Module 1: Safety
Safety in medical nursing is the provision of the best health outcomes by use of the available resources and circumstances about the care of the patient. It is the reduction of harm risks to a minimum level that is acceptable.
Medication administration is the process that includes prescription, transcription, dispensing, administration of drugs and monitoring the response of the patient. Medication errors can happen at any of the stages. Many errors occur at the prescription stage which is obstructed by the nurses, pharmacists or other staffs. Most of the medication is carried out by the nurses. Some elements of medication use that alteration to them can lead to medication error are adequate communication, patient information, drug information, patient education, environmental factors, medication storage and distribution, staff education and competency, drug packaging and labeling, quality processes and risk management, and drug-device acquisition, use, and monitoring (Cheragi, et al, 2013)(Keers, et al, 2013).
Medication errors as a result of miscommunication occur when health professionals do not communicate adequately (Keers, et al, 2013). While it can cause the wrong diagnosis to the patient, to some cases medication error can lead to serious health complications or death. Missing or incomplete information between nurses leads to serious medical mistakes and diagnostic errors(Keers, et al, 2013). Poor communication can occur as a result of the transfer of patient records from one department to another, handing of shifts and lack of coordination between the nurses (Hayes et al., 2015). This leads to wrong treatment procedure, delivery of incorrect medication to the patient and treatment delays. Poor communication can be prevented by proper and transparent communication during the change of shifts by the nurses. Patient information such as side effects, allergies, and any other critical information should be clearly communicated.
Right patient information should also be obtained for proper medication administration. Information such as name, age, weight, date of birth, allergies, diagnosis, vital signs and current lab results should be verified. Scanning patient’s armband for identity can help prevent medication errors (Ranji, Rennke&Wachter, 2014). Important drug information should also be provided to the nurses. Information on categories of medication such as drug-to-drug interactions, therapeutic class, trade, and generic names, nursing considerations, dosing, drug cautionary, side effects and reactions should be provided in print or electronic media (Ranji, Rennke&Wachter, 2014). This will help in reducing or preventing medication errors. Wrong use, acquisition, and monitoring of devices used in drug delivery can lead to a medication error(Keers et al., 2013). Proper storage of medication should also be considered. Medication to be refrigerated should always be refrigerated to ensure efficacy and labelled the date of expiration to ensure it’s not used beyond the date. Those to be kept at room temperature should also be stored well. Nurses should ensure that all medications are labelled clearly in their dosing packages. Some medications look- alike while others sound-alike in their packaging and names. This alone poses an error which should be handled with utmost care. A nurse can have another nurse read it back to ensure the prescribed medication is correctly transcribed.
Module 2: Confidentiality and Ethical Issues in Nursing
Some environmental factors can also lead to medication errors. Increased acuity of the patient, inadequate lighting, distractions during preparations and administration of drugs, cluttered environment and fatigue can lead to medication errors which can be rectified (Hayes et al., 2015). Nurses should also consider continuing their education to be updated. This will help reduce the errors (Cleary-Holdforth&Leufer, 2013). They should always be aware of the “five rights” to guide them. That is the right patient, right drug, right dosage, right time and right route.
Confidentiality is the right of the patient to have their personal and medical information kept private(Davis et al., 2015). In nursing, every nurse respects and understands the need for keeping the information regarding the patient confidential (Tingle &Cribb, 2013). Patient’s information includes the patient’s past, present and future physical or mental condition, health services and payment of the services. Patients understand their rights and control of how their information on health is to be used or shared. The connection between nurses and patients depends on confidentiality. Maintaining the trust of patients in their caregivers is important to get the correct information regarding their history, proper health record and be able to carry out the correct treatment (Davis et al., 2015). If a nurse fails to keep the privacy, their relationship with the patient may not bring the best outcome (Reinbeck & Fitzsimons, 2013).
However, nurses are faced each day by the challenges that pose a threat to confidentiality. Most clinical setups are frequently overcrowded and busy with an environment that is not conducive. The conversation between the nurses and patients can be easily overheard prompting questions of what can be done to such situations (Burkhardt& Nathaniel, 2013). Patient’s families and well-wishers often come to visit and ask on the patient information and treatment proceedings which may seem harmless, but again it violates their rights (Kourkouta & Papathanasiou, 2014). Labelling the drugs with the details of the patient promotes safety and care while discarding these used items in trash poses a question of whether their information is compromised. Information in the hospital is usually stored in computer databases for easy access and retrieval while ensuring safety. However, any information can be accessed through the internet today (Ben-Assuli, 2015). Unauthorized access can be made but how much of the information should be provided.
When it comes to the issue of carers and confidentiality, nurses should share information of the patient with the consent to do so. Confidential information regarding the patient is disclosed in very limited situations like the health being at high risk or in legal situations(Reinbeck & Fitzsimons, 2013). Although the consent of the patient about relaying information to the carer is required, non- personal information can be shared without breaching confidentiality (Tingle &Cribb, 2013). General advice and support information can be shared. Sharing may be difficult, but often it is good for the well- being of both the patient and the carer. This is because if the carer is excluded from discussions that are important regarding the patient can have consequences to both. Lack of involving the carer can lead to grief, loss, and isolation. Nurses also face difficulties about the sharing of information. They are faced by ethical and legal obligations which can lead them to face disciplinary measures and legal proceedings such as being sued or dismissed (Winland-Brown, Lachman& Swanson, 2015). Agreement by the patient on disclosure of their information is also an issue for nurses. This is because most carers and patients are not aware that consent must be given before sharing any information. Nurses also feel that involving carers fully will make them not have enough time for the patients. Nurses can also get false pictures as a result of a strained relationship between the patient and carer brought by a crisis which is not true in the end.
