Overview of the Assessment
Patient A was an 81 year old woman, who was having breathing problem due to crepitus or a crackling sound around her lungs. She had high Jugular Venous Pressure, which indicates right ventricular failure and congestive heart disease (Schuetz et al., 2014). When the oral Lasix or furosemide, used to treat the heart failure, did not improve her condition, she was admitted to the local hospital. She was dizzy and very weak, and her Atrial Fibrillation rate was 120/min, which is quite high. This was probably due to hypertension and coronary artery disease. She refused to eat or drink anything and started to develop abdominal pain. The next morning the Visiting Medical Officer (VMO) reported that Patient A was depressed, stressed and needed to be mobilized to another hospital. Soon after this visit the patient felt unwell and lacked sufficient energy for mobilization. Her respiratory rate was recorded to be 28-30/min at this time, but other vital signs were within normal range. On the progress note it was then recorded that at 1820 hours patient A could not tolerate dinner and her respiratory rate (RR) increased up to 40/min at 1910 hours. Even her heart rate exceeded greatly to 122/min which is considered tachycardic. At 1930 hours her skin turned very cold and clammy and she developed severe back pain. Her heart rate increased to 168/min and her sugar level critically raised to 16.1 mmol/L. When the VMO was notified about the patient’s condition, he suggested Digoxin and Valium for the patient, which treats heart conditions including Atrial Fibrillation and anxiety, respectively. At 2100hours, the patient’s RR was still at 40/min. The next day, Patient A was unable to void, had pale and clammy skin and was experiencing nausea. At 0830 hours, the VMO assessed the patient and ordered some pathological tests for her. At 1330 hours, the VMO noted that the patient cannot be mobilized due to severe back pain and pain in her abdomen. Her pathological tests showed that her WBC count had raised to 17.5, despite a fever and she was diagnosed with urinary tract infection (Foxman, 2014). At 1430 hours she was started on IV antibiotics in order to treat the urinary tract infection (Mody & Juthani-Mehta, 2014). At 1720 hours she was reported to feel dizziness, had 8/10 abdominal pain and elevated RR of 40-44/min, along with a severe decline in BP and heart rate which showed 89/53 and 88, respectively. At around 1810 hours, the patient had continual diarrhea. Later at 2100 hours her condition started to deteriorate and by 2200 hours she was critically unwell. Her family was informed about her condition. At 2300 hours she was treated for severe dehydration with a large bore IV canula. Over the course of the night, the hospital attempted to transfer the patient to a referral hospital, but her critical condition did not allow for the hectic transfer process. The next morning the hospital tried to transfer her with the help of an air evacuation team. She passed away while the team was assessing her. Her cause of death was stated to be septicaemia, which occurs when bacteria enters the bloodstream and damages multiple organs (Kaniyarakkal et al., 2016). Usually the chemicals that enter the bloodstream to treat a certain kind of infection, somehow trigger inflammation throughout the body, leading to a cascade of changes that ultimately result in multiple organ failure and thereby death of the individual (Martin et al., 2014).
The Clinical Incident and Patient History
From the start, Patient A suffered from high respiratory rate, irregular heart-beats and had problems with breathing. She had an immensely high blood sugar level which needed to be taken care of by the nurse in order to avoid further physical complications. By the time the Registered Nurse (RN) John started his shift, the patient’s condition was already critical. Patient A required immediate nursing. Therefore, John should have attended her soon after her admission. Although, after he commenced his shift, John read Patient A’s progress notes and was concerned about her condition. Patient A had been diagnosed with urinary tract infection and was started on IV antibiotics. When the enrolled nurse informed John about the patient’s dizziness, abdominal pain and other vital signs He should have went to review the patient immediately without waiting for the locum to arrive. Shortly after the patient had continual diarrhoea and the enrolled nurse made John aware of this too, he still refused to go and check up on the patient. He kept waiting for the locum to arrive. After the patient developed continual diarrhea, the RN should have been there immediately to start treating her or give her some IV medications for fast improvement of her condition if necessary (Van Bogaert et al., 2014). RN John should have asked for the required medicines from the Clinical Nurse Manager or at least he could discuss the patient’s condition with her, and ask her for suggestions. The Clinical Nurse Manager could provide him some valuable suggestions that he could imply in this situation for a better patient outcome.
