Professional Accountability and Patient Safety: A Case Analysis

This essay presents a comprehensive analysis of a case involving a registered nurse, Mr. Smith, and a patient at a mental health unit. Mr. Smith's actions, which included a physical altercation and inappropriate restraint techniques, led to patient injury and a breach of professional conduct. The essay examines the specific actions and omissions of Mr. Smith that contributed to the adverse outcome, highlighting violations of the Australian professional code of conduct and national competency standards for registered nurses. It further explores system-based factors, such as the lack of adequate training in aggression management and appropriate restraint procedures, that may have contributed to the incident. A literature review reinforces the importance of adhering to professional guidelines and ethical principles to ensure patient safety and maintain the integrity of the nurse-patient relationship. The essay concludes by emphasizing the need for improved training, standardized procedures, and a commitment to ethical practice within healthcare settings to prevent similar incidents.

PROFESSIONAL ACCOUNTABILITY AND PATIENT SAFETY
Professional Accountability and Patient Safety
Name of Author
Institution
Date of Submission
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PROFESSIONAL ACCOUNTABILITY AND PATIENT SAFETY
Professional Accountability and Patient Safety
Introduction
Nursing practice presents diverse and unique challenges to the nurses that can be difficult
to handle at times. However, the conduct of nurses in every presenting situation is governed by
the existing Australian nurses and midwifery professional codes of conduct as well as the
national competency standards of registered nurses (Birks et al. 2016). This case paper relates to
the case of Mr. Smith, a registered nurse who got himself into a situation while working at the
mental health unit. His conduct raised a lot of questions regarding his professionalism and
competency as a registered nurse after he causes injury and pain to a patient under his care.
Question One: Synopsis of the Case
Link:
http://decisions.justice.wa.gov.au/SAT/SATdcsn.nsf/%24%24OpenDominoDocument.xsp?
documentId=59FFDF9C16C2A1EF48257FED0018CB44&action=openDocument
The case involves a patient whose name has been withheld from the website. The patient
had been admitted at the Mental Health Unit which is a campus of Joondalup Health Campus and
located in Western Australia. The patient suffered injuries and pain, especially in their left eye
and throat. The registered nurse involved was Mr. Smith Roha. Subsequently, the State
Administrative Tribunal of Western Australia found Mr. Smith in breach of the professional code
of conduct. As such, he was reprimanded and disqualified from applying for any kind of
registration as a nurse for a period spanning one year as well payment of $1700 to the Nursing
and Midwifery Board of Australia (Nursingmidwiferyboard.gov.au 2017).
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Question Two: Actions of Mr. Smith
Firstly, Mr. Smith got himself involved in a physical altercation with a mentally ill
patient. Notably, Mr. Smith failed to exercise emotional control and professional decorum. This
is because; he clearly understood the reason why the patient had to be restrained by more than
one nursing staff. Being aware of such a mental incapacity, he was to exercise professionalism
and ethical practice principles while dealing with the patient to avoid getting into an altercation
with them. During the process, he got his arms around the neck of the patient in a way that
possibly restricted the airway of the patient. Moreover, he utilized unnecessary force by putting
his fingers into the eyes of the patient.
Secondly, Mr. Smith utilized a very inappropriate physical restraint on the patient during
the physical contact. His emotional imbalance clouded his ability to make the right decisions in a
professional manner. He sought to survival rather than respecting the health condition of the
client and taking necessary realistic actions. This was done by holding the airways of the patient.
Further, he held onto the client for too long on the ground. This was a deliberate act to punish the
patient for not behaving according to his expectations and putting up a fight with him. Mr. Smith
failed to act in a professional manner.
Moreover, by inappropriately restraining the patient and engaging in a physical
altercation, he breached the Australian professional code of conduct. According to the Australian
professional code of conduct, he deliberately failed to respect the dignity of the patient who was
receiving care. Similarly, Mr. Smith failed in his responsibility of providing safe and highly
competent care to the patient. Based on the same professional code of conduct he violated the
provision that expects him to promote the preservation of trust and privilege associated with
patient-nurse relationships. Further, he has acted unethically by not upholding the ethical
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principle of beneficence. He did not have passion to the client who was under his care, and failed
to take positive actions towards the patient. His actions were largely tainted with malice.
