Episodes Of Nursing Practice - Article Example

Introduction It is common for patients undergoing treatment to develop complications that may lead to adverse outcomes, including death. Although some cases are unpreventable, others are as a result of poor care delivery and management of patient. Even when early signs are visible, some caregivers fail to identify or manage patients who are likely to experience adverse outcomes or become critically ill. Such occurrences should be of concern to policy makers and managers of health institutions. This paper examines a case study of a patient who developed complication during his treatment and highlights issues related to care provision in acute care environments. It proposes how the caregivers should have been aware of early warning signs, suggests the appropriate clinical actions and communications to the health care team, and applies the five rights of clinical reasoning to the case scenario as well as explains how the patient’s adverse outcome could have been averted. Early and late warning signs Time is often a critical aspect when treating patients in acute settings. The time taken to identify and act on the right signs of a medical condition often dictates the success of the treatment of a patient. A number of authors are in agreement that nursing professionals attending to patients should be able to capture warning signs and act on them early enough to avert complications (Banning, 2008; Clarke, 2004; Hoffman, Aitken, & Duffield, 2009; Levett-Jones, et al. 2010). Note that the cost of capturing cues late is high and may lead to unpleasant outcomes, including death. Detecting signs late is often linked to poor clinical reasoning skills. It is known that some nurses often fail to recognize patients in need of urgent attention, and/or fail to take timely action. Hoffman, Aitken, & Duffield (2009) have concurred that ‘novice’ nurses often do not collect reasonably adequate cues on time to evaluate a patient’s condition. Yet, being able to make appropriate decisions regarding treatment of a patient is hinged on timely availability of a wide array of cues (Hoffman, Aitken, & Duffield, 2009; Levett-Jones, et al. 2010). The ability to detect early warning signs is dependent on a number of factors. Clarke (2004) has pointed out staffing as one factor that affects nurses’ ability to make early identification of complication. The level of nursing experience and education also matters when identifying early signs for potential complication. Levett-Jones, et al. (2010) have emphasized that education enhances the clinical reasoning ability of nurses to become competent in managing patients at high risk of developing medical complications. Therefore, a nurse assessing a patient’s condition should have proper educational background and wide experience in nursing practice. The nurse should also collect adequate cues before making decision regarding a patient. Failure to rescue Nurses’ inability to identify worsening condition of patients and failure to take action are likely to result in unpleasant outcomes. These outcomes include death, which Clarke (2004) and Levett-Jones, et al. (2010) have termed the “failure to rescue.” It is worth to note that failure to rescue is associated with complications acquired through the treatment process. A number of factors contribute to the failure to rescue. One main factor is nurses’ poor clinical reasoning skills. As Levett-Jones, et al. (2010) notes, clinical reasoning involves judging a patient’s condition and deciding the course of action. Clarke (2004) summarizes the causes of unpleasant outcome as the failure to correctly diagnose a condition and give proper care. Inapt handling of complications also leads to failure to rescue (Levett-Jones, et al., 2010). If a nurse fails to make correct judgement and/or does not take appropriate action, it is likely for the patient to develop severe complications or even die. The ability to make appropriate judgements and decisions is correlated to education and experience. Levett-Jones, et al. (2010) notes that nurses with proper education and extensive experience in acute care rarely commits errors. However, some other factors such as organizational attributes, staffing, remuneration and working conditions may determine the outcome of a patient’s treatment. Clarke (2004) has highlighted that the variations in the number of staffs and the working conditions among various health institutions are empirically linked to patient outcomes and nurses’ performance. The percentage of mortality among patients who experience medical complications during treatment has been linked to availability of resource in the health institution and by to staff involved in their care Clarke, 2010; Levett-Jones, et al., 2010). In addition, Clarke (2010) has noted that higher staffing levels are associated with lower unpleasant outcomes, or failure to rescue. Communication Communication is a critical aspect in provision of care and management of patients in acute care settings. Effective communication facilitates proper deliver of care, while poor communication curtails it. Haig, Sutton, and Whittington (2006) have agreed that unfavourable patient outcomes are largely due to poor communication among care providers. However, poor communication is still prevalent in care delivery (Haig, Sutton, and Whittington (2006). According to Hoffman, Aitken and Duffield (2009) novice nurses have problems communicating patients’ problems to the rest of the health professionals. Nursing professionals ought to have confidence and communication