Legal and Professional Issues
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INTRODUCTION
Early identification of clinical deterioration is crucial for preventing the risks associated with a patient’s health condition. This essay is a critical analysis of a case study where an infant died due to unsatisfactory professional conduct by a paediatrician that was concluded during a Professional Standards Committee (PSC) hearing. A six-month-old was diagnosed with gastroenteritis and was later revealed that the baby was suffering from a bowel obstruction. However, after the decision was taken to transfer the baby by an ambulance to a tertiary hospital, the baby, unfortunately, died at the tertiary hospital. Various complaints were raised against the nurses for their failure in communicating and managing with the paediatrician changes. A PSC hearing was conducted based on various complaints, and there were several specific findings related to the case (Nursing, 2020). This essay will highlight all the specific findings, along with an analysis of the conditions that were imposed on the nurses and paediatricians.
DISCUSSION
Issue
The complaint alleged that the nurses who were taking care of the six-month-old baby failed to appropriately communicate or manage the changes regarding paediatrician change along with responses to the condition of the patients. After the death of the infant at the tertiary hospital, a finding of unsatisfactory professional conduct was made against both the nurses as a form of response to the allegations raised and a paediatrician was also charged with unsatisfactory professional conduct during a separate PSC hearing. The hearing found the conduct of the practitioners failed to demonstrate the skill, knowledge, care or judgment that is expected in nursing practices (Nursing, 2020).
The findings of PSC hearing
There were inadequate documentation and poor observation of the urinary output. The practitioners failed to maintain proper clinical records which are an essential component of good professional practice and quality healthcare delivery. The baby was initially diagnosed with gastroenteritis, and it was essential to properly observe the urinary output to which the nurses failed. In addition to that, proper documentation of clinical records can enable continuity of care and enhances communication between different healthcare professionals which was crucial in the given case study. As per the seventh principle of the Caldicott report, the duty of sharing information is equally important as the duty of protecting the patient’s confidentiality (Contributor & Contributor, 2020). Continuity in clinical notes would have been beneficial for the infant’s care, as there were various medical professionals involved in the infant’s treatment. There are three major pillars of legal obligation regarding the handling of clinical records. The first pillar is legibility and accuracy of clinical records content, the second pillar is data protection and confidentiality, and the third pillar is the access of patient’s to their medical records (Output & Brashear, 2020). Therefore, as per the PSC hearing findings, the first point of inadequate documentation and poor observation of urinary output is reflected in the practitioner’s negligence or unsatisfactory professional conduct.
The second finding suggested poor understanding of nursing care’s importance in the case of an infant’s death or assessing the urinary output’s adequacy in infants. Quality nursing care is characterized by personal caring and competence, supported by professionalism (Newborn, 2020). Quality nursing care should be the top priority for nurses as a patient’s life is dependent on nursing care. In the given case study, the nurses failed to properly access the adequacy of urinary output that can be calculated by using the formula Urine output = Total urine output/ Weight in kg * hours (MD, 2020). A decrease in urine output is common among critically ill patients; hence, it was essential on behalf of the practitioners to access the adequacy of urinary output. Amongst all the members of the healthcare team, nurses play a vital role in ensuring patient’s safety by monitoring clinical deterioration, near misses and error detection. A proper understanding of nursing’s care would have potentially saved the infant’s life as proper urinary output assessment would have given a prior indication to the deteriorating health condition. Therefore, the second finding reflects the fact that caring is one of the most important aspects of nursing practice, and any kind of negligence can lead to severe consequences.
The third finding suggested a failure in adequately recognizing and assessing the infant’s hydration status with very little importance placed on balanced fluid data. Fluid management is a vital aspect of patient care, and each patient demands careful consideration regarding their individual fluid needs (Geeky, 2020). There is an important distinction in managing fluids based on differentiating between fluid replacement and fluid maintenance. It was required on behalf of the nurses to carefully consider the size of the infant while determining the fluid maintenance rate. Nurses spend more time than any other healthcare member with the patients, and they can provide the best possible assessments of a patient’s volume status through documentation of frequent visual assessments and vital signs. In addition to that, nurses are also very helpful in assessing the ability of patients to tolerate fluids to which they failed in the given study. Since the patient was a six-month-old baby, so it was crucial for the nurses to keep a proper fluid check and maintenance (Dehydration, 2020). There are several ways to assess a patient’s volume status for determining their fluid needs, and one can often determine the fluid status of a patient through a wide range of physical exam findings and their vital signs.
The fourth specific findings included poor situational awareness and a lack of understanding regarding the potential consequences of dehydration. Dehydration is caused by a decrease in total body water content and the nurses in the given case study did not access the situation of the infant properly that leads to the infant getting dehydrated (Lumen, 2020). Water is an essential component of all living cells, and it acts as a solvent by regulating body temperature and acid-base balance. Healthcare professionals are aware of fluid balance states, and the risk of developing urinary tract infection, dental carries, renal stones and constipation increases due to dehydration. The nurses could have observed the dry lip of infant and check the hydration level that could have potentially prevented the death of the infant. Therefore, it is evident that water plays a vital role in maintaining several physiological functions, and the presence of orthostasis suggests dehydration (Diane, 2020). For a nurse, it is mandatory to have situational awareness as a patient’s health might deteriorate without any prior indication, and situational awareness can help in mitigating difficult situations (Davis, 2020). The negligence on the part of nurses caused misery and led to the six-month-old baby’s death.
