Impact of Clinical Policy and Legislation on Patient Care: NUR018-1

This report provides a commentary on a nursing case, focusing on the impact of clinical policy and legislation on patient care. The author, a nursing practitioner, describes a situation involving a patient experiencing autonomic dysreflexia due to a spinal cord injury. The report highlights the importance of clinical reasoning and professionalism in nursing practice, demonstrating how the nurse's actions, guided by policy and legislation, directly influenced the patient's safety and well-being. The commentary details the nurse's interventions, including assessing the patient's condition, informing the doctor, and implementing immediate measures to control the patient's blood pressure. It emphasizes the potential risks associated with uncontrolled hypertension and underscores the significance of patient-centered care. The report references relevant sources, including guidelines from the UK Department of Health and the Australian Commission on Safety and Quality in Healthcare, to support the discussion on quality assurance and improvement in healthcare settings. The case study exemplifies how nursing practices and standards ensure patient health and safety are prioritized, while highlighting the importance of professional conduct in delivering effective care.

Commentary

Introduction
In the UK, the emphasis on safety of patients is integrated at all the levels of education and
training for the healthcare professionals. The NHS patients expect highest standards of care
because all the individuals and organizations in the healthcare sector all over the UK region
emphasize on the safety of the patients in whatever they do (UK Department of Health,
2019). In 2014, NHS England emphasized on improving the quality by establishing 15
Patient Safety Collaborative, led by Academic Health Sciences Networks (AHSNs). To
achieve the purpose, the nursing students are provided with the education regarding the
patient experiences as well as importance of patient-centred approach to care delivery.
Case Study
One such case has been experienced by me as a nursing practitioner in the hospital in which I
am working, where, professionalism and clinical reasoning was the essential requirement.
One patient admitted to the hospital in emergency with the complaint of severe headache,
flushed feeling, blurred vision, nasal congestion and sweating. As I measured the blood
pressure of the patient, it was 190/110 i.e. hypertension (Healthwise, 2018). I informed the
doctors about the condition of the patient and meanwhile had a look on his previous reports
submitted by one of his relatives to examine the reason behind sudden increase in blood
pressure of the patient. The medical history of the patient revealed that he had spinal cord
injury above the sixth thoracic vertebrae. It triggered in my mind that the patient might have
Autonomic Dysreflexia, which is characterized by increase in the baseline blood pressure.
Because of spinal injury, the upper brain centres become unable to modulate sympathetic
discharge leading to increase in the blood pressure (Healthwise, 2018).
As I identified that the patient might have high blood pressure due to Autonomic Dysreflexia,
as a part of nursing intervention, I asked the patient to sit straight and raise head to look

ahead. I asked him to lower down his legs and to sit upright until blood pressure comes to
normal. I ensure that his clothes are loosen and took out his socks and shoes (Healthwise,
2018). I also asked him to empty his bladder and about his bowel movement because
abdominal pressures also increase blood pressure of the patient. I checked his skin for any red
spots so that any kind of pressure injury could be detected. However, his blood pressure
started going down. I informed the doctor about his blood pressure previously and in present
condition (ACSQHC, 2010). The doctor praised my presence of mind as I successfully
managed to control the blood pressure of the patient which is highly essential. Such a trigger
in blood pressure could have led to retinal detachment, stroke, and myocardial infarction and
even lead to death of the patient. In this way, clinical reasoning and professionalism assisted
me in doing my job perfectly and nursing practices and standards have been followed by me
to ensure safety and health of the patient on priority. The professionalism of my nursing
practice influenced the care being provided by me to the patient suffering from autonomic
dysreflexia.
References
ACSQHC, 2010. Patient-Centred Care: Improving Quality and Safety by Focusing Care on
Patients and Consumers. [Online] Available at:
https://pdfs.semanticscholar.org/dce8/582215a272b0a1ee7d5fad43fb1e15a59e85.pdf
[Accessed 30 August 2019].
Healthwise, 2018. Spinal Cord Injury: Autonomic Dysreflexia. [Online] Available at:
https://www.healthlinkbc.ca/health-topics/ug2980 [Accessed 29 August 2019].
UK Department of Health, 2019. Improving the quality and safety of patient care. [Online]
Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/508385/40021_UKTI_Patient_Safety_brochure_final_LR.pdf [Accessed
29 August 2019].