Essay On Nursing Risk And Challenges


Quality and safety are two primary issues which should be maintained by a Registered nurse or RN in order to provide high quality patient care and support. According to the action 8.04 of the “National Safety and Quality Health Service or NSQHS Standards”, the presence of clinicians that can effectively detect the signs if patient deterioration is necessary (NSQHS-Standard 8, 2022). Moreover, the standard 2 of NSQHS states that effective partnership should be present between the consumers and the healthcare professional to maintain patient’s safety (NSQHS-Standard 2, 2022) RN and clinicians are required to maintain adequate patient safety by determining the signs of deterioration through the patient’s vital signs and medical notes. The present case shows that due to lack of medical documentation, proper clinical diagnosis and treatment could not be performed to a 6-year-old child (M) who was suffering from Melioidosis. Due to the absence of clinical documentation on 5th to 8th January, the concerned patient C died instead of receiving adequate treatment and care from 10th January of 2017.

Oldland et al., (2020) have shown that a reduction in the care quality can be observed on the condition RNs are not aware of their overall roles and adequate responsibilities. It has been observed that effective and evidenced-based medical practice, adequate safety management maintenance and quality management maintenance is effective in proper safety management of patients. C has not received proper care due to lack of medical documentation and this has  resulted in misdiagnosis of C’s medical condition to viral gastroenteritis and pneumonia instead of Melioidosis. This delayed the overall treatment which worsened the child’s condition and ultimately resulted in his death due to acute septic shock. The present essay highlights overall safety concepts of medical treatment and discusses the missed treatment and adequate nursing opportunities. The essay also highlights the potential nursing roles and explains its efficacy in proper nursing communication and clinical documentation. Moreover, the nurses are required to show adequate nursing strategies which would help them in understanding the problem's efficacy.

Discussion Of Key Safety Concepts

The primary safety issue that has been highlighted in this case is after the investigation of the Health Ombudsman, it has been observed that the lack of effective record keeping especially during the treatment of children can place a major health risk. In this case, failure of proper medical records are the primary reason for C’s health deterioration. According to the standard 1 and standard 5 of the NMBA registered nursing standards, nurses are required to collect every piece of evidence which can improve the overall care provided to the patient (, 2022). However, in the present case, the evidence has not been extracted in the form of medical records.

Moreover, it has been observed that the safety concerns and words of the child’s parents were ignored repeatedly as found in the investigation of the coroner and the health ombudsman during 5th January to 8th January. According to standard 2 of the NMBA registered standards, nurses are required to provide effective therapeutic communication with the patient and the patient’s family which would provide them a sense of safety and security.

Misdiagnosis is another major safety issue in this case. It has been observed that due to lack of clinical records, the patient C’s disease has been identified as viral gastroenteritis.This has delayed the intravenous administration of antibiotics. The misdiagnosis has helped in disease prognosis which resulted in pneumonia and adequate septic shock after administration of antibiotic therapy which includes meropenem, erythromycin, lincomycin and vancomycin.

Missed Opportunities

In the present case there are several missed opportunities identified which can be analysed from the perspective of an RN.

Late administration of antibiotics: It has been observed that after C’s admission the overall administration of antibiotics has been delayed by approximately 5 hours whereas it should have been administered within 1 hour. According to standard 6.1 of the NMBA standards, RNs are required to provide effective, safe and high quality nursing practice to the patient which wou;d help in improving the patient's condition (Ossenberg et al., 2020). However, the late antibiotic administration proves that a safe and quality practice has not been maintained properly.

Lack of communication: It has been observed that the decision for administration of Ceftriaxone has been taken approximately 2 hours and 20 minutes late which has worsened the patient’s condition. This has occurred due to lack of communication. As an RN, effective communication should be present between the medical professional and the nurses which would help the RN in providing the correct medication administration and also would help in providing high quality treatment and care to the patient. According to Hammoudi et al., (2018), lack of effective nursing report and communication is the primary issue that causes medication error and delays the administration of correct medication. This is an effective health hazard which can reduce the overall health progress of the patient.

Wrong medication: Meropenem is the correct antibiotic drug for treating Melioidosis. However, due to lack of clinical records, the diseases could not be detected and thus correct medication could not be administered. Different studies have shown that RNs are accountable for providing safe medication to the patient. They are also accountable for communicating with the medical practitioner and reporting the medication and clinical report of the patient to them (Shore et al., 2022; Jones & Treiber, 2018).

