Utilisateur
Catheter pt- shouting and screaming- actually in pain
S- A patient has disclosed they are being abused to me.
T- As an NQN i have a responsibility to respond to a safeguarding disclosure and prioritise the patients safety.
A- Remain calm, listen. Open and non leading responses, let them talk. Reassure pt they have done right thing. Reassure confidentiality, but will tell people that can help keep them safe. Consider if pt is in immediate danger. Escalate to NIC and consider local guidance for reporting safeguarding concerns.
R- The concern would be esacalated and documented properly, ensure that the patient is safeguarded, and the correct policies were followed. Maintained professionalism and trust, acted promptly.
T- Maintain pt safety while remaining within my scope of practice and maintaining professional accountability.
A- Respond respectfully and professionally, explain that I am not yet competent in the task proposed. Emphasise that my concern is patient safety and not an unwillingness to help/ contribute. Offer safe alternatives ie supervision or another staff member who I know to be competent. Remain calm and professional.
R- Patient safety is maintained, professional accountability is achieved, and I remained within my scope of practice.
T- Ensure pt safety while maintaining safe medicines management, and acting with honestly and integrity.
A- Avoid making assumptions or blaming anyone. Consider legitimate explanations such as documentation errors. I would check the drug chart/ CD book if necessary. If I couldn't see a reason, I would escalate the issue to the NIC and follow local policies and guidance. I would act promptly. I would ensure the incident is properly documented as per trust guidelines.
R- Any potential risk is effectively managed, supporting a culture of accountability and integrity.
S- HCA called a patient a big baby because she needed full assistance with eating, dressing, and toileting
T- I have a professional responsibility to uphold the sginity and respect of patients, challenge unprofessional conduct, and advocate for the patient.
A- I addressed the calmly and non-confrontationally but firmly. I said that the patient was not a baby, she is a grown woman with experiences, memories, family, and an identity that should be respected. I kept my tone professional to avoid escalation, while still clearly challenging the statement in order to promote respect and compassion, in line with OUHT values, the NMC code, and the 6 Cs.
R- I continued to work with this HCA after this shift, and the comment was not repeated, but our professional relationship was stronger for it.
R- On reflection i was proud of myself for maintaining and practicing principled and compassionate care, and I will continue to perform in this way as an NQN
S- Nurse has administered an incorrect drug
T- Maintain patient safety and promote professionalism and effective care
A- Immediately intervene. Inform the nurse involved- be calm and non judgemental, avoid blame, focus on learning. Consider the type of drug administered, and complete observations and an A-E assessment if necessary. Escalate to the nurse in charge, follow local policies and guidelines on incident reporting. Continue to monitor over time for deterioration. Document the situation thoroughly and effectively. Communicate the situation to the patient to support duty of candour. Check the background of the error to ensure that this was a one off, human error, and didn't involve a faulty system or another staff member. Escalate any concerns to the NIC.
R- Reflect on the situation to consider how I can prevent this occurring within my own practice.
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- Use A-E approach to identify most clinically urgent patient. Assess pt A-E and complete observations and initiate basic interventions ie oxygen/ look at PRNs. Escalate as necessary.
- Delegate an HCA to speak to the upset family member to discuss the issue before it escalates. If necessary they can say that I will be in to speak in a moment but I am busy with a patient at the moment.
- Ask a colleague to administer analgesia to the patient in pain if it is prescribed. If not, see if someone can do a set of observations/ A-E assessment on this patient to identify if there is any other symptoms before escalating to the doctors for analgesia prescribing.
- Complete medications round for other patients, prioritising time-sensitive medication
- Always prioritise patient safety and clinical urgency.
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T- make sure the patient receives safe appropriate care while maintaining professional communication and working within my scope of practice.
A- I would avoid acting on either instruction until I had clarified the situation and care plan with one or both of the staff members. If there was still uncertainty, I would consult the nurse in charge or the appropriate senior clinician for the correct course of action. I would ensure that this action and the eventual decision were communicated and documented.
R- This ensures the most appropriate line of care while reducing the risk of error. This demonstrates professional accountability and speaking up when something is unclear.
R- this reinforced the importance of clear communication and seeking clarification, and developed my confidence in speaking up respectfully. It also demonstrates the importance of professional accountability regardless of seniority.
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