Clinical Deterioration Analysis: Patient Care and Nursing Skills

This essay critically analyzes the complexities of clinical deterioration in patient care, focusing on the nursing skills, legal, and ethical duties involved in managing critically ill patients. It presents a case study of a patient who died due to multi-organ failure, discussing the challenges faced by nurse...Read More

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Clinical Deterioration
Introduction
The objective of this essay is to analyse important nursing practice and skills required to
manage a patient in the critical and serious illness and to focus on demonstration of the
serious estimation of a patient worsening incident that finished in demise of the patient. This
essay will discuss a case study describing the effects of patients complex situation lead the
issues to the death and will critically identify legal and ethical duties of nurses engaged in the
caring of the patient and responsibility of the patients towards the treatment (Ashton 2016).
This essay will recommend the nurses and to patients with the suggestions that matches with
the Australian National Safety and Quality Health Service, (NSQHS) Standards, and will
afford detailed analysis of clinical challenges and guidelines for the burses with the help of
relevant literature reviews (Akre et al. 2010).
Recognizing and responding to deterioration in complex clients
Active surveillance and observation of admitted patients is the primary main step in
classifying the deteriorating patient with effective managing activities for their care. A patient
moving from one medical state to a poorer medical state that possibly upturn their separable
risk of injury, including dysfunction of any body part, extended hospital stopover, ill health
and sometimes death this is very challenging situation for the nurses. Hence, nurses are
essential to require practising active identification according to the guidelines of nursing
practices by the Australian National Safety and Quality Health Service, (NSQHS) Standards
(Bonafide et al. 2012). These standards are encapsulated the nursing behaviour required
effective four themes that are related as evaluating the patient, Knowing the patient,
Learning, and analysis of the environmental factors affecting the health of a patient. Problems
complex in well-timed acknowledgment with reaction to medical deterioration stay complex,
however patient security trusts on nurses’ well-timed valuations and arrangements. Replying

Clinical Deterioration
to patient fall majorly summarized in these three topics, (1) non-technological skills; (2)
admittance to care and (3) adverse emotional reactions of any aspect as it patient or any other
service related to the patients. Patient in this case study was facing the illness issues and
recognition of these issues was essential for the nurses engaged in the care practices (Choi &
Emily 2016).
Case study evaluation
This essay represents the facts of Recognizing and reaction to deterioration in a complex
clients as discussed and represented in the situation of Mr Stephen Andrew Charles 50 years
old aged man died St Elsewhere hospital, South Australia. The reason identified by the nurses
for the reason behind his death was multi-organ disappointment due to acute sepsis,
pancreatitis, and generalised varicella zoster virus poison due to immunodeficiency
connected to Non-Hodgkin’s Lymphoma. Mr Stephen had a criminal and custody life as a
prisoner at St Soul’s prison for the past seven years. Mr Charles was treated with Non-
Hodgkin’s Lymphoma before 13 years of his death and had needed bone marrow transplants
in 2011 to treat this condition. Nature of Mr Charles was annoying and he used to deny the
treatment facilities provided by the prison nursing and clinical staff, he took the treatment
only when he himself felt need in his body. This nature was continuing in the hospital
treatment, he was released from the prion on 7th March feeling unwell from last 2-3 days.
However, he hides this from the nurses and doctors, his medicinal records described him to
be dehydrated, hence doctors prescribed to give him six litres of normal saline IVI over the
next 24 hours, and doctor kept him in the hospital till the sent him in the hospital for 9th
March 2015.
Research the conditions and management recommendations

Clinical Deterioration
Critical analysis of the situation of the case study includes due to major hospital admission
block and the need for Mr Charles to have isolated room. He remained in the ED until his
death, waiting for a single room in the ward was related to dis-management of the hospital,
and reflect the carelessness of the nursing staff to ignoring the basic needs and priorities of a
patient (Dickinson, Taylor & Anton 2018). Mr Stephen Andrew Charles’ medical case study
reflects a bone marrow surgery, history of dehydration and stomach abandon pain. Most
importantly, he had lived in the prison and had many issues in coordination with other
nursing staff (Giddens 2018).
After analysis of the given clinical case study, many reasons were identified responsible that
lead the deterioration in the case study. First reason was the lack of ethical and legal duties
for the patient’s safety and treatment. Nurses are responsible to treat the patient facing the
trouble but in the case of given medical study they missed it. Moreover, the biased behaviour
of Charles leads the issues causing challenges to cure for the nurses. He used to avoid
communication with the others about his disease (Hart et al. 2014). Many issues were causing
him ill health issues and he was losing his immunity to fight with the dieses that caused the
inability to move easily. These all issues result the deterioration event that ended in death of
the patient (Huston 2013).
The important patient-related complexities that contributed to deterioration and death of
Charles in the end before death him during his blood transfusion that morning removed his
blood transfusion IV line, and that resulted in significant blood loss before being rectified. In
the early hours of 12March 2015he tried to get himself out of bed. He was reported to be very
indisposed to follow requirements to stay in bed. He had additional commandeering while
trying to get out of bed and he expired at 1148 that day in status epileptics (Nelson et al.
2014).

