In nursing practices, a number of incidents are likely to take place, and such incidents can affect the safety of patients. A number of issues surround the practicing of nurses, and thus, incidents taking place must be controlled, in a way that they do not affect the quality of the patient care. In this case, nurses are required to display certain competences in their practices in an effort to avoid disasters from taking place. In most cases, disasters take place because nurses are not trained to provide quality patient care. This calls for the application of competences of quality and safety education in nursing (QSEN) practice. Nevertheless, some events take place in a hospital environment indicating lack of practical application of QSEN nursing competences, and this paper highlight a case that happen in one of the daily nursing practices.
One issue that took place in the Broward North hospital was giving one patient another patient’s drugs, and failing to come and check the progress of the patient after administering treatment. In a hospital setting, patients are grouped together in a ward based on the type of diseases they are suffering from. However, there is a variation from one patient to another and at no any time do two patients receive similar prescriptions. This means interchanging the drugs between two patients can lead to disaster. Drugs have a considerable negative side effect, and thus they ought to be handled with care. The patient should not take drugs that have not been prescribed to him or her. Giving a patient a wrong prescription can result in death or permanent damage. As a result, nurses ought to be careful when giving drugs to patients.
Developing the Patient’s Scenario
It was on a Friday evening, and a number of doctors were not around. Jane (not her real name) was in charge of a PACU floor, which is a floor that had a many patients after surgery. At 7.00 pm, she performed her duties of checking around the floor, recording temperature and blood pressure levels of patients, and distributing drugs as prescribed by a doctor. After completing her round, she went to rest for about 30 minutes. A 9 pm, another nurse on duty with Jane decided to make some rounds in the floor just to ensure everything was okay. On reaching one of the beds where a middle-aged man recovering from a broken metatarsal, she realized that that man was unusually inactive because the floor had grown used to him. On examining him closely, she realized that his blood pressure, which refers to the pressures the blood exerts along the arterial walls, was very low, based on observable sings. The patient had shallow rapid breathing and was exhibiting signs of tiredness and fainting. This was unusual because the man was recovering well and had no history of low blood pressure. Next to that man was also another middle aged and well-built man lying helpless on the bed nose-bleeding and exhibiting sings of shortness of breath. He had a record of high blood pressure, but his situation ought not to have worsened because he had just taken his medicine to reduce the pressure. On inquiring in the situation, Jane realized that she had interchanged the drugs for the two men and hence the reactions. Since the hospital did not have a bedside verification system, Jane had to rely on her memory.
The patient who had a broken metatarsal only needed painkillers and antibacterial drugs. However, since he was given the drugs belonging to a patient with high blood pressure, his blood pressure reduced considerably to the point that everyone thought he would die. On the other hand, the patient with high blood pressure was given painkiller and antibiotics, which was not what he needed most. Although these drugs did not have a considerable negative effect on him, he missed the vital drugs to lower his blood pressure, and thus his blood pressure went up to near death point, which was 160. The nurse who had given them the treatment also failed to check everything on time, and had it not been for another nurse checking on the patients, the two could have died.
How Nursing QSEN Competences Were Not Followed
Nursing care should adhere to the competences of QSEN for effective results. There are six competences and all of them are related to one another. The case of Jane indicates that she failed to consider all of these competences as analyzed in this section.
Patient-centered care implies providing care based on the needs of the patient. In this case, each case is treated uniquely and the patient’s values are respected. The nurse or the healthcare provider is supposed to recognize the patient as the source of control, as well as a full partner when providing coordinated and compassionate care based on the respect of the values, needs, and preferences of the patient (Brenner, & Iafrati, 2014). In the case example, the hospital had respected the rights, values, and preferences of the patient and that is why each patient is given a special prescription based on his or her needs. However, Jane, the nurse, failed to recognize and practice patient-centered care on the two patients she interchanged their drugs. If her care were based on the needs of the patient, she could have discussed meds with patient before administering them. Since each patient had had his own needs, Jane was supposed to respect them and offer them prescription based on the needs. This means this competence was lacking in her.
Teamwork and Collaboration
Teamwork and collaboration are vital in all workplaces. One person cannot master everything and he or she needs the input of his or her colleagues. In the nursing environment, teamwork is essential because it enables medical practitioners to function effectively through fostering of mutual respect, open communication, shared decision-making, and coordination within professional teams to achieve quality patient care (Flores, Hickenlooper, & Saxton, 2013). In the case presented, there was no teamwork and collaboration within the floor. Jane was not the one who prescribed the drugs to the patient; another person did. Her role was to distribute the drugs already prescribed by another person. Such roles are supposed to go hand in hand or concurrently to avoid any confusion. However, Jane’s colleague demonstrated teamwork when she decided to inquire on what Jane had done. She employed the process of verifying on what the colleague had done to ensure everything was okay. Through the process, she discovered that Jane had made some mistakes. Thereafter, they collaborated to ascertain the cause of the problem. This saved the situation and ensured that the situation was brought in control. This means teamwork saved the situation and was evident in Jane’s situation. However, she failed to make use of it to avoid the situation prior to its happening. She could have collaborated with the medical staff to administer the drugs.
