Nursing Case Study: Critical Responses to Clinical Incident

This nursing case study discusses critical responses to a clinical incident using the National Safety and Quality Health Service Standards and NMBA professional practice documents. It covers what happened in the incident, activities nurses need to complete in immediate situations, professional behaviors that can make a difference, and what can be learned from the case study about preparedness for professional practice.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student:
Name of the University:
Author Note:

401021 Being a Professional Nurse or Midwife –
Assessment 2
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Students are to draw on the National Safety and Quality Health Service Standards
and the NMBA professional practice documents to develop critical responses to the clinical
incident. The following questions are required to be answered for this assessment:
Q1. What happened in this clinical incident?
Patient A was hospitalised and reported atrial fibrillation and dizziness with rapid heart rate.
He was reported weakness and abdominal pain. Assessment was done by the VMO and it was
identified that the patient was distressed, depressed and anxious as well and ordered the
nursing staff to encourage the patient to mobilize. Poor intake of food and increased RR was
also noted. Patient A gradually start deteriorating with the high RR and rapid heart rate.
Patient also reported about feeling woozy and cold and clammy skin. Complain regarding
severe back pain was also reported. 16.1 BSL and heart rate of 168/m in ECG have been
found. Patient was taken digoxin and Valium, but no improvement was recorded.
During further assessment VMO reviewed and UTI diagnosed and provided IV
antibiotics. The registered nurse john from afternoon shift has failed to escalate the care in
urgent basis when Patient A complained about abdominal pain and dizziness. His observation
was increased RR and very low BP and severe diarrhoea. RN john assessed the patient but
escape documentation and escalate the patient condition with the Clinical Nurse Manager. In
this emergency condition the doctor has attended the patient and provided IV cannula,

however, during the assessment of air evacuation team patient A died. Septicaemia has been
considered as the main cause of death.
Q2. What activities did the nurse or midwife need to complete in the immediate situation?
RN John should respond to the critical condition of the Patient and identify the
patient’s deteriorating health condition including organise a medical review when very low
blood pressure such as 89/53 mmHg, high respiratory rate such as 40 to 44 breaths per
minute, abdominal pain and diarrhoea were observed. With the vital sign assessment the
registered nurse should have collect past medical history and current medication. It could
help him to recognize that whether the increase in breathlessness is due to the adverse effect
of some drugs for example, Lasix (Gulanick & Myers, 2016). After observing high
respiratory rate the registered nurse should have assessed the air way and provide adequate
oxygen therapy to manage the shortness of breath in an effective manner. It could help him to
relief the patient (Doenges, Moorhouse & Murr, 2014). The nurse should have introduced
some relaxation techniques to relax the patient and inform the patient regarding the
effectiveness of the treatment as well. It could help the registered nurse to reduce the pain,
depression and anxiety of the patient and help the patient in improving mobilization in an
effective manner (Acebedo-Urdiales, Medina-Noya & Ferré-Grau, 2014). As the pain was
measured 8/10 in the pain scale, it was important to introduce effective nursing interventions
in order to reduce the pain. Effective medication could be provided to the patient in order to
manage rapid heart rate and low blood pressure (Gulanick & Myers, 2016).
As a registered it was the duty of John to provide adequate mental support to the
patient beside medical support. As the patient has refused to take any food or fluid the

registered nurse should have communicated with the patient and made her understand about
the importance of healthy food habit in such critical health condition. In such way the
registered nurse could convince the patient for healthy diet and improve the blood pressure as
well (Doenges, Moorhouse & Murr, 2014). In this way the RN should have maintained the
standard 1 of Australian commission on the safety and quality in health care that provides
guidelines for safety and quality in health service (Australian Commission on Safety and
Quality in Health Care, 2012). In addition the registered should have conducted
documentation of the patient’s health condition. It could help to prioritise the area of care and
introduce adequate health interventions to cure the patient. This activity could help to
maintain the standard 9 of Australian commission on the safety and quality in health care that
indicates recognising and responding to clinical deterioration in acute health care
(Australian Commission on Safety and Quality in Health Care, 2012). With such the
registered nurse could save the life of patient A.
Q3. What professional behaviours may have made a difference in this situation?
As seen from the case of patient A, the nurses that were engaged in caring of the
patient A lacked the safe and responsive nursing practise with quality care. The registered
nurse should have maintained the professional behaviour in nursing. For example, the nurse
should have escalated the care to the VMO when deterioration in the health of patient has
been measured. It could help the registered nurse to provide adequate care to the patient
during the time of need and could save the life of patient A (Faden, Beauchamp & Kass,
2014). The nurse should have taken the vital signs properly and document each findings
appropriately. It could help the registered nurse to comply with Standard 4 and standard 5 of
NMBA that provides guidelines for holistic assessment in order to recognize the severity and