Discussion On Ongoing Assessments, Communication And Documentation 

Effective nursing assessment is the most effective healthcare practice for RNs (Immonen et al., 2019). They are required to effectively plan and provide adequate patient-centred care and effective family centred care to each patient. However, the concerned case, the family’s concerns and worries for patient C has been ignored repeatedly. The standard for national competency of the NMBA for RNs states that effective comprehensive and adequate systematic nursing assessment should be done ( 2022). Moreover, the overall planning for nursing care should be done after effectively consulting with the patient, patient’s family and the total healthcare team that are associated with the care. Nurses are also required to analyse adequate symptoms of rapid deterioration of patients. It has been observed that proper communication and adequate clinical documentation is effective as it helps nurses in conducting effective comprehensive assessment.

Nurses are required to document all the observational findings in an effective flowchart for documenting observations. This would help nurses in maintaining adequate comprehensive care for the patient. In the present case, no clinical documentation has been performed which has resulted in the patient's death. The ongoing assessment should have been performed by the RNs after C’s admission in the hospital. This could be done by effectively reviewing the ViCTOR graph after 2 hours to analyse the observational progress of the clinical symptoms (Olivares Bøgeskov & Grimshaw-Aagaard, 2019; Jungquist et al., 2020).

Relevance To Nursing Communication

Presence of human factors: According to NMBA nursing standards, maintaining patient’s safety is the ultimate aim of RNs (Nagle & Vogt, 2018). Human factors are essential for maintaining adequate safety and quality care. In the present report, during 5th and 6th January, although the patient has shown appropriate illness and deterioration symptoms, the patient admission has not been performed and clinical documentation has not been done due to lack of proper nursing staff in the weekend. This proves that the presence of proper human factors are necessary. According to NSQHS standards, effective presence of efficient nursing staff and healthcare staff helps in maintaining safety and high quality treatment (NSQHS, 2022).

Presence of teamwork: According to the Standard 2 of NSQHS, adequate collaborative care and partnership should be present which would help RN in creating a better care plan for the patient  (NSQHS-Standard 2, 2022). Due to lack of proper teamwork. C’s treatment got delayed which has resulted in the patient deteriorating.

Presence of effective communication: According to standard 6 of NSQHS, effective communication should be present between the patient, patient’s family, healthcare staff and the nursing leader (NSQHS-Standard 6, 2022). This helps in understanding the patient’s needs and requirements and also helps in providing high quality care. Due to delay in the communication for antibiotic administration with the paediatric registrar of the regional hospital, C’s condition got worse and he suffered from stroke and septic shock which resulted in his brain death.

Synopsis Of Suitable Strategies 

According to the safety standards of NSQHS, RNs are required to provide adequate collaborative and safe care which would help in reducing the medication error and improving the patient’s safety and helps in providing quality treatment. On the condition that effective health services were present for the treatment of C, the incident of patient deterioration and adequate sepsis would not happen.

The  “Royal Children’s Hospital's Transition Support Service” has effectively maintained a planned transition and adequate purposeful transition for providing quality care to paediatric patients such as C who are vulnerable. The hospital has maintained adequate NSQHS standards of standard 5.3, 5.4, 5.5, 5.6, 5.13 and 6.4 (, 2022). These standards have helped in maintaining a proper quality care and adequate community care for patients. These strategies could have been implemented in the case of C in order to reduce the complications of C. A planned nursing care should have been implemented for C which would help the RNs and the clinical professionals in analysing the deterioration signs of C. Moreover a detailed clinical examination including blood culture analysis could have been performed which would help the nurse and the clinicians in determining C’s actual problem of Melioidosis.


Therefore from the above discussions it can be stated that a planned nursing documentation and clinical care is necessary for improving the patient’s condition. The discussion and argument have shown that absence of proper clinical documentation is the main factor for misdiagnosis. It has been observed that lack of proper communication between RN and the patient’s family can lead to diagnostic error and can even lead to patient death which can be evidenced from C’s condition. Effective collaborative care should be present between the RN and the medical practitioner which would help in providing proper care and support to the patient. The NMBA and NSQHS quality care and safety standards have shown that proper addressing of patient’s safeguarding issues are necessary for an RN. This would have been helpful in preventing the death of C. The synopsis strategies have shown that effective maintenance of patient’s clinical records, adequate collaborative care and maintaining patient’s safety is necessary for reducing patient mortality.


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