Case Study Analysis: Nursing Care, Standards, and Safety

This case study analyzes the care of an 85-year-old woman, Daisy Mayes, admitted to the hospital with pneumonia and a fractured femur. It identifies several clinical practice issues, including inadequate wound care, lack of an advanced care plan, medication documentation errors, ineffective communication, and patient falls. The analysis highlights breaches of nursing standards and National Health and Safety Standards, particularly regarding safe and responsive care. The case study recommends addressing these issues by improving wound management, ensuring patient proximity to the nursing station, providing constant patient supervision, and implementing electronic medication records. Further recommendations emphasize frequent follow-ups, wound cleaning, delegation to specialized nurses, increased staffing, and improved medication documentation to enhance patient safety and prevent future adverse events. The case study underscores the importance of adherence to nursing standards and national safety standards in healthcare settings.

Running head: CASE STUDY 1
Case Study
Name
Institution

CASE STUDY 2
Case Study
Question 1
From the provided scenario, it is mentioned that Daisy was presented to the emergency
department with pneumonia and a chest infection. Several clinical practice issues are
encountered in the hospital during the care delivery to improve the health outcomes of Daisy.
Clinical practice issues may be defined as the problems experienced in the delivery of care
services (Cherry & Jacob, 2016). Clinical issues from the case study include being placed in a
bed in a wardroom that was far away from where the nurses were stationed. Another issue was
that Daisy lacked an advanced care plan. The lack of an advance care plan puts one at risk of
receiving care that may go against their wishes and values (Houben, Spruit, Groenen, Wouters &
Janssen, 2014). Additionally, Daisy’s morning medication is not documented as required thus
making it difficult to track her adherence to medication. Furthermore, the nurse in charge fails to
contact Carol regarding the worsening condition of her mother Daisy even after she had made a
request to be contacted. Another clinical issue is that Daisy was left in the ward alone at night
when she fell and had a laceration on her forehead and a broken hip. Finally, lack of constant
follows up post-surgery led to the worsening of Daisy’s wounds that resulted from infections.
Standards of nursing are important because they guide the practice of nursing to ensure safe care.
From the provided case study, some nursing standards were breached. The second standard of a
registered nurse requires a nurse to engage in therapeutic and professional relationships through
effective communication and respect for the values and rights of an individual (Jones, Shaban &
Creedy, 2015). The nursing staff, however, failed to practice effective communication when they
failed to inform Carol of Daisy’s worsening condition. Another nursing standard that was
breached in the case study is the provision of safe, appropriate, and responsive quality nursing

CASE STUDY 3
practice (Jones et al., 2015). The nurse in charge of caring for Daisy, however, breached this
standard by leaving her unattended to. As a result, Daisy got disoriented and removed her
oxygen mask putting herself in danger. After being attended to, the nurse again left her alone and
she fell off her bed leading to a laceration on her forehead and a rotated right foot ankle.
The National Health and Safety Standards provide a statement that is consistent across the entire
nation to ensure that consumers of healthcare receive the best available care from healthcare
organizations ("The NSQHS Standards | Australian Commission on Safety and Quality in Health
Care", 2019). The clinical practice issues identified above indicate that some National Health and
Safety Standards were breached. One of them is the comprehensive safety standard that ensures
that patients are prevented from harm during care delivery. This standard ensures that patients
and their families receive care that suits their needs ("The NSQHS Standards | Australian
Commission on Safety and Quality in Health Care", 2019). This standard was therefore breached
when the patient was left alone thus experiencing a fall that led to a laceration on her forehead
and a broken hip. Another standard is communicating for safety that ensures effective
communication between healthcare practitioners and patients and their families. This standard
ensures that communication is timely and driven by a purpose to guarantee patient safety ("The
NSQHS Standards | Australian Commission on Safety and Quality in Health Care", 2019). It is
worth noting that communication is needed throughout the delivery of care and especially in
high-risk situations.
Question 2
The clinical issues presented in the scenario must be addressed to ensure that Daisy’s condition
gets better. The first issue that must be addressed is healing her wound that developed after a hip
surgery. Wound infection after surgery may cause excessive fever, too much pain from the

