401021 Nursing Case Study: Professional Conduct Analysis & Reflection

This case study examines a clinical incident involving an 81-year-old patient (Patient A) who presented with breathlessness, dizziness, and atrial fibrillation. The analysis focuses on the actions and decisions of the nurse and VMO, highlighting potential negligence and misdiagnosis. The study evaluates the nurse's adherence to National Safety and Quality Health Service Standards (NSQHS) and Nursing and Midwifery Board of Australia (NMBA) professional practice documents. It identifies areas where comprehensive physical assessment, avoiding assumptions, extensive consultation, recognizing worsening conditions, and collaboration could have improved patient outcomes. The reflection underscores the importance of critical thinking, timely intervention, and continuous learning in professional nursing practice. Desklib provides a platform to access similar solved assignments and past papers for nursing students.

R AD A R SS A RS R M DUNNING HE : BEING P OFE ION L NU E O I WIFE 1
Being a professional Nurse or Midwife
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A R SS A RS R M DBEING P OFE ION L NU E O I WIFE 2
Being a professional nurse or midwife
Q1.What happened in this clinical incident?
Septicemia is a very contagious disease which needs very urgent medical attention. This is an
infection of the blood and it is also known as bacteremia or blood poisoning. It arise whenever a
bacterial infection takes place in another organ for example the lung and then it enters into blood
(Munro et al., 2014). It is a very serious condition since bacteria produce toxins which can be
carried to other parts of the body. If the condition is not treated early enough, it eventually leads
to what is known as Sepsis
In this particular scenario or case study, there was a patient who will be referred to as Patient A
for confidentiality purposes. The patient was a woman and she was 81 years old. The patient
presented at the healthcare facility with a series of complaints such as breathlessness and
shortness in breath .This was on the first day. The patient was keenly examined and discharged.
The third day when the patient came back to the facility was the most significant. This is because
patient A was complaining of both dizziness as well as atrial fibrillation. A diagnostic test to find
out the pulse rate indicated 120 beats in a minute. The patient could also not eat or drink and she
complained of severe abdominal pains. After review by a VMO, it was recommended that patient
A be diagnosed of depression and anxiety and that there should be ambulation as a treatment
option. The patient was then discharged .Few hours after discharge however, the situation
deteriorated as the patient could not take breakfast and lunch. An abdominal ultrasound and
pathology were ordered the following day but unfortunately the condition got worse and the
patient eventually died.
Q2.What activities did the nurse or the midwife need to complete in the immediate
situation?
The nursing profession is one of the most critical occupation since it dedicates one to serve
patients in a holistic perspective. The baseline for the nursing practice is evidence based practice.
All the registered as well as the midwives have a very important role in maintaining the
professional standards in the course of providing care to the patients with the objective of
achieving quality outcome(Duffy, 2013). The National Safety and Quality Health Services has
however stipulated some standards which nurses should operate along in order to boost the
quality of care they provide (Greenfield et al., 2014) .In the case study that involved patient A,
the nurse was supposed to take time and assess the patient then later on formulate a care plan
which states the nursing intervention and the rationale behind it. Besides, the nurse was supposed
to first identify the report and finally analyze the worsening condition of patient A. This is in
accordance to the National Safety and Quality Health Services.
Currently, there are eight NSQHS. However, going by this case study, the most relevant is the
number 8 whose core objective is to prevent pressure injuries at the healthcare facility. It is
recommended that upon arrival, the patient should be screened quickly then nursing
interventions should be started (Clark, Collier, & Currow, 2015). The nurse should begin by

