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- Subject Code : NUR3201
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- Subject Name : Nursing
Quality, Safety and Risk
Introduction to Improving Therapeutic Communication in Nursing
Troy almond was born on 9th October, 2014 and died due to septicemia on 22nd march, 2016. He died because of septicemia, due to late and poor recognition of his condition, by the nurses aligned for providing him medical care. There were multiple clinical signs and symptoms that were neglected throughout the course of treatment. The patient was admitted to the healthcare facility multiple times. His condition worsened over the due course of admission in the hospital facility. The basic signs that could have been easily determined with the help of constant vitals monitoring, were neglected by the nursing as well as the doctors providing care to the patient. There was a major lack of communication between the various team members, that helped in providing care to the patient. The clinical handover provided by the nurses during change of shift was not up to the mark. There were many details that should have been focused upon, were left untouched and not bothered about. In a way the delivery of handover from one nurse to another was somewhat compromised. This led to delay in preventive intervention to the patient. It also led to medical error in terms of providing the patient with the required healthcare solution as per hos respective medical needs. There was also a crucial delay in administration of antibiotics to the patient, which lead to exaggeration of his clinical signs and symptoms. There was a display of poor management and coordination from the healthcare staff assigned to the care of Troy Almond. The parents were also not informed dully about the deteriorating signs and symptoms of the patient. The overall negligence and ineffective communication between the team members, led to inadequate delivery of care to the patient. This eventually led to worsening of his symptoms and thus, led to his death. The following case study will help in defining various elements associated with the case and its implication in the healthcare delivery system. The study will also help in analyzing limitations and highlights that were missed during the course of treatment provided to the patient. The case study analysis will also help in pondering upon the ethical and legal consideration aligned with the case study.
Role of The Nurse
Nurse are the primary source of contact in any healthcare setting for the patient and their families. It is the duty of the nurse to not only provide healthcare solutions to the patients, but also develop a strong communication with the family members. It is also the duty of the nurse to make sure that patient health and safety remains the topmost priority at all times. The primary function should be assessing the patient from a holistic point of view and taking notes of all possible signs and symptoms that help in developing a robust and effective intervention plan for the patient. It is also the duty of the nurse to provide healthcare to the patients, within the bounds of ethical and legal implications of the healthcare setting they are working in. The patient’s case study should be analyzed from multiple points and angles to make sure that no stone is left unturned in providing the required medical attention to the patient (Baumgartner, 2017). It is also one of the main duties of the nurse to provide a safe environment to the patient, making sure no harm is inflicted upon them. The patient in the given case study was admitted multiple times for occasional respiratory tract infection and vaccination. He was treated with strong medication and was discharged as well, without a delay. However, before his death the patient has an underlying infection, which went undetected and there was a delay in correct treatment to be provided to the patient. Communication is also another vital aspect of nursing care, that should be strictly abided by, to avert any medical errors while managing patient care (Blake, 2018). However, in the given case scenario, there was a major lack of proper communication between the multidisciplinary team members. Nurses should also be efficient in clinical handovers. These handovers are quite vital from the point of view of collecting important clues and information regarding the patient. These sets of crucial information are imperative to be collected in the correct patten to devise the best possible intervention for attaining positive healthcare outcomes.
Highlights Missed
The patient in the case study was admitted to the healthcare setting multiple times for respiratory care management since his birth. The doctor assigned in the case study, only made presumption for the patient based on his vitals collected on prior basis. The patient should have been assessed on eth basis of current vitals dully documented in the file. The patient also had a red macular rash that was blanching. Initially the rash was documented as non-blanching. Even after noting for the increased body temperature of the patient and the red patch on his skin, the doctor failed to connect the dots, available in the form of clinical signs and symptoms. The patient was presumed to have a bacterial infection and was treated for the same. There was no repetition of blood samples taken, even with the rising body temperature readings, indicating for presence of active infection. The patient was also discharged from the clinical settings without ordering any lab tests for examining for signs of infections. There was a presence of constant levels of high-grade fevers, yet no blood tests were ordered and the previous history was tried to connect with the present clinical signs and symptoms reflected by the patient. The nurse assigned to the patient care also alarmed the doctor regarding his rising fever and heart rate, but both of these signs were quite obviously ignored by the doctor. The primary doctor was also clanged to the favor of discharging the patient, rather than taking a specialist consultation. The patient’s mother also showed concerns about the abnormal vitals but they were dully neglected by the primary care physician, leading to further deterioration of the patient’s health status.
Ethical and Legal Considerations
The Nursing and Midwifery Board of Australia has defined and established certain ethical codes of conducts that are to be followed while taking care of the patient. These codes of conduct are to make sure of patient safety as well as allow the healthcare professionals to carry out their duties in an ethical manner (NMBA, 2018). The given case study can however, be reflected as the breath of the same. Not only the codes of ethics were violated but lack of sense of responsibility led to patient’s death. Multiple codes have been violated in the give case scenario (Brothers, 2016). There has been underreporting of the case study in term of written handover provided to the nurses and the doctors assigned to the care of patient Troy Almond. Safe clinical practices were not followed, as obvious signs of underlying infection were neglected. The nurse knew the deteriorating signs reflected by the patient but only informed the doctor regarding the same, rather than informing it to a senior authority. The negligence of not providing patient with antibiotics course of treatment, eventually led to his death. There was a lack of professionalism in eth behalf of both doctors and nurses, who didn’t not talk the required steps needed for the patient’s best interest. Due to lack of noting for clinical signs and inadequate interventions planned, there was a strong beach of basic ethical and legal considerations required for patient care in a critical setting. The case of Troy Almond was treated very casually, whereas, the situation could have been averted by taking proper blood samples and specialist advice to manage the deteriorating signs and symptoms of the patient (Gleason, 2017). Even being evidently visible signs of increased temperature and infection, there was a sheer neglect reflected by the healthcare team members.
