B700 Adult Nursing

Introduction

In addition to the demonstration of evidence based practice as well as compliance to patient needs of safety and disease management, effectiveness of nursing practice is also assisted with the extent to which nurses demonstrate professionalism within the workplace (Kim and Kim 2019). Professionalism in nursing practice implies the provision of quality care to patients while also complying with the ethical values of respect, accountability, integrity and person centeredness respectively (Park and Kim 2018).

Thus, with this respect, the following the paper aims to provide a comprehensive and critical analysis of a nursing incident and range of nursing behaviours which contributed to an adverse incident such as the death of an elderly patient – that is, 86 year old Gloria who was experiencing health concerns of shortness of breath and a chesty cough. To address the same, this paper will focus upon and evaluate the appropriateness of the behaviours demonstrated by the nurses in this scenario, by taking insights from evidence based practice, the Code by the Nursing and Midwifery Council (NMC), ethical principles, healthcare policies and guidelines and legislations which are relevant to the healthcare context in the United Kingdom respectively.

NMC Code

According to Standard 3.1, nursing and healthcare assistants are required to remain attentive towards addressing the wellbeing needs of the patient as well as demonstrate attentiveness during the prevention of illness and while being responsive to the changing healthcare needs and demands of the patient respectively (NMC 2015). Such standards thus demonstrate the need for nurses to not just remain vigilant towards the changing needs of patients but to also to engage in adequate healthcare, preventive or delegation practices to prevent any risks to the patient’s health and safety (Cusack et al. 2019).

In this case, it is observed that Fatima demonstrated little attentiveness with regards to her duty to ensure that Gloria had taken her medication and that the GP was informed of the need to arrange for a follow up by the community nurses respectively. Even though certain aspects like the GP’s unavailability over the phone and Gloria’s inability to take her medication were beyond the nurses’ control – Fatima however did not undertake any follow up with Gloria or inform Isla regarding the fact that a voice message was left to the GP thus demonstrate inappropriateness of nursing professionalism and violation of the NMC (2015) Code.

Additionally, Standard 11.2 of the NMC (2015) Code demonstrates the need for nurses to ensure that the healthcare professionals to whom they have delegated roles and responsibilities are supported with adequate resources and supervision so as to enable them in the provision of compassionate and safe patient care respectively. Thus, this standard implies the need for nurses holding senior levels of authority to ensure that they adequate support, supervise and assist in their team member’s ability to deliver evidence based and safe patient care practice (Charania et al. 2017). Upon close examination of the case study, it can be observed that James – who has recently been allocated with the responsibility to supervise junior nurses, contributed little effort to supervise Isla, Jeanette or Fatima in their roles and responsibilities on grounds of a busy shift – thus demonstrating his lack of professionalism and clinical appropriateness in nursing practice respectively.

Lastly, Standard 10.2 of the NMC (2015) Code necessitates the need for nurses to engage in the identification of any risks or concerns which may have emerged during their scope of practice and undertake adequate actions to mitigate the same, so as to ensure that other healthcare professionals have sufficient resources and supports to overcome such issues respectively. With this respect, it is thus important that nurses engage in continuous collaboration and communication with others, in order to ensure adequate and timely mitigation of any form of issues and concerns which may have emerged during their patient care responsibilities respectively (Clark 2017).

In this case, it can be observed that Fatima and Isla did not follow up with Bashir or James with the issues they may have faced with respect to contacting the GP or informing Gloria’s daughter of her missed medications respectively. This is in turn can be understood as a form of inappropriateness and lack of professionalism in their nursing practice since such negligence contributed to a delay in a follow up by the community nurses and the resultant sudden death of Gloria respectively.  

Relevant Legislation

The relevant legislation which is responsible for regulating nursing and healthcare professional practice is the Nursing and Midwifery Order 2001 (NMC 2021). The Nursing and Midwifery Order 2001 establishes a range of obligations for nurses and healthcare assistants to comply with, one of the primary responsibilities being the need to protect the public from disease and illness (NMC 2021). Additionally, the Care Act 2014 is key legislation which establishes the obligation of healthcare professionals to protect the elderly and safeguard them from any form of harm, abuse or neglect (Legislation UK Government 2021).

In the case of the patient Gloria, while no form of abuse was observed, it can be observed that the nurses such as Isla and Fatima as well as James overlooked the need for her to receive timely medications and follow up and even failed to communicate or inform any authority on concerns such as the missed call to the GP and her missed medications respectively. Such actions thus demonstrate a lack of nursing professionalism and appropriateness of nursing practice in the form of a violation of the Care Act 2014 and an inability to provide protection to Gloria for her existing healthcare condition as per the Nursing and Midwifery Order 2001 since the same contributed to three days of missed care from the community nurses resulting in the patient’s unfortunate death respectively (Legislation UK Government 2021; NMC 2021).

Policies and Guidelines

According to the Health and Safety Policy developed and published by the National Health Service (NHS 2017), informs the need for healthcare professionals to be provided with a working environment which is supportive and contributes to positive outcomes in their wellbeing, health and safety. Upon close examination, it can be observed that in response to complaint filed by the community nurses and Gloria’s daughter, the nurse in charge James blamed Isla for the incident who in turn, shifted the blame to Fatima.

