Aim of Assessment:
\nThe aim of this assessment is to develop your understanding evaluating the professional conduct of a nurse\/midwife in the case study provided.
\nThe case study provided is a decision statement selected from Decisions of the Professional Standards Committee from the Nursing and Midwifery Council New South Wales – The Health Care Complains Commission (HCCC). You are to identify professional practice issues from the case study and then draw on the professional frameworks and regulatory legislation, to develop sound and appropriate responses to the clinical incident that will inform your future practice.
\nDetails:
\nThis assessment requires you to identify and summarise the professional practice issues in the case study from either a nursing or midwifery practice perspective. You need to identify and evaluate relevant professional errors identified that potentially contributed to the incident happening. Finally, discuss on how your future practice might change and develop as a result of this learning.
\nStudents are to draw on the National Safety and Quality Health Service (NSQHS) Standards, NMBA professional practice documents and NSW Health policy documents (where appropriate) to develop informed responses.
\nStudents must refer to and use the case studies located on vUWS under Assessment 2 tab for this assessment. There is one nursing case study and one midwifery case study to choose from.
\nA Critical Analysis Essay:
\n1. Is very well structured
\n2. Presents a clear logical argument
\n3. Presents and critiques [interprets] the argument
\n4. Uses critical analysis language features
\n5. Is well considered and thought out.
\n6. Has references to support the main ideas.
\nIntroduction paragraph (around 150 words = 1 paragraph) 10 marks.
\n\u2022 Orient reader to the topic; clarify and define all major topics
\n\u2022 Include thesis statement
\n\u2022 Outline the main ideas of your essay body
\nBody section 1 (around 200 words = 1 paragraph)
\n\u2022 Summarise the case study professional practice issues comprehensively and clearly from a nursing\/midwifery perspective . 10 marks.
\n\u2022 Reference the case study the first time you mention it (see next slide for how to reference the case study).
\nBody section 2 (around 600 words = perhaps divided into 2-3 paragraphs)
\n\u2022 Identify the relevant professional errors that potentially contributed to the incident happening. Use clear, clinical reasoning that matches the context of the errors. 30 marks.
\n\u2022 Refer to NSW health policy documents and other useful sources of literature
\nBody section 3 (around 400 words = 1-2 paragraphs)
\n\u2022 Assignment help – Discuss\/ Reflect on how your practice might change and develop following this incident. 20 marks.
\n\u2022 Relate your ideas to the case study context using critical thinking
\n\u2022 Use recent and relevant references to support your answer including NMBA Standards for Practice document\/s and National Safety and Quality Health Service (NSQHS) Standards
\n\u2022 First person writing here OK, eg. I\/me\/my
\nConclusion paragraph (around 150 words = 1 paragraph) 10 marks.
\n\u2022 Summarise your arguments \/ main ideas. Restate thesis. End with a concluding statement (eg. recommendation\/ application to nursing practice)
\n\u2022 No references needed.
\nReference list
\n\u2022 Minimum of 8 references including NMBA Standards for Practice document\/s and National Safety and Quality Health Service (NSQHS) Standard
\n1 \u2022 Identify & summarise the professional practice issues in the case study from either a nursing OR midwifery practice perspective.
\n2 \u2022 Identify and evaluate [analyse from your perspective] relevant professional errors [from the case study] that potentially contributed to the incident happening.
\n3 \u2022 Link and support these using the professional practice literature and policy documents [nursing policies\/ professional guideline documents] [Again, analyse and interpret them-don\u2019t just copy\/paraphrase them \u2013tell us what they actually mean in practice]
\n4 \u2022 Assignment help – Discuss how your future practice might change and develop as a result of this incident
\nHealth Care Complaints Commission v Youssef & Health Care Complaints Commission v McArthur [2021] NSWCATOD 2
\n[HCCC v Youssef & McArthur [2021] NSWCATOD 2]
\nPreamble
\n1) The Health Care Complaints Commission prosecuted a complaint against Registered Nurse, Ms Nelley Youssef before the NSW Civil and Administrative Tribunal.
\nOn 9 February 2017 an 80-year-old patient who had a laryngeal stoma was found unresponsive. The Commission alleged that Ms Youssef had inappropriately agreed that a junior colleague apply dressing to the stoma and provided the dressing to the colleague for that purpose. It was also alleged that when the patient was later found unresponsive, she failed to remove the dressing for resuscitation to occur and provided misleading information by stating that when she found the patient unresponsive, the dressing was not covering the stoma.
