Nursing Care and Risk Management

The assignment focuses on the crucial role of nurses in providing safe and effective patient care. It emphasizes the importance of applying clinical knowledge, demonstrating empathy towards patients, and implementing robust risk management strategies to minimize harm and enhance positive patient outcomes. The discussion highlights how these elements work together to create a safe and supportive environment for patients.

Running head: PROMOTING CLINCIAL EXCELLENCE
Promoting quality care of patient by analysing an incident
Name of the Student
Name of the University
Author Note

1PROMOTING CLINICAL EXCELLENCE
Nursing profession is one of the largest healthcare related workforce. Nurses analyse a
patients’ needs and health demands, they execute care plans, and maintain medical records
(Lindrooth et al. 2015). While working as an associate nurse, I was directly involved with the
delivery system of the hospital, focused on caring for my patients and their family. This essay
will present a reflective overview of an incident which occurred and will analyse the possible
methods of clinical governance that could have produced a better patient outcome in the incident.
I will use the Driscoll’s reflective framework to narrate the incident.
What?
The situation, which I will explore, occurred during my work as an associate nurse in
India. The patient was Jyoti (name changed) had been admitted to the emergency department
after complains of nausea, chest pain, palpitations, trembling and dizziness. On assessing her
medical records I realized that she was on medications, for anxiety disorder prescribed by the
GP. She was also suffering from depression. Her mother accompanied her and was extremely
distressed and for not being able to protect her daughter from mental issues. As a young girl she
was diagnosed with anxiety and oppositional defiance disease which often made her aggressive.
Owing to the severity of her symptoms, I was immediately advised by the doctor-in-charge to
keep in a seclusion room. Seclusion and restraints should be the last resort of intervention to
manage behavioural emergencies in mentally ill patients. However, the doctor adopted that
measure to immobilize her (Sherwood and Barnsteiner 2017). She was confined in a room,
which was poorly lit and drab. I was instructed to go there and introduce myself to her. I
approached the room where she was and introduced myself. I tried to explain about her mental
health condition and assessment. However, she began to shout ' get out, go away'. I was
uncertain regarding my proceedings this response was completely unexpected. I therefore

2PROMOTING CLINICAL EXCELLENCE
returned to my senior to report the incident. There was miscommunication between the two
graduate nurses attending the incident and they failed to inform the doctor about her current state
of mind. An hour later when I was again instructed to go to her room along with one of the two
nurse trainees, to give him medicines, she escalated into a meltdown. She did not want to take
those medicines. The nurse talked to her in some language, unworthy of respect and made fun of
her mental state. I was agonised. Jyoti became aggressive and punched and hurt the nurse. We
alerted the staff to control her. They grabbed her and threw her to the bed. She wailed and
howled and gasped for breath. While shouting at the staff, she fell from the high bed and suffered
injuries in the head. I ran to call the doctor and informed her mother as well. She became calm
after taking pain killers and dressing the wound . My mentor returned after speaking discreetly to
her and for an hour and disclosed that she had experienced a panic attack which made her
agitated. She felt isolated and traumatised inside the dark room. Moreover, while being brought
to the seclusion room, she had received lewd remarks from some of the staff members regarding
her health. When the nurse talked to her inappropriately, it caused her meltdown and she
attacked the junior nurse. I felt relieved that she was ready to allow me complete her mental
health analysis (Miraglia and Asselin 2015).
So what?
I was horrified with what had just happened. From my nursing knowledge I knew that
clinical excellence and patient safety promote high quality healthcare practice. Clinical
excellence encompasses different aspects of proving patient centred quality care like clinical
knowledge, humanism and professionalism, diagnostic acumen, interpersonal skills, skilful
negotiation and having a scholarly approach to the situation (McCaughan and Kaufman 2013).
My view on clinical excellence was influenced by my philosophical approach to nursing, my

