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The Impact of An Electronic Patient Bedside Observation and Handover System on Clinical Practice

In the provided case study, it was observed that a mental health patient loses his life due to the carelessness of the mental health nurses. The role of the registered nurses is to provide the patient with quality practice and to look after the wellbeing of the diseased individual. The nurse, thus, needs to maintain the welfare of the patient physically and mentally by making correct and timely assessments (Nursing and Midwifery Board APHRA, 2020). But, in this case, both the registered nurses (RN) that is, RN Pandya and RN Prasad were not able to perform their duties in an accurate manner and the results have to be faced by the patient. In this essay, mistakes and errors demonstrated by both the registered nurses will be seen in detail and therefore, solutions would be provided so that these faults will not be made in the future practice and could be eliminated so as to ensure the safety of the patients.

The most important thing which was missed by RN Pandya during the case was that he failed to observe the patient behaviour in the mental health setting. RN Pandya acknowledges his mistake of not doing proper observation and documentation at 1400 and 1420 hours. He also failed to do accurate record-keeping which further suggests that his care was not patient-centred. The visual observation by the nurse was so important because by doing this, self-harm behaviour could be seen and thus intervention could be provided so that their health and life quality upholds. With that, Ms. Muller also explained that self-harm tendency in Patient A was high because he was recently admitted to the ward. Therefore, a thoughtful observation was required from RN Pandya’s side to ensure the safety of the patient. In NMBA standards also, it is mentioned that registered nurses need to execute comprehensive assessments on the patient which is holistic in nature with the aid of assessments strategies and techniques for the collection of correct and relevant data. In addition to that, the registered nurses are bound by the obligation of mandatory reporting about the potential danger which could compromise the patient safety and health quality (Nursing and Midwifery Board APHRA, 2020). So, in future, it is recommended that correct and complete assessments should be made on the patient in a timely manner so that his health could be maintained. 

The other most significant error done by RN Pandya was that he did not keep clinical notes regarding the case of Patient A. He did not completely perform his duty of observation and thus forget to write down the examination which needs to be performed. This shows that his nursing practice was below standards and his professional conduct was unsatisfactory. Therefore, RN Pandya disregarded his duty to keep notes about the examination on patient A, who was a mental health patient. Clinical notes are important because they reduce the time which is spent on accessing and inputting the data and information. In addition to that, it provides healthcare workers with complete information and the full set of examination observations. It also helps in taking fast decisions for the health of the patient thus it enhances the safer working of the healthcare professional with the diseased individual. As a result, it can be said that clinical notes keeping provide support toward work and thus enable accessing the current records about the diseased or problem of the patient (Lang et al., 2019; Olsen et al., 2019). In the National Safety and Quality Health Services (NSQHS) Standards, it is mentioned that healthcare organization plus healthcare workers should participate in clinical handovers. The healthcare professionals need to prepare these handovers and should inculcate relevant information in it. With that, they should be aware of the needs and requirements of the patient and their preferences (National Safety and Quality Health Services, 2017). Therefore, it is recommended that clinical notes or handovers are created which contains all the information and data about the patient condition and his time to time observations.

One of the problems in this case which are raised by RN Prasad was that she had an inadequate understanding of patient A and his case. She demonstrated that she did not have complete knowledge about the mental health nurse and the roles associated with it. She also showed a lack of knowledge about the mental illness and the patients who were involuntary admitted and suffered their first episode of psychosis in addition to being at high risk of suicide. The registered nurse in the mental health setting has the responsibility of taking care of the patient and providing them with their regular medications so that patient health status remains maintained. They also need to focus on the diseased individual mental status and understand the problem that is faced by the patient and thus giving him with utmost quality care (Farmakas et al., 2014; McTiernan & McDonald, 2015; Kurjenluoma et al., 2017; Lambrou et al., 2015). In addition to that, nurse practitioners should have clinical knowledge and skills for complicated decision-making. They should also have advanced education and with skills for clinical reasoning and diagnosing. Moreover, nurses should also evaluate and make management plans which are therapeutic for the patient (NSW Government, 2020). Therefore, for future practice, it is recommended that the mental health nurse should have complete information about mental illnesses and the patient. They should be more understanding of the patient situation and thus perform their roles more effectively in the mental health institute.

