Nur3020 Professional Transitions:Albert Eric Bruce Assessment Answers

Assignment Brief

Conduct an analysis of the Case: Findings of the Inquest into the death of Albert Eric Bruce Biffin addressing the three sections as outlined.

In the report of the Inquest into the death of Albert Eric Bruce Biffin¹ the Coroner identified the medical cause of death as complications of an incarcerated umbilical hernia. It was known that Mr Biffin had a long medical history however was still relatively independent in his residential care environment. Mr Biffin died on February 27, 2013 at the age of 86.

A number of registered nurses, were involved in Mr Biffin’s care in the period February 24, 2013 to February 27, 2013. The role of the assistant in nursing, the endorsed enrolled nurse and the registered nurse were key within the chain of events that transpired and affected the deterioration and death of Mr Biffin.

In a chapter provided for you on DIRECT readings on the study desk for NUR3020, McDonald and Then (2014) discuss that while individuals can make errors, it also may be difficult to attribute to one person.

Assignment Section One: Patient Safety/Nursing Care

Section 1 - Conduct an analysis of the nursing care (pages 7 – 11) that is outlined by the coroner in the Inquest into the death of Mr Albert Eric Bruce Biffin¹ in terms of the involvement of the assistant in nursing, endorsed enrolled nurse and the overarching accountability of the registered nurse

Assignment Section Two: The Tort of Negligence

Answer:

Section 1

Nurses play an essential role in providing quality health care to all and being respected healthcare providers they are expected to be adequately qualified and maintain professionalism with a caring concern for the patients (Daly, Speedy, & Jackson, 2017). Under section 141 of the Nursing Act 1992, any person who is authorized to use the titles, enrolled nurse and registered nurse are entitled to practice nursing. A registered nurse and an enrolled nurse work together and an enrolled nurse assists the registered nurse in decision-making process relating to the medical status of the patient (Gaskin, 2017).

The primary responsibilities of an enrolled nurse is to recognizing normal and abnormality in assessment; performing the delegated responsibilities; monitoring the impact of care by assessing the health status of any individual (McDonald & Then, 2014). The enrolled nurse is required to communicate with the registered nurse relating to the health status of the patients on a regular basis. There are times, when it becomes imperative and a necessity for a registered nurse to give more attention and be more involved with any particular patient, especially, under circumstances, when the patient is responding unpredictably or there is a constant change in the health status of the patient (Masters, Role development in professional nursing practice, 2015). The registered nurse must also be more attentive under circumstances, when the patient is subject to continual assessment and there is a constant need to make changes in the care plan of the patient.

In regards to the nursing care outlined in the Inquest into the death of Mr. Albert Eric Bruce Biffin, it questions the accountability of the nurses and the adequacy of the medical care that was provided to Mr. Biffin. The coroner found that Bruce was suffering from umbilical hernia that had developed recently, which called for immediate medical treatment by his general practitioner Dr. Lambie, following nursing care.

An enrolled nurse called for a registered nurse on 24 February as Bruce had vomiting. The registered noted that he was suffering from pain in his lower abdomen and she detected hernia. She advised the enrolled nurse to give Movicol to Bruce for his constipation and advised to monitor Bruce. Thereafter, as the registered nurse was communicating with Bruce she noticed the size of the hernia that looked inflamed and pink. Since she was meeting Mr. Briffin for the first time and he did not complain of any pain in his stomach, the registered nurse did not examine the hernia and thought that he was feeling unwell due to constipation, thus, advised him movicol.

Here it can be observed that the registered nurse did not pay much attention to the changing health condition in Mr. Briffin in that while she assessed him, he complained of feeling unwell and a stomachache. However, in the next minute he denied of having any pain or did not seem to be stressed. Furthermore, he even told the registered nurse about the hernia and that it was not painful and seemed to be more worried about his constipation. As per the nursing code of practice, a registered nurse is required to be more attentive towards patients who have rapid changes in their health status and requires constant assessment (Kangasniemi, Pakkanen, & Korhonen, 2015). However, even after noticing and being aware of the hernia and the stomachache, the nurse neither touched nor examined the same.

Further, another registered nurse reviewed Bruce on 24 February afternoon and gave him another dose of Movicol for constipation. The nurse noted about his vomiting and pain in lower and central lower abdomen and a prominent bulging of umbilical hernia.

The registered nurse mentioned that he is required to be assessed by Dr. Lambie next day mentioning about an offensive wound in his lower leg. After Dr. lambie’s visit, no registered nurse recorded the observations until the registered nurse who visited Bruce on Sunday evening, although three registered nurses were scheduled to observe and take care of Bruce. Further, since Mr. Biffin was in the residential aged facilities (RACFs) where the nurses are responsible for daily maintenance, recording and reporting of the operation of the facility and care of each resident, the registered nurses failed to perform their responsibility of taking account of the condition of Mr. Biffin (Gaskin, Georgiou, Barton & Westbrook, 2017).

