Comprehensive Nursing Case Study: Patient Safety and Standards

This case study analyzes a nursing scenario involving an elderly patient, Betty, admitted with pneumonia and multiple comorbidities. The analysis highlights several clinical issues, including inadequate patient care, medication errors, and breaches of the National Safety and Quality Health Service Sta...Read More

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

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Table of Contents
Answer 1:.........................................................................................................................................2
Answer 3:.........................................................................................................................................5
Answer 4:.........................................................................................................................................8
Reference.........................................................................................................................................9

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Answer 1:
Betty has been admitted to the hospital care unit due to the fact that she has been suffering from
breathing trouble and chest congestion. After she was admitted to the hospital, the immediate
diagnosis declared that he has been suffering from pneumonia. The major clinical practice issues,
in this case, is due to the fact that Betty is an aged individual and she is currently suffering from
multiple medical concerns including hypertension, asthma, osteoarthritis and
hypercholesterolemia.
It can be said in the context that most of the people are not able to get the proper forms of
medical treatment on several occasions due to age related complications (Ackley et al., 2016).
After her diagnosis was done, she was admitted to the respiratory ward of the hospital. The ward
of the hospital has four beds and the aged lady was given the bed at the extreme corner of the
room. This will raise the clinical issues due to the fact that it will not be possible for the lady to
move freely. Moreover, as the location of the bed is much away from the nurse’s wards it may
not be possible for them to provide with immediate care during the time of emergency.
It is also important for the nurses to keep a well-maintained track and record of the
medication that has been provided to the patient (Alkon et al., 2016). Nevertheless, in the given
case it has been seen that the nursing staffs are not able to remember about the medication that
has been provided to the patient. The medication chart is one of the important medical records
that are needed in case of all future references for providing medical treatment. In the given case,
the lack of the medication chart is one of the major clinical issues. Moreover, due to her age, it
may not be possible for Betty to keep a track of her mental health. Hence, the clinical issue in

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this context is due to the fact that the nurses have to keep a track record of the activities of the
patient (Camicia et al., 2013).
It has been seen in the case that the nurse had not given the extra care that is needed to
deal with Betty in order to deal with the mental disturbance issue. It was important in these cases
for the nurse to provide the mental support and assurance to the patient that can help them during
the time of recovery. Due to the negligence of the nurse, Betty had to suffer the consequence of
laceration and suffer from high level of bleeding. This also resulted in the hip fracture of the
patient that was diagnosed from the X-ray report of the patient.
After considerable discussion with the patient’s daughter, the doctor had decided to
conduct a surgery for the fractured hip of the patient. However, four days after the surgery was
over, it was noted that the patient has not displayed much sign of improvement. On the contrary,
it was observed that bad odour was spreading from the surgical site. Hence, it can be said that
decision of conducting the surgery owing to the condition of the patient was not done in proper
manner. The clinical condition of the patient worsen due to the fact that proper care was taken
for the recovery of the patient during the period of post-surgery.
Answer 2
The standards of the National Health and Safety Standards have been issued by the health
care department of the Australian government. This was done in collaboration and coordination
with the group of the judicial commission along with that of the stakeholder groups of healthcare
(Gulanick& Myers, 2013). The main purpose of these health standards is to ensure that quality
and safety standards of the health care are being maintained and it is possible for the patients to
get the best quality of healthcare service. It is also possible to monitor the organizational

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performance of the healthcare sector and also that of an individual nurse with the help of the
parameters of these standards ("Accreditation and the NSQHS Standards | Safety and Quality",
2017).
The standard 3 of the National Safety and Quality Health Service Standards is about
“Preventing and controlling of Healthcare associated infection”. This will help to ensure that the
patients are kept in the neat and healthy environment can prevent the risk of disease from being
spread. In the given case study, there has been a clear breach of this standard. It has been seen
that there has been seen that in spite of her vulnerable condition Betty has not been kept in the
clean and safe environment within the hospital.("Australian Commission on Safety and Quality
in Health Care", 2017). Safety measures also were not incorporated during the time of surgery
that had resulted in the worsening condition in the post-surgery period.The standard of
preventing falls and harm from the falls also has been violated in the context due to the fact that
the patient has suffered from the accident during the night time. This is also the clear violation of
the standard 10 and 9, which is "Preventing Falls and Harm from the falls" and "Recognizing and
responding to Clinical Deterioration in Acute healthcare”("Accreditation and the NSQHS
Standards | Safety and Quality", 2017).Due to the violation of these code of conduct, it was not
possible for Betty to get the best care from the administration of hospital. This is due to the fact
that the nurses have not been able to respond properly according to the deterioration of the
mental condition of the patient.
The standard 4 is about “Medication Safety”. It is important for the nurse and the health
workers to keep track of the medication that has been provided to the patient that can help them
as the reference source for future treatments("Australian Commission on Safety and Quality in
Health Care", 2017). In the given case, however, the nurses have violated the protocol of this