Clinical Deterioration
Legal and ethical issues
Advanced mental expertise are indispensable capabilities for nurses linking the technically
and progressively multifaceted health precaution situation to deliver innocuous and operative
nursing care (Nursing 2020). Instructors and clinical organizers have renowned that newly
skilled nurses face difficulties to encounter the anticipations for entry level medical decision
and are held responsible for verdict satisfactory learning skills as training for such exercise
demands (Spring Silve; 2014). The issues that add to a disappointment to distinguish and
response properly to medical deterioration are compound and overlying (Smith & Roberts
2015). They contain questions about information and services of staff, the technique in which
care is provided, administrative systems, attitudes, and sharing behaviour for communication
of material. All of these aspects are essential to be addressed for patients who deteriorate to
constantly have safe and extraordinary quality care (Van Graan, Williams & Koen 2016).
Literature review
According to Van Graan, nurses are essential to train in their training with skills useful for
decision making in the critical situation identification and solution (Mayeda‐Letourneau
2014). Findings of this article are based on survey done on eleven professional nurses
employed at public, private hospitals, primary health care hospitals, participated voluntarily,
and integration of the relevant literature concludes that, basic knowledge about the clinical
judgement and decision making skills is indispensable for refining independent and blamed
nursing care (Van Graan, Williams & Koen 2016).
According to Code of Ethics, AMA, provision 4 relates the ethical and legal duties invested
in the nurses for making the effective decision in health care practices. This provision deals
with the accountability, for nursing judgements, decisions and actions requires effective
understanding (Mayeda‐Letourneau 2014). A patient in complex situation needs support and

Clinical Deterioration
nurses are in duty to provide this as it is their essential part of job (Mahnaz, Shahin &
Shahdoust 2019). Guidelines of American Nurses Association provide a base of nursing
training to the nursing organisation worldwide (Spring Silve; 2014).
According the Australian Commission on Safety and Quality in Healthcare ((NSQHS)
Standards a patient in critical situation stay in the hospital means he is depend on the nurses
and doctors (Leistner & Carlin 2019). This result that nurse are bound to treat the patients,
but many challenges are associated with a patient that leads to the clinical deterioration, One
study has recognized that 4.5% of hospital patients meet specified some level of clinical
deterioration. This identified many issues responsible for and suggested to practices essential
to involve in the critical judgement for patient (NSQH; 2008).
According to Bonafide and others, the acute weakening rate is a binding, practical contiguous
product related with in-hospital transience (Lavoie, Pepin & Cossette 2015). It has great
possible for completing current patient safety measures for evaluating RRS presentation.
Findings suggest that primary duty in critical health care is associated with the identification
of patient’s issues leading the clinical deterioration and support the nursing staff to handle the
issues and avoid the death of patient (Bonafide et al. 2012).
According to Lavoie and others, nurse’s requirements to be ready to identify marks and
indications of patient worsening so they can get help from appropriate defendants and start
saving interpolations to deliver optimum care (Jacobs 2016). Based on the reviews of
empirical studies of educational interventions, and medical research guidelines this article
define the expansion of a post-simulation learning intermediation intended at educating
nurses' and nursing students' acknowledgment and reaction to patient deterioration. This
involvement receipts the procedure of a questioning after a simulated patient deterioration

