Assignment Task Details

Assessment 4	Report of the Evidence
Task Description	The aim of this assignment is to analyse the legal, ethical and professional responsibilities of the registered nurse in practice in Australia.     Your analysis will focus on the case study below and explore the three (3) key issues identified in appendix 1.   For each key issue: ·         A brief summary of each key issues in appendix 1 and explaining its context within the case study ·         Examine the legal, ethical and professional knowledge required for safe, accountable nursing practice in Australia ·         You must use relevant and current Nursing Midwifery Board of Australia (NMBA) Codes/Standards, Australian Guidelines and Policies, NSW Health Ministry of Health guidelines and policies and contemporary scholarly research to inform your discussion of each issue   Your report is to include an introduction and conclusion. Headings are to be used to highlight and break-up your main points of discussion.
Assignment length	2500 words
Assessment criteria	Content 70%   Organisation, style & language 20% Research & referencing 10%
Referencing style	Author – Date (Harvard).   Note: No references over 10 years old.
Submission	Via Turnitin submission box
Weight of assignment	60%

 

Case Study

Mrs Spring is a 70 year- old woman who underwent a small bowel resection for bowel cancer at a metropolitan hospital on the morning of 21 May 2017. Mrs Spring was transferred to the Surgical ward post-operatively at 1430 hours following the procedure.

A Medical Officer (MO) assessed Mrs Spring at 1630 hours on 21 May due to the patient reporting abdominal pain and distension. Mrs Spring’s distended abdomen and pain levels were documented in the patient’s health record by the MO and a phone call was made to report this information to the surgeon who performed the procedure. Analgesia was prescribed (10mg morphine SC) at 1715 hours to be given PRN 6 hourly in response to the patient’s reports of pain.

Ms Tracey was the RN working on the 15-bed surgical ward with an Enrolled Nurse (EN) on 21 May. Ms Tracey had been a registered nurse for five years. As per hospital policy, Ms Tracey and the EN were the only two staff members rostered to the ward on night-shift that commenced at 2245 hours.

The surgical ward was at capacity on the night of 21 May. Two of the other male patients admitted to the unit were distressed; one was continuously vomiting post-cholecystectomy and the other a dementia patient who was post TURP, he had already experienced a fall on the afternoon shift. During the night, he was agitated and walking into other patient’s rooms.

There was also a female patient admitted to the ward who was very upset at being placed in a room with male patient’s due to her religious beliefs. This patient, who had very limited English language skills, was crying and expressing anger over the fact that hospital management had not resolved this issue as promised to the patient and her husband on the afternoon shift.

It was hospital procedure that staff in the Post-Anaesthesia Care Unit (PACU), located adjacent to the surgical ward assist the surgical staff when needed. The RN in-charge of the PACU on night-shift was required by hospital policy to regularly check by phone with the surgical RN to see if assistance was required. There was no request made for assistance by Ms Tracey on the night of 21 May despite the fact the in-charge of the PACU reportedly contacted Ms Tracey five (5) times throughout the shift.

At 0210 hours on 22 May 2017, Ms Tracey documented the following in Mrs Springs health record:                    ‘Temp 38.9, P 126, Resp Rate 28 and BP 105/70’

These were the only observations documented during the night- shift.

There was no evidence of analgesia administration documented on Mrs Springs medication chart by the time day-shift staff commenced work. The day- shift RN for 22 May did report that Ms Tracey had verbally stated that she had been “flat out” all shift and had “not finished her notes” by the time handover occurred.

At 0700hrs RN Tracey requested to morning staff that she handover at the nurse’s station as she had to get home quickly to get her kids to school but she would return later to complete her nursing notes. Morning nursing staff received handover from RN Tracey and proceed with their shift.

At 0745 hours, a PACE call was made on Mrs Spring. Her observations were Temp 39 degrees, HR 140bpm, RR 30 BP 80/46, SaO2 87%. Mrs Spring was moved to the Intensive Care Unit where she was successfully treated for Sepsis secondary to bowel contamination at the site of the anastomosis.