CASE STUDY 4
wound, loss of ability to move, redness and swelling around the wound, and a hot skin around
the area of the wound (Lindeque, Hartman, Noshchenko & Cruse, 2014). The second issue that
must be addressed involves placing Daisy in a wardroom close to the nurse’s station. This
ensures that the nurse in charge of care for Daisy can respond promptly to calls for concern and
ensure that no harm comes to the patient while in care. The third issue to be addressed is
ensuring that the nurse in charge is always around Daisy or delegate the responsibilities to other
clinicians when they cannot be present themselves. This will ensure that maximum care is
provided so that Daisy does not experience another fall in the future (Singh, Okeke & Edwards,
2015). The last and final issue that can be addressed is documentation of medication. The
nursing staff failed to document Daisy’s medication and therefore it became difficult to identify
whether she had taken medication or not. According to Blignaut, Coetzee, Klopper & Ellis
(2017), documentation helps in preventing medical errors that may put the safety and health of a
patient at great risk.
Some recommendations to ensure the reoccurrence of the above clinical issues are necessary for
ensuring that the safety of patients in the healthcare facility is guaranteed. Frequent follow-ups
and wound cleaning and management are important in ensuring that wound infection does not
occur. Wounds must be kept as clean as possible to prevent infections. This can be done by using
the non-touch technique during wound dressing or undressing (Anderson et al., 2014).
Additionally, the hospital could delegate issues regarding wound management to tissue viability
nurses who have the required expertise in handling post-operative wounds. Wards should also be
situated close to nurse’s stations to ensure that they can respond to calls from patients as soon as
possible. This also ensures that the patients receive the best available care thus improving their
safety and preventing harm and injuries (Reiling, Hughes & Murphy, 2019). Furthermore, to

CASE STUDY 5
ensure that patients always have nurses attending to them in the wardrooms, it would be
necessary for the hospital to employ more staff. Understaffing is a serious problem in most
healthcare facilities that leads to a low quality of care (Glette, Aase & Wiig, 2017). Therefore,
increasing the number of staff in the hospital can help in ensuring that the ratio of doctor to
patient is in line with WHO recommendations. As a result, the quality of care is improved and
the safety of patients is guaranteed. Finally, documentation of medication administration is also
important in ensuring that all the records about every drug are kept to avoid the possibility of
drug duplications. This could be done by using an electronic medication administration record to
help in tracking and recording the administration of medications electronically (McComas,
Riingen & Kim, 2014).

CASE STUDY 6
References
Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L.,
... & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care
hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.
Blignaut, A. J., Coetzee, S. K., Klopper, H. C., & Ellis, S. M. (2017). Medication administration
errors and related deviations from safe practice: an observational study. Journal of
clinical nursing, 26(21-22), 3610-3623.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
Glette, M. K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and
patient safety in hospitals-A literature review with thematic analysis.
Houben, C. H., Spruit, M. A., Groenen, M. T., Wouters, E. F., & Janssen, D. J. (2014). Efficacy
of advance care planning: a systematic review and meta-analysis. Journal of the
American Medical Directors Association, 15(7), 477-489.
Jones, T., Shaban, R. Z., & Creedy, D. K. (2015). Practice standards for emergency nursing: An
international review. Australasian Emergency Nursing Journal, 18(4), 190-203.
Lindeque, B., Hartman, Z., Noshchenko, A., & Cruse, M. (2014). Infection after primary total
hip arthroplasty. Orthopedics, 37(4), 257-265.

CASE STUDY 7
McComas, J., Riingen, M., & Kim, S. C. (2014). Impact of an electronic medication
administration record on medication administration efficiency and errors. CIN:
Computers, Informatics, Nursing, 32(12), 589-595.
Reiling, J., Hughes, R., & Murphy, M. (2019). The Impact of Facility Design on Patient Safety.
Retrieved 3 October 2019, from https://www.ncbi.nlm.nih.gov/books/NBK2633/
Singh, I., Okeke, J., & Edwards, C. (2015). Outcome of in-patient falls in hospitals with 100%
single rooms and multi-bedded wards. Age and ageing, 44(6), 1032-1035.
The NSQHS Standards | Australian Commission on Safety and Quality in Health Care. (2019).
Retrieved 3 October 2019, from https://www.safetyandquality.gov.au/standards/nsqhs-
standards