Nursing Practice Standards And Patient Care: A Case Study

The Role of Registered Nurse in Providing Patient-Centered Care

Select a recent day in clinical practice and write about incident a cardiac arrest that happened while caring for a client.

In my academic career as a nurse, I was caring for a patient of 70 years old suffering from dementia in a health care setting. At the time when I was assisting the patient with his medications, the patient suddenly collapsed by clasping his chest. The person was breathing heavily indicating shortness of breath. The patient was near fainting, when we put him in the stretcher and took him to the Intensive care unit.  

It is necessary to begin Cardio-pulmonary resuscitation (CPR) to check the breathing of the unconscious person (Hellevuo et al. 2013). A registered nurse would be competent enough to initiate the CPR before the arrival of the doctors. The enrolled nurses are entitled to keep a record of the vital signs and the medications allotted for the patient in the supervision of the registered nurse.

After the CPR I tried to optimize the ventilation and measured the oxygen saturation level of the patient. I checked and cross checked a medication that has been allocated for the patient to prevent any medication errors.

The case study reveals the patient had been suffering from dementia, which suddenly suffered from the cardiac arrest; hence I was sure while applying the antipsychotic medications that can interfere with the medicines of cardiac disease. I believe that I have practiced a patient-centered care by addressing both his cardiac and his cognitive problems. It is essential to maintain the fluid volume balance of a patient who had just suffered from a cardiac arrest (Morton et al. 2017). Hence I have continuously monitored the fluid status of the patient by auscultating the lungs. I also monitored the daily body weight of the patient and also assisted the patient to adhere to a low sodium diet. I have also looked after the psychological wellbeing of the patient by providing a non-hostile environment to the patient.

There are certain standards and codes of nursing that nurses are expected to perform competently. The standard 1 of registered nurse is to focus upon the needs of the patients that help them to think critically of the nursing practice. The nurses need to analyze critically all the available evidences that can help them to ensure maximum safety. The practice needs to be enhanced using the developed practice (Nursingmidwiferyboard.gov.au 2018). As a professional nurse it is also essential to respect the needs of every culture and use the proper ethical standards for the decision making process. Breaching of those standards may cause penalties in many cases and may affect the professional life of nurses as well as the delivery of care to the patients (Morton et al. 2017). As a nurse I should be able to avoid any medication errors or mal practice by promptly reporting of the incidents for any deviations in care. I should remain updated with the facility’s policy and the regulations. In this case I should maintain confidentiality and integrity and should also maintain the rules of disclosure during an adverse event. It is essential to abide by the nursing code of ethics and follow the principles of beneficence, non-maleficence, justice and autonomy (Morton et al. 2017). In this case study, since I am dealing with a person with dementia, situations may arise where restraints have to applied, which leads to the breaching of the nursing standard. In the given case, the nurse has breached the standard 6 of the registered nursing practice. This helps them to provide the maximum safety environment within the healthcare practice. Initially the standard suggests that it is essential to identify all forms of risks that are associated within a health care environment. A nurse should be able to extend its limitations with a goal to provide comprehensive care to the patient.

Medication Management and Fluid Balance Maintenance

Time counts a lot while handling patients who had just suffered from a cardiac arrest. In the given regards the standard 5 of the nursing practice is being implemented according to which, it is possible to implement the best plan. The entire nursing plan needs to be implemented within a fixed time frame. It was a good job on my part to assess the facial signs of the patient and to detect that the patient night be having cardiac problems and to shift him immediately in the emergency care unit. I also emphasized on initiating the CPR at the right time as a bit delay in diagnosis may cause life threatening conditions such as dysrrhythmias and death. Delay in CPR may cause the pulse to stop leading to death in patient. CPR may force the heart to pump blood and deliver the oxygen to the brain until some definitive treatment would stimulate the heart to start working (Wissenberg et al. 2012).