skills in order to be able to convey their need for urgent support when necessary. Levett-Jones, et al. (2010) have agreed that safe and successful care provision is dependent on effective communication among nursing professional. It is worth to note that education plays a key role in enhancing effective clinical communication. Banning (2008) has warned that it is difficult to communicate instinctive decisions without scientific knowledge. Communication in healthcare settings should be structured and standardized. Haig, Sutton, and Whittington (2006) have noted that lack of standardization in communication contribute to difficulties in commutation among healthcare professionals. The SBAR (situation, background, assessment, and recommendation) model was proposed for communication in healthcare settings to overcome the challenges of varying communication styles among caregivers, and to allow effective relay of messages (Haig, Sutton, and Whittington, 2006). Levett-Jones, et al. (2010) have recommended the application of acronyms in telephone conversations and during handover of patients. Such an approach is a move towards standardized and structured communication. For instance, as Levett-Jones, et al. (2010) have noted ISBAR (identify, situation, background, assessment, and recommendation) provides a structure for communicating in a consistent manner. A standardized and structured communication also promotes safety of patients in the sense that appropriate messages are relayed. Applying five rights Levett-Jones, et al. (2010) have proposed fives rights as the basis for making effective clinical reasoning: the right cues, the right patient, the right time, the right action, and the right reason. Application of these rights could have averted the deterioration of the patients described in the case study. Appropriate clinical reasoning and subsequent care requires that the care giver is able to identify a patient cues. Cues are information related to a patient such as reports, charts, history, previous assessment, and etcetera (Levett-Jones, et al., 2010). The cues gathered must be relevant, adequate, and well clustered. It is necessary to avoid assumptions, prejudices, and stereotypes while collecting cues (Hoffman, Aitken, & Duffield, 2009). A nursing professional should be able to recognize and prioritize the right patient. The right patient is one who is at risk of developing complications and/or death, and therefore requires urgent attention. Early warning signs are useful in identifying the right patient. However, a patient exhibiting late signs is likely to develop complications and experience unpleasant outcomes. It is therefore necessary that nurses are competent and experience in dealing with patients in acute settings. The nurse providing care to the patient should be able to identify the patient at high risk early enough and take appropriate measures at the right time to avert unpleasant outcome. The amount of time taken in making clinical decisions is dependent on the nurse’s expertise (Levett-Jones, et al., 2010). Therefore, a nurse with adequate qualification should have been assigned to the patient needing urgent attention. After identifying cues and the right patient, it is paramount for the caregiver to take the right action. It involves employing practical skills, performing intellectual tasks, and using appropriate communication to implement plans basing on priorities. Note that the right action might mean communicating a patient’s problems to a senior health professional. Therefore, effective clinical communication is critical. The right reason refers to reaching the right conclusion in the right manner (Levett-Jones, et al., 2010). In other words, it implies using proper processes to reason in a professional, legal, and ethical manner, and arriving at the right conclusion. Conclusion A case study of a patient who deteriorated during his treatment and hospitalization has been examined to foster a discussion. It has highlighted how patients can develop complications and experience adverse outcomes during their treatment process. However, such complication and outcomes can be averted with proper care delivery and nursing practice. This paper has suggested corrective measures to the case scenario. It has proposed how nurses should have been aware of early warning signs, suggested appropriate clinical actions and communications to the health care team, and employed the five rights of clinical reasoning to the case scenario as well as explained how the patient’s adverse outcome could have been avoided. Reference list Banning, M 2008, ‘Clinical reasoning and its application to nursing: Concepts and research studies’, Nurse Education in Practice, vol. 8, no. 3, pp. 177-183, viewed 01 April 2011, Elsevier, ScienceDirect. Clarke, S & Aiken, L 2003, ‘Failure to Rescue’, The American Journal of Nursing, vol.103, no. 1, pp. 42-47. Haig, K, Sutton, S & Whittington, J 2006, ‘SBAR: a shared mental model for improving communication between clinicians’, Journal on Quality and Patient Safety, vol. 32 , no.3, pp.167-175. Hoffman, K, Aitken, L & Duffield, C 2009, ‘A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis’, International Journal of Nursing Studies, vol. 46, no. 10, PP. 1335-1344, viewed 06 April 2011, Elsevier, ScienceDirect. Levett-Jones, T, Hoffman, K, Dempsey, J, Jeong, Y, Noble, D, Norton, A, Roche, J & Hickey, N 2010, ‘The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients’, Nurse Education Today, vol. 30, no. 6 pp. 515–520, viewed 02 April 2011, Elsevier, ScienceDirect. Read More