You are a first year RN who has been working in intensive care unit for the past six months. Today you are caring for a post-operative patient admitted from theater following thoracic surgery. The patient has the following: indwelling urinary catheter, an intravenous analgesic infusion, oxygen therapy, a central venous line for fluids and antibiotics, two wound drains and an underwater seal drain that is vented to the air and is currently swinging on inspiration.
You know it is going to be a busy late shift. There are two third year nursing students that commenced their four week placement in the unit two days ago. The shift is progressing well and your post-operative thoracic patient is stable with their pain under control. Bethany, one of the nursing students asks if there is anything she can assist you with. You ask if she has emptied wound drains and a urinary drainage bag before. The student tells you that she has in the previous surgical placement. You ask if the student knows where all the equipment is kept and where to chart the drainage volume? Bethany says yes and goes off to carry out the task. You are entering data from the shift about your patient while sitting at the end of the patient bed. Bethany has just completed empting the wound drains and the urinary catheter when the patient begins to gasp for breath griping the bed sheets. You immediately go and assess the patient and discover that Bethany had emptied the underwater seal drainage bottle.
Describe how you are to respond to the incident. Describe the action you must take
As for the answer of the scenario, it is important for the nurse to always consider about the fair practice of other individuals. This is regardless if the professional is newly hired or not. This is all about the question on how a person should be complying with their competencies with their professional practice. The clarification is correct, but it is important to check that the patient has been already prescribed with the medication before administering it. In this case, the procedure made by Bethany was not correct because the patient was seen to be gasping for air after changing the drainage. The issue in this case is all about the correct administration of water seal drainage management because it is a practice that the nurse should maintain to ensure that the safety of the patient will be always ensured according to Thoms (2011).
Responding to the incident
It is important to fill up the drainage immediately in order to seal the respiratory system of the patient. Our environment is considered to be the source of negative pressure, which sucks up the air from the respiratory system. By filling the drainage bottle and then securing it by covering the tubes, it will help the patient from having their lungs to be exposed into the outside environment. Allow Bethany to be always keep in mind that drainage bottle is always a risky procedure as it affects the chest of the person.
Proper procedure for chest drainage management
- Check for doctor’s order: Checking the patient’s chart for new doctor’s order is an essential procedure. This is to check the name of the patient, the procedure or management, dose, route, and the time of the order. And then confirm it to the bedside by determining the right patient to be administered with the medication.
- Prepare equipment: It is important to prepare necessary equipment so that it will be easier to administer medication. This includes syringe, medication, alcohol, cotton ball, and the label. Open the drain packaging by observing in a sterile technique.
- Approach the patient: This is an important procedure in order to determine if the person is the right one to be administered. Asking the name of the patient by allowing them to verbalize their concern will enable to ensure that the medication will be administered with the right patient and negligence will not push through. Establish rapport and explain the procedure to be applied.
- Ask for assistance: If you are a student nurse, it is always important to call for the attention of the staff. This includes allowing the staff to observe while you are performing the medication administration. Passing the sterile end of the tubing to nurse or doctor inserting the drain is important to avoid respiratory complications.
- Apply suction to drain: This will be eliminating excessive secretions so that it will provide a comfortable breathing pattern for the patient. It seeks to maintain the integrity to the respiration of the patient by means of having a clear airway clearance.
- Secure drain and tubing to bed and patient: This is to prevent the bottle from any unexpected movements that may cause the tube to be dislodged. Securing all connections with cable ties are important to prevent the patient from any accidents that might harm their health.
- Discard: All used cottons and other materials should be discarded to prevent contamination that might cause diseases.
- Perform hand hygiene: Prevents the spread of infection.
- Documentation: After providing medication administration, it is important to document the procedure to provide legal reference in the future and will endorse it to the staff on duty.
Nursing education applied for Bethany and the staff
Safe and Quality Nursing Care – This is a competency that allows the nurse to demonstrate their knowledge and skill while providing care for the patient by checking again the drainage after Bethany managed the drainage. Since the patient has been gasping for air, it is important to fill the drainage bottle and secure it. A nurse should always think for the safety of the patient while responding be able to preserve their physical wellness and to prevent the possibility of acquiring illness. Quality nursing care can be managed by nurturing the patient’s need by providing protective gear such as helmets and blankets for the patient to be kept in a warm and comfortable environment as a measure for the core competency to promote their health. As an expanded scope of practice, the nurse always seek for promoting the patient’s safety by placing the victim on a safe zone during disaster incidents to prevent further injury that can cause significant damage to the patient’s health care status. As an ethical practice, the nurse should always show politeness while rescuing the patient that are in need of emergent rescue as well as avoiding to hold private parts of the patient to avoid legal lawsuits. Patients need adequate and reasonable health care services which are stated from the patient’s bill of rights and if this right will be violated by the nurse as a health care provider will be facing charges that can lead to revocation of license as well as being imprisoned.