After Dr. Lambie left on Monday, an enrolled nurse reviewed Mr. Biffin, he complained of feeling nausea, and that he was not feeling well. Instead of administering medicines, she merely described that he was feeling unwell before Dr. Lambie’s visit as well. Thereafter at 16:30, a registered nurse gave him two doses of Movicol. Thereafter, neither any nurse nor any doctor visited or reviewed Mr. Biffin until the next day, Tuesday 26, lacking responsibility to provide health care.

The clinical nurse observed he had not vomited and was given movicol for his constipation. Although the responsibility of the clinical nurse was to supervise the enrolled and the assistant nurses in Jacaranda and supervise all the residents, in particular those who had been unwell and are undergoing frequent changes in the health status, which implies she should have taken extra care towards Mr. Biffin. Although she asserted that she had asked the enrolled nurse to take observations of Bruce but she did not record this document as she expected that in case any abnormality is observed in the observation, the enrolled nurse would inform the registered nurse about the same. She was not even certain whether she instructed the enrolled nurse to inform Dr. Lambie in case of any abnormal condition is observed. This demonstrates how the clinical nurse had acted in contravention of her professional conduct (Davis, Morgans, & Burgess, 2017). She merely noted that Mr. Biffin did not vomit without having any knowledge about his health condition or that he was feeling unwell, which contradictory to her early statement that she saw Bruce is looking unwell while he was sitting on his chair.

A clinical nurse held a more senior position and had more responsibilities as compared to the other staffs providing care o Mr. Biffin. Despite the fact that she was not directly involved n the treatment of Mr. Biffin but her primary responsibility is to oversee a resident who had a recent hernia operation and required special care.  A mere verbal instruction to an enrolled nurse that too, on her first shift, to observe the patient accordingly portrays lack of guidance to a less experienced nurse and it is less information that is required for a clinical nurse to obtain about an aged patient like Bruce (Scanlon, Cashin, Bryce, Kelly, & Buckely, 2016).

Furthermore, the enrolled nurse was aware of the deteriorating condition inform the but instead of informing the registered nurse she handed over to the assistant nurse merely mentioning that Mr. Biffin needed assistance to bathroom. When Bruce’s condition deteriorated, the assistant nurse called the registered nurse who met Bruce for the first time. While she was reading the records, instead of calling the ambulance she helped the assistant nurse to change Bruce’s dress, clearly demonstrating lack of decision-making ability that is expected from a registered and a qualified nurse (Street, Ottmann, Johnstone, Considine, & Livingston, 2015).

The above-mentioned instances are evident of the fact how the nurses have failed to discharge their professional conduct and have raised question about their competency and accountability. The registered nurses are expected to use their professional knowledge in a direct non-clinical relationship with patients and play significant roles that ensure effective and safe delivery of health services in the health profession (Chadwick & Gallagher, 2016). Instead of giving more attention to the hernia pain and nauseous feeling, they continued to give high doses to Mr. Biffin when he regularly complained of feeling and was unable to eat. They were accountable for the health services that were required to be provided to Mr. Biffin in the residential care facilities which they have failed to exercise.

Section 2

The practice of nursing often entails close physical proximity between the patient and the nurse. If a patient suffers damage due to lack of proper care and diligence exhibited by the nurses, the patient is entitled to sue the nurse on the ground of negligence. The party complaining about the negligence must establish the fact that he/she has suffered damages because of the breach of duty of care (Masters, 2015). In order to establish the claim of negligence, it is important that the aggrieved party establish the following essential elements:

• that the defendant owed a duty of care towards the plaintiff;
• that the defendant failed to exercise the required standard of care;
• that the plaintiff has suffered damages due to the breach of the duty of care;
• that the defendant could reasonably foresee the damages caused to the plaintiff;

In the given case, the registered or the clinical nurses have demonstrated a breach of a duty of care that they owed to Mr. Biffin. The nurses owed a duty of care towards Bruce, as he was a resident of the Residential Aged Care Facilities (RACFs) and being a registered nurse she was responsible to give more attention to patients who display frequent changes in their health status and their response is unpredictable (Dwyer, Craswell, Rossi, & Holzberger, 2017). The registered nurses are accountable for conducting regular and continual assessments changing the care plan for such patients. Mr. Biffin being in an advanced age, was suffering from umbilical hernia and regularly complained of feeling nauseous and unwell, but he was mostly given doses of movicol for his constipation.