\nIn its decision on 13 January 2021 the Tribunal found all allegations against Ms Youssef proved and that they amounted to unsatisfactory professional conduct and professional misconduct.
\n2) The Health Care Complaints Commission prosecuted a complaint against Registered Nurse, Mr Seamus McArthur before the NSW Civil and Administrative Tribunal.
\nOn 9 February 2017 Nurse McArthur was caring for an 80-year-old patient who had a laryngeal stoma. The Commission alleged that Nurse McArthur inappropriately placed a dressing over the stoma to enable the patient\u2019s stoma to remain dry while having a shower. The dressing obstructed the patients only airway. The Commission also alleged that Mr McArthur provided misleading information to the Commission.
\nThe Tribunal found that Mr McArthur\u2019s decision to apply the dressing to the stoma and his lack of knowledge surrounding the stoma amounted to unsatisfactory professional conduct.
\nReason for the decision
\nOn 13 March 2020 the Health Care Complaints Commission (the HCCC) applied to the Tribunal under the Health Practitioner Regulation National Law (the National Law) for orders against Registered Nurses Nelley Youssef (proceeding 2020\/00081521) and Seamus McArthur (proceeding 2020\/00081523).
\nAt a direction hearing on 24 July 2020 an order was made that both proceedings be heard together, with evidence in one to be evidence in the other.
\nThe complaints against each practitioner are brought in relation to their conduct on 9 February 2017, when they were rostered to work on Ward DB4, the respiratory and infectious diseases ward at a large metropolitan hospital in Sydney (the Hospital).
\nPatient A was an 80-year-old man who had been admitted to Ward DB4 the afternoon before after spending several days in the Intensive Care Unit (ICU) for hypotension with a background of infective exacerbation of chronic obstructive pulmonary disease (COPD). Patient A had an established laryngectomy stoma following surgery for laryngeal cancer in 2002. Patient A had a total laryngectomy, which meant that his larynx had been surgically removed and a permanent neck stoma created. That stoma was his sole airway.
\nPatient A sought RN McArthur\u2019s assistance in preparing for a shower. RN McArthur at that time, with the consent of Patient A, applied a Mepilex occlusive dressing that covered the whole of Patient A\u2019s stoma. Prior to applying the dressing, RN McArthur checked with RN Youssef to see if the application of the dressing would be appropriate, which course of action RN Youssef agreed to. RN McArthur then left Patient A to shower.
\nSometime later RN Youssef entered the bathroom and observed that Patient A was non-responsive. Attempts were made to resuscitate Patient A which were unsuccessful.
\nNSW Police attended, and an autopsy report was prepared for the Coroner and witness statements were taken from a number of Hospital staff. The autopsy report concluded that the disease or condition directly leading to death was \u201cocclusion of the external airway in the context of a permanent tracheostomy after the treatment of laryngeal carcinoma\u201d. The Tribunal was informed at the hearing that the matter is still being considered by the Coroner. There are no pending criminal proceedings.
\nThe complaints
\nThe complaints against each practitioner were amended by consent at the hearing. Particular 1 of Complaint One against RN Youssef originally was that RN Youssef had \u201cadvised a nursing colleague\u201d to apply the dressing and was amended to be that she \u201cresponded to a request for advice from a junior colleague by agreeing that it was okay\u201d to apply the dressing. Particular 1 of Complaint Two against RN Youssef and RN McArthur originally was that each had provided false and misleading information \u201cto the Hospital\u201d in their statements of 27 February 2017 and 9 March 2017 respectively; the reference to \u201cthe Hospital\u201d was deleted from particular 1 of Complaint Two against each of RN Youssef and RN McArthur.
\nRN Youssef
\nThere are three complaints against RN Youssef.
\nComplaint One is that she is guilty of unsatisfactory professional conduct under s 139B(1)(a) of the National Law in that her conduct was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience, in that she:
\nInappropriately responded to a request for advice from a junior nursing colleague by agreeing that it was okay to apply a Mepilex occlusive dressing to cover Patient A\u2019s stoma;
\nInappropriately provided a Mepilex dressing to her colleague to be used to cover the stoma before Patient A commenced his shower;
\nDemonstrated a lack of knowledge of the underlying anatomy and clinical history of Patient A;
\nDemonstrated a lack of knowledge that the laryngectomy stoma was Patient A\u2019s sole airway;
\nFailed to seek advice from a more senior colleague regarding the appropriate management of Patient A\u2019s laryngectomy with respect to the appropriate dressing to cover his stoma while he showered; and
\nFailed to remove the dressing from Patient A\u2019s stoma when she found him unresponsive in the shower, thereby failing to ensure he had a clear airway when resuscitation efforts were commenced.
