• Subject Name : Nursing

The Impact of Risk Management Culture on Mental Health Nursing Practice

People who are diagnosed with the mental disease are more at risk than the people having any other diseases. Most of the dangers to these diseased people are from having psychosis, anxiety disorder and mood disorder. Many people also lost their lives who are suffering from mental disorders. Unnatural deaths are the major reason for mortality in these individuals such as committing suicide. Therefore, for the prevention of such incidents, mental healthcare nurses should have knowledge, confidence and skill to handle the situations which involve the patient who is suffering from mental diseases. Nurses could observe the risks and can act to reduce them so that patient safety could be remained intact (Dickens et al., 2019). In the case of a registered nurse (RN) Pandya and RN Prasad, various mistakes have been committed by them. Because of these errors, one of the patients committed suicide and therefore legal actions were taken against both the RNs. 

The first mistake that was performed by RN Pandya was that he failed to tell his team leader Ms Khan that he was leaving early from his shift by half an hour. He mentioned that after coming to work he communicated his concern to Ms. Khan and in response, Ms. Khan said that it will be okay for him to go but Ms. Khan denied saying this. She stated that she told him the different thing that it would be all right if he arrived at 3:00 PM. It is evident that there was a miscommunication between the two individuals. Also before leaving, RN Pandya did not mention again his departure to his team leader. He thought he had already told Ms. Khan about his early departure from the ward in the morning and that's why he left without telling her. This mistake would have been avoided if the nurse would have worked according to the Nursing and Midwifery Board Australia (NMBA) standards. The standards clearly outline that the nurse should think clearly before taking any decision as it can have a direct impact on the diseased individual under his care. The nurse should analyze his practice so that changes can be made and better quality of care can be provided to the patients (Nursing and Midwifery Board APHRA, 2020). With the help of critical thinking, nurses could actively participate in the treatment of the patient and can analyze and synthesize the collected data and information by using observation, communication and experience (Papathanasiou et al., 2014). Therefore, it would ultimately enhance patient safety.

Another mistake that was performed by RN Pandya was he acted inappropriately while leaving the mental ward unit on the day of his patient committed suicide. He did not obtain permission before leaving the unit and also did not check with his team weather the arrangements are satisfied or not. He also did not handover the details to the relevant person and leaves the floor knowing that the staff will be short in number. With that RN Pandya also did not make the necessary observation of the patient behaviour before his departure from the setting. These mistakes would have been rectified if RN Pandya would have worked according to the National Safety and Quality Health Service (NSQHS) standards. If the nurse would have identified the risks that were involved then the patient life could be saved. He could have used clinical and other data to support the assessment that he has made for the probable danger. The nurse could also reduce the danger by involving techniques. He could also enhance the effectiveness of the system which involves risk management. He could also have reported about the risks to his team leader or any other person who have authority. With that, he could also have managed and plan for the emergency situation that could risk the life of the patient (National Safety and Quality Health Service, 2017). The nurse could also use multiple strategies so as to reduce the risk that is by close observation, door locking, seclusion and defensive nursing practices. The nurse could also provide meaningful treatment to the client by giving them person-centred care (Slemon, Jenkins & Bungay, 2017). Thus, by observing and managing the risk, this accident would have been prevented.

Another mistake that was committed by RN Pandya was that he failed to deliver the handover. He admitted that before leaving the mental healthcare setting he did not provide the other nurse with the handover and moreover, he did not talk to RN Tint about the mental state of the patient. He also did not wait to make sure that RN Tint has taken the responsibility of the concerned patient or not. This mistake would have been corrected if RN Pandya has provided RN Tint with the appropriate hand over so that he could have examined the condition of the patient in an appropriate manner. In NMBA guidelines, it is stated that the nurse should document and determines the future goals and aims of the treatment with a relevant person. The nurse should also revise the treatment plan after he completes the evaluation. With that, it is the responsibility of the nurse to monitor or evaluate the results and goals which are expected (Nursing and Midwifery Board APHRA, 2020). Providing handovers help in reducing the risks and errors that can be made while taking care of the patient. It also enhances the communication process. Nurses also gain about the background information and all the necessary details about the patient at the same time which helps them to make the assessment more quickly (Kumar et al., 2016). Therefore, if the nurse would have documented and provided handovers to the relevant person then the mistake would have been prevented.