Such behaviours thus demonstrate a lack of professionalism and appropriateness in nursing practice in the form of nurses not collaborating with each other to provide a supportive working environment but rather in the form of engaging in conflict and negligence with each other (Glasper 2017). If not controlled, this in turn can contribute to poor nursing performance, increased risk of medical errors and risks to the health and safety of the patient resulting in adverse incidents as observed in the sudden of death of Gloria respectively (Havenga et al. 2018).

Additionally, according to the Health and Safety Policy formulated by the NHS (2017), healthcare professionals and nurses have a responsibility to cooperative and collaborate with their colleagues in the compliance of safety and health responsibilities respectively. In this case, it can be observed that the nurse in charge James did not demonstrate any form of support to delegate roles and responsibilities to the junior nurses Isla and Fatima but rather shifted the blame upon them respectively. Hence, such behaviours demonstrate an absence of nursing professionalism and appropriateness during patient care practice in the form of the absence of any supportive working environment to ensure long term provision of a safe and quality healthcare services to the patient respectively (Dubree et al. 2017).

Ethical Principles

Ethics or ethical practice imply the set of moral principles and behaviours which regulate the behaviours and attitudes of healthcare professionals. In addition to complying with relevant legislations, codes of practice as well as guidelines and policies, professionalism in nursing practice is also associated with the extent to which, nurses comply with relevant healthcare ethical principles within the healthcare environment (Gallagher 2017). Non-maleficence and beneficence are two healthcare ethical principles which are highly significant to nursing practice. Beneficence is associated with the moral obligation of ensuring that the nursing interventions so implemented induce positive health outcomes in patients (Yildiz 2019).

Non-maleficence on the other hand, is associated with ensuring that nurses implement interventions which minimize the risk of harm to a patient’s health and safety respectively (Sofronas, Wright and Carnevale 2018). Upon close examination, it can observed that the lack of professionalism demonstrated by all nurses within the scenario were indicative of non-compliance towards ethical principles respectively. For instance, had nurses holding positions of considerable seniority – such as James and Bashir – been actively involved in the supervision of Isla and Fatima – then the junior nurses would have successfully been able to provide timely discharge and medication administration resulting in positive health outcomes within Gloria respectively.

Additionally, had Isla and Fatima followed up later with the GP or even James and Bashir with respect to the missed medication and the need to provide timely follow up to Gloria – then adverse incidences and harms in the form of Gloria’s untimely death would have been prevented respectively. The violation of complying with ethical principles which are relevant to nursing practice thus demonstrate the lack of professionalism and appropriateness in the behaviours demonstrated by the nurses in the case scenario respectively (Garcia-Capilla et al. 2019).

Future Implications and Recommendations for Practice

The findings obtained from the evaluation of this case study in the contest of policies, guidelines, legislations and codes relevant to nursing practice, demonstrate useful implications in the form of providing an understanding to future nurses on the ways by which they can practice professionalism within the nursing environment respectively (Wagner 2018).

Based on the findings, it is firstly recommended that nurses who are entrusted with the responsibility of leadership, demonstrate responsibilities in the form of supporting and assisting healthcare professionals and junior nurses to provide safe and quality care while delegating them with roles and responsibilities respectively (Walker et al. 2021). This can be done in the form of engaging in continuously monitoring and supervising along with collaborating with them while providing evidence based care to patients respectively. Such supervised delegation not only instils a sense of motivation and wellbeing in nurses but also inculcates a culture of professionalism wherein all healthcare workers and nurses are committed to providing long term quality care to patients respectively (Campbell et al. 2020).

Additionally, the findings of this case study also demonstrate useful implications in the form of demonstrating the need for nurses to engage in continuous feedback and interpersonal communication as a means of mitigating any errors or issues of missed practice respectively. This can be done in the form of engaging in continuous patient assessments and documentation of any issues in nursing practice which can then be referred to by other nurses and healthcare professionals respectively. Such precautionary practices will thus ensure that any risks or potential errors are mitigated in a timely manner resulting in patients receiving a safe healthcare environment (Bullington et al. 2019; Lord et al. 2021).

Conclusion

Nursing professionalism is paramount to nursing practice due to its ability to ensure the deliverance of timely and safe care to patients as well as engage in interpersonal communication and delegation as a means of mitigating any concerns or issues which have emerged in nursing care respectively. This paper provides a succinct yet comprehensive information on the extent to which nursing professionalism and appropriateness in nursing practice were complied with, within the given scenario of the untimely demise of an 86 year old female patient. Based on the findings, it was observed that a lack of professionalism in the nurses and healthcare assistants were observed in the form of their non-compliance to the Code, policies and guidelines which are relevant to nursing practice and also legislations and ethical principles which are significant within the context of healthcare. In conclusion, this case study and its evaluation in the context of relevant nursing principles and procedures, demonstrate the importance of maintaining nursing professionalism in ensuring long term positive outcomes across patients and communities respectively.

References

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