The clinical nurse is the senior nurse who is responsible for over viewing all the residents of the resident age care facilities, especially, patients who requires regular observations and have frequent changes in the health status (Blackman, et al., 2015). Instead of the overviewing the compete records of Bruce and being aware of the high dose of movicol given to him, she merely instructed the enrolled nurse, a less experienced nurse, to observe his health conditions. This establishes the breach of the duty to exercise care towards Mr. Briffin. Furthermore, the registered nurses continued to give him doses of movicol for his constipation. Despite the critical health condition, the enrolled nurses with less experience were attending Bruce. The registered nurses lacked a decision-making skill, as is evident when Bruce’s condition was deteriorating, instead of calling for an ambulance, and Dr. Lambie, the registered nurse was assisting in changing his dress (Chang & Daly, 2015).

The breach of the duty of care by the nurses caused deterioration of the health condition of Mr. Briffin and the nurses despite, being aware of the deteriorated condition of Bruce; they did not transfer him to hospital or informed Dr. Lambie for immediate medical assistance. This implies they could reasonably foresee the damage that would be caused to Bruce (Foley & Christensen, 2016).  

The Coroner may refer to section 10AA under the Coroners Act 2003 (the Act) that defines the deaths caused due to lack of health care and the professional and the Framework for Nurses and Midwifes in Queensland approved by the council in 2005. Therefore, a claim for negligence can be made against the clinical nurses for breaching their duty of care.

Section 3

It is essential for health care providers to take the concerns and management of patients into consideration and that idea decision-making process includes ethical principles, which requires the health care providers to have the will to take actions for safeguarding the disadvantages and the vulnerable. The nursing profession recognizes the standards of human rights in health care that requires them to safeguards the fundamental human right of all people to attain the highest standard of health. The nurses are required to demonstrate adequate knowledge of ethical responsibilities as moral accountable healthcare practitioners (Heaton, 2014).

In this case, the Clinical nurse had the responsibility to supervise the assistant and the enrolled nurses and held a senior position. She was accountable for overviewing all the residents of the residential age care facility and was required to give more attention to the patients who were subject to regular evaluation and had been reported to have frequent changes in their health condition. She failed to exercise her duty and did not even assess the medical records of Bruce; instead instructed the less experienced enrolled nurse verbal instruction to observe his condition, demonstrates lack of decision-making ability (Anderson, Malone, Shanahan, & Manning, 2015).

An enrolled nurse is required to assist the clinical nurse in decision-making using reflective and critical skills. It is an ethical responsibility of nurses to promote effective health care, and in case of aged parents whose health conditions changes frequently, it is important to give more attention to them (Parahoo, 2014). The residents of residential age care facilities are entitled to receive care and services whenever they require them. Moreover, the nurses also share an informal relationship with the patients so that the patients share their fear, doubts regarding their health and it is ethical responsibility of the nurses to pay attention to their needs and attempt to resolve their issues.

References

Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover–an integrated review of issues and tools. . Journal of clinical nursing, , 24(5-6), 662-671.

Blackman, I., Henderson, J., Willis, E., Hamilton, P., Toffoli, L., Verrall, C., & Harvey, C. (2015). Factors influencing why nursing care is missed. . Journal of clinical nursing,, 24(1-2), 47-56.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.

Chang, E., & Daly, J. (2015). Transitions in Nursing-E-Book: Preparing for Professional Practice. Elsevier Health Sciences. 

Daly, J., Speedy, S., & Jackson, D. (2017). Contexts of nursing: An introduction. Elsevier Health Sciences. 

Davis, J., Morgans, A., & Burgess, S. (2017). Information management in the Australian aged care setting: An integrative review. Health Information Management Journal,, 46(1), 3-14.

Dwyer, T., Craswell, A., Rossi, D., & Holzberger, D. (2017). Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. BMC health services research, , 17(1), 33.

Foley, M., & Christensen, M. (2016). Negligence and the Duty of Care: A Case Study Discussion. Singapore Nursing Journal, , 43(1). .

Gaskin, S. G. (2017, August 20 ). Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities. Retrieved from BMC Geriatrics: https://www.biomedcentral.com/1471-2318/12/1/40

Heaton, L. (2014). Legal aspects of nursing. Kozier & Erb's Fundamentals of Nursing Australian Edition,, 3, 57.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. . Journal of advanced nursing, 71(8), 1744-1757.

Masters, K. (2015). Role development in professional nursing practice. Jones & Bartlett Publishers.

McDonald, F., & Then, S. N. (2014). Ethics, Law and Health Care: a Guide for Nurses and Midwives. Palgrave Macmillan.

Parahoo, K. ( 2014). Nursing research: principles, process and issues. Palgrave Macmillan.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. . Collegian, , 23(1), 129-142.

Street, M., Ottmann, G., Johnstone, M. J., Considine, J., & Livingston, P. M. (2015). Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. Health & social care in the community, , 23(5), 513-522.