There are several situations that could have been handled differently for a positive patient outcome (Manojlovich & Ketefian, 2016). First of all the registered nurse (RN) John’s lack of professionalism is definitely one of the main reason behind Patient A’s demise. The patient was admitted to the hospital on 6th January and John commenced his afternoon shift on 11th January, 5 days later. Although when he was made aware of the patient’s worsening condition including her severe abdominal pain, dizziness, low BP and heart rate, he did not review her immediately. This was highly unprofessional act from a nurse. Any person involved in nursing profession, must always prioritize patient care above any other task. Immediate assessment and treatment of Patient A was a prerequisite in this condition. Even when John did assess Patient A, he did not document any of the observations he made. RN John should have addressed the patient immediately and document all the observations in detail so that any staff taking care of her, could keep a track of her condition. Later when he phoned the Clinical Nurse Manager Ms Sophie Smith or even when the manager herself attended the hospital, he did not raise any issues concerning Patient A. He should have discussed Patient A’s condition with the manager and arrange some medicines that could be helpful for Patient A (Keeling & Templeman, 2013). While reviewing the VMO’s performance, it is quite evident that there was no lack from his side. The VMO has been nothing but professional from the start and started to take care of the patient as soon as he was informed. Every time the nursing staff made him aware of the patient’s discomforts he instructed them properly regarding any possible treatment or processes that could have been done to improve the physical state of the patient (Park, 2015). In the end, after Patient A’s condition had worsened, the hospital tried to transfer her to another referral hospital. This was a highly unprofessional act from the hospital authority. Patient A’s condition was critical and deteriorating. Had the authority been able to transfer her earlier, she could have been treated properly, but that was not an option anymore since the patient’s condition had deteriorated critically in the past 2 days. If the hospital was unable to treat the patient properly, they should have made the transfer earlier.
Evaluation of the Registered Nurse’s/Midwife’s Professional Conduct
From this case I have been able to acknowledge the importance of constant patient care. Especially the patients who show various critical symptoms and complain about their discomforts and sufferings, must never be neglected (Kitson et al., 2013). The registered nurse must always be prompt and ready to handle the situation well. The patient’s vital signs must be recorded at all times. After a certain time, the patient needs to be repeatedly reviewed for any changes, whether positive or negative. All the reviews made, needs to be documented in detail, without missing any point. If the patient’s condition worsen, the nurse must ask the doctor to overview the situation and help relieve the patient. Even if complete recovery is not achieved, a tireless approach to treat the patient must be taken.
References
Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious disease clinics of North America, 28(1), 1-13.
Kaniyarakkal, V., Orvankundil, S., Lalitha, S. K., Thazhethekandi, R., & Thottathil, J. (2016). Chromobacterium violaceum septicaemia and urinary tract infection: case reports from a tertiary care hospital in South India. Case reports in infectious diseases, 2016.
Keeling, J., & Templeman, J. (2013). An exploratory study: student nurses’ perceptions of professionalism. Nurse education in practice, 13(1), 18-22.
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
Manojlovich, M., & Ketefian, S. (2016). The effects of organizational culture on nursing professionalism: Implications for health resource planning. Canadian Journal of Nursing Research Archive, 33(4).
Martin, N. G., Sadarangani, M., Pollard, A. J., & Goldacre, M. J. (2014). Hospital admission rates for meningitis and septicaemia caused by Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae in children in England over five decades: a population-based observational study. The Lancet Infectious Diseases, 14(5), 397-405.
Mody, L., & Juthani-Mehta, M. (2014). Urinary tract infections in older women: a clinical review. Jama, 311(8), 844-854.
Park, H. J. (2015). Correlations among nursing professionalism, critical thinking disposition and self-leadership in nursing students. Journal of Korean Academic Society of Nursing Education, 21(2), 227-236.
Schuetz, P., Kutz, A., Grolimund, E., Haubitz, S., Demann, D., Vögeli, A., … & Hoess, C. (2014). Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: results from the randomized ProHOSP trial. International journal of cardiology, 175(3), 464-472.
Van Bogaert, P., Timmermans, O., Weeks, S. M., van Heusden, D., Wouters, K., & Franck, E. (2014). Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey. International journal of nursing studies, 51(8), 1123-1134.
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