Professional Practice

Introduction to Professional Practice

Patient health and safety are crucial elements of the due responsibility of healthcare professionals (Mueller et al., 2019). The primary aim of providing suitable care to the patients is based on the four primary ethical principles that include justice, non-maleficence, beneficence, and autonomy (Olinski & Norton, 2017). These principles ensure that the well being and rights to adequate healthcare of the patient are maintained. This document will provide critical analysis of a particular case concerned with the state coroner's court of the New South Wales and discuss the factors associated with the clinical incident, legal and regulatory framework and ethical issues identified in the scenario, and thereby apply the clinical reasoning to critique the nursing practice followed by the professions of the case. The document will also discuss the significance of recommendations provided in congruence with the established guidelines. 

Case Overview

An eleven-week-old boy, Esteban, died of sepsis because of late recognition and poor overview of the senior doctors. The handover and communication between the professionals were compromised that resulted in the delayed application of the intervention for the administration of the antibiotics and indicated inadequate coordination in the provision of care.

Factors Associated with The Clinical Incident

The primary factors that are associated with the case study are the patient, the system, and the nursing care provided. Esteban was born prematurely with 28 weeks of gestation and spent initial months of his care in the hospital environment (Gupta et al., 2017). Children with premature births have an underdeveloped body and require more intensive care as they are more prominently subjected to health risks. When Esteban was perceived to be unwell and was admitted at the West meads Children's Hospital (WCH), it took 20 minutes at triage for the nurse to come for an inspection. The nurses were reported by the mother of Esteban to be ignorant of their priorities for catering the patient. This indicated a poor system of function in the hospital as well as of the nurses administered for the provision of care (Lavoie et al., 2019).

A critical component of poor system organization, in this case, is the lack of adequate communication between the doctors and the nurses catering to Esteban. The signs of sepsis were detected by Dr Schofield who had acknowledged the need to test the blood samples for the administration of antibiotics. However, with the recollection of handover by Dr Clepsham a complete septic framework was introduced based on presumption. When Dr Clepsham required assistance, her call for help was not registered and translated to Dr Schofield. Lack of electronic records resulted in wrong cannulation and presumption of vitals of the patient to be within the normal range that further resulted in the application of poor interventions and resulted in failure to save the life of Esteban.

Legal, Regulatory, and Ethical Frameworks

The Nursing and midwifery Aboard of Australia have established the code of conduct that commands the healthcare professionals to work ethically and within the guidelines to ensure the well being of the patient (Bryce et al., 2017). The given care scenario serves to be an example of breach of multiple codes of ethics. The working of the healthcare professionals is obligated under the National law of Australia and is commanded under the sections 129,130,131, and 141 (Cusack, 2018). The ethical and adequate functioning of the healthcare professionals in Australia is also obligated by the AHPRA (Australian Health Practitioner Regulation Agency) that imposes the actions of legal operations and working by the healthcare professionals and functions to identify the breaches in conduct for suitable action (Cowin et al., 2019). The provided case study also serves as an example of a breach of the professional code of conduct of the registered nurses established by the Nursing and Midwifery Board of Australia. As per the first principle of the code of conduct, compliance with these laws is obligated to a healthcare professional (Forrester, 2017).

Subsection three of the first standard of the ethical code of conduct asserts mandatory reporting of critical significance. In the given case scenario, the nurses fail to acknowledge the need for the help of a doctor for catheterization and do not take responsibility for the action. The third principle in the code of conduct asserts the need for effective communication that was also missing in the scenario (Cowin et al., 2019). The fourth principle of the code asserts the importance of professional behaviour that was not exhibited by the doctor as well as the nurses (Forrester, 2017). Assessment of the patient and application of the interventions was done based on presumptions and lack of handover check. This is a major breach as it can directly impact the health of the patient and can be suggested as sheer ignorance and intended harm. Also, the nurses in the care setting failed to attend the patient on priority and caused a delay in the application of suitable intervention through lack of adequate communication (Cusack, 2017). The colleague nurses failed to correct this ignorant behaviour of nurses or take into account this unprofessional practice equivalent to a breach of principle five of the code of conduct that demands supervision and assessment of the practice of colleagues to ensure patient well being and overall better quality of care for the patient (Cusack, 2018).

Clinical Reasoning and Critique of Nursing Practice

Professional nursing requires diligence and vigilant behaviour to ensure the well being of the patients and to intend no harm in the practice. In the given case scenario, the primary cause of concern was the lack of professional behaviour and poor communication skills. It has been reported by the parent that nurses delayed the initial acknowledgement of the patient that marks a lack of professional ethics (Panigarhi et al., 2017). Instead of catering to the coffee, the nurses must have addressed the need of the patient on priority in the emergency department as an escalation of poor health can serve to be fatal and in critical cases, immediate attention is needed (Butts & Rich, 2019). The second critique of the nursing practice exhibited was lack of acknowledgement and responsibility, the doctor in charge had sought assistance in catheterization of the patient through a nurse at the site.

