Medical Case Study Sample
Mr. Yellow is an 83 year old resident in a hostel who has been experiencing abdominal pain and changes in bowel habits for approximately three months. He was referred to a general surgeon for investigation and is now a ward patient.
· He was diagnosed of having a early dementia though there was no formal diagnosis.
· According to the psychologist he has a cognitive impairment.
· Mr. Yellow needs to have a colostomy bag as a result of his bowel surgery because of his bowel tumour with end to end anastomisis.
· His son signed the operation consent form allowing the surgery ans colostomy.
· The stoma therapy nurse had marked an X on Mr. Yellow’s patient to note that he does not want a colostomy,
Analysis of the Mr. Yellow’s Case
Nursing is the process of caring for, or nurturing, for an individual known as the ‘patient’. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (Gubrium, 1993).
According to the Code of Professional Conduct (NMC, 2002), a registered nurse, midwife or health visitor is accountable for what they practice. Furthermore it noted that the following should be followed when caring for patients and clients:
o “respect the patient or client as an individual
o Obtain consent before you give any treatment or care
o protect confidential information
o co-operate with others in the team
o maintain your professional knowledge and competence
o be trustworthy
o act to identify and minimize risk to patients and clients”.
On the other hand, according to the College of Registered Nurses of Nova Scotia (2003), the nursing profession has the following interrelated standards:
1) “ Accountability – the registered nurse is accountable to the public for competent , safe and ethical nursing practice
2) Continuing Competence – the registered nurse attains and maintains competencies relevant to own scope of nursing practice
3) Application Knowledge, Skills and Judgment – the registered nurse demonstrates competencies relevant to own scope of nursing practice
4) Professional Relationships and Advocacy – the registered nurse establishes professional therapeutic relationships with clients and advocates for clients in their relationship with the health system
5) Professional Leadership – the registered nurse demonstrates professional leadership in the delivery of quality nursing and healthcare services to the public
6) Self – Regulation – the registered nurse assumes personal accountability to practice nursing competently and ethically.”
According to an interview with a hospital lead nurse (assigned in older people’s acute care) people published in the Evening Chronicle (2004, November 8) good nursing practice is defined as:
“Good nursing practice is all about providing holistic, personalized care that is respectful of the individual and nurses are at their best when caring for older people”
The individual healthcare professional's ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring safe clinical care. But professional competence is only part of the picture. Good people, with good skills and good intentions, sometimes make mistakes. As part of this professional issue, to be a nurse is to observe a dynamic process of caring based on a theoretical body of knowledge.
The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing practice is on individuals' specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles.
Therefore, a good nursing practice is one that involves the patient in his own care. The patient’s role in his own care must be acknowledged and given importance by the healthcare professional
A specific example of a good nursing practice I have witnessed is having an open (and effective) communication between the patient (and / or the patient’s family) and the healthcare professional. First and foremost, the healthcare professional consults the patient about what are his preferences regarding his care and / or treatment. This is of significance in the patient – healthcare professional relationship; because it will prevent any misunderstanding that might arise when a decision regarding the patient’s care and / or treatment must be made. The patient is also given accurate and / or truthful information of his condition. Furthermore, the information regarding the patient’s condition is not relayed on very technical terms but rather using terms and / or language that is easily understood by the patient. This provides a better understanding for the patient on his medical condition. If in case a patient refuses to accept or undergo a treatment, the patient’s wishes are respected and followed by the healthcare professional.
Furthermore, a patient’s consent is first obtained before any treatment (and / or operation) is performed on the patient. The patient is informed of the effects and / or benefits of the treatment. And if the patient refuses the treatment and / or operation, his wishes are respected. And in cases such as that (a patient refuses treatment), the patient is informed of the consequences of the non-treatment and at the same time, possible alternative treatments (in place of the refused treatment) and the possible consequences and / or effects of the alternative treatments. In case, the patient was not able to give his consent an able (and legal) representative of the patient will be informed of the patient’s condition and asked for consent on the proposed treatment.
This is significant so that the healthcare professional will not be made liable on possible unfortunate consequences of the treatment or non-treatment; since it is the patient’s decision that has been respected and obeyed. Aside from that, the patient will have a better understanding of his condition and would feel more responsible about his health. Furthermore, he would be able to think over his refusal of the treatment and might concede to the healthcare professionals’ opinion or decision.
Another aspect of patient’s consent is his consent regarding on his medical records. Not only a patient is informed of his medical records but at the same time, he is informed on who has access to it and / or who knows about his medical records and how the information on his medical records are used in relation to his care and / or treatment. Furthermore, the patient’s consent is obtained regarding on who among his family members or other relations should learn of his medical condition and / or have access on his medical records.