\nComplaint Two is that she is guilty of unsatisfactory professional conduct under s 139B(1)(l) of the National Law in that she engaged in improper or unethical conduct relating to the practice or purported practice of nursing, in providing false and misleading information:
\nIn a statement dated 27 February 2017 when she stated that at the time, she found Patient A unresponsive, \u201cI noticed that the Mepilex Border dressing was no longer in situ. The stoma was not covered, and I did not see the dressing in the surrounding area\u201d, in circumstances where the dressing was in situ at the time; and
\nIn her letter to the HCCC dated 15 June 2017 when she stated that when she found Patient A unresponsive \u201cthe Mepilex dressing was no longer in situ, the stoma was not covered\u201d, contrary to s 99 of the Health Care Complaints Act 1993 in circumstances where the dressing was in situ at the time.
\nComplaint Three is that she is guilty of professional misconduct, relying on the particulars of Complaints One and Two both individually and cumulatively.
\nRN Youssef admits in response to Complaint One that she agreed a Mepilex dressing would be suitable, and that she provided a Mepilex dressing. She admits that she had a lack of knowledge of the underlying anatomy of Patient A\u2019s altered anatomical state after his laryngectomy in 2002, and denies that she did not have knowledge of Patient A\u2019s clinical history. She admits she had a lack of knowledge that the laryngeal stoma was Patient A\u2019s sole airway, and that she failed to seek advice from a more senior colleague. She denies that she failed to remove the Mepilex dressing when she found Patient A unresponsive in the shower.
\nIn response to Complaint Two RN Youssef denies that she provided false and misleading information. In response to Complaint Three she relies on her responses to Complaints One and Two.
\nRN McArthur
\nThere are three complaints against RN McArthur.
\nComplaint One is that he is guilty of unsatisfactory professional conduct under s 139B(1)(a) of the National Law in that his conduct was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience, in that he:
\nInappropriately applied a Mepilex occlusive dressing to cover Patient A\u2019s laryngeal stoma before he commenced his shower;
\nDemonstrated a lack of knowledge of the underlying anatomy and clinical history of Patient A; and
\nDemonstrated a lack of knowledge that the laryngectomy stoma was Patient A\u2019s sole airway.
\nComplaint Two is that he is guilty of unsatisfactory professional conduct under s 139B(1)(l) of the National Law in that he engaged in improper or unethical conduct relating to the practice or purported practice of nursing, in providing false and misleading information:
\nIn his statement dated 9 March 2017 when he stated that after covering Patient A\u2019s entire stoma site with a Mepilex occlusive dressing he waited with Patient A for \u201cat least 5 minutes or longer after I had applied the dressing to Patient A\u2019s stoma site\u201d, in circumstances where he did not remain with Patient A for a period of 5 minutes or longer after he applied the dressing;
\nIn a letter sent to the HCCC by his legal representative dated 15 June 2017 in which he stated that when he \u201capplied the dressing prior to entering the bathroom and it was at least 5 minutes or longer after applying the dressing that RN McArthur left Patient A in the bathroom\u201d, in circumstances where he did not remain with Patient A for a period of 5 minutes or longer after he applied the dressing; and
\nIn the letter sent to the HCCC by his legal representative dated 15 June 2017 which stated that \u201cwhen Patient A was responding to RN McArthur\u2019s questions about the dressing he was speaking without difficulty and in full sentences, and did not show any signs of respiratory distress\u201d, contrary to s 99 of the Health Care Complaints Act 1993, in circumstances where the practitioner did not remain with Patient A to observe him speaking without difficulty nor showing signs of respiratory distress.
\nComplaint Three is that he is guilty of professional misconduct, relying on the particulars of Complaints One and Two both individually and cumulatively.
\nRN McArthur admits that he inappropriately applied the Mepilex dressing to cover Patient A\u2019s stoma, and that at the time he had a lack of knowledge of the underlying anatomy and clinical history of Patient A and demonstrated a lack of knowledge that the laryngectomy stoma was Patient A\u2019s sole airway. He denies providing false and misleading information in the statement of 9 March 2017 or the letter dated 15 June 2017. He denies that he is guilty of professional misconduct.
\nIf you wish to access the full document, use this link<\/p>\n","protected":false},"excerpt":{"rendered":"
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