However, this information was never communicated to the concerned doctor. The doctor did not remember the name of the nurse who was asked to acknowledge this duty. This resulted in a further delay in care. Nurse Toole responded that he had also tried to attempt the intubation but failed. The concerned nurse should have acknowledged the given responsibility to be acknowledged for the consequences of the action. The handover was not available in reach for the doctor at the time of practice that led to poor decision making and application of wrong interventions. The nurse in the practice should have arranged for the records immediately for suitable intervention application and prevention of such fatal consequences (Butts & Rich, 2019).

Significance of Recommendations Applied

Development of the pediatric sepsis pathway by the hospital post the incidence is of prime importance as it will help by providing established guidelines and prevent clinical errors (Schlapbach & Kissoon, 2018). As the pathway is inclusive of early intervention by a senior and commencement of antibiotics with confirmed tests within one hour of presentation delay and ambiguities in the procedure will be avoided (Schlapbach & Kissoon, 2018). The availability of this document at all desks will ensure its easy reach. Suitable training of the professionals is in congruence with the code of conduct and professional nursing guidelines by the Nursing and midwifery board of Australia as it helps in skill development and enhances the competence in the healthcare professionals (Forrester, 2017). Official visits by senior doctors will help enhance the accountability of the professionals through supervision and promote diligence in practice. Presence of a rapid response team will ensure that emergency cases are treated with priority and no further delay so that cases like that Esteban are treated without any loss (Kitney et al., 2017). Presence of electronic health records like “FirstNet” by the hospital will provide availability of the patient vitals at all times to the professionals and thereby prevent incidences of clinical errors (Kitney et al., 2017). Focus on care treatment, effective communication, and availability of resources will also enhance the quality of care provided and minimize the fatalities and casualties in the premise due to clinical errors (Rahman et al., 2017). 

Conclusion on Professional Practice

This document presents a critical analysis of a case scenario of an eleven-week-old patient, Esteban who died of sepsis in the hospital premise. The case was an avoidable fatality that revealed the existing flaws in the hospital system. The document identifies the clinical factors that were associated with the case in terms of patient, system and nursing care provided. The document also identifies the course of unprofessional and unethical behaviour depicted by the care personnel involved and identifies the legal and ethical obligations associated with the case. A critique of clinical practice by the nurses and the impact of the changes and recommendations made has also been assessed in this paper. 

References for Professional Practice

Bryce, J., Foley, E., & Reeves, J. (2017). Conduct most becoming. Australian Nursing and Midwifery Journal, 25(6), 25.;dn=244867266310727;res=IELHEA

Butts, J. B., & Rich, K. L. (2019). Nursing ethics. USA: Jones & Bartlett Learning.

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328.

Cusack, L. (2017). Get to know your code before it takes effect on 1 March 2018. Australian Midwifery News, 17(4), 18.;dn=292399975990395;res=IELHEA

Forrester, K. (2018). Codes of Conduct-A New Era for Nursing and Midwifery in Australia. Journal of Law and Medicine, 25(4), 929-933.

Gupta, S., Agarwal, R., Aggarwal, K. C., Chellani, H., Duggal, A., Arya, S., ... & Gupta, A. K. (2017). Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial. The Lancet Global Health, 5(5), 501-511.

Kitney, P., Tam, R., Bennett, P., Buttigieg, D., Bramley, D., & Wang, W. (2017). Handover between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR principles: a quality improvement study/Le transfert des soins entre les anesthesistes et le personnel infirmier de l'unite de soins postanesthesiques a l'aide des principes ISAER: une etude sur l'amelioration de la qualite. ORNAC journal, 35(1), 13-26.

Lavoie, P. M., Popescu, C. R., Molyneux, E. M., Wynn, J. L., Chiume, M., Keitel, K., ... & Kissoon, N. (2019). Rethinking management of neonates at risk of sepsis. The Lancet, 394(10195), 279-281.

Mueller, B. U., Neuspiel, D. R., & Fisher, E. R. S. (2019). Principles of pediatric patient safety: reducing harm due to medical care. Pediatrics, 143(2), 649.

Olinski, C., & Norton, C. E. (2017). Implementation of a safe patient handling program in a multihospital health system from inception to sustainability: Successes over 8 years and ongoing challenges. Workplace Health & Safety, 65(11), 546-559.

Panigrahi, P., Parida, S., Nanda, N. C., Satpathy, R., Pradhan, L., Chandel, D. S., ... & Chaudhry, R. (2017). A randomized synbiotic trial to prevent sepsis among infants in rural India. Nature, 548(7668), 407-412.

Rahman, A. E., Iqbal, A., Hoque, D. E., Moinuddin, M., Zaman, S. B., Rahman, Q. S. U., ... & Kissoon, N. (2017). Managing neonatal and early childhood syndromic sepsis in sub-district hospitals in resource poor settings: improvement in quality of care through introduction of a package of interventions in rural Bangladesh. PloS one, 12(1), 0170267.

Schlapbach, L. J., & Kissoon, N. (2018). Defining pediatric sepsis. JAMA pediatrics, 172(4), 313-314.

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