The major mistake which was committed by RN Prasad was that she signed the observational records inappropriately. She signed the document without having interaction with the patient and also she did not make the required observations at the correct intervals. This error in the care would be prevented if the nurse would have worked under her scope of practice and would practice nursing under the relevant guidelines, regulations, policies and standards. If the nurse would have effectively supervised the patient then his life could be saved. The nurse would also identify the probable risk or danger to the patient and would have reported it. This event could also be avoided if assessments are done in a holistic way (Nursing and Midwifery Board APHRA, 2020). If the nurse would have followed the rules and protocols then also patient condition could be known and better steps could be taken to prevent the suicide by the patient (National Safety and Quality Health Service, 2017). Continuous observation helps in decision making and also facilitate in finding risky behaviour among the patients. It also helps in delivering care which is patient-centred and thus, increases the safety of the patient (Barnicot et al., 2017). Therefore, the error could have been rectified if RN Prasad has made the correct observation at the appropriate time and would have worked under the guidelines and legislation by the following protocol.

After reviewing the whole case and finding the mistakes of both the nurses who are involved, various lessons for future practice have been known. So for the future work, it is necessary that various strategies and techniques are used so that the best decision could be made for the benefit of the patient. It is also important to provide safe quality care to the patient by making decisions after reviewing the best available material. The care which should be given to the patient should also be focused on the patient and his well-being. There is also a need to create an environment of safety and should engage with the patient via a therapeutic relationship. It is also crucial that all the guidelines are followed and work is done under the legislation. With that, proper documentations are also significant (Nursing and Midwifery Board APHRA, 2020). Moreover, for the future, it is important to show clinical leadership at the workplace so better results could be achieved and quality improvement could be done that will directly impact the patient safety and would provide him with more comfort. Management of risk should also be focused so that threats to patient safety could be identified in advance and steps could be taken to reduce the danger or eliminate it (National Safety and Quality Health Service, 2017).

In conclusion, it can be said that if RN Pandya and RN Prasad have followed the rules and protocols then the accident could be saved. Both the nurses could have worked according to NMBA guidelines and NSQHS standards. In addition to that, if RN Pandya did not leave the facility early or have informed his team leader properly and did complete documentation by providing the handovers then the suicide could have been prevented. Moreover, if RN Prasad has done an examination of the patient at the right time then also the incident could be prevented. For the future practice, it is important to work in accordance with the guidelines, policies and procedures so that adverse events like these did not happen again.

References for Safety in Psychiatric Inpatient Care

Barnicot, K., Insua-Summerhayes, B., Plummer, E., Hart, A., Barker, C., & Priebe, S. (2017). Staff and patient experiences of decision-making about continuous observation in psychiatric hospitals. Social Psychiatry and Psychiatric Epidemiology52(4), 473–483. https://doi.org/10.1007/s00127-017-1338-4

Dickens, G. L., Ion, R., Waters, C., Atlantis, E., & Everett, B. (2019). Mental health nurses’ attitudes, experience, and knowledge regarding routine physical healthcare: Systematic, integrative review of studies involving 7,549 nurses working in mental health settings. BMC Nursing18(1), 16.

Kumar, P., Jithesh, V., Vij, A., & Gupta, S. K. (2016). Need for a hands-on approach to hand-offs: A study of nursing handovers in an Indian neurosciences center. Asian Journal of Neurosurgery, 11(1), 54. 10.4103/1793-5482.165776

National Safety and Quality Health Service. (2017). National Safety and Quality Health Service standards. Available at https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Nursing and Midwifery Board Aphra. (2020). Available at https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. Acta Informatica Medica: AIM: Journal of the Society for Medical Informatics of Bosnia & Herzegovina: Casopis Drustva za medicinsku informatiku BiH22(4), 283–286. https://doi.org/10.5455/aim.2014.22.283-286

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry24(4), e12199. https://doi.org/10.1111/nin.12199

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