Analysis of Improving Therapeutic Communication in Nursing
The case demands of clinical reasoning and rationaling to be done. The case should be analysed form the point of view of sepsis risk development. In the case study the clues and information were dully collected but somehow, they were neglected and not pondered upon seriously. There was a lack of vigilant and professional behaviour on the part of healthcare professionals. Even with sufficient means available for the patient cure the implementation of these techniques was not done effectively. Even being admitted in the emergency care department the clinical issues for Troy were not dully escalated like they should have been. There was not only a lack of identification of proper interventions needed but also a lack of goal settings for the patient. the main limitation can be the acknowledgement of the underlying sepsis and the treatment of antibiotics to be provided to manage the condition. The issue of not acknowledging for the deteriorating signs of patient having persistent fever, led to a delay in proper clinical decision-making for the patient, eventually leading to his death. The use of Ryan’s rule could have been helpful in this given case scenario (NSW Government Health, 2016). As the patient can recognize when there is something wrong with their child, they can call for help. The parents of Troy Almond should have been more engaged in the process and nurse should have worked along side them. The patient also required a specialist consultation. The role of family can be very helpful in this case as they can switch between the treating physicians if they are not satisfied with the treatment. The nurses can engage themselves with patient’s family imparting education to them about their rights as per the Ryan’s rule (Dwyer, 2018). This could have been an effective method for providing timely intervention to Troy and thus, everting his death.
Recommendations on Improving Therapeutic Communication in Nursing
There is a dire need of developing a paediatric sepsis pathway by the healthcare setting (NSW health Pediatric sepsis guidelines, 2018). These guidelines will help in improving the overall quality of the care for the patient through a set of rules. It will also be helpful in reducing and marginalising the medical errors and will help in averting in such un-called-for situations. The rule for proper diagnostic interventions should also be applied in the given case scenario. The patients should not only be periodically monitored, but should also be checked for proper blood testing’s, to check for underlying and undetected infection they might be having. The role of multidisciplinary team can be very fruitful in the given scenario. The team approach with proper communication should be followed to make sure that patient care delivery is not lacking in any aspect. Due consideration for ethical and legal obligations should be considered while rendering care to the patient, especially in emergent cases. The healthcare professionals engaged in patient care should be accountable for their respective actions and should have the capability to think and evaluate the situation critically. The main focus should be improving communication, improving care treatment and management, reducing errors, ensuring overall quality of treatment and making sure that patient safety is always intact. The role of family, especially in paediatric care is quite vital and imperative. The family members should be constantly involved in the process and should also be a part of shared decision-making for the patient.
References for Improving Therapeutic Communication in Nursing
Baumgartner, R., Ståhl, C. H., Manninen, K., & Hedman, A. R. (2017). Assessment of nursing students in clinical practice-An intervention study of a modified process. Journal of Nursing Education and Practice, 7(11), 111-122. DOI https://doi.org/10.5430/jnep.v7n11p111
Blake, T., & Blake, T. (2019). Improving therapeutic communication in nursing through simulation exercise. Teaching and Learning in Nursing, 14(4), 260-264. DOI https://doi.org/10.1016/j.teln.2019.06.003
Brothers, K. B., & Goldenberg, A. J. (2016). Ethical and legal considerations for pediatric biobank consent: current and future perspectives. Personalized Medicine, 13(6), 597-607. DOI https://doi.org/10.2217/pme-2016-0028
Dwyer, T. A., Flenady, T., Kahl, J., & Quinney, L. (2020). Evaluation of a patient and family activated escalation system: Ryan's Rule. Australian Critical Care, 33(1), 39-46. DOI https://doi.org/10.1016/j.aucc.2019.01.002
Gleason, K. T., Davidson, P. M., Tanner, E. K., Baptiste, D., Rushton, C., Day, J., ... & Newman-Toker, D. E. (2017). Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis, 4(4), 201-210. DOI https://doi.org/10.1515/dx-2017-0015
NMBA, 2018. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx
NSW Government Health. (2016). Retrieved from Clinical Excellence Commission website: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/343475/Paediatric-Sepsis-Pathway.pdf
NSW health Pediatric sepsis guidelines (2018). Initial management of spectic child. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjO4_H25L_rAhXb8XMBHephCHsQFjAAegQIBBAB&url=https%3A%2F%2Fwww.aci.health.nsw.gov.au%2Fnetworks%2Feci%2Fclinical%2Fclinical-resources%2Fclinical-tools%2Fadvanced-life-support%2Fpaediatric-sepsis-toolkit&usg=AOvVaw0LpXpHwLiAPBmp5H7lnhrl
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