Clinical Deterioration
experience, intentions to organize nurses to identify and react to patient deterioration (Lavoie,
Pepin & Cossette 2015).
According to Akre and others, resolute staff consciousness of deterioration in patient
prominence former to the event as showed by refers, totalling of nursing tools or improved
regularity of assessment helps to decline the risk of hurdles in patients’ health care (Akre et
al. 2010).
According to Hart and others, absence of an effective structured education curriculum leads
issues to the new registered nurses to recognise and deal with the patient’s clinical
deterioration. Investigators have confirmed an absence of ample clinical cognitive services in
new graduate nurses is an issue in dangerous patient events (Hart et al. 2014).
Recommendations to improve strategies
The aspects that add to a failure to identify and reply to a deteriorating patient are compound
and intersecting. Issues that have been identified includes, absence of information of signs
and indications that might hint deterioration, inadequate to identify the importance of
outward deterioration, delay by medical staff, lack of nursing skills and training and lack of
clarity about the duties invested in (Kanaskie & Snyder 2018). To solve the issues following
are the recommendations for nurse and medical staff to including a particular system or
techniques.
Including a system that will to provide “Quick Reaction Structure and System” this system
can be used by the hospital and nursing training organisations to resolve the issues of nurse’s
incapability to identify the symptoms of clinical deterioration (Kim & Ogcheol 2020). This
system will work on the given stages:

Clinical Deterioration
Nurses will be trained to examine the patients on the base particular signs that represent the
patient clinical deterioration for example their medical history, communication behaviour and
other symptoms hidden in the patients (Burchum & Rosenthal (eds.) 2019). Sometimes
patient provide no data about medical history and hide the health issues this critical situation
need effective motivational communication with patient to identify the risk of clinical
deterioration in them (Daly, Speedy & Jackson 2017).
After identification nurses calls the staff for assistance and medical aid. They respond to
solve the issues by taking the patient in ICU, belong the medical emergency team and
providing quick services to solve the issues (Geyer 2016). These all works to solve the crisis
associated with the health of complex patient.
As same in the case of Mr Charles nurses were responsible to identify the risk associated with
him and infect he had a critical medical history that represents the crisis associated with his
health. Here nurse failed to recognise the issue and this lead the death of Charles (Giddens
2018).
Applying leadership approaches to the situation to promote alternate outcomes
Effective leadership is very important as this guides the nursing staff to perform in
professional manner in the critical situation. Application of the “Quick Reaction Structure
and System” with effective technical application nurses registers in a hospital need effective
guidance to implicate and use the steps of this system (Daly, Speedy & Jackson 2017).
Assistance available for the nurse during emergency helps to deal the decision making step
effectively ad nursing is profession that is never complete because many new challenges are
available for these partitions, to deal with these challenges nurses practice the new learning
hence effective leadership to learn the new things can help them to learn and practice
effectively (Giddens 2018).

Clinical Deterioration
Recommendations with (NSQHS) Standards
Above given recommendations are align with the (NSQHS) Standards as it focuses to include
the “Rapid Response System.” It focus to provides a tool for identifying cautionary signs that
may sign deterioration quick, developments for replying to these signs rapidly to stop further
deterioration or events, and having provisions in abode to confirm that the scheme is
acknowledged and implanted within the organisation (Smith & Roberts 2015).
Support recommendations/strategies
To apply the suggested mechanism in a hospital effectively and to solve the crisis situation
following steps are essential to process as Recognise the events and provide fast assistance to
the patients, provide personnel and tools resources to discourse the requirements of critically
ill patients in appropriate time. Begins tools to gather data and deliver response to sources,
organisers, patients, and relatives to recover responses and donate to avoidance of future
events and administrative uses of the services to coordinate effectively in such situation (Choi
& Emily 2016).
Conclusion
Based on the above discussion and critical evaluation of the case study this essay concludes
that the problem of ensuring that patients who deteriorate are difficult in some situations
where patients is not willing to accept the treatment or no proper medical history of disease
is available. Failure in recognition leads to worsening of the patient’s situation sometimes
leading the death as in the given case study. Nurses assisted with the clinical aid and facilities
are responsible to identify the issues of clinical deterioration on the first priority and then try
to solve the issues. Availability of practical guidelines and effective training helps nurses to
identify the issue quickly and apply the medical aid service more rapidly to overcome the

Clinical Deterioration
issues and save the life of the patients. This essay has suggested the mechanism important
and suitable to apply in a hospital that is matching with the mechanism and strategies
applicable and identified at Australian Commission on Safety and Quality in Healthcare
((NSQHS) Standards to deal the challenges effectively.

Clinical Deterioration
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