Module 3: Reflection
To avoid all these ethical dilemmas of confidentiality in the medical set up, issue of confidentiality should be discussed earliest possible either on the first assessment or during admission before the patient is acutely ill (Kourkouta&Papathanasiou, 2014). They should also be recorded in the patient’s notes for care continuity(Reinbeck & Fitzsimons, 2013). At this time the patient may be feeling unwell or betrayed by their carer’sinclusion in the assessment hence refuse permission. Regular review is essential when they are calm in order to get a clear understanding. If permission on confidentiality is not given nowthen general information can be shared with the carer. If the patient has lost mental capacity and unable to provide clear information then the information will be shared on a ‘need to know’ basis (Kourkouta&Papathanasiou, 2014). They should be allowed in making of decisions of care and treatment if the patient lacks the capacity to consent (Davis, et al, 2015). The carer can be named in a different document and then consulted to sign up the document.
When patients are discharged from the hospital for a home environment, they are left under the care of family caregivers. Most of the caregivers are not prepared and mostly end up feeling burdened by the whole situation. They are faced by financial challenges such that they may not be able to cover for medication, food, and transport. The health and wellbeing of the caregiver are also compromised. The caregiver is also overwhelmed by the whole situation of caregiving to an extent they get isolated from other important opportunities of life. They don’t have time for their other family members or friends. Due to the situation they are in they also forget their health which may affect them physically and emotionally.
I feel saddened by the situation of the caregivers and what they have to go through while caring for their loved ones. Being responsible for everything can be breathtaking as it makes one feel occupied and go an extra mile to ensure all is fine which is very challenging. I feel empathetic for them since they may also lack time for themselves and other family members. It makes them withdrawn from many activities why in turn affects their health due to time imbalance. There is a need to help the caregivers. They can be helped through guidance and counselling, financially while being assisted in caring for the patient.
When it comes to transitioning of patients from healthcare to home care, caregivers receive new roles. That is the patient may require special care and monitoring that is different from other family members. The roles can include a special diet, medication, cleaning and bathing the patient. In our case, the caregivers complained of the new roles that they had to put up with. Carers require support in caring for the patients. They complained of being left to provide for everything to the patient which in my view is overburdening (Adelman et al., 2014). Carers also need support from the nurses and healthcare on how to care for their loved ones. They also need emotional and physical support for their wellbeing (Tsai et al., 2015).
Caregivers should be supported in caring for their loved ones. Health professionals and volunteers work together with the patient and their families to meet social, physical, psychological and spiritual needs. They provide services to them like medical and nursing care, counselling, dietary consultation, emotional support, and social services to the caregiver and the patient (Tsai et al., 2015).
Most cares need support by being given hope and confidence since the numerous commitments weigh heavily on them. There are groups to support caregivers where family and friends come together regularly to share and discuss matters and also provide solutions for common problems. They also encourage each other and can reduce stress factors (Zarit&Zarit, 2015).
There should be programs to provide caregivers with counselling on personal issues such as financial crisis, stress, addiction, depression so as they can be able to cope with their new situation.
Nurses and other professionals also should also visit the carer and the patient more often to monitor their progress and also offer care where it is needed. This will create collaboration between hospital and home care hence promoting good health (Joyce & Lau, 2013).
References:
Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., &Lachs, M. S. (2014). Caregiver burden: a clinical review. Jama, 311(10), 1052-1060.
Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 287-297.
Burkhardt, M. A., & Nathaniel, A. (2013).Ethics and issues in contemporary nursing.Nelson Education.
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., &Ehsani, S. R. (2013).Types and causes of medication errors from the nurse’s viewpoint.Iranian journal of nursing and midwifery research, 18(3), 228.
Cleary-Holdforth, J., &Leufer, T. (2013). The strategic role of education in the prevention of medication errors in nursing: Part 2. Nurse education in practice, 13(3), 217-220.
Davis, C., Dendrinos, K., Janssen, M., Kranz, K., &Reeb, S. (2015). Patient Rights.eMedicine. com. Retrieved August, 28, 2015.
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.
Joyce, B. T., & Lau, D. T. (2013). Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: a providers survey. Palliative Medicine, 27(4), 329-338.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication administration errors in hospitals: a systematic review of the quantitative and qualitative evidence.Drug Safety, 36(11), 1045-1067.
Kourkouta, L., &Papathanasiou, I. V. (2014). Communication in nursing practice.Material socio-media, 26(1), 65.
Ranji, S. R., Rennke, S., &Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ QualSaf, 23(9), 773-780.
Reinbeck, D. M., & Fitzsimons, V. (2013).Improving the patient experience through the bedside shift report. Nursing management, 44(2), 16-17.
Tingle, J., &Cribb, A. (Eds.). (2013). Nursing law and ethics.John Wiley & Sons.
Tsai, P. C., Yip, P. K., Tai, J. J., & Lou, M. F. (2015). Needs of family caregivers of stroke patients: a longitudinal study of caregivers’ perspectives. Patient preference and adherence, 9, 449.
Winland-Brown, J., Lachman, V. D., & Swanson, E. O. C. (2015). The new code of ethics for nurses with interpretive statements'(2015): Practical clinical application, Part I. Medsurg Nursing, 24(4), 268.
Zarit, S. H., &Zarit, J. M. (2015).Family caregiving. In Psychology and Geriatrics (pp. 21-43).
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