A R SS A RS R M DBEING P OFE ION L NU E O I WIFE 3
conducting a physical assessment as well as obtaining patient history so as to know where to start
when giving care. This is contrary in the case study. The nurse was supposed to carry out a
complete physical assessment so as to get oriented to the health problem. The should also get at
least some baseline data as this enables proper planning since the nurse will be better equipped to
prioritize needs depending on the urgency (Edvardsson, Watt, & Pearce, 2016). In this case, the
patient was not feeding well besides abnormal vital signs. The priority nursing intervention in
this case therefore was to ensure that the patient achieves normal homeostasis.
Critical thinking is a core aspect in providing care to patients. This is in accordance to the code
of ethics in the nursing practice and safety standards .Critical will always make the nurse make
wise decisions that will generally improve the patients’ situation. Critical thinking has the ability
to make the nurse avoid certain complications (Hall, Halton, Macbeth, Gardner, & Mitchell,
2015). In this case study, the nurse was aware that the condition was getting worse. What he
could have done is to think critically then call in a physician to review the situation. The nurse
could however not this do as he waited for the locum to arrive yet this was an old patient who
was very sick and demands immediate review.
Q3.What professional behavior may have made a difference in this situation?
To provide quality patient care as well as improving patient outcomes, the nursing profession is
usually guided by professional standards of practice .This is in accordance with the Nursing and
Midwifery Board of Australia (NMBA).In the case of patient A ,there are certain professional
behaviors that could have made changes(Nguyen, Chaboyer, & Whitty, 2015). One of the
behaviors is the comprehensive physical assessment. This could have brought about changes in
the outcome. It would have assisted the nurse to detect any complications early enough and this
could have improved the quality of life of the patient .Another important behavior that could
have brought up positive outcomes is avoiding assumptions. In this case study, there wrong
diagnosis due to the luck of a focused assessment (Considine et al., 2018). A focused assessment
involves a detailed head to toe assessment of the patient and accurate history taken from the
patient. The patient in this case was prescribed medication due to assumptions where she could
later die and the correct disease or condition diagnosed thereafter. If the nurse could have carried
out a comprehensive assessment, the condition could have been detected and treated early
enough.
Extensive consultation is another important behavior that would have made a very big difference
in this case. The patient in this scenario was 81 years old, she was very weak and was not eating.
What the Nurse could have done in this scenario is call in the physician quickly to review the
patient and not wait until the locum arrives. A quick review would have led to the detection of
the problem early enough and the patient would have been treated. Nurses should therefore
develop the behavior of consulting immediately and not waiting for the shift.
Advocating and then recognizing the worsening health condition in healthcare facilities is
another behavior that would have made a difference. This is also one of the NSQHS standards. In
this case study, the condition of the patient was getting worse yet the nurse would still discharge

A R SS A RS R M DBEING P OFE ION L NU E O I WIFE 4
her. This is wrong and nurses ought to develop the habit of recognizing worsening condition and
initiate the necessary nursing interventions to improve quality of life of the patient.
Collaboration is a behavior that improves the patient’s outcome. Collaboration is an art of
different professionals working together but with a common objective (Dewing, Eide, &
McCormack, 2017). In this case study, the nurse failed to collaborate with other professionals to
quickly review the condition of the patient. Could the nurse have swiftly worked with other
physicians, the situation could have not gotten that far. The problem could have been identified
early enough then initiate the nursing interventions for better outcome.
Q4.What do you learn from this case study about your own preparedness for professional
practice?
This case study has taught me so much about preparedness for the nursing practice .One thing I
have come to learn is that negligence is detrimental. Another important lesson is that
misdiagnosis is very harmful and should be avoided at all costs .In this case, the condition of the
patient was getting worse on a daily basis yet the nurse was neglecting that and discharging the
patient. I have also learnt that nurses should always think critically in all their routine practices.
The nurse in charge could have called the physician early enough after seeing the condition get
worse and not sit there and wait for the locum.

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References
Clark, K., Collier, A., & Currow, D. C. (2015). Dying in Australian hospitals: will a separate
national clinical standard improve the delivery of quality care? Australian Health
Review, 39(2), 202. doi:10.1071/ah14175
Considine, J., Hutchison, A. F., Rawson, H., Hutchinson, A. M., Bucknall, T., Dunning, T.,
… Street, M. (2018). Comparison of policies for recognising and responding to
clinical deterioration across five Victorian health services. Australian Health Review,
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Dewing, J., Eide, T., & McCormack, B. (2017). Philosophical Perspectives on Person-
Centredness for Healthcare Research. Person-Centred Healthcare Research, 19-29.
doi:10.1002/9781119099635.ch2
Duffy, J. R. (2013). Quality Caring in Nursing and Health Systems.
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Edvardsson, D., Watt, E., & Pearce, F. (2016). Patient experiences of caring and person-
centredness are associated with perceived nursing care quality. Journal of Advanced
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Greenfield, D., Hinchcliff, R., Banks, M., Mumford, V., Hogden, A., Debono, D., …
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Hall, L., Halton, K., Macbeth, D., Gardner, A., & Mitchell, B. (2015). Roles, responsibilities
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Munro, E. S., McIntosh, R. E., Weir, S. J., Noguera, P. A., Sandilands, J. M., Matejusova, I.,
… Smith, R. (2014). A mortality event in wrasse species (Labridae) associated with
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Nguyen, K., Chaboyer, W., & Whitty, J. A. (2015). Pressure injury in Australian public
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