Further, Mr. Smith failed to act in an appropriate manner to protect the dignity and
integrity of the patient by losing control and engaging in an altercation. He violated the National
Competency Standards for registered practicing nurses. This is because he failed to fulfill his
duty and responsibility of care as expected of a registered nurse. Mr. Smith lost emotional
control quickly without thinking about alternative causes of action. He would have requested for
help from the fellow nurses who were still in the vicinity. He could have avoided the fight if only
he disengaged himself early enough from the patient upon falling on the floor. Further, Mr.
Smith failed to let the patient go upon falling on the floor. He persistently held the patient in an
uncomfortable manner for a considerable duration of time. It indicates that he was out of control.
He manifests his anger by supporting himself on a patient’s throat while getting up. Further, Mr.
Smith violated the ethical principle of autonomy by not respecting the wishes of the patient.
Hence, there was a lack of competency on his part as a trained registered nurse and non-
maleficence where a nurse is not expected to behave in a manner that can be interpreted to be
malicious and likely to cause harm to the client.
Question Three: System-Based Factors that contributed to the Action and Adverse
Reaction
The case of a physical altercation and forceful restraint surrounding Mr .Smith reveals
some systemic inconsistencies that should be addressed. First, one can note that the hospital
lacks a well laid out standard procedure for straining patients. The incidence follows a meeting
on the specified intramuscular injection to be administered as well as the required availability of
other nurses to help with the restraining. However, it seems the nurses are not prepared with
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adequate skills to handle diverse patients. This is because, at the slightest provocation, Mr. Smith
loses his temper and engages in an altercation with the patient. In his actions, he neither
manifests neither professionalism nor competency in handling such aggressive situations. There
is no evidence of professional training and development from the hospital in areas regarding
management of aggression, de-escalation techniques and conflict resolution (Elliott, Rodwell &
Martin 2017). It is important that hospitals provide training to their nursing staffs depending on
the nature of their practice (Britten et al. 2018). This was a great omission on the part of the
hospital to fail to train and assess the competency of the nurses when involved in aggressive and
conflicting situations. The omission is evident from the fact that Mr. Smith has practiced nursing
for like 30 years and could not manage a little aggression from the client in a manner congruent
to professional requirements. Mr. Smith would have been better placed and competent to handle
the patient situation after restraining them for the treatment.
The case of restraining patients by the hospital and the manner in which the patient was
restrained indicates a failure on the side of the hospital. There are numerous techniques that can
be utilized by the hospital to restrain patients in a better way. This is because the safety of both
the patient and the nursing staff should be a matter of priority (Martyn, Zanella & Wilkinson
2017). Some of the methods that can be used including the use of leather straps as a form of 4-
point restraint, sedation techniques using drugs, soft velcros as well as the use of roll-belts. It is
worth noting that restraining can only be utilized when there is no other way to handle the patient
in a manner to prevent self-harm and potential harm to others (Kinner et al. 2017). If the facility
had an alternative method of restraining the patient, there is a high likelihood the physical
altercation would have been avoided.
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Question Four: Literature Review
The pain and injury caused to the patient at the mental health unit would have been
avoided. This is because there are elaborate methods and policies that guide the actions of
registered nurses like Mr. Smith in their professional practice. Such guidelines are very clear
from both competency perspectives as registered nurses and for professional conduct
expectations (Kinner et al. 2017; Brophy et al. 2016). Under the Australian National Competency
Standards for Registered Nurses, it is emphasized that registered nurses should fulfill the duty of
care responsibility to all patients (Birks et al.2016; Terry et al. 2017). Within the confines of the
requirement, a registered nurse should at all times perform specified nursing interventions
according to the standards of professional practice. Further, the registered nurse must ensure they
adequately understand and recognize the responsibility to prevent harm from occurring to the
patient (Brown & Crookes 2016). According to the particulars of the case involving Mr. Smith,
he got engaged in a physical altercation with the patient thus causing them physical injury and
pain. Mr. Smith as a registered nurse had a responsibility to prevent such harm from happening.