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standard by not keeping a note of the medication that was given to the patient at the emergency
ward.Proper documentation of the medication can also ensure that safety is being maintained
while prescribing to the patients. The patient also needs to be informed about the medication that
has prescribed. This will ensure that the patient will be aware of the side-effects that are
associated and thereby able to take proper intervention steps("Accreditation and the NSQHS
Standards | Safety and Quality", 2017 and Standard, 2012).
In the given case, it has been seen that the nurses have not followed the steps of the
proper identification. It is the duty of the clinical leaders to specify the needs of the individual
patients according to their current medical condition. The nurse has not been able to identify the
case ofBetty and also the critical nature of her medical condition. This will not allow the nurse to
provide the right kind of intervention measures that are needed. Without the process of patient
identification, it may not be possible for the health workers to properly match the needed
requirements of the medical treatment process (Castellan et al., 2016).
The breaches within the clinical process and also within the safety process have
comprised the level of quality health service for the case of Betty("Australian Commission on
Safety and Quality in Health Care", 2017).
Answer 3:
It is important for the healthcare centres to avoid the breaching of the healthcare code in
order to ensure the safety of the patient.
In the case of Betty, one of the major breaches that have been identified is the lack of
patient’s safety from the nurses and other healthcare workers. In the given case, there has been a
clear breach of the standard 9 and 10 of the National Health and Safety Standards. It is important

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for the nurse of an organization to respond to medical deteriorated condition of a patient. This
can be achieved by regular monitoring process of vulnerable patient. (Morton et al., 2017). The
health care organization needs to implement the special policy that will ensure that none of the
patients had to suffer due to negligence. There are various patients admitted to the hospital, who
are more vulnerable due to their age related issues and physical or mental challenges. Hence,
they are at the risks of facing worse medical condition. Special care also needs to give for the
patients, who are being admitted to the emergency ward with critical condition. Moreover, due to
the high-pressure situation of in the emergency department, it may not be possible for the nurse
to keep a track of the medical treatment that is being provided to the patients. Hence, it is
important for the hospital management to allocate the skilled and experienced nurse to perform
the duty in the emergency ward. The nurses and the healthcare workers need to have the skill of
maintaining the record that can be used in cases similar to that of Betty for future purpose. From
the sides of the management of the hospital, it is necessary for them to improve upon the
infrastructure related to the healthcare information system. This will help the nurse and other
healthcare workers to have the ability to keep track of the medication that is being given to the
patient. The nurses also need to have sufficient knowledge about the use of the medication and
also the proper dosage that is necessary according to the current and past medical condition of
the patients. They also have to provide the efforts for the aged individuals like the case of Betty,
who is also suffering from the mental disorders. The healthcare organization need to appoint
mental health care nurses, who will have the ability to make the patient feel comfortable with the
hospital environment. It is important from the perspective of the hospital to invest in awareness
and training program for the nurses. This is one of the important steps for improving up on safety
skills within the hospital working staffs (Boyd& Sheen, 2014).

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The breach within the safety is also associated bridging the conduct of preventing fall and
the harm associated with fall. In the case of Betty, this thing is mainly applicable due to her age
and the risk of fall that is associated due to her age and limited functioning ability. It is important
to follow all the major safety protocols in order to minimize the harmful effect associated with
fall and injuries of the patient within the hospital (Moorhead et al., 2014). It is important to keep
all the vulnerable patients like aged individuals under 24-hour strict surveillance. This will
ensure that they do not have to carry out any movement activities on their own. The nurses
should have improved level of communication in order to understand the exact requirement and
trouble of the patient. This will help them to provide maximum assistance.
Nevertheless, in many cases like that of Betty, it is not possible for the patient to properly
communicate with the attending nurse due to the mental stress and poor mental ill condition.
Hence, it is important for the hospital to recruitment mental health counsellors, who will have the
ability to properly communicate with the patient and also understand their exact mental and
physical condition. In the given case, it was seen that the patient has been kept in an isolated bed
away from nurse's ward. Hence, it is important to plan properly about the location of the bed in
the hospital, which will ensure that all beds are easily accessible to the nurse and allow them to
immediately intervene during the time of emergency (Doenges et al., 2014).
There are various risks that are associated with fall. This includes the risk of injuries,
bone fracture and muscle cramps. For aged people any minor injuries can we prove fatal due to
the fact that their body does not have the capability of full recovery. Proper documentation of all
the risks that are associated with the fall is also and necessary intervention that needs to be
implemented. There also should be a strict protocol for all nurses who are responsible for
monitoring the condition of the patient. The bed of the patient especially the aged individual

