professional practice issues
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Introduction
Nursing shift handovers are expected to be seamless, and be carried out professionally. This ensures that the quality of care given to the patient does not dip as the changeover happens, and that the patient is attended to at all times. In the case study under review, this did not happen. The patient was unattended for a time, during which he took his own life. The two nurses at the centre of the case – RN Pandya and RN Prasad failed in executing the handover properly, and in line with commonly accepted principles on such handovers. This paper will review the professional practice issues raised, the professional errors done by the nurses, and what could have been done differently to avoid this scenario.
Professional practice issues identified
The Nursing and Midwifery Board regards a comprehensive assessment of patients to be a key deliverable or registered nurses (RNs). The assessment considers cultural issues, and needs to be as holistic as possible. When this happens, the health of outcomes are invariably better – the patients will have better care accorded to them, and the nursing diagnoses and care plans to care for them will be better and patient centred. Ultimately, a comprehensive assessment of patients serves to enhance the safety of the patient, thereby reducing mortality rates, hospital stay, and rehospitalisation (Campinha-Bacote, 2011). The comprehensive assessment of Patient A would have shown the two RNs that the patient was in poor mental health, as well as other issues which were overlooked, and the knowledge of which would have arguably changed their approach in dealing with the patient, and the shift changeover.
To comprehensively assess all patients, a RN needs to maintain the capability for practice. A well-trained and educated RN need to demonstrate superior self-management, as well as timely and appropriate response to situations that require their input. This can only happen when the RN has undertaken lifelong learning, which continually exposes them to new and best practices in nursing practice, and promotes their professional development. A nursing professional who is capable of practice understands the integral role that nursing practice plays in ensuring good health outcomes for patients (Carthon et al, 2019). The nurses in the case were unable to convincingly demonstrate that they were capable to provide professional nursing care to the patient. This had disastrous effects, and ultimately cost the life of a patient. According to the analysis, it is clear that had there been better capacity on the nurses’ part, this death could have been avoided.
For nurses to ensure that their patients achieve good health outcomes, it is necessary to devise good nursing plans. These nursing plans use the best available evidence, and provide for timely and regular evaluation. At the same time, such plans should be developed in partnership. All the parties that are involved in a nursing care plan should be on the same page, constantly engaging, communicating, and sharing knowledge. The expected outcome is that the plan will not be fragmented, but will be applied uniformly and seamlessly (Bvumbwe, 2016). The manner in which the two RNs handled their patient, and managed the handover suggests that the nursing plan in place did not pass these tests. For instance, had it been done in partnership, there would have been no lapse in managing the patient, meaning that he would have been attended to at all times. Additionally, the two nurses seem to have had different approaches in dealing with the patient, which signifies the presence of a faulty, or poorly communicated nursing care plan.
Continuing education is essential to safe and effective nursing practice. Through her notes on nursing, Florence Nightingale emphasized the importance of constant learning for nurses, due to the added perspectives it added to nurses’ practice. Today, continuing education has become one of the most important factors in determining best industry practice, and acceptable standards of practice. In fact, several nursing bodies around the world have worked to facilitate easy access to education for nurses, so that they can continually improve their knowledge and capacity in nursing. Nurses must know that the accepted way of doing things is not always the best (Witt, 2011). By reviewing the circumstances of the two nurses’ conduct, it can be argued that there might have been a lapse in updating their education. This could be a reason behind the committee’s recommendation that one of the RNs undertake further education to improve his capacity, and update her skills to modern best practice.
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Professional errors
The patient handover process is an important part of the nursing care process. In many situations, it becomes one of the most important factors determining the effectiveness and quality of nursing care in health-providing institutions. Errors that happen at this stage are often costly, as seen in this case study.
One of the errors that happened in this case is the clear lack of communication between the two nurses involved in the handover. According to the report, the first nurse left the institution around 30 minutes before time, as there were other commitments to meet. This left the other nurse in a disadvantaged position, whereby insufficient or incomplete information on the patient was given. The patient had pre-existing conditions that could have encouraged the nurses to closely watch the patient. They did not do this, mainly because there was a serious breakdown in communication between the two care providers.