Marking Guide

Criteria	Absent	Inadequate	Satisfactory	Good	Excellent	Marks
Content (70%)
Brief summary of the three (3) key issues, explaining their context within the case study	0	1-14	15-21.5	22-26	27-30	/70
Identification and examination of the legal knowledge required for safe, accountable nursing practice in Australia	0	1-4	5-6	7-8	9-10
Identification and examination of ethical knowledge required for safe, accountable nursing practice in Australia	0	1-4	5-6	7-8	9-10
Identification and examination of professional knowledge required for safe, accountable nursing practice in Australia	0	1-4	5-6	7-8	9-10
Discussion is supported by references to NMBA documents and other professional and scholarly resources	0	1-4	5-6	7-8	9-10
Organisation, style and language (20%)
Report is logically developed and clearly constructed, evidence of links between ideas	0	1-2	2.5	3-4	5	/20
Appropriate introduction, body and conclusion, adheres to word limit	0	1-2	2.5	3-4	5
Syntax, grammar, punctuation and spelling are of an appropriate standard for professional report	0	1-2	2.5	3-4	5
Objective and succinct writing style, appropriate use of academic language	0	1-2	2.5	3-4	5
Research and Referencing (10%)
Appropriate quality and quantity of resources selected	0	1-2	2.5	3-4	5	/10
Integrated use of references, referencing as per School Guidelines	0	1-2	2.5	3-4	5

Total Marks:              /100

Appendix 1

Issue One

Melnyk, BM, Gallagher-Ford, L, Long, LE & Fineout-Overholt, E 2014, ‘The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs’, Worldviews on Evidence Based Nursing, vol. 11, no. 1, pp. 5-15.

Article Summary

Melnyk et al. (2014, pp. 5-15) conducted a study aimed at developing relevant clinical competencies for RNs, which can be used to facilitate adequate and effective implementation of Evidence-Based Practice (EBP) in various clinical settings. The study involved a Delphi survey based on a sample of 80 EBP mentors who were responsible for consensus building and clarification of clinical competencies. The survey came up with 13 competencies, which include the need for RNs to question the existing clinical practices to improve healthcare quality and critically appraising the available research before incorporating it into practice. Furthermore, RNs are expected to provide leadership in applying evidence to practice and sustaining EBP (Melnyk et al. 2014, p. 5-15). Overall, the authors recommend that competencies should be incorporated into job descriptions, performance appraisals, and promotion strategies to support widespread and sustainable EBP implementation (Melnyk et al. 2014, p. 5-15).

Analysis

It is becoming increasingly evident that EBP is a major driving force behind improved quality of care and positive patient outcomes in a wide range of clinical settings (Curtis et al. 2017; Majid et al. 2011; Melnyk et al. 2014). Various barriers to EBP implementation in nursing practice have been identified, and they include time constraints, increased workloads, and lack of knowledge to understand research statistics as well as inability to undertake systematic literature searching (Chien et al. 2013; Farokhzadian et al. 2015; Laura 2012). A good example is provided in the case scenario whereby Tracey was unable or did not have the time to recognise the early warning signs of sepsis, which is a life-threatening complication among patients who have undergone bowel surgery (Gauer 2013, pp. 44-53).

If only RN Tracey was in possession of appropriate EBP competencies, then she would have been able to detect and manage the early signs of deterioration in Mrs. Spring’s condition. Here, note that sepsis or what is known as “blood poisoning” and may develop if the stitches used to close the wound in the bowel become undone, leading to the spillage of bowel contents into the site of the injury whereby an infection may develop (Weledji & Ngowe 2013, pp. 290-295). The main signs of sepsis include severe abdominal pain, chills, fever, vomiting, and myalgia (Gauer 2013, pp. 44-53). If it goes undetected and untreated, a patient can die due to septic shock; hence, it should be treated like a medical emergency (Sartelli et al. 2014, p. 22). This is exemplified by the actions of the day-shift nurse who could initiate immediate measures, which led to the admission and treatment of Mrs. Spring in the ICU. As for Tracey, there is need to consider developing the appropriate EBP skills and competencies through proper training and mentorship as recommended in the abovementioned article (Black et al. 2015; Melnyk et al. 2014). This will go a long way toward ensuring that Tracey is in a better position to recognise and manage deteriorating patients without compromise.

Issue Two

Connell, CJ, Endacott, R, Jackman, JA, Kiprillis, NR, Sparkes, LM & Cooper, SJ 2016, ‘The effectiveness of education in the recognition and management of deteriorating patients: A systematic review’, Nurse Education Today, vol. 44, pp. 133-145.