introducing proper plan of care to provide adequate health service
(nursingmidwiferyboard.gov.au, 2018). In this way the nurse could help the patient to
improve her condition and avoid the incident of death.
Furthermore, the registered nurse should have reviewed the health condition of the
patient and follow up the patient effectively. In this regards the registered nurse should have
discussed with the clinical nurse manger regarding the health condition of patient A and
would have asked for effective medication to manage the severe condition. Such
communication would help the registered nurse to collaborate with the nursing practice and
build professional relationship in an effective manner (Kourkouta & Papathanasiou, 2014).
According to the standard 2 of NMBA, it is impor5ant to establish therapeutic relationship in
the nursing practice in order to collaborate effectively and enhance the quality of service
(nursingmidwiferyboard.gov.au, 2018). Person centred care is another important behaviour
that could be used by the registered nurse in case of patient A. Person centred care focuses to
the requirement of individual patient and prepare care plan according to the need. It helps to
provide effective care and resolve the health issue in an effective manner. In this case the
registered nurse should have prepare the care plan based on diarrhoea, abdominal pain, rapid
RR and heart rate and breathlessness. Such person centred care would help to improve the
health condition and could save the life of the patient (Broderick & Coffey, 2013). In addition
the registered nurse should have used the skill of critical thinking in nursing to evaluate the
health condition of the patient and introduce appropriate nursing interventions to help the
patient to recover faster (Gulanick & Myers, 2016). Such behaviours could help to provide
quality service and ensure patient safety, thus, the healthcare team could avoid the incident of
patient mortality.
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401021 Being a Professional Nurse or Midwife –
Assessment 2
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Q4. What do you learn from this case study about your own
preparedness for professional practice?
The case study has helped me to learn about the necessity of utilising the guidelines
provided by NMBA standard of nursing and standards of Australian commission on safety
and quality in health care. The case study has demonstrated the importance of skill for
documenting the health condition of the patient. It would help to identify the priority of care
and introduce effective care plan. Through this case study I was able to understand the
importance of professional accountability in the nursing practise. I have learned that it is
important for a registered nurse to become professionally accountable as it helps to expand
the nursing skills and introduce evidence based practice to guide the clinical practice. In
addition the case study has elaborated the escalation of care. It determines the proportion of
patients that are audited but lack adequate care. I have learned that if a nurse delays to
escalate care it could leads to the consequence of morbidity and mortality as well. As a new
nurse I have gather knowledge from the case study and would like to implement the learnings
in my clinical practice. I would like to utilise the guidelines provided by NMBA standard of
nursing care and standards of Australian commission on safety and quality in health care to
improve my service quality and ensure patient safety. I will escalate the care where necessary
without any delay. However, I have identified that my communication skill is not that good,
therefore I would think about some strategies for preparedness of practice. It is expected that
with such strategies I could improve my skills and establish myself as a successful nurse in
future.

Reference List
Chang, E. (2015). Transitions in nursing: Preparing for professional practice. Elsevier
Health Sciences.
Acebedo-Urdiales, M. S., Medina-Noya, J. L., & Ferré-Grau, C. (2014). Practical knowledge
of experienced nurses in critical care: a qualitative study of their narratives. BMC
medical education, 14(1), 173.
Australian Commission on Safety and Quality in Health Care. (2012). National safety and
quality health service standards. Australian Commission on Safety and Quality in
Health Care.
Broderick, M. C., & Coffey, A. (2013). Person‐centred care in nursing
documentation. International journal of older people nursing, 8(4), 309-318.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: guidelines for
individualizing client care across the life span. FA Davis.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative
effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans-E-Book: Nursing Diagnosis and
Intervention. Elsevier Health Sciences.

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia
socio-medica, 26(1), 65.
nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia -
Registered nurse standards for practice. Retrieved from
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards/registered-nurse-standards-for-practice.aspx