Nursing Assignment: Clinical Issues and NMBA Standards

This nursing assignment discusses the clinical issues and NMBA standards in the case scenario of an 85-year-old patient with bilateral lower lobe pneumonia and a fracture in the right neck of femur. The nurse committed several clinical issues while providing treatment to the patient. The article also provides recommendations for the identified clinical issues.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author note:

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PART A
Question 1
1. A. This case scenario will focus on the patient named Daisy Mayes, 85-years-old women.
She was admitted to the hospital due to chest infection and was diagnosed with bilateral
lower lobe pneumonia. She was admitted to the emergency department as she had sustained a
fracture in the right neck of femur. The past medical history of the patient exhibited she was
suffering from hypertension, COPD, hypercholesterolemia, and osteoarthritis. Her past
medical history also exhibited the condition of bowel cancer which was treated through
surgical procedure, twenty years ago. The practice of the registered nurses is dependent on
the person-centered and evidence-based method with the element of curative, preventive,
formative, supportive, palliative and restorative (Gómez-Barrena et al., 2015). The registered
nurses must develop effective professional and therapeutic relationships with the family
members, groups, families, and communities (Lutz et al., 2017). However, in the provided
case scenario, the nurse had committed few clinical issues while providing treatment to
Daisy. The clinical problems exhibited by the nurse is described as follows:
1. Accommodation of the patient in a ward containing four-bed, far away from the
nurses' station is one of the biggest clinical issues. It would have been better if the
patient was kept in a room near the nursing station.
2. The next clinical issues identified was that the nurse had not incorporated the updated
medicines in the handover, which was violating the nursing code of conduct.
3. The daughter of the patient was not informed regarding the accident, which was
considered as the major clinical issues as the daughter had specifically communicated
with the nursing staff to inform her in case any emergency.

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4. The nurse was unable to provide adequate psychological assistance to the patient
even though the patient was not behaving normally.
5. The nurse had failed to maintain the hygienic environment after the surgery was
over, due to which the patient suffered from delirium.
6. The nurse was negligent as she failed to perform the routine check-up of the patient
appropriately.
7. The major clinical issues identified was that the nurse was unable to develop a
therapeutic relationship with the patient and also failed to communicate the need and
requirements of the patient.
B.
The NMBA registered nursing standards for practice provides a rich mixture of how a
nurse must engage herself in professional and therapeutic relationships. In this case scenario,
the nurse had breached the nursing standards 1, 2, 4, 5, and 6 (Nursing and Midwifery Board
of Australia, 2019).
C.
The NMBA nursing standards 1: Thinks critically and analyse nursing practice,
exhibit that the registered nurse must appropriately use the strategies for delivering safe and
high quality of care to the patient that includes the evidence-based and person-centred
framework. The NMBA nursing standards 2: Engage in professional and therapeutic
relationship, exhibit that should purposefully involve in the professional and therapeutic
relationship with the patient to develop respect and mutual trust. The NMBA nursing
standard 4 and 5, guide the nurses to develop a health care plan by conducting comprehensive
assessments, and lastly, NMBA standard 6 suggest the nurses in providing a safe and
appropriate treatments. The above mentioned NMBA nursing standard was violated by the

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nurse as she had failed to conduct comprehensive assessments for the patient and was also
unable to implement her knowledge and experiences while treating the patient. The nurse did
not develop any professional or therapeutic relationship with the patient and had also failed to
communicate with her daughter. The clinical issues 1and 5 breaches the nursing standard 6,
as the nurse had failed in providing a safe environment to the patient and should have avoided
admitting the patient in such a distant room where she could rarely visit. The clinical issue 2
had violated the nursing standard 3, as the nurse was unable to maintain the capability of
nursing practice. The clinical issue 3 is showing the lack of therapeutic and professional
relationship with the family members of the patient. The clinical issues 6 and 7 are violating
the nursing standards 1 and 4. Hence, it was evident that the nurse was not efficient in
conducting the comprehensive assessments of the patient and manage the postoperative
complications of the patient.
Question 2
2. A. From the above mentioned list of clinical issues, the top four priority issue that is
identified in the provided case scenario are as follows:
1. The nurses had failed to maintain the hygienic conditions for the patient post-surgery,
due to which the patient had to suffer from an infection.
2. The nurses had to provide psychological assistance to the patient as her daughter had
already communicated that her mother was not behaving normally.
3. The next crucial clinical issue identified was that the daughter of the patient was not
informed regarding the accident; however, the daughter told them to inform her in
case any emergency arises.
4. The nurse was negligent as she failed to perform the routine check-up of the patient
appropriately.

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B.
Recommendations for issue 1- The nurses must be aware of the post-surgical complications.
Wound healing is one of the critical side effects of any surgery. The nurses should take
precautions to avoid such incidents in future. The nurses should focus that the patient is not
scrubbing or rubbing the incisions (Gillespie et al., 2015). The tapes should not be removed
until or unless the doctor informs the nurse. The incisions must not be exposed to sunlight
(Harper et al., 2015). The nurse should not allow the patient to have a bath until the incisions
are dried. The nurse must use gloves to clean the wound areas and also sterilize the materials
(Auchincloss & Wright, 2016). If the nurses notice any signs of infection, then instantly, it
should be reported to the doctor (Lazar et al., 2016). The nurse could have administered
antidepressants, sedatives, and thiamine for treating delirium. Proper counseling might also
help the patient in regaining her thoughts (Neufeld et al., 2016).
Recommendation of issue 2- The nurse is not only responsible for providing physical
assistance to the patient, but are responsible for providing mental support. This helps the
patient to feel free to share all health issue that they are suffering from (Heidari & Ghodusi,
2015). The nurses should communicate effectively by being polite with the patient. In the
given case, the nurses failed to do that because of which the patient was not allowing her
daughter to leave her (Berli et al., 2017).
Recommendation of issue 3- The family members of the patient have the right to know
about the changes in the health conditions of the patients. This is not only a clinical issue but
also an ethical issue (Wyld, Audisio & Poston, 2015). The nurse should inform the family
members of the patient instantly of the health condition deteriorates (Dietz et al., 2015).

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Recommendation for issue 4- To avoid this type of incidences in future the nurse must visit
the patients at regular interval of time to check the health condition of the patients (Khan et
al., 2015).

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References
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