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Health, Medicine, Nursing
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Explaining Practices For Proper Nursing Leadership As Well As Clinical Management (Coursework Sample)




Nursing Leadership and Clinical Governance
By Student’s Name
Having practical skills in leadership and management, change management, quality improvement, and clinical risk management is a significant requirement among nurses. Before getting employed and recognized as practitioners by various relevant bodies, nurses are often required to demonstrate their academic qualification in these areas, with the perception that they have the ability of transforming what they learn in class to real life practice and ensuring appropriate standards of practice are achieved in hospitals (Alemdar, &Aktas, 2014). However, the Jarrett Case Study demonstrated that nurses can be negligent after employment and official recognition by various bodies, a factor that poses risk to the health of patients.
The Nurse, Jarrett, was accused of unsatisfactory professional conduct regarding seven different issues related to the care she provided to one patient. The son of the patient claimed that the inability of the nurse to act according to the required professional standards led to his father’s death barely a day after admission and investigations led to seven different charges related to unsatisfactory professional conduct, six of which were held to be true.
This paper gives an analysis of the case using three different episodes: examination and determination of the level of emergency in newly admitted patients, immediate and accurate intervention to reduce the severity of the patients suffering, fully disclosure of information related to the medical condition of a patient to the doctor.
First Episode of Care: Examination and Determination of Level of Emergency
A nurse should have the ability to examine the condition of a patient and determining the level of emergence of the situation. When patients are admitted to a hospital, some need more urgent care than others. Regardless of the time of admission, the nurse in charge should immediately examine the condition of the patient and be able to rate the level of emergency of the medical condition (Sand‐Jecklin & Sherman, 2014). This is often achieved through a review of the medical history of a patient, a brief interview regarding the background of the present condition as well as its nature at the time the patient is admitted, and undertaking a few basic examinations to confirm the nature of the patient’s ailment. The use of the medical history, brief interview on the background of the disease and basic examination should give nurse the ability of determining the level of emergency of the patient’s condition, and the most appropriate method of intervention that should be undertaken before a doctor finally examines the patient for more details (Corbally & Timmins, 2016). This controls the pain and suffering of a patient, and the relief is meant to give adequate lapse of time before a doctor’s arrival. This implies that in case the situation is an emergency, a doctor should be summoned to attend to the patient immediately.
In Jarrett Case Study, the first accusation was that the nurse failed to conduct or request a fellow nurse on duty to conduct thorough assessment of the patient until three hours after he was admitted to the facility. Actually, it was claimed that the patient’s assessment was conducted only after the observation that he was breathing harder, and became more restless, combative and agitated. Even after explaining that she instructed EN Flaherty to undertake general observation on the patient and there was no report about any changes in the patient till after three hours, the committee reviewing the issue concluded that the nurse failed to act as per the required standards of practice. She should have ensured that a full nurse assessment was undertaken within the three hours, including the physical observation. It was thus right to believe that her professional negligence led to worsening of the condition of the patient and finally the death. The nurse did not demonstrate the required leadership skills, because she ought to have delegated duties appropriately in case she was held up with other tasks. She should have assigned another nurse on duty the role of undertaking a full examination on the patient and determining the level of emergency of the case.
Second Episode of Care: Timely and Accurate Intervention
The main reason of undertaking immediate and full nurse assessment is to determine the level of emergency of the situation, and the appropriate intervention that should be taken to reduce the pain and suffering of the patient. Intervention can take many forms depending on the type of disease that a patient is suffering, and the level of the ailment (McGilton et al., 2012). Some patients whose cases are not more urgent can take necessary medication and await doctors, while those with conditions that require immediate attention can be given medication to relax them while the doctor is immediately summoned to undertake more specific medical examination and provide the desired treatment. When intervention that is provided is inaccurate, it might lead to worsening of the medical condition of the patient, or might not alter the medical conditions in any way. As such, the nursing assessment has to be accurate enough to ensure that the most appropriate intervention is given. The nurse should be keen about the medical history of the patient, the background of the disease, and the current condition suffered by the patient (Strupeit et al., 2013). These alongside a few examinations will lead to accurate determination of the condition of the patients and the right intervention to be provided.
From the Jarrett Case Study, the nurse was accused of failing to request the doctor in charge to attend the hospital and provide the necessary treatment to the patient even after noting significant changes in the patient’s medical conditions after three hours. This accusation was accepted by the nurse, who in her defense cited her past experiences with the doctor and poor personal relationship. She was also accused of inappropriately requesting the order of the doctor for a wrong sedation, a claim that was found to be untrue. Moreover, the nurse was accused of failing to minimize the risk of fall of the patient because she did not review any medical history of the patient that could have given information about potential fall. This accusation was found to be true, and pointed out that the nurse failed to undertake appropriate assessment that could result provision of the most desirable intervention. From the analysis of the case and the accusations against the nurse, it emerges evidently that the nurse failed to provide the most appropriate intervention, a factor that resulted from the failure properly asses the medical condition of the patient. This is an indication of poor clinical risk management as well as quality improvement. In these accusations, the nurse acted inconsistently with the required standards, and thus her actions probably led to deterioration of the patient’s medical conditions as well as final death.
Third Episode of Care: Full disclosure of Information to the Doctor in Charge
The nurses are meant to examine the patients and provide the doctors with basic information that would lead to detailed analysis and determination of the exact medical needs of the patients. After carrying out proper nurse assessment and provision of the necessary intervention, it is the role of the nurses to provide the doctors with the information to help in provision of accurate medication and performance of further examination in a timely manner (Happ et al., 2014). False information by the nurses or failure to provide vital information can lead to poor levels of treatment and thus deterioration or stagnation of the patient’s medical condition (Fagin & Garelick, 2004). In worse cases, the failure to provide full information or the provision of wrong information might result into administering wrong medication, or medication that the patient has allergies towards. Successes often result from accurate analysis of the patient’s condition, determination of the background of the disease, and review of the medical history of the patient (Gunnarsdóttir et al., 2009). This would ensure that the doctor provide more precise tests and accurate treatment that would lead to a rise in the medical condition of the patient.
In the Jarrett Case Study, the nurse was accused of failing to give information to the doctor regarding the fact that the patient had gone through unwitnessed fall form a chair he was sitting on to the flow after Valium 5mg was administered. This accusation was found to be true, and the committee concluded that it meant the nurse failed to act according to the required professional standards. Moreover, the nurse was accused of failing to call the doctor to attend to the patient after the fall between 0630 and 0700 hours had taken place. Even after citing the past relationship with the doctor as a reason for failure in contacting him, the committee concluded that the nurse was guilty for the failure to contact the doctor to attend to the case of emergency. The final accusation was the failure of the nurse to inform the doctor about the deterioration of the health of the patient after the occurrence of the un-witnessed death. The nurse was found guilty of this and the committee concluded she acted in a manner that does not reflect the expected professional conduct. As such, it would be concluded that the failure of the nurse to adhere to the required standards of practice pointed that she had poor management and leadership skills, change management skills, and clinical risk management. These might have led to the final death of the patient.
The ability to transfer the theory that is...
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