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Assessment 1

Section 1: Summary

The HCCC v Ndiweni case involves Nurse Ndiweni, who faced allegations of unsatisfactory professional conduct during a specific patient care incident. The primary accusation was related to Nurse Ndiweni's handling of an Indwelling Catheter (IDC) change procedure. Nurse Ndiweni's defence centred on his assertion that he had adequately interacted with the patient, including explaining the procedure and obtaining consent. Further scrutiny revealed issues with Nurse Ndiweni's assessment of the patient's suitability for the procedure, with his admission of an incomplete assessment. In the case, concerns about the proper deflation of the IDC balloon and the angle of insertion during the procedure, both of which were sources of conflicting evidence were also highlighted.

A particularly sensitive aspect of the case revolved around Nurse Ndiweni's alleged request for another staff member to hold the patient's penis during the procedure. Nurse Ndiweni denied explicitly making this request, while the staff member recalled complying with it. Additional disputes included whether sterile water was used for catheter flushing and the inadequacy of Nurse Ndiweni's clinical notes. Lastly, concerns were raised about Nurse Ndiweni working outside his scope of practice in an aged care facility where he might not have been adequately prepared for the responsibilities. Ultimately, the committee decided to issue a reprimand to Nurse Ndiweni and imposed practice restrictions to ensure patient safety.

Section 2: Relevant professional errors

Firstly, Nurse Ndiweni's failure to conduct a thorough assessment of the patient before performing the IDC change stands out as a critical error. The Nursing and Midwifery Board of Australia (NMBA) Standards for Practice (Standard 4) explicitly requires registered nurses to carry out comprehensive assessments to ensure patient safety (NMBA, 2023). In this case, Nurse Ndiweni neglected to review the patient's medical history, perform a physical examination, or assess for contraindications, including fluid retention. This disregard for fundamental assessment protocols directly contributed to the patient's adverse outcome, underscoring the importance of adherence to these standards.

Moreover, Nurse Ndiweni's inability to recognize and appropriately manage complications during the procedure highlights another professional error. According to the National Safety and Health Quality Service (NSQHS) Standards (Standard 6), healthcare providers are expected to prioritize teamwork and communication in critical situations (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2017). Nurse Ndiweni's reluctance to seek assistance and collaborate with colleagues when complications arose not only jeopardized the patient's well-being but also violated these critical standards.

Insufficient documentation makes the problem worse. Healthcare workers must retain thorough and accurate records, according to NSW Health policy directive PD2012_069, which underlines the necessity of this (NSW Government, 2021a). Similarly, according to Standard 1.6 of the NMBA Standards for Practice, nurses must keep accurate, thorough, and up-to-date records of patient care (NMBA, 2023). The clinical notes written by Nurse Ndiweni were considered inadequate since they did not include a precise and thorough account of the surgery and the patient's state. This inadequate documentation compromises not just the continuity of treatment but also accountability as well as transparency in the provision of healthcare, constituting a breach of both policy and practice norms (Håkonsen et al., 2019).

In addition, Nurse Ndiweni's choice to work a shift in an elderly care home without first confirming that he had the required knowledge and abilities raises significant questions. To ensure patient safety, the NMBA Standards for Practice (Standard 6.2) place a strong emphasis on the necessity of nurses practising only within the bounds of their licensure (NMBA, 2023). This idea is reinforced by NSW Health policy directive PD2021_012, which emphasizes the necessity for healthcare organizations to make sure that their staff members have the education and training necessary for their positions (NSW Government, 2021b). By placing him in a circumstance where he was unprepared to provide the required care, Nurse Ndiweni's failure to follow these standards threatened patient safety.

Section 3: Future practice

First and foremost, there must be an emphasis on enhanced assessment protocols. The NMBA Standards for Practice (Standard 4) clearly outlines the significance of comprehensive patient assessment, which includes reviewing medical histories, conducting physical examinations, and considering contraindications (NMBA, 2023). In my practice, I would place a greater emphasis on meticulous assessment, ensuring that no detail is overlooked. This approach aligns perfectly with the NSW Health policy directives, particularly PD2017_032, which guides nurses in conducting thorough assessments for quality care delivery during clinical procedures (NSW Government, 2017). Another critical area for improvement is communication and teamwork. The NSQHS Standards (Standard 6) highlight the importance of effective communication and teamwork in healthcare (ACSQHC, 2017). To prevent similar incidents, I would prioritize open and effective communication with colleagues and healthcare providers, especially in critical situations. Seeking assistance and collaborating with the healthcare team when complications arise should be standard practice (Rosen et al., 2018).

Exemplary documentation is paramount. Proper documentation, following NSW Health policy directive PD2012_069 and NMBA Standards for Practice (Standard 1.6), is essential for maintaining transparency and accountability in patient care (NSW Government, 2021a; NMBA, 2023). I would ensure that my clinical notes are comprehensive, accurate, and timely, covering all aspects of a procedure, any complications, and the patient's condition.

Adherence to the scope of practice is another area that requires attention. NMBA Standards for Practice (Standard 6.2) and NSW Health policy directive PD2021_012 stress the importance of only working within one's qualifications and competencies (NMBA, 2023; NSW Government, 2021b). In light of the incident, I would adopt a more cautious approach when considering work in unfamiliar or new clinical settings. Ensuring that I possess the necessary qualifications and competencies for a specific role or clinical environment is vital to maintaining patient safety and avoiding potentially harmful situations (von Vogelsang et al., 2020).

Continuous professional development is a core component of nursing practice, as highlighted by the NMBA Standards for Practice (Standard 3.3) (NMBA, 2023). In response to this incident, I would commit to ongoing professional development to stay up-to-date with best practices and emerging guidelines. This commitment ensures that I continue to evolve and improve in my role as a nurse, ultimately contributing to enhanced patient safety. Lastly, I would actively promote a culture of safety within my healthcare institution. Creating an environment where patient safety is paramount is essential in preventing similar incidents and ensuring the well-being of all patients (Rangachari & Woods, 2020).

References

Australian Commission on Safety and Quality in Health Care. (2017). National Safety and Quality Health Service Standards. https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Håkonsen, S. J., Pedersen, P. U., Bygholm, A., Thisted, C. N., & Bjerrum, M. (2019). Lack of focus on nutrition and documentation in nursing homes, home care-and home nursing: The self-perceived views of the primary care workforce. BMC Health Services Research, 19, 1-15. https://doi.org/10.1186/s12913-019-4450-1

Health Care Complaints Commission. (2022). Health Care Complaints Commission v Ndiweni. https://www.hccc.nsw.gov.au/decisions-orders/media-releases/2022/mr-thamsanqa-ndiweni-registered-nurse-unsatisfactory-professional-conduct-and-reprimand

NSW Government. (2017). Clinical procedure safety. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_032.pdf

NSW Government. (2021a). Documentation in the health care record. https://www.seslhd.health.nsw.gov.au.pdf

NSW Government. (2021b). Recruitment and selection of junior medical officers in the NSW health service. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2021_012.pdf

Nursing and Midwifery Board Aphra. (2018). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Rangachari, P., & L. Woods, J. (2020). Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers. International Journal of Environmental Research and Public Health, 17(12), 4267. https://doi.org/10.3390/ijerph17124267

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433. https://doi.org/10.1037/amp0000298

von Vogelsang, A. C., Swenne, C. L., Gustafsson, B. Å., & Falk Brynhildsen, K. (2020). Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper. Nursing Open, 7(2), 495-502. https://doi.org/10.1002/nop2.424

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