Appropriate Incident Analysis

At change of shift, a nurse who is working days in a nursing home is told by the night nurse, “Mr. Jones is always tied in a vest restraint at night, just to make sure he doesn’t get out of bed and fall, but he’s really upset. He just doesn’t understand it’s for his own good.” The nurse quickly reviews Mr. Jones’s record. He is noted to be a competent, compliant adult, without a psychiatric history or evidence of mental disorientation. He takes no medications that would alter his mentation. When the nurse enters the room, Mr. Jones is weeping. He states, “I feel like a criminal being tied up. I’ve urinated in my bed because no one answered my call light. I’m so

The facts of this case are that Dr. Guiles who is self-conscious of his prostate cancer diagnosis is treated horrendously when he finally decides to have surgery ( Buchbinder, Shanks & Buchbinder, 2014). Considering that Dr. Guiles is already sensitive about his condition, his unbearable symptoms are not helping matters (Buchbinder et al, 2014). Upon arrival at the hospital, he is treated subpar. The admitting clerk is rude and unbecoming to a patient who isn’t feeling well and who is embarrassed about his sickness (Buchbinder et al., 2014). To make matters worse, he has to find his own way up to the floor by walking, which causes him to be even later in checking in because of the need to stop frequently to urinate as well as having difficulty in walking (Buchbinder et al., 2014). Once he arrives on the floor, the charge nurse is not welcoming and unprofessional (Buchbinder et al., 2014). After figuring out what to do with the paperwork; and the nurse aide delivers Dr. Guiles to his room, the nurse aide does not offer to help settle him in (Buchbinder et al., 2014). Therefore, Dr. Guiles is faced with battling obnoxious family members who are on his bed and to make matters worse someone is in the bathroom which doesn’t help his need of having to frequently urinate (Buchbinder et al., 2014). When the issues are brought up to the charge nurse, the charge nurse accuses Dr. Guiles of wanting preferential treatment

I returned to the recovery ward, my patient was still hypertensive and tachycardic and I felt by assessing her non-verbal signals of communication that she was still in great discomfort. After 15 minutes of no improvement I returned to theatre to see the anaesthetist, I explained that I was not happy with the patient’s level of pain and requested that he come to the recovery ward to assess the patient. He reluctantly came to the recovery ward and after spending a few minutes assessing the patient agreed that she was in an unacceptable level of pain and prescribed a further 5mg of morphine which I duly gave to the patient in 2.5mg increments. After this the patients heart rate and blood pressure decreased to pre operative levels, she seemed to be more relaxed and eventually fell asleep. After a further period of time spent continually reassessing the patient and when I was satisfied she was comfortable and haemodynamically stable I discharged the patient back to the ward.

The State of Tennessee Board of Nursing’s Rules and Regulations of Registered Nurses, Rule # 1000-01-.13-1r states that unprofessional conduct is defined in part by "failing to take appropriate action in safeguarding the patient from incompetent health care practices" (State of Tennessee, 2011). There are a number of arguments in this case study that incompetent health care practices are being performed, from the decision to place a patient on a ventilator for an oxygen saturation of 88%, circumventing the patient’s written and verbal advanced directives, utilizing an unauthorized family member to get consent for

PART B: FIRST MARKER COMMENTS – to identify strength, weakness and specific action required.Name 1st Marker ______________________________________ Date

To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008).   For patient characteristics, Mr. B was a 67 year old patient with routine use of oxycodone to treat chronic pain.  Because of his routine use of oxycodone, he may need a different dose to get to a sedated level than other people who are not on any medication.  Next is the task factors, the hospital had a policy which requires that anyone who are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is done and patient is in stable condition.  Mr. B was not being monitored accordingly during the sedation process.  Another task factors is that all staffs must first complete a training module on sedation before performing the task.  Individual staff is a factor too, Nurse J had completed the training module on sedation, he had an ACLS certification as well as experience working as a critical care nurse.  Team factors include communication between staffs; an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.  Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs.  According to the scenario, additional staffs were available for back up support and all the equipment needed

It is important that the patient is aware not only of their rights, but of their individual responsibilities.

