Question 1. The case describes a 37-year-old woman who underwent a Caesarean section at her 36 weeks of gestation. The article reports that the woman has been in the hospital for about three weeks because she was suffering from placenta praevia grade IV condition where her baby's placenta was lying over the cervix (McDonald et.al, 2014). In many cases, the placenta praevia occurs when the unborn baby's placenta is lying partially on the mother's cervix. Furthermore, it also occurs when the baby's placenta totally covers the opening of the cervix. This condition may result in serious bleeding before the baby is born or even after the delivery. Therefore, the caesarean section was prompted by the commencement of the premature labor. However, the Caesarean section activity was delayed for about three hours as the doctors had to attend a more urgent case even though an IDC had been inserted at 0915 hours. The delay saw the 37-year-old woman delivering a live baby with good conditions at 1220 hours through the Caesarean section. However, after the surgery was recorded to be unremarkable, the woman had to be returned to the ward for post-operative activity at 1430 hours. Under the post-operative plan, the mother was found to be having some complications. For instance, the doctor found out that the patient had low pressure and that there was no vaginal bleeding or wound oozing, and this prompted him to order for additional intravenous fluids where the patient was given a total of 6000ml of the crystalloid IV fluids recommended for post-operative period. Furthermore, the patient was expected to undergo urine checks every hour four times with the aid of a urinary catheter. Additionally, the doctor order the patient experience an FBC blood test the following morning. The results of the blood test recorded a pressure of 84/46Hg. As the blood pressure was low, a MET was to be called to attend the patient, but the nurse attending the patient reassured the staff that the patient had a history of low blood and thus she was comfortable.
Furthermore, the condition of the patient worsened as night shifts done by the nurses did not hand over the patient according to her conditions. The nurses who undertook the night shifts did not care about the 37-year-old mother as each worked independently according to the normal ward practice. Fortunately, the night duty nurse found the patient not breathing and her skin had turned pale, and thus she notified other staff who organized for the MET call where extensive resuscitation was conducted but the patient passed on later on. The problem can be attributed to poor post-operative plan that can be described as subtle and unresponsive on a timely basis. Furthermore, the MET call delayed as a result of unorganized nursing hand over system that did not provide an opportunity for nurses to ask questions but instead prioritize workload. Furthermore, the hospital was found to be having a low number of midwifery attendants and thus resulted in poor patient attendants
Question 2. As a new graduate midwives and nurses, we will majorly rely on the handover systems which outline changes in patient's situations. The case study provides an unsafe handover incident and thus through it I can development teamwork skills and other midwifery and nursing skills. The case study is significant for the improvement of my nursing knowledge and expertise. NBA, 2008 shows that the nursing midwifery skills and knowledge are necessary for effective service delivery. This is an important case as it provides a critical environment where I can consolidate and further developed the nursing competence. Furthermore, it is an important case since it provides the crucial platform for the development of safe, accountable and confident nursing profession. According to Nursing and Midwifery Board of Australia (2008), the code of conducts for a nursing is significant to nurse. Thus, learning the mistakes that the nurses and staff are attending the 37-year-old nurses did, I can be able to articulate the nursing code of ethics. In the case study, it is seen that the nurses missed the code of nursing ethics, and thus they did not provide all the details while handing over to the night shift nurse. What is more, the case is also important for me because through it I can be able to develop and implement strategies that can be used to attend emergency pregnancy cases. Additionally, the case is significant as it provides an opportunity for learning the importance of teamwork in nursing and healthcare provision.
Question 3. There were several factors which led to the situation. The first factor was the practice of taped handover which provided limited opportunity for the discussion and agreeing on a proper post-operative care. Another factor was the culture of working in isolation that had been developed by the hospital staff. The culture of isolation indicated that there was no effective team working, and thus the patient did not get the opportunity to be attended by the senior staff. It is seen that the patient was not given assessment by the senior nursing staff as the staffing of the post-natal ward had no relationship with the surgical outcomes (Cashin et.al, 2015). The hospital had recorded an increase in the number of caesarean section cases, but there was no skill mix. For example, the staff did not take into consideration the number of patient acuities, surgical patients and even the requisite mix in skills when undertaking the shifts.
Another factor that led to the situation is the lack of proper exchange of information. It is seen that there was a poor channel of commutation among the nurses and the surgical doctors. Therefore, improper transfer of useful exchange of information was facilitated by poor ward routine developed in the hospital. For example, when one patient that require emergency attendance is brought to the hospital, it diverts the attention of attending to other patients.
The nurses were also unable to adhere to the existing medical regulations and laws. The nurses were not effective because they were not following the set nursing regulations. According to NMBA, 2008, a nurse is supposed to follow the pregnancy and midwifery rules and regulations. All the procedure of attending to the patients were to be followed strictly, and the handing over was to be to be documented before handing over the incoming nurse. The nurses in the hospital were to be guided by NMBA, 2016 registered nurse standards for practice that provides competency skills and knowledge to the midwifery nurses (Nursing & Midwifery Board of Australia, 2016).
Question 4. When involved in a similar clinical situation, I will ensure that an effective ward culture value teamwork regarding the patient care and importance of sharing clinical practice. It is also imperative to follow all the nursing laws and regulations. The most important thing is to ensure that the NMBA code of ethics for midwives guide the process of midwifery. I will ensure all the processes before and after caesarean section are documented and thus can be referred later. Furthermore, I will ensure develop teamwork in the ward, and this will ensure that collaborative efforts are from all junior and senior staff are taken into consideration (Chang & Daly, 2016). Additionally, for effective delivery of midwifery services, I will also develop good communication channels. Communication between the surgical staff and nurses will be of great significance since it will ensure that the required information is appropriately handed over. Communication among the nurses and staff is important as it will facilitates effective delivery of nursing services. For instance, when the staff have good communication strategy hand over system will be effective as the nurses will ensure that all what is required is communicated to the nurses whom he or she hands over to. It is important to develop a culture of good communication among the nurses to it provide an opportunity for nurses to ask relevant questions and pass credible information to the relevant persons (Wright & Australian Catholic University, 2014). Effective communication in nursing is only possible through the teamwork among the nursing and surgical staff which further promote the provision of nursing services. I will ensure that the surgical information is well transferred to the post-natal ward to facilitate routine checks to the patient. The clinicians can work as a team to support the culture of safety and engagement with standards by ensuring that a closure observation of the patient is conducted. Furthermore, they also ensure that more effective exchange of information regarding the unwell patients is facilitated among the wards and surgical rooms (Wright & Australian Catholic University, 2014).
Chang, E. & Daly, J. (2016). Transitions in nursing. Chapter 21, pp. 329-341.
Cashin, Andrew, Heartfield, Marie, Cox, Darlene, Helen. (2015). Knowledge and motivation: two elements of health literacy that remain low with regard to nurse practitioners in Australia. C S I R O Publishing.
Nursing & Midwifery Board of Australia, (2016). Registered nurse standards for practice.McDonald, Fiona, Then, & Shih-Ning. (2014). Ethics, Law and Health Care: a Guide for Nurses and Midwives. Palgrave Macmillan.
Wright, C. L., & Australian Catholic University. (2014). Bachelor of Midwifery (BM) students' experiences of reflective practice: A grounded theory study: a grounded theory study.
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