Once RN Prasad realised that the patient was missing, there was no serious effort to locate the patient. The nurse, feeling that there were other things to deal with, delegated this to another nurse. It was only after some moments that Prasad realised that the patient had taken his or her own life. This could have been avoided. Even if the delegation of duties may not have saved the patient’s life, it would have enabled a faster response once it became clear what the patient had done.
Current nursing practice dictates that nursing care handovers should be as seamless as possible. This ensures that harm to the patient, which could arise due to having incomplete handovers are eliminated. However, this has not always been the case. There is a need to update nurses’ understanding of this best practice, to enable them give the best possible care to patients (Disha, Sembian, & Kumari, 2016).
In many cases, a multidisciplinary team of professionals, which is keen to guarantee the best health outcomes for them, but who, due to their different focus, do not have the same information, handles patients. For instance, nurses, doctors, associate nurses, and clinical officers have different points of emphasis. However, it has been found that an integrated handover mechanism would drastically reduce the incidence of errors as was evidenced in this case. Therefore, it is necessary to have all the professionals who are caring for the patient to be in the loop regarding any changeovers, and any changes in the patient’s health condition (Estryn-Behar et al, 2014).
Points learnt from case
Increasingly, interprofessional collaboration in healthcare delivery is becoming a key aspect of quality patient care. A well-functioning healthcare system or institution requires the cooperation of various professionals, all focused on a single goal. According to Karam et al (2018), there are several conceptual frameworks that have been devised to ensure that healthcare professionals are on the same page regarding patients, and that their combined efforts help, rather than negatively impact, patient safety and health. As a nursing professional, this case has made this issue vividly clear. It is important that interdisciplinary and interdisciplinary collaboration be fostered to ensure high quality care. Beyond patient safety, this collaboration significantly reduces healthcare costs, and the overall expense of public health.
Crucial to ensure that the patient handover process is as seamless as possible. This can only happen when the nurses involved have a full understanding and appreciation of the importance of carrying out handovers effectively. Handover interruption has been found to be a significantly negative influence on patient care (Gleicher, Mosko, & McGhee, 2017). Patient handovers that are not well done increase medical errors happening, where patients are either misdiagnosed due to lack of sufficient information, or given the wrong medication. In this case, it could create a lapse, which could harm the patient, sometimes fatally.
Nursing practice should always be evidence based. As noted earlier and quoting Nightingale, what is currently accepted is not always the best way of doing things. In many cases. What has been taken for long as the gospel sometimes falls short of best practice, especially when taken through a rigorous evidence – based examination. It is clear that in the case of the two RNs, Prasad and Pandya, there was little reference to evidence on the best way of dealing with patients, especially those that have mental health issues. The correct means of handing over the patient would have ensured that at all times, the patient was closely watched, and any issues regarding their temperament or other character be immediately communicated.
Conclusion
The integration of evidence-based models in nursing has been ongoing, and has increasingly dominated nursing discourse. Simultaneously, nurses are expected to always stay up to date. They need to educate themselves in the newest practices, while looking for the best new evidence on how to deal with patients. As this happens, nurses understand the expected levels of practice expected of them. More importantly, they understand how these standards help improve patients’ health outcomes, and their shortened stays in hospital.
References
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Disha D., Sembian, N.,Kumari, V. (2016). Effectiveness of shift handover guidelines on handing over practices and work related concerns among staff nurses in adult intensive care units. International Journal of Medical and Health Research, 2(2), 21-24.
Estryn-Behar, et al. (2014). Shift Change Handovers and Subsequent Interruptions: Potential Impacts on Quality of Care. Journal of patient safety. 10. 29-44. 10.1097/PTS.0000000000000066.
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Karam, M., Brault, I., Van Durme, T., & Macq, J. (2018). Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research. International journal of nursing studies, 79, 70-83.
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