Aside from that, the healthcare professional works as a team. Each and every healthcare professional that works in relation to a patient’s care and / or treatment coordinates with one another. Each and every one of them respects each other’s abilities, skills and opinions regarding the patient’s medical condition. A harmonious relationship lessens if not totally avoid misunderstandings, conflicts and tensions within the healthcare institution. Thus, a harmonious relationship in the medical team produces better results in the patient’s medication. Aside from that, a harmonious relationship amongst the healthcare professionals improves their performance which leads to better service and / or care to the patient.
Being a healthcare professional involves a great responsibility; since the health and possibly, the life of an individual lies in your hands. The patient depends on the healthcare professional, on the healthcare professional’s knowledge, expertise and skills. However, the patient should have an active role and / or participation on his own care and / or treatment. And in order for the patient to have a role and / or participation regarding on his care and / or treatment, there should be an open line of communication between the patient and the healthcare professional(s) who is (are) responsible for his care.
Based on my observation, an active role and / or participation of the patient on his care and treatment proves to be beneficial not only to the patient but at the same time the health care professional who is responsible for the patient’s care. It is important that the patient’s wishes or decisions is considered and respected. The patient feels better if he is consulted on decisions that are to be made with regards to his care and / or treatment. Furthermore, if the patient’s wishes or decision is considered and respected, he will respect and eventually obey the healthcare professional responsible for his care. The healthcare professional will gain a higher level of morale when he is respected and obeyed by his patient(s). And if the healthcare professionals have a high level of morale, they will perform better at work. This improvement of work will reflect in their care and / or service to the patients.
Aside from that, it is also beneficial that the patient has a truthful account of his medical condition. It is also important that the account of his medical condition be relayed to him in a way that can easily be understood. A truthful account of his condition will enable the patient to decide better regarding the treatments that he wants or refuses to take or undergo. At the same time, he should also be informed of who has access or knowledge of his medical records or condition and how the information on his medical condition is used. This is to protect the patient’s privacy and/ or confidentiality. The patient should also be consulted on whom among the members of his family or relations should have knowledge of his medical condition or should have access on his medical records.
It is also important that to obtain the patient’s consent before any treatment (or possibly, non-treatment) or care is to be given to him. First and foremost, the patient is authorized by the law to give or refuse consent regarding medical treatment, that’s why his wishes or decisions should be respected and obeyed. Aside from that, it will be more beneficial to the patient if he has knowledge of what has to be done to him; because it will make him understand his condition better. The patient should be well informed about the benefits and effects (as well as the possible negative effects) of the proposed treatment. The healthcare professional should also inform the patient of possible alternative treatments and cite the differences of the alternative treatments to the proposed treatment. Furthermore, the patient should also be informed of the consequences of his refusal to the proposed treatment. This should be done in order for the patient to have a clearer and deeper evaluation of his medical condition and for him to eventually arrive at a more intelligent decision on whether to refuse or grant consent on the proposed treatment. If the patient is unable to give his consent, an able (and legal) representative of the patient should be informed of the patient’s medical condition and the proposed treatment. The alternative treatments should also be disclosed. Obtaining patient’s consent is mandatory for the healthcare professional to avoid any criminal liability if ever an unfortunate incident happens to the patient.
Another important good nursing practice is for the healthcare professionals responsible for the care of a patient to work as a team. As a team, each and every one of them should recognize and respect each other’s expertise, knowledge and skills. This is important in order to have a positive and harmonious working environment not only in relation to the patient but to the health institution as a whole. A positive and harmonious working environment will improve the healthcare professionals’ morale and eventually will improve their performance. An improvement in their performance will reflect on the care and service they will give to the patients.
Therefore, a good health professional must not only focus on the technical aspects of his profession. At the same time, healthcare professional should consider the patients’ role and / or participation. Giving the patient participation regarding his care and / or treatment has positive effects not only to the patient but also to the healthcare professional but to the health institution as a whole. Aside from that, healthcare professionals should recognize that each and every one of the healthcare professional that are working for the care of the patient are working as a team. Thus, they should exercise professional ethics, such as respecting each other’s expertise, skills and knowledge. And most importantly, the healthcare professionals should always remember that the health and / or life of an individual are in their hands. Furthermore, they should remember that they are accountable for all the decisions and / or actions that they make or do in relation to a patient’s care and / or treatment.
Dedicated To Work. (2004, November 8).Evening Chronicle,p.11.
Gubrium, J. and De Gruyter, A. (1993) Speaking Of Life: Horizons of Meaning for Nursing Home Residents.
Nursing and Midwifery Council. (2004). Code of Professional Conduct.United Kingdom
College of Registered Nurses of Nova Scotia.(2003).Standards for Nursing Practice.
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