Nursing Case Study: Analysis of Professional Errors and Practice

This case study analyzes the professional nursing practice of a registered nurse in the care of an 81-year-old patient admitted to the hospital with breathlessness and other symptoms. The case study details the patient's declining health, the nurse's actions, and the eventual diagnosis of a urinary tract infection that led to septicemia and the patient's death. The assignment critically examines the nursing practices, identifies several professional errors, and discusses how these errors contributed to the patient's deteriorating condition. The analysis references key standards, including the NMBA and NSQHS standards, to evaluate the nurse's actions regarding patient assessment, medication administration, and communication. The study emphasizes the importance of critical thinking, therapeutic relationships, and timely diagnoses in professional nursing practice, concluding with implications for future practice and how the nurse's behaviors could have made a difference in the patient's outcome. The assignment also highlights the need for proper assessment, communication, and adherence to established nursing standards to prevent similar incidents in the future.

Running head: BACHELOR OF NURSING
BACHELOR OF NURSING
Name of the Student
Name of the University
Author note

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Criteria 1
The practices of the registered nurses involve person centered care and evidence based
care with different measures consisting of curative, preventive, formative restorative and
palliative. However the nurses also create certain professional errors which can contribute to
different serious incidents regarding health conditions of the patients (Parker & Hill, 2017). The
registered nurses have to work both in therapeutic relationships and in professional relationships
with the individuals, with the patients and also with the family members of the patient (Jones,
Shaban & Creedy, 2015).
The given case study is about an 81 year old patient who came to the general practitioner
regarding the problem of two nights of breathlessness even lying flat and shortness of breath.
After diagnoses, the patient was found to show fine crepes at lung base and increase in the
jugular venous pressure. The health condition of the patient was sill same even after she was
administered with oral Lasix. The chest x-ray report and the blood tests reported that she had
diarrhea and the tenderness on the right side of the abdomen. The patient was suffering from
dizziness and depression and was becoming anxious quickly. She was showing abnormal
respiratory rate of 40/minute, which is quite high than the normal value of respiratory rate. On
the 11 January the patient was found to unable to void, the patient was looking pale and grey and
was also suffering from clammy skin and nausea. The doctor after watching this symptom
ordered for the abdominal x-ray and the other pathology test. The patient was also suffering from
back pain and abdominal pain and the count of the white blood cells also got increased to 17.5
though the patient was not suffering from fever. Finally the patient was diagnosed with urinary
tract infection. The registered nurse was taking care her but still she was becoming weak and the

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respiratory rate of the patient increased to 40- 44/ minute. Finally it was confirmed that the
patient was suffering from continual diarrhea.
Criteria 2
According to the standards of practices of the registered nurses, the registered nurses
should think critically and also must analyze the nursing practices properly, must engage in the
therapeutic as well as professional relationships, develop the nursing practices, prepare the
nursing plan and perform the nursing practices comprehensively (Scanlon et al., 2016). However
in the given case study, the patient had to suffer a lot because of the negligence, lack of
knowledge about the therapeutic processes as well as lack of the knowledge about the diagnoses
of the disease. According to NMBA Standards of practice 2016, the nurses must engage properly
with both the professional and therapeutic relationships but the nurse of the case study did not
maintain this.
Some professional error identified in the case study are, she was advised to do the scan
of lung when the patient was suffering from diarrhea and slight tenderness in the right side of the
abdomen. The patient was applied with digoxin and valium in order to reduce the problems of
heart and valium in order to reduce the anxiety, but the respiratory rate of the patient was still
40/mint. The respiratory rate had thus increased rather than decreasing. According to National
Safety and Quality Health Service Standards 2012 the nurses are supposed to provide the patients
with proper medications with appropriate dose. So this standard has been violated (Gilbert et al.,
2017). Previously the respiratory value was 28-30, but after the application of those medicines it
had got increased (Westra et al., 2015). So the doctors may be have applied the wrong medicines.
Even new medicines were even not administered when it was found that the medicines were not
working. The patient was suffering abdominal and lower back pain because of urinary tract

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infection. During the initial stages, the patient was admitted to the hospital because of the
breathlessness and was diagnosed for the breathing and the respiratory problems but proper
medications were not prescribed to her. The inappropriate medicines and the negligence of the
hospital authority led the patients to acquire intestinal infections. Another error was that, it was
too late to treat the dehydration condition of the patient, the doctor came at the end of the night to
check the patient. After that the patient was supposed to send to the rural hospital but she died in
the next morning only and it was found that she died because of septicemia (Neuss et al., 2016).
The nurses should not have delayed the treatment of the urinary tract infection. Proper treatment
should have prevented the patient from septicemia. According to National Safety and Quality
Health Service Standards 2012, the patient was supposed to receive comprehensive care, but it
was not provided.
According to the standards of practice for the registered nurses, one of the
important aspect of the nursing activities is the proper engagement in both the therapeutic and
the professional relationships (Fisher et al., 2016). In the given case study, the nurses were
completely out of focus of their practices. They were even not confident about the diagnoses of
all the diseases. The health condition of the disease declined mainly because of the lack of proper
diagnoses. Being a professional nurse, a nurse should also have communicated with the patients
in order to ascertain about the different issues that the patient is suffering from. The nurse did not
followed the communicating for safety standard of the NHQHS standards.
Criteria 3
This learning will surely help the nurses to change the professional nursing practices. The
case study has portrayed about how the heath conditions of a person can decrease due to
providing the patients with inaccurate treatments. Another important aspect of the nursing

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practices is the proper diagnoses of the diseases and that also at the right time (Laverty,
McDermott & Calma, 2017). The registered nurses have to work both in therapeutic
relationships and in professional relationships with the individuals, with the patients and also
with the family members of the patient (Jones, Shaban & Creedy, 2015).
In the case study, it is seen that the registered nurse after checking the condition of the
patient commented that the health condition of the patient deteriorated because of the negligence
of the hospital and also because of the unavailability of the equipment required for the treatment
of the patient (Birks et al., 2016). If a patient has been diagnosed with proper tests but at the
wrong time then the patient is surely not going to receive the right treatment. So the nurses and
the doctors should never delay in diagnosing the patient. The urinary tract infection of the patient
was identified much later, if the disease would have identified before only, then the treatment
procedure of the patient would have started long ago only. According to the NMBA Standards
for practice, 2016, the nurses must engage properly with both the professional and therapeutic
relationships but the nurse of the case study did not maintain this.
Nothing was mentioned in the case study about the communication of the nurses. The
effectiveness of the therapeutic and the professional relationships are also determined by proper
communication with the patient and also with the family members of the patient. If the nurses
communicate with the patient with much care and politely, then it would become easier for the
nurse to know about all the health issues of the patient (Ratwani et al., 2015). The nurse in this
case did not followed the communicating for safety standard of the NHQHS standards. In future,
the nurses must become concerned about the relation in between the diseases. Every diseases
must be treated at the acute conditions, if the disease becomes chronic then it will become
difficult for the nurses to treat that disease along with the patient may get acquired with other

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diseases also which can lead to the death of the person (Hepburn et al., 2015). According to
NMBA Standards for practice 2016, the nurses must conduct the assessments comprehensively
but in the case study the nurses failed to conduct proper assessment. The nurses must thoroughly
follow the nursing practices set by the NSW health policy documents. Proper assessments of the
patients and preparation of appropriate nursing plan are the most important aspects of the nursing
practices. In future the nurses must focus on this so that they can become efficient in their
profession.

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