Developing Professional Practice in Adult Nursing
Summative Assignment Scenario and Questions
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.
CASE STUDY
Leila’s is a newly registered nurse who has been working for 6 month as a community nurse. In one particular busy day she was allocated 5 patients to visit within the radius of her working area. She was not sure about visiting Albert, an African –Caribbean patient who is disabled and has multiple diabetes leg ulcers. She had visited him once together with a senior community nurse. stated to the manager that Albert always needed two nurses for his visit as his partner leaves the house to do chores once she knows Albert is due to be visited by nurses . The manager dismissed Leila’s concern and told her that she was allocated as a Practice Supervisor to a Year 2 student nurse, Abigail, and she can use her as a good pair of hand to care for patients with complicated nursing needs. Leila quietly whispered, ‘’Albert shouts at me and does not like me to do his dressings either’’ to which she gets no response. Leila was scheduled to first visit Albert to dress his leg ulcers. On the way to Albert’s house, Leila learnt from Albert’s electronic file on her Ipad that he had been discharged from hospital two days ago after an episode of UTI (Urinary Tract Infection) with new indwelling catheter.
This took Leila by surprise as it had not been mentioned during handover. Leila and Abigail found Albert in bed on arrival. Albert’s pillow was on the floor and his duvet was hanging off the bed. He asked if they would first give him his insulin injection today and then would help him into his wheelchair using the hoist provided by the local authority. Leila was unfamiliar with the type of hoist he used but agreed to help him asking Abigail if she could help her operating the hoist . She then asked Albert if he has a correct dose set on the Insulin pen. Albert nodded and Leila gave him his insulin injection . She followed Albert’s instructions on how to secure the straps of the hoist but during the move from bed to chair Albert fell out of the hoist and on to the floor. He was in severe pain. Leila asked Abigail to stay with Albert so she could go out of the room and immediately call for an ambulance as she was not getting any signals on her mobile phone. Abigail kept Albert calm and as comfortable as possible as she could; but suddenly noticed that he was getting clammy with heavy breathing, not quite responsive anymore and his body was shaking violently. Abigail panicked and started shouting Leila’s name and left Albert to quickly find her but returned within 30 seconds as she was worried about him. Leila returned and upon noticing Albert’s shaking; asked Abigail to make a clear safe space around him but the hoist legs has stuck under the bed and it was impossible to make more space so they covered his surrounding with pillows and duvet from his bed. Leila suddenly noticed that the insulin pen on Albert’s bedside table was Novorapid. She realised that in a hurry to help Albert she had not checked this before injecting Albert.
She put him in recovery position, and asked Abigail to find some sugar tablets in Albert’s house. Shortly after the ambulance arrived and the paramedics took over. Albert was given glucose 20% by ambulance crew and he was stabilised and regained his alertness . Leila kept apologising and continued to reassure and comfort Albert till he was transferred to the ambulance to be taken to the local hospital. When the patient was safely in the care of others Leila immediately reported the incident to her line manager in line with the organisation’s policy for reporting adverse incidents. However the manager told her she should have got on with the rest of her patient and hand over on her return as some patients were already calling and complaining that their nurse was late. This made Leila agitated and tearful. Abigail tried comforting her but she did not know how she could help. Leila managed to compose herself and continue visiting the rest of her patients with Abigail without any further events, however she finished an hour later than usual.
Leila filled in an incident form on her return and asked Abigail to be her witness. Abigail was happy to help Leila as she thought that it was a good day for her and she had learnt a lot from Leila who patiently answered all her questions during the day. Leila learnt that Albert had suffered a fractured left hip, she asked the manager to go and visit him in hospital. The manager told Leila that he is well looked after in hospital and she should focus on her patients in community during her working hours. A week later Leila went to visit Albert after her working hours to apologise again. At the hospital she learnt from Albert’s partner that he had endured severe pain and discomfort and had developed a chest infection due to lack of mobility which led to an extended stay in hospital. Albert and his partner were not happy with Leila, therefore Leila left his bedside after 5 minutes. Later Leila’s manager told her that a complaint has been filed against her by Albert’s partner.
QUESTIONS
Question 1: 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.
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 professional nursing practice.