The fifth specific findings include feeding of inappropriate oral feeds that were not approved by the paediatrician. The process of feeding is very complex and requires the interaction of the peripheral and central nervous systems. It is crucial to provide oral feeds based on the approval of paediatrician or else it might cause severe bad effects on the health (Center, 2020). A nurse does not have the authority to feed any oral intake without the approval of paediatrician and in the given case study; the infant was fed with liquids without the knowledge of the paediatrician. The infant was suffering from gastroenteritis, and there was sheer negligence on behalf of the nurses in terms of handling the infant’s feeding process. The feeding process for an infant is very sensitive, and the slightest of mistake can lead to severe health complications for the infant (Prevention, 2020). Therefore, it was essential on behalf of the nurses to provide paediatrician approved oral feeds. Overall, the inappropriate oral feeds might have caused a severe decline in the infant’s health as the components of the given fluid might not have been suitable for the infant.
The sixth specific finding included failure in communication with the paediatrician regarding the deterioration in the patient’s condition. There was a clear lack of communication in the case study between the nurses and the paediatrician as the patient’s deteriorating health condition was notified lately. The infant was diagnosed with gastroenteritis, and later on, the medical staff stated that the baby has been suffering from a bowel obstruction. The diagnosis was conducted late, and the paediatrician did not have any knowledge regarding the deteriorating patient’s condition. It was the responsibility of the nurses to assess the infant’s deteriorating health condition and update the paediatrician regarding the same. However, in the given case, the paediatrician came to know regarding the bowel obstruction very late, which proved to be fatal, and it resulted in the infant’s death. As per the basic ethics of nursing practice, a nurse should immediately inform the doctor regarding any changes in patient’s health as the proper in-time assessment is the most crucial aspect of medical practice (Condition, 2020). The infant faced the consequences of communication failure between nurses and paediatrician and complying with in-time communication could have potentially saved the baby’s life.
The seventh specific finding included the lack of clarification around the urgency regarding the departure of the patient from the hospital. In the given case study, the infant was transferred to a tertiary hospital because of the severe bowel obstruction, but the decision of transferring the baby by ambulance was taken late as there was a lack of clarification about the urgency of patient’s departure. The baby was suffering from a serious condition of bowel obstruction that required immediate medical attention. The nurses and the paediatrician lacked the skill of decision making that was crucial to saving the life of the infant. The main purpose of an effective emergency medical system is to provide timely medical care that can prevent death or disability (NSW, 2020). Delay in medical can be life-threatening as it happened in the given case study and the time of delay in medical care is defined as the interval between the symptom’s onset and treatment’s moment. Therefore, it is essential to have a proper understanding and clarification regarding the patient’s departure so that there is no scope of delay in the treatment in terms of serious life-threatening illness (Acem, 2020).
The eighth specific finding included inadequate communication to the ambulance service. Communication to the ambulance service is the most vital aspect in terms of medical emergencies. As a healthcare professional, it is essential to implement useful communication skill for various aspects associated with a patient’s treatment (Australia, 2020). In the given case study, the infant required immediate medical attention due to bowel obstruction, and ambulance service was a crucial factor in determining the time required for transfer to a tertiary hospital. Inadequate communication to ambulance can be a fatal issue for patients dealing with a life-threatening situation. It is essential to effectively integrate the ambulance service so that along with documentation of patient care, there is more useful and efficient information. The nurses and the paediatrician failed to satisfy the professional conduct that is expected from a healthcare professional in terms of mitigating the emergency situation. The communication was significantly below the standards of training or experience, and it raised several questions regarding the ability of clinical reasoning.
CONCLUSION
The given case study reflects the importance of proper knowledge, skill and experience required for handling difficult medical emergencies. In the case study, a six-month-month-old baby was taken to a rural hospital’s emergency department where two nurses took care of the baby. The initial diagnosis of gastroenteritis gave the baby was suffering from a bowel obstruction and was required to transfer to a tertiary hospital for further treatment. However, significant mistakes occurred on behalf of the nurses and paediatrician that claimed the baby’s life. The nurses lacked proper communication skill and did not provide oral feeding based on paediatrician’s recommendations, which was a major breach of nursing care. The decision to transfer the baby to a tertiary hospital was taken late along with inadequate communication to ambulance service that proved to be fatal by claiming the baby’s life. Overall, healthcare professionals must strictly adhere to the principles and ethics of medical practice as a patient’s health is the most sensitive aspect of medical practice. The baby’s life could have been potentially saved if the nurses had communicated efficiently with the paediatrician, and the paediatrician could have had better clarification regarding the infant’s health condition. Thus, the analysis of the given study highlights all the potential mistakes that proved costly and claimed an infant’s life.
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