Another mistake which was done by RN Prasad was that she was not able to locate Patient A in the mental health setting. This demonstrated that she has poor judgment in the situation as she did not find the Patient in the bathroom but started to look into the doorway. She also looked for patient A in the interview rooms to check if he is with one of the doctors. She did not consider looking inside patient A’s bathroom and that is why RN Griffiths found him lying on the floor. It was mentioned in this case that Ms. Muller has illustrated out that risk of self-harm is the greatest in the initial week of admission and that the patient already had met with the doctor during lunchtime. But, RN Prasad did not know that because she was not aware of the clinical notes in which the information was present. Therefore, this shows that RN Prasad demonstrates very causal behaviour towards patient A and conducted her duties below the standards. In NMBA standards also, the role of the registered nurse that have been mentioned talks about thinking critically and performing duties with the best available material so that the care which is given is person-centred. Other than this, the nurse also needs to engage with the patient in a therapeutic and professional manner so that agreed goals and outcomes could be achieved (Nursing and Midwifery Board APHRA, 2020). With that, mental health nurse should also solve the problems that arise in the institute and should establish the concept of self-encouragement and self-expectation for better nursing practice (Du et al., 2020; Hou et al., 2020). Therefore, it can be said that nurses should take decisions through critical thinking and works with the best available material. In addition to that, they should also improve their practice by self-evaluation.

Another error which was committed in the case by RN Prasad was that she left the floor at the wrong time and when there was insufficient staff present on it. She did not consider knowing that the accurate number of staff members is present on the floor or not. With that, she also did not complete the observation on the patient which should be done at 1400 and 1420. This shows that she did not comply with her role. Also, her actions were not therapeutic for the patient. In the NSHQS stands, it is discussed that healthcare professionals should maintain processes and systems which help in the delivering of comprehensive care to the patient. The standards also say that risks towards the patient should be managed so the life and well-being of the patient remain preserved. For that, the nurse needs to develop a care plan and deliver complete care with minimizing the risks (National Safety and Quality Health Services, 2017). Therefore, it can be said that for future practice the nurse should manage the risks of the patient and thus create a care plan for him.

In conclusion, it can be said that RN Pandya and RN Prasad created many errors while dealing with patient A and because of this nursing care and safety of the patient was compromised. RN Pandya did not manage to observe the behavioural characteristics of the patient and the appropriate time. This could be corrected if the timely assessment can be performed. RN Pandya also did not keep clinical notes of the patient. This should be rectified by keeping complete documentation of the patient which has complete information in it. RN Prasad also showed an inadequate understanding of patient A case which should be eliminated if the nurse would know about the mental illnesses and the conditions. RN Prasad was also not able to locate the patient and she did leave the floor while it was understaffed. These mistakes could be prevented if the nurse would think critically and would manage the risks effectively.

References for Challenges in Mental Health Nursing

Du, M. L., Deng, W. X., Sun, W., Chien, C. W., Tung, T. H., & Zou, X. C. (2020). Assessment of mental health among nursing staff at different levels. Medicine99(6), e19049. https://doi.org/10.1097/MD.0000000000019049

Farmakas, A., Papastavrou, E., Siskou, O., Karayiannis, G., & Theodorou, M. (2014). Challenges in mental health nursing: Working in institutional or community settings?. Journal of Psychiatric and Mental Health Nursing21(1), 39–45. https://doi.org/10.1111/jpm.12045

Hou, T., Zhang, T., Cai, W., Song, X., Chen, A., Deng, G., & Ni, C. (2020). Social support and mental health among health care workers during Coronavirus Disease 2019 outbreak: A moderated mediation model. Plos One15(5), e0233831. https://doi.org/10.1371/journal.pone.0233831

Kurjenluoma, K., Rantanen, A., McCormack, B., Slater, P., Hahtela, N., & Suominen, T. (2017). Workplace culture in psychiatric nursing described by nurses. Scandinavian journal of caring sciences31(4), 1048-1058. https://doi.org/10.1111/scs.12430

Lambrou, P., Papastavrou, E., Merkouris, A., & Middleton, N. (2015). Professional environment and patient safety in emergency departments. International Emergency Nursing23(2), 150-155. https://doi.org/10.1016/j.ienj.2014.07.009

Lang, A., Simmonds, M., Pinchin, J., Sharples, S., Dunn, L., Clarke, S., Bennett, O., Wood, S., & Swinscoe, C. (2019). The impact of an electronic patient bedside observation and handover system on clinical practice: Mixed-methods evaluation. JMIR Medical Informatics7(1), e11678. https://doi.org/10.2196/11678

McTiernan, K., & McDonald, N. (2015). Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a D Dublin region. Journal of Psychiatric and Mental Health Nursing22(3), 208-218.https://doi.org/10.1111/jpm.12170

National Safety and Quality Health Services. (2017). National Safety and Quality Health Services Standards. Available at https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

NSW Government. (2020). Nurse practitioners in NSW. Available at https://www.health.nsw.gov.au/nursing/practice/Pages/nurse-practitoner.aspx

Nursing and Midwifery Board APHRA. (2020). Registered nurse standards for practice. Available at https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Olsen, S. L., Søreide, E., Hillman, K., & Hansen, B. S. (2019). Succeeding with rapid response systems–a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS. Resuscitation144, 75-90. https://doi.org/10.1016/j.resuscitation.2019.08.034

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