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.
‘’Susan is a newly qualified nurse who works in a medical ward. She is assigned to a junior sister for orientation period of 4 month to aid her to settle in and build up confidence. Susan was in second month of her employment when an Asian elderly patient, who was not speaking English fluidly, was admitted to the ward after being diagnosed with heart failure. A fluid balance chart was set up to monitor fluid intake and the nursing staff recorded each time the patient was given a drink. She noticed that the junior sister fills in the chart by putting a check mark in the chart, without asking the patient or knowing the actual amount of fluid being taken by the patient and sometimes guesstimates the urine output so that chart was filled in and looked good. Susan mentioned to the junior sister that her recording was not accurate to which the junior sister replied: ‘’ are you going to teach me how to do my work after two month of being here?’’. Susan kept quiet as she did not like confrontations and wanted to avoid conflicts. Susan continued to fill up the fluid chart accurately whenever she was assigned to care for the lady by asking another patient who was speaking the same language to obtain accurate information from the patient. On a Monday, she returned to duty after 3 days off work during weekend and noticed that the patient fluid chart was not kept up to date. The patient seemed a bit confused and disorientated. Concerned relatives asked her why their mother was confused when she was perfectly lucid two days ago when they visited her.
Susan acted immediately by investigating why the patient had become confused. She found that she has not been drinking or eating well for past two days and as the fluid balance chart had not been kept up to date, she concluded that the patient’s dehydration was causing her confused state. She informed the doctors and the Nurse in-charge. An intravenous infusion of normal saline was prescribed for the patient. The nurse in charge asked Susan to make sure she was given regular drinks and that this was recorded on the fluid chart. The patient recovered from the confused state and the intravenous infusion was stopped the following day. As soon as the dehydration and its cause were treated, Susan spoke to the patient and their relatives to explain what had happened and she apologised. The relative thanked Susan and told her that she was a good nurse.
Susan noticed that the Junior sister had been in charge of the ward during the weekend and the patient had been under her care. After much contemplation Susan raised her concern with the manager who told her to be considerate toward the junior sister as she was going through some tough time at home and that she should concentrate on developing herself and leave managing staff to the manager’’.
Consider the current NMC Code, relevant legislation, policies and guidelines and ethical principles and identify, discuss and analyse the appropriateness of behaviours of the nurses involved in the scenario.