Health Education – Orienting Bethany regarding the proper procedure is important because it helps her experience to improve her knowledge on how to prevent things from happening again in the future. This is to protect the dignity of the patient as well as not being involved in future negligent actions of chest drainage management. this is an event when the attending nurse on duty will always orient the patient regarding the date, the time, and the place because this is an orientation process that will keep them aware for their current status.
Establishing rapport is always important while providing health education to be able to gain the patient’s cooperation for being attentive to all the instructions and information that are being mentioned while attending with the patient. In the same manner, health education is one of the most important that supports the nursing core competencies to be able to implement the patient’s acquisition of having the right to obtain information. In addition to the scope and practice of competency, health education can be done by stating the patient’s current physical illness and the underlying factors that created this kind of medical irregularity so that the patient will collaborate with the attending nurse practitioner that helps them to recover. Providing the patient’s rights such as the right to information and to obtain the patient’s basic health care needs is a requirement by the law to avoid legal malpractice suits.
Ethico-moral responsibility –In this process, the nurse should always know the procedures for responding to patients to maintain their level of professionalism. In any case that the nurse that does not have any knowledge or skill to accomplish emergent tasks such as medication administration. Deciding against the patient’s right to live by not attending to their medical needs in the disaster site is an immoral act for the reason that the nurse deprives the patient against their right to live, which can be considered as an immoral act that can be imprisoned with corresponding fines.
Personal and professional Development – this process is essential for nurses that are attending with patients that are under disaster circumstances in order to gain experience and practice. Skills will be improved into a higher level for the fact that patients undergoing training will be able to become confident for efficiently accomplishing procedures at a short period of time as an emergent response for urgent cases. Being personally and professionally trained will make the nursing professional to become more self-reliant and more efficient for handling complex health care services that will prevents the possibility of committing negligence or other unethical activities that may harm the patients according to Nursing and Midwifery Board of Australia (2015).
Quality improvement – This pertains to any health care services that needs to be improved so that responding health care utilizing medication administration will be accomplished independently to upgrade the integrity of professional image as indicated by Emerson (2010). As a scope for this practice, this can be done by evaluation for the past health care services that have been conducted to measure the efficiency if the services have been fully or partially provided to review past intervention that needs to be restructured. In cases that there are failure of health care provision especially for not saving patient’s lives that are confined in hospital should be taken into consideration to discover some procedures that have been forgotten to be delivered efficiently because these cases can lead into legal disputes such as homicide due to negligence. In the study of ethics, a nurse can lose their professional license if they have been proven to be negligent from their previous act of allowing the patient to end their life due to incompetency such as by not watching the patient while they fell from their bed and ended their lives. Quality improvement solves nursing competency integrity by improving nursing care services that helps the professional nurse to become as a role model and inspiration for new professionals that are starting to practice their profession as new health care providers according to Grossman (2011).
Research – As an emergent practice for chest tube drainage management is significant because it is a continuing process of acquiring more knowledge to increase awareness regarding issues about responding to wrongful medical administration. In this manner, the scope will be to attend trainings, seminar, or enrolling with academic institutions to continue the learning process of providing chest tube drainage. Researching more facts or insights will increase the nurse’s self determination and reliance to significantly accomplish health care tasks of saving patient’s life from disaster conditions. As an ethical circumstances, having a wrong information or notion such as providing false information to clients and other health care workers can cause miscommunication and disputes, which is a form of unethical instance that should not be practiced by nurses. Research is the process of obtaining more information that can be practiced by internet surfing, going to the library to read scholarly articles, and by reading newspaper journals to know something about current events that are related the professional nursing practice according to South Australian Health (2013).
Record management – Mahagan (2010) indicated that the process of documentation or record management pertains to a core competency to identify and collect relevant data that are based from nursing or health care services because all kinds of information will be needed to be recorded for the purpose of future reference for other health care professionals. As a scope for this action, this can be done by collecting significant data that came from nursing assessment of objective and subjective data that contains patient’s chief complaints and symptoms of the diseases that are needed to be treated that will be written to charts. Planning and interventions management are essential for the records management for the reason that this is the process of recording the current prognosis of the patient’s treatment plan that were experienced by patients in need of medical attention. The ethical issue that can be related to this event is to provide a concrete evidence for all the nursing and health care services that will be provided by the attending nurse and physician on duty because these will serve as legal documents according to the law. In any circumstance wherein there will be reproducing of these medical records can be sanctions by imprisonment, dismissal, and revoking of license as a consequence. Record management is important for health care practitioners for the reason that this competency will legally help the nurses to fight for their rights and privileges in instances that there are cases of abusive behaviors according to Hughes (2013).