Article Summary

The findings of this systematic review show that educational interventions are very effective in enhancing the techniques and skills required by RNs to recognise and respond to patient deterioration (Connell et al. 2016, pp. 133-145). The authors observe that educational interventions are important in terms of improving the nurses’ knowledge and performance, increasing the timely activation of rapid response systems, and ultimately, reducing the patient’s length of stay and adverse events (Connell et al. 2016, pp. 133-145). The most effective educational programs are those that incorporate high-fidelity simulation with brief sessions, lasting around 40 minutes (Connell et al. 2016, pp. 144-145). The authors also noted that regular in situ simulations can effectively sustain the effective implementation of patient monitoring and response systems.

Analysis

Tracey had failed to recognise and adequately respond to the deterioration of Mrs. Spring’s condition. Most adverse events, such as unplanned ICU admissions often arise from nurse-related causes, such as forgetting to monitor the patient’s condition, failing to measure vital parameters, and failing to request for assistance (van Galen et al. 2016, p. 93). Some of these causes of adverse events are evident in the case scenario whereby the RN was too busy to adequately monitor Mrs. Spring’s condition, but then failed to request for assistance from other nurses. The early recognition and response to patient deterioration is very important because it guarantees lower levels of adverse events, such as reduced ICU admissions, shorter length of ICU or hospital stay, and lower rates of mortality (Douw et al. 2015; Parham 2012; Spiers et al. 2014).

Hospitals in most developed countries, such as Australia, use various track and trigger systems or early warning scoring systems to support the early recognition and response to clinical deterioration, such as the DETECT and PACE program in NSW hospitals (Bonnici et al. 2016; Smith & Aitken 2016; Subbe et al. 2017). Despite the existence of effective patient monitoring systems, reports increasingly show that lack of or delayed recognition of clinical deterioration is a major problem across many hospitals (Elliott et al. 2014, p. 40). As noted in the abovementioned article, educational preparation should form the basis for implementing the available patient monitoring systems (Connell et al. 2016, pp. 133-145). With the right education, RNs can effectively assess and identify patients at risk of deterioration and proceed to trigger the right response mechanisms (Massey et al. 2017, pp. 6-23). In this regard, it is recommended that Tracey should consider enrolling in an educational program so that she can build on her techniques and skills in recognising and responding to patient deterioration and apply them appropriately in her future practice.

Issue Three

Starmer, AJ, Spector, ND, Srivastava, R, West, DC, Rosenbluth, G, Allen, AD, et al. 2014, ‘Changes in medical errors after implementation of a handover program’, The New England Journal of Medicine, vol. 371, no. 19, pp. 1803-1812.

Article Summary

Starmer et al. (2014, pp. 1803-1812) observe that miscommunications are among the major causes of negative patient outcomes and medical errors. In the current study, the authors evaluated a handover improvement intervention program in terms of its impact on nursing error rates, the rates of preventable adverse events, communication, and workflow (Starmer et al. 2014, pp. 1803-1812). In the program, nurses in nine hospitals were introduced to standardised oral and written handovers besides being trained on effective communication during handovers. The study findings show that the handover improvement program was effective in reducing the rates of errors and preventable adverse events as well as improving handover communication without significantly hampering workflow (Starmer et al. 2014, pp. 1803-1812).

Analysis

The significance of effective communication during patient handovers should not be overlooked considering that it guarantees the passage of all critical patient information from the outgoing to the oncoming nurse (Cohen & Hilligoss 2010; Wakefield et al. 2012; Welsh et al. 2010). During a shift handover, it is expected that the outgoing nurse should record and communicate all the information regarding the patient’s care plan so that the oncoming nurse can effectively and adequately provide the required care. In most cases, it is recommended that patient handovers should take place at the patient’s bedside so that the oncoming nurse as well as the patient are well-informed of the plan of care (Dufault et al. 2010; Staggers & Jennings 2009). Bedside handovers are not only important in terms of increasing patient satisfaction, but they can also enhance teamwork and lead to effective communication (Baker 2010; McMurray et al. 2011).

 

However, the kind of patient handover that was provided in the case scenario was ineffective considering that Tracey did not provide all the critical patient information to enable the day-shift nurse to adequately care for Mrs. Spring and perhaps avoid the unplanned ICU admission. More specifically, there is evidence that Tracey did not complete the shift handover report as expected and took place at the nurse station as opposed to the patient’s bedside. These inconsistencies may have undermined the day-shift RN’s ability to recognise that Mrs. Spring was a medical emergency, which required immediate attention. As evidenced in the abovementioned article, nurses are more likely to effectively communicate complex patient information when they follow a structured sequence.