient. Nurse Valentine also did not uphold this principle. When Nurse Valentine changed the patient’s nasal prongs with Hudson Mask, she did not attach it to the oxygen mask and the patient’s oxygen saturations started declining. Beneficence This principle entails doing good and patient advocacy. Healthcare providers should be compassionate and take positive actions to assist patients with an aim of doing good (Holt & Convey, 2012). Nurses should focus on making sure that patients get the best nursing care and treatment to attain optimal results. RN Manton was not compassionate to Mr. Hammett when he complained of pain. RN Manton did not even administer the patient with analgesic and even referred to him as a whimp because the patient constantly complained of high levels of pain. RN Gibbons also did not uphold this principle. First, RN Gibbons didn’t check any of the patients including Mr. Hammett and entirely depended on EN Valentine. In this regard, RN Gibbons did not take any positive action to help the patient with an aim of doing good. On the other hand, EN Valentine upheld this principle by upholding patient advocacy and doing good. EN Valentine would replace the patient’s mask whenever he removed it. The nurse also informed the RN of the patient’s deteriorating oxygen saturation levels in order for the patient to be attended to. Patient’s Rights Patients have the right to get treatment basing on their health needs and to comment on or complain about their care and have their concerns tackled properly and promptly (Holt & Convey, 2012). In this case, Mr. Hammett’s rights were not respected by the nurses. First, nurse Manton ignored the patient’s request for painkillers. Secondly, nurse Manton referred the patient as a “whimp” just because the patient complained of pain. Nurses are supposed to treat patients with respect and compassion and in this case the nurse was neither respectful nor compassionate towards Mr. Hammett. In addition, the patient did not receive the right treatment basing on his health needs. An example is where the patient’s pain complains, were not addressed and instead the nurse gave the patient the wrong treatment by removing the oxygen mask and replacing it with nasal prongs. Mr. Hammett had the right to receive the right treatment. References Armstrong F, 2009, Ensuring quality, safety and positive patient outcomes, Australian Nursing Federation. Ballard K, 2006, Patient Safety: A Shared Responsibility, Journal of Issues in Nursing, Vol. 8 No. 3, Manuscript 4. Daugherty K, Derieg M & Persing R, 2010, Improving Patient Safety Through Provider Communication Strategy Enhancements, Denver Health Medical Center, Denver, CO. Holt J & Convey H, 2012, Ethical practice in nursing care, Nursing Standard, vol. 27, no.13, p. 51-56. Hughes R & Clancy, C, 2005, Working conditions that support patient safety, Journal Nursing Care Quality, vol. 20, no.4, p. 289-292. Tingle J, 2013, Establishing breach of the duty of care in the tort of negligence: 2, British Journal of Nursing, vol.11, no.18. The Nursing and Midwifery Board of Australia, 2010, National competency standards for the registered nurse, The Nursing and Midwifery Board of Australia, Melbourne. Ulrich C, Taylor C, Soeken K, O’Donnell P, Farrar A, Danis M & Grady C, 2010, Everyday ethics: ethical issues and stress in nursing practice, Journal of Advanced Nursing 66(11), 2510–2519. World Health Organization (WHO), 2007, Communication during Patient Hand-Overs, Patient Safety Solutions, vol. 1, no. 3. Wade A, 2015, The BON’s Authority to Interpret Regulations, Negligence, and Nurse Practice Act Statutes, Journal of Nursing Regulation, vo. 6, no. 3. Read More