It is essential for the caregivers to stick to the environmental safety guidelines in order to prevent infections in hospitals that may contribute to mortality and morbidity in patients (Hellevuo et al. 2013). While handling the patient I have made sure that I follow hand and hygiene. I am well acquainted with the fact that inadequate access to hygiene services may exacerbate the disease burden. Already the patient had been suffering from a cardiac arrest and any further hospital acquired infections may deteriorate his condition.

The different health informatics that I have come across in my academic career as a nurse is the bed management systems that allow the hospitals to manage the census of their patients. Electronic portals that help the patient to give access to their health care records, radio frequency identification (RFID) that assists to track the different patients, staffs and the equipments (Coiera 2015). Health information management is believed to be one of the essential part of the nursing standard of the National Informatics Standards for Nurses and Midwives. This can help on to identify the loopholes and risks that are associated with a particular health care system.

Problem solving in nursing is one of the main factor in preventing mortality and morbidity. As a nurse firstly I had to assess whether the patient actually needed CPR. A CPR in absence of a medical officer may lead to slow chest compression rates, hyperventilation, long pauses in the CPR, yet the condition of the patient was quite delicate to wait for the arrival of the medical officer (Hellevuo et al. 2013). Furthermore taking the patient at the right time and initiating the treatment depicts a utilization of the problem solving skills (Titzer et al. 2017). Again, choosing the right types of medications in case of adverse drug reactions also requires efficient problem solving skills.

Importance of Adhering to Nursing Ethics and Standards

As a nurse I have always maintained privacy and confidentiality in preserving the health care information as many patients are concerned regarding the discrimination and the stigma associated with their diseases especially those with Sexually transmitted disease. I have assured that a privacy mechanism is maintained that will boost up the public confidence and trust in the health care system. Public liability is a part of the tort law that mainly focuses on the civil wrongs (Griffith and Tengnah 2017). As a nurse I am well acquainted with the duty of care that a patient is entitled to receive in a setting breaching of that duty of care may bring about legal charges in the patient. I have ensured that the patient is taken to emergency unit and was give the life care support at the right time to prevent fatal conditions thus maintaining the duty of care.

Nursing is a female dominant position and has always failed to attract male staffs. This can be attributed in part of issues such as pay and status. Nursing has been considered as a suitable job for women as it is like an extension of their domestic role, but in reality there is actually no disparity in the care provided by a male and a female nurse (Elliott et al. 2013). A nurse, be it of any gender should entirely focus on patient advocacy, safety and well being. Aged nurses might not be well informed with advanced technologies and may be following the conventional nursing methods instead of practicing evidence based nursing.

References

Coiera, E., 2015. Guide to health informatics. CRC press.

Elliott, M.N., Lehrman, W.G., Beckett, M.K., Goldstein, E., Hambarsoomian, K. and Giordano, L.A., 2012. Gender differences in patients’ perceptions of inpatient care. Health services research, 47(4), pp.1482-1501.

Hellevuo, H., Sainio, M., Nevalainen, R., Huhtala, H., Olkkola, K.T., Tenhunen, J. and Hoppu, S., 2013. Deeper chest compression–more complications for cardiac arrest patients?. Resuscitation, 84(6), pp.760-765.

Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Nursingmidwiferyboard.gov.au. 2018. Nursing and Midwifery Board of Australia – Registered nurse standards for practice. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx [Accessed 29 Jan. 2018].

Titzer, J.L., Swenty, C.F. and Hoehn, W.G., 2012. An interprofessional simulation promoting collaboration and problem solving among nursing and allied health professional students. Clinical Simulation in Nursing, 8(8), pp.e325-e333.

Wissenberg, M., Lippert, F.K., Folke, F., Weeke, P., Hansen, C.M., Christensen, E.F., Jans, H., Hansen, P.A., Lang-Jensen, T., Olesen, J.B. and Lindhardsen, J., 2013. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. Jama, 310(13), pp.1377-1384.