Court cases like Martha Bull’s who reads “Greenbrier Nursing and Rehabilitation Center had been negligent in treatment of Martha Bull, 76, who died at the nursing home April 7, 2008 after staff failed to act on a doctor 's orders to get her transferred to a hospital emergency room for treatment of severe abdominal pain,” are one of the many that support this disturbing stigma. Something as simple as a competent health provider, that was willing to see a task out into its completion could have been the saving grace for this women. For almost an entire twenty-four hours’ staff heard her cries of agony yet never made sure the proper paperwork was completed once it was filed. (Brantley, 1) In the case of Holder Vs. Beverly Enterprises Texas, Inc. an 83-year-old, bedridden woman by the name of Ruth Waites was hospitalized for dehydration as a result of an understaffed nursing home. Once admitted back to the nursing home she had developed pressures sores from being left unattended. The pressure sores soon became so severe that they caused a serious infection and led to Ms. Waites’ death. This entire case is a story of neglect, what the nursing home states as understaffing, and fraud. The fact that the nursing home was understaffed should have never been hidden from the families of the patients. These are facts that should have been announced to the community so that the appropriate qualified personnel could have attempted to solve the issue. (Nursing, 1) Another case follows with

It is always important to follow doctor’s orders. In the New Jersey case of Szczuvelek v. Harborside Healthcare Woods Edge, that is exactly what nurses failed to do. Nurses at Harborside Healthcare Woods Edge failed to follow the hospital medical order for patient Eugene Burns stating that he be suctioned every four hours. Not only that but they also failed to follow the nursing home orders that required healthcare personnel to "suction Q shift and PRN." Burns had to be suctioned because on February 1999 he had been admitted to Robert Wood Johnson Hospital in New Jersey for treatment of an aneurysm. During that surgery a tracheotomy tube had to be inserted which left him unable to speak. On April 13, 1999, after two months of being in the hospital he was transferred to the nursing facility for

Given the aging of the population, elder abuse has become more a prevalent and a more serious issue in recent years. "Every year, an estimated 4 million older Americans are victims of physical, psychological or other forms of abuse and neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect reported to authorities, experts estimate as many as 23 cases go undetected" (Elder abuse and neglect, 2013, APA report: 1). Elder abuse is both against the law and an ethical issue for the nurse. The nurse must find a way to ensure that the needs of the patient are taken care of, and the stress of the caregiver of the elderly person is managed appropriately. This paper will apply the five steps of ethical decision-making to dealing with the issue (Swinton 2007). The ethics of elder abuse deal with a number of issues that can be extremely sensitive subjects for the nurse; including parent-child relationships; past relationships amongst different members of the family; the responsibilities of caregiving; and the autonomy of the patient.

The Curious Incident Of The Dog In The Night-Time, written by Mark Haddon, is a mystery novel about a young boy with Asperger’s Syndrome. Christopher Boone, the narrator of the book, compels the reader to feel the most sympathy towards him, due to his Asperger’s Syndrome. Not only is this portrayed by this affliction but also by his parents’ separation and losing the stability of a family life. Ed Boone, Christopher’s father, can be sympathised with when his wife leaves him and he struggles with being a single parent of a child with a disability. Mrs Shears has also suffered loss when her dog, Wellington, was killed and then when her husband left her for another woman. Haddon retells the life of Christopher Boone, through a variety of different techniques such as repetition, dialogue, expletive language and short sentences.

The use of physical restraint is quite common among caregivers in health facilities when dealing with geriatric patients. Yet this topic is one of the most debated issues in healthcare and medicine. The purpose of medical restraints is to prevent patients from harming themselves or those around them. It seems to be a simple solution and panacea for unruly patients who needs to be treated. However, ethical implications surround its usage as the practice of physically restricting people strips them of their autonomy as well as other psychological factors, such as agitation and trauma. Therein lies the dilemma on how to approach such an issue.

Ethical principals are the seed of which nursing flourishes from. Many ethical principals were involved and dishonored in this case such as, justice, autonomy, beneficence, non-maleficence, confidentiality and fidelity (Burkhardt et al., 2014). I believe justice was the main principal involved as the entire ethical predicament was revolved around unjust behavior and treatment of the residents. The residents were treated poorly and given unequal rights as a causation of their illnesses. Autonomy, an essential piece of human rights was also being violated in this ethical dilemma. The residents did not have any choice or independence in their care or how they were being treated. Beneficence and non-maleficence are significant dynamics of this ethical situation, as the health care providers needed to reflect on how they can have the maximum benefit while diminishing possible damage to the residents (Burkhardt et al., 2014). Our actions as nurses should always be beneficent and non maleficent, continuously being kind, compassionate and doing what is in their best interest as well a removing and preventing harm. Confidentiality is a key component of nursing and it was blatantly being violated as the health care

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to

Nurses are subject to a plethora of legal, ethical, and professional duties which can be very challenging on a day to day basis. Some of these duties include respecting a patient 's confidentiality and autonomy, and to recognize the duty of care that is owed to all patients. As nurses our duties are always professional; however there are legal implications if these duties are breached. We also must consider when it is okay as nurses to breach these duties and therefore ethical issues arise. As nurses one of our main priorities is to advocate for our patients, without our own personal feelings on the matter taking over.