Medical care practices are changing as a result of evolution in the care. In this case, new systems are being introduced to ensure patients receive the best care. Nurses ought to be up-to-date with new methods that have proven as effective. They should also integrate clinical expertise with best current evidence to ensure they deliver quality care. They should further involve family or the patient when designing the medical care to be given to them (Flores, Hickenlooper, & Saxton, 2013). In the case presented, Jane, the nurse, did not provide evidence-based care to the patient. She was expected to employ the seven rights of patient’s medication. In this case, she was supposed to ascertain the patient was the right client, the route of administration was followed, the drug given was the right one in their right amount at the right time. Also, she was supposed to ensure that the documentation was done to prevent duplication and should have give the patient the right to refuse the medication. By providing evidence-based care, she was supposed to have examined the patient again and known the type of drugs the patient needs. A nurse who demonstrates evidence-based practice is supposed to identify drugs easily because he or she has mastered and applied them in various situations. In this case, she cannot confuse painkillers with tablets to reduce the high blood pressure. In addition, she would have collaborated with the patient to assure him that the type of medicine being given to him was to assist him in as number of ways, and this could have triggered a re-evaluation of drugs to ascertain if they were really meant for the condition mentioned. Nevertheless, Jane’s colleague demonstrated evidence-based practice and care when she went around examining the effect of the drugs on the patient.
Quality improvement is vital in all organizations because it ensures an improvement on the existing conditions from the previous situation. In this case, data is utilized to design and advance the quality of health care given to patients (Sherwood & Zomorodi, 2014). In the case study mentioned, there was no application of quality improvement and Jane did not demonstrate this competence in her practice. Given that every patient has a record near his or her bed, she was supposed to examine those records and compare with her latest data before issuing out the drugs. It could have been simple to notice that the patient with high blood pressure needed the drugs to reduce the pressure and this could not have been confused with antibiotics. Additionally, she was expected to take note of the reaction of the drugs on the patient to ascertain if they were working or needed some improvement. In this case, she was expected to remain within the floor for a considerable time. Luckily, her colleague who understands quality improvement took that bold step and discovered what had transpired. She understood the value of observing patient reactions to drugs, and cross-checking to ascertain the authenticity of the drugs administered.
Safety is a priority in all cases. In a hospital setting, safety is enhanced through risk minimization on nurses, patients, and the environment. The goal is to ensure effectiveness in individual performance. Patient safety should involve accurate medication, and a system to alert the nurse in case of any danger (Sherwood & Zomorodi, 2014). In the case study hospital presented, there was no Electronic Medical Administration system to ensure safety of the patient. At the same time, there were no regulations requiring nurses to stay within the ward, or a system, such as bedside alarms to alert nurses in case of any danger. As a result, patients are exposed to risks, such as being given wrong drugs, and dying without notice.
Informatics refers to a system to ensure communication and technology within a hospital setting. Informatics supports decision-making process and eliminates errors within the system (Tamura-Lis, 2013). In the case study organization, there was no effective application of informatics, and thus nurses made errors. There were no computerized MAR or bar coding used for administering meds. Informatics could have ensured that each drug had an identity with the patient’s bed number, and this could have ensured that no drugs were interchanged.
Importance of Integrating QSEN Competences in Clinical Practices
QSEN competences are vital in clinical practices for a number of reasons. In the first place, these competencies ensure that patients are handled in a safety way. At the same time, these competencies ensure that the practices offered are quality because data is utilized to design and improve the quality of care given to patients. In addition, each case is treated uniquely and the patient’s values are respected. These competences further ensure that clinical care is provided in an environment integrated with information and technology with a quest for continuous improvement (Dykema, 2014).
If the QSEN competences could have been integrated, Jane would have been informed on method and procedures of applying meds. She could have applied the seven rights of patient’s medication, which ensures that a patient is given medication without any confusion.
Importance of Integrating QSEN Competences in Nursing Education
QSEN competences are essential in nursing education. In the first place, it ensures graduates make use of evidence-based standards and interventions in their practices. The competences equip the student nurse with skills to work across various teams with family partners and patients. The competences mould nurse graduates into role models in nursing practices. The competences demonstrate the level of academic qualifications for nurses. The changes realized in education are reflected in practice (Dolansky, & Moore, 2013).
Importance of Integrating QSEN Competences in Nursing Research
Research forms the vital backbone of nursing practices, and thus it should be emphasized in all levels. When integrated with nursing competences, nursing research is tailored at ensuring innovative ways of providing patient-based care and ensuring quality improvement in nursing practices. Nursing research ensures acquisition of data, which is utilized to design and improve the quality of care given to patients. Also, competence is integrated in every level of study and they ensure that students design their research work based on these competences (Flores, Hickenlooper, & Saxton, 2013).
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