3PROMOTING CLINICAL EXCELLENCE
education, background and nursing experiences. However, this particular incident failed to
provide quality care to Jyoti owing to lack of participation, clinical effectiveness, risk
management strategies and effective workforce. I was able to recognize the aspects that needed
greater emphasis for effective patient care (Taschuk et al. 2017).
Now what?
Consumer participation, effective workforce, clinical effectiveness and risk management
procedures could have helped in improving the care provided to the patient.
Impact of consumer participation- Consumer participation includes involvement of
patients with the care givers in the design, development and implementation of their own
treatment. The inclusion of consumers in their mental healthcare services as co-investigators
likely enhances the effectiveness of the service (Byrne et al. 2014). Jyoti and her mother needed
to be involved and engaged from the beginning with the physicians and nurses who were looking
after her. It is the legal right of a consumer to have knowledge into how the programs and
services are run. The doctors should have acknowledged the benefits of the patient’s
participation in formulating an effective therapeutic strategy. Organizing open meetings where
the patient could express her views on the service could prove beneficial (Tobiano et al. 2015). It
also ensures appropriate training for staff. Well trained staff would not have passed lewd remarks
against Jyoti. This could have prevented her meltdown.
Impact of clinical effectiveness- Clinical effectiveness is the application of best
knowledge, derived from clinical experience, research and patient preferences used to achieve
best outcomes for patients. The staffs are provided support to focus on their team effectiveness
and patient outcomes. The staff works to deliver excellence when their efforts are recognized

4PROMOTING CLINICAL EXCELLENCE
(DiCenso, A., Guyatt and Ciliska 2014). Recent research and developmental strategies should
have been studied by the staff members and physicians to deliver proper care to the patient.
Recent research suggests minimizing the use of seclusion rooms. They make a patient more
violent and traumatized (Johnson et al. 2017). The staff should have adequate knowledge on the
possible ways to avoid such trauma incidents. Jyoti should have not been kept in isolation, had
the staff been aware of the harmful effects of their approach. Evidence based treatment strategies
should have been followed from translational research. Implementing basic science findings on
practical applications while designing a care for the patient would have enhanced her wellbeing
(Kirkman 2013). All students and staff should have been able to access best evidence to support
efficient clinical trials and policy making.
Impact of effective workforce- A workplace has an overarching culture along with a
plethora of sub-cultures. Each culture is represented by a set of beliefs, values, attitudes, social
customs and professional norms (Triolo 2012). Efficient workplace practices can enhance mental
healthcare provisions. Regular surveillance on the competency of the workforce would have
prevented any form of miscommunication. Effectiveness of a healthcare organization involves
optimal performance of the staff, avoidance of any stigma related to mental health,
encouragement of recovery and good partnership between the staff allocation system. This
would, help in meeting the patient’s needs. A good workforce effectively works together to
promote mental health prevention, and rehabilitation. There should have been a leadership and
collaboration focused on the state of anxiety and depression. Staff retention to ensure practice
excellence and proactive risk management would have proved useful in pacifying her and
reducing her agitation.

5PROMOTING CLINICAL EXCELLENCE
Impact of risk management- Patients suffering from mental illness should receive care in
a safe environment. However, several risks like suicide, falls, injuries and violence occur.
Clinical risk management relies on effective treatment that studies a patient’s history and tries to
prevent adverse effects while proving potential treatment opportunities. Recently, emphasis has
been laid on patient safety measures across the world through different legislative changes,
policy reforms and standard care development (Cole, Chaudhary and Bang 2014). Four main risk
factors that need to be considered are vulnerability of the patient to external factors, intentional
injury, suicide, hallucinations or psychotic phenomena, causing harm to others and risk form
falls. Her health demands needed to be balanced with public and personal and safety issues.
Healthcare providers should have balanced decision making according to Jyoti’s personal
demands. The service users should have taken support from her mother to comply with their
duties. Some interventions can present a risk to service users, such as some types of medication
which may have unwanted side effects. So the concept of risk is much broader than often
portrayed or acknowledged. Inpatient falls are a matter of concern for patient safety issues.
Increased surveillance, increased funding for bed alarms and construction of low beds can
eliminate chances of such falls and related consequences.
Conclusion:
A detailed investigation of the study has been carried on the importance of health and
safety of patients and the responsibility of the medical practitioners. Patient safety is a
fundamental healthcare principal and refers to the ways by which hospitals and healthcare
centers protect the patients from medication errors, fall risks, accidents, injuries and infections.
In carrying out such activities, risks are inevitable. Managing risk should not just focus on
eliminating risk, it is about Risk management generally provides a process that ensures

6PROMOTING CLINICAL EXCELLENCE
identification of potential benefits which reduce the likelihood of harms. The health
professionals should have taken reasonable care to protect her safety and welfare along with the
safety of the other persons involved. Thus, it can be concluded that application of clinical
knowledge, empathy and risk management strategies help in improving patient outcomes.

7PROMOTING CLINICAL EXCELLENCE
References
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8PROMOTING CLINICAL EXCELLENCE
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