Task
Read below case study and choose one of the following questions to discuss professional issues relevant to the scenario. You are expected to comprehensively discuss professional aspects of nursing practice and draw to conclusions covering all learning outcomes of the module.
James is an adult nurse who has been working for past two years in a rehabilitation centre. He has been recently promoted to act as a Junior charge nurse for maternity cover. On this particular day he was working with a newly registered nurse, Isla, who had been working in the centre for 5 months . They were working together with a very experienced HCA, Bashir, a year 2 student nurse, Fatima, and a newly appointed HCA, Jeannette, who was on her orientation week in the centre.
On delegating tasks, James told Bashir to take care of patients' personal care, and let him know if there was anything wrong with the patients, which he needed to know as he was going to catch up with his paperwork. He then asked Jeannette to "follcw Bashir around to learn from him". Bashir took Jeannette with him and asked her to first tidy the linen room and then prepare patients for bed baths.
He allocated Isla and Fatima to take care of Gloria, an 86 year-old- lady who was coming to the end of her stay in the rehabilitation centre. Isla was responsible for the patient's discharge planning. She noticed that one of her legs looked more red and swollen than usual and that she had developed a chesty cough and appeared slightly breathless. She called the duty doctor who examined Gloria and diagnosed a chest infection. The doctor prescribed some Amoxicillin and asked that the community nurses visit the patient within a couple of days of discharge to check on her condition. Isla asked Fatima to give Gloria's her antibiotic and call GP and the district nurse and inform them that a community nurse should visit her within the next couple of days to see how she was getting on. Fatima checked the oral antibiotic with Isla and they signed the prescription, Fatima left the antibiotic on Gloria's bedside table with some water for her to take it later as she was nodding off and Fatima did not want to disturb her. Fatima then called the GP practice, but the number was engaged and the line led her to an answering machine. Fatima left a message on the answering machine and told Isla that she had informed the GP practice. Gloria was discharged home at midday. Fatima found the antibiotic still sitting on the bedside table. She notified Isla to which she replied: "oh well, nothing we can do about it now, she will take the next dose as soon as she is at home". She asked Fatima to throw the tablet in the bin.
Isla handed over to James that Gloria was discharged and a request for a follow up was sent to the GP. James nodded in response and showed a thumbs up as he was busy on the computer typing a letter.
Fatima's message was not picked up till the end of GP hours in the following day. A message was left for the community nurse to visit Gloria at home the next day. Due to a high workload, the community nurse was unable to visit her until three days after Gloria's discharge. When she visited Gloria at home, she found her almost unresponsive in her armchair, with bilateral leg swelling and her clothes were wet due to excessive sweating . She immediately called the ambulance to take Gloria to hospital. Unfortunately, Gloria passed away after 12 hours.
A post mortem found the cause of death was a PE (Pulmonary Emboli) caused by undiagnosed deep vein thrombosis (DVT). During root cause analysis the Hospital informed the GP and the rehabilitation centre and asked them to follow the best practice policy and investigate the late diagnosis of DVT . The community nurse filled in an incident form and the GP informed the Clinical Commissioning Group for full clinical review. James's manager organised a team meeting in the rehabilitation centre with everyone who was involved in Gloria's core. During the meeting James blamed a" busy shift" and "Isla for not doing her job properly". Isla tried to shift the blame to Fatima for confirming that the GP practice was asked to follow up on Gloria. Fatima said that "she was only a student and she did what she was asked to do". Gloria's daughter, filed a complaint against the rehabilitation centre for not informing her that her mother was going to be discharged prior to sending her home. Had she nave been notified she claimed that she could have taken time off work to help her mother settle in and prevent her death.
Question 1: Consider the current NMC Code, relevant legislation, policies and guidelines, ethical principles and identify, discuss and analyse the appropriateness of behaviours of the nurses involved in the scenario.
Question 2: What Professional approach would you take in a similar situation if you were the registered nurse? Discuss appropriate professional behaviour, supported by the NMC code, Key ethical principles, legislation and policies and guidelines relevant to professionalnursing practice.