He breached the competency standard requirement by placing his arm to the neck of the patient
blocking their airways as well as putting his finger to the left eye of the patient (Ossenberg,
Dalton & Henderson 2016).
Subsequently, the national competency standards stipulate that registered nurses must all
strive to maintain the integrity and dignity of the patients (Brown & Crookes 2016). By the
application of inappropriate physical restraint methods, Mr. Smith failed to maintain the dignity
of the patient. A registered nurse must at all times respect the belief and demonstrates respect to
the patients as well as appreciates the individual rights of the patient during professional practice
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(Cashin et al. 2017; Martyn, Zanella & Wilkinson 2017). By restraining the patient on the ground
for 10-15 seconds until the support nurse ordered him to get off, Mr. Smith imposed his personal
values and attitudes to the client. Imposition of such values to a client is contrary to the
competency standards of registered nurses (Gill et al. 2017; Kinner et al. 2017). Similarly, a
registered should always maintain an effective process of care in situations where they are
confronted by different beliefs, biases, and attitudes from patients. A registered nurse should not
lose sight of his professional expectations while handling patients (Brown & Crookes 2016). As
such, he violated the competency requirements of a practicing registered nurse.
Moreover, all medical professionals are guided by a strict code of conduct. The registered
nurses like Mr. Smith are under an obligation to respect and remain compliant to the professional
code of conduct as a guide to their practice (Scanlon et al. 2016). The Nursing and Midwifery
Board of Australia ensures all their associated and registered professionals follow the codes of
conduct to ensure they deliver safe practice (Halcomb et al. 2016). The codes are also supposed
to cover for all the professional behavior expectations that are expected from nurses and
midwives (Hendricks, Cope & Baum 2015). Engaging in a physical altercation with the patient
was a gross violation of the trust and privilege that existed between Mr. Smith and the patient
who was receiving care. Mr. Smith ought to have shown and manifested kindness and respect to
the patient who had been restrained for treatment. This is because the patient was in a position of
vulnerability and powerlessness as shown by their condition. If Mr. Smith had respected and
treated the patient with kindness, the incident would not have escalated to cause the patient pain
and injury (Snelling 2016).
Subsequently, as revealed by the case of Mr. Smith he failed to provide safe and
competent care to the patient. This behavior violates the professional code of conduct for
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registered nurses that require that they should all nurses must strive to be accountable to provide
safe and competent care to their patients (Birks et al. 2016; Ennis, Happell & Reid‐Searl 2015).
For instance, a nurse should be engaging in professional training to improve their knowledge,
skills, and attitudes regarding their areas of practice (Fisher 2017; Cashin et al. 2017). Further,
Mr. Smith was expected to report and reveal to the other nurses about his attitude towards some
patient behavior that he could not tolerate. He fails to admit any information about his
professional development training on his weaknesses as well as to disclose necessary information
about his emotional issues that led to his incompetence. Disclosure of such information and
undertaking a professional development training would have ensured the patient is treated with
high dignity and competency required (Best & Gorman 2016).
Conclusion
As noted above, the conduct of Mr. Smith as a registered nurse led to his suspension for
12 months. He failed to behave professionally and competently as embodied by the practice rules
in the Australia Nursing and Midwifery board code of conduct as well as the National
Competency Standards for Registered Nurses. His actions caused patient injury and pain as a
result of a physical altercation and inappropriate restraining method. Further, there were system
errors that would have prompted the reactions and subsequent injury of the patient. For instance,
the facility does not have in place professional development training to help their staffs to
improve their attitudes and skills in practice. Also, the conduct of Mr. Smith is contrary to the
ethical practice requirements of beneficence, justice and autonomy. As noted above, it is the
responsibility of the hospital management and the nurses themselves to ensure safe and
competent care is delivered to the patients.
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