Communication – This application utilizes communication to be able to establish responsive interaction between the victim and the health care provider during chest tube drainage management. This management helps the process of nursing competency by providing basic life support for patients under an emergent situation to prevent the patient from respiratory arrest. In addition, this can be done by stating your name to the patient and identifying yourself as a rescuer with valid proof of identification card for the patient to become aware that they are now being rescued and will be transported to a safer place. Walker (2005) stated that communication can also develop harmonious interpersonal communication with the attending nurse because in this process of core competency that helps the patient to be attended with their medical needs while being rescued or being treated in health care facilities. On the other hand, communication between other health care team members create positive collaboration and teamwork that is an important quality to gain more trust between health care team members to efficiently save patient’s lives. As an ethical principle, communication blocks the possibility of misunderstanding and as a conflict such as by practicing verbal harassment due do miscommunication incidents.
Collaboration and teamwork – cooperation with other health care team members especially in a disaster situation will help to unify complex tasks of saving patients with chest tube drainage. In this process, the scope of chest tube drainage management for nursing is by having an organized system of task delegation that will avoid confusions between health care team members. While attending patients, each task that are delegated represents a systematic flow of activities that creates as an inspiration for attaining goals successfully without experiencing any kind of constraints that affects the process of helping victims to be saved from harm such as injuries and damages. Collaboration is the process of helping other health care team members while teamwork pertains to the ability of the health care team to systematically accomplish tasks as a scope of the core competency. Disorganized collaboration and failure of teamwork can lead into negligence that can potentially affect the essence of professionalism between attending health care team members especially in a disaster circumstances.
Implication and Recommendation of the Study
As an implication, it has been learned from the study that core competency is important for a practicing health care professional particularly with licensed nurses for the reason that it represents their degree of professionalism and competitiveness as a professional. This involves coordinating with the staff nurse if the student nurse will provide medication administration and then charting it for legal purposes. Nursing competencies is essential because there are lots of insights that can be learned from being a nursing professional in order to become self-reliant and independent as indicated by Harisson (2009). There are many concepts that can be affected by the underlying competencies that will be needed by the practicing nurses for them to improve their knowledge and skills as a professional. Therapeutic health care services will be implemented while engaging core competencies because this can be considered as a part of learning process for the nurses to enhance their practice of providing tender loving care to boost the patient’s self-worth while undergoing rehabilitation. Ethical standards of nursing practice should be embraced for all practicing health care professionals for the reason that these are standards for maintaining moral principles of respecting patients, other health care professionals and for their own self. Advanced learning practice enhances the process of improving the degree of knowledge and skills to become more organized and systematic on providing health care services to avoid ethical lawsuits.
As a recommendation for this practice, the process of nursing competencies should be more studied and researched to be able to learn new knowledge and insights that will be beneficial to all practicing health care professionals that aim for client’s satisfaction of health care services. All health care professionals should attend regular trainings and seminars for all advanced nursing care topics such as advanced cardiac life support and basic life support to be able to have the ability to save lives for patients that are under a disastrous condition without the help of physicians or paramedics. It is important to know for a nurse that attends on real life situation of rescuing victims that are suffering from injuries that are brought about by earthquakes or other natural disasters as hazards should be equipped with facilities and protective equipments to prevent them from committing negligence due to the extent of hazards that are contained according to Snowball (2012).
Hughes, Clifford (2013). Clinical Incident Management in the NSW Public Health System: Looking, Learning, Acting. Auckland: Academic Press.
Mahagan, R.P. (2010). Critical incident reporting and learning. British Journal of Anaesthesia 105 (1): 69–75 (2010) doi:10.1093/bja/aeq133.
Nursing and Midwifery Board of Australia (2015). National competency standards for the registered nurse. Prentice Hall.
Olivar, Manson (2008). Description of Competencies. Retrieved from: .
Snowball, Kim (2012). Clinical Incident Management Policy. Sydney: Government Press.
South Australian Health (2013). Patient Safety report. Sydney: University press.
Thoms, Debra (2011). Wow: Ways of Working in Nursing: Resource Package. Sydney: Academic Press.
Walker, Cathy (2005). Effective Communication. Accessed: .
Wilson, Harisson (2009). Core Competency Framework. Available: http://www.cna-aiic.ca/CNA/documents/pdf/publications/Competency_Framework_2010_e.pdf