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should be designed in a proper manner in order to avoid the risk of fall (Vandervoort et al.,
2014).
The fall prevention plan is one of the important accessory official steps that are needed in
order to deal with the harmful consequence and injuries that can compromise upon the health
condition of the patient. Proper equipment and instruments are the basic infrastructures that the
Healthcare institution need to have in order to provide full assistance to the physically disabled
patient, like that of Betty that can help them to prevent the consequence of fall. Quality
management planning is also an important part of fall prevention that the patients are provided
with immediate health care support in the emergency department during any unprecedented
accidents. With the help of the proper documentation, it is possible to prepare and advance
planning and duty allocation of the nurses, which will help the hospital management to identify
any negligence during the time of the accident with the patients (Elo, 2017).
Hence, with the help of proper documentation and nursing protocol guidelines, it is
possible for the Healthcare Institute to use relevant literature for helping the patient get the best
quality of health care service.
Answer 4:
In order to implement the changes in the policies for preventing any Healthcare breach, it is
important for the hospital to properly monitor all the activities of the nurses and other Healthcare
workers. The management of the hospital needs to implement proper monitoring system in order
to evaluate the performance of individual nurse (Lehne& Rosenthal, 2014).
This thing can be achieved with the help of patient survey, where every patient and the
family will be enquired about the experience they have gained from the health care service of the

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hospital and also the behavior of the nurse and Hospital staffs (Brazil et al., 2017). From the
guidelines of the nursing protocols, it is clear that proper training and guidance should be
provided to every nurse in order to ensure that they are able to properly communicate with the
patient and their family and also understand their needs. They also need to have professional
guidance in order to avoid all type of negligence is that can compromise upon the health
condition of the critical patient. They also need to have the skill of proper data documentation
that can help them to ensure full safety of the patient and use all their information of medical
history for providing future treatments (Magrabi et al., 2013).It is important for the hospital to
keep proper documentation of the National Health and Safety Standards that can help them to
deal with the all the major challenges in the healthcare service. This will also help them to easily
monitor the breach within the standards that can compromise upon the quality of the healthcare
(Matney et al., 2016).

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Reference
Accreditation and the NSQHS Standards | Safety and Quality.(2017). Safetyandquality.gov.au.
Retrieved 19 August 2017, from
https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016).Nursing Diagnosis Handbook-E-Book:
An Evidence-Based Guide to Planning Care.Elsevier Health Sciences.
Alkon, A., Rose, R., Wolff, M., Kotch, J. B., & Aronson, S. S. (2016). Health and Safety
Checklist for Early Care and Education Programs to Assess Key National Health and
Safety Standards.Maternal and child health journal, 20(1), 114-127.
Australian Commission on Safety and Quality in Health Care.(2017). Safetyandquality.gov.au.
Retrieved 20 August 2017, from https://www.safetyandquality.gov.au/
Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards
requirements for orientation and induction within Australian Healthcare: A review of the
literature. Asia Pacific journal of health management, 9(3), 31-37.
Brazil, K., Carter, G., Cardwell, C., Clarke, M., Hudson, P., Froggatt, K., ...& Kernohan, W. G.
(2017). Effectiveness of advance care planning with family carers in dementia nursing
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0269216317722413.

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Camicia, M., Chamberlain, B., Finnie, R. R., Nalle, M., Lindeke, L. L., Lorenz, L., ...& Jones, T.
(2013). The value of nursing care coordination: A white paper of the American Nurses
Association. Nursing outlook, 61(6), 490-501.
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Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014).Nursing care plans: Guidelines for
individualizing client care across the life span. FA Davis.
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Gulanick, M., & Myers, J. L. (2013).Nursing Care Plans-E-Book: Nursing Diagnosis and
Intervention.Elsevier Health Sciences.
Lehne, R. A., & Rosenthal, L. (2014).Pharmacology for Nursing Care-E-Book.Elsevier Health
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Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017).Critical care nursing: a
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