Diabetes UK (2008) explains that Diabetic Ketoacidosis (DKA) occurs when blood sugar levels are consistently high. When there is certainly lack of glucose in the blood vessels, the body's cells use excessive fat stores to acquire energy, this process produces an acid called 'ketones'. As ketones are probably harmful to your body, it tries to get rid of them by excreting them in the urine. If the amount of ketones in the bloodstream continue to go up, ketoacidosis occurs whereby the blood turns acidic. as a consequence, patients may feel nauseous, have blurred eye-sight and have very rapid deep breathing. Because people vomit, the body becomes dehydrated which is harder for your body to flush out the ketones, if this happens and is remaining untreated, the patient will fall into a coma which can be fatal.
As Daniel was suffering from a chest illness, he was at high risk of expanding DKA as his body was launching more glucose in to the blood stream and stop insulin from working effectively, this is a brought on response to the problem (Moore, 2004).
How is DKA handled?
Kisiel and Marsons (2009) explore the regime which is usually completed in hospitals confronted with patients like Daniel. Firstly, a analysis of DKA would have been made alongside hypoglycaemia (high blood sugar levels). His urine would have been analyzed for ketones as standard regime. Arteirial blood vessels gas measurement may also have been performed to show the level of acidity. A series of blood tests could have been taken to assess Daniel's urea and creatinine levels (actions of kidney function), markers of disease would also have been measured such as white blood vessels cell count. Liquid replacement could have been commenced, insulin administered and his potassium level could have also been monitored in the high dependency product.
What might have influenced Daniel's increasing BMs?
It should be taken into consideration that Daniel's growing blood sugar could be affected by lots of factors and Jo should take these into account. Jo should check the gear delivering Daniel's insulin as it could be defective or the pump might not be functioning correctly. She also needs to ensure that the collection is properly linked to the cannula and that it is not leaking or that there surely is no blockage over the collection, or that the cannula hasn't 'tissued'. Daniel's cannula site should be inspected on every change to check on for Phlebitis using the Aesthetic Infusion Phelbitis score (VIP) consistent with local policy.
Nursing decisions
Many factors could have added to both Jo and the Senior Nurse's decisions and the decision made in any event could effect on Daniel's condition. If Jo had decided not to increase the insulin and the older nurse hadn't increased it either, Daniel may have slipped back into a coma as his blood glucose levels have been rising over time. This would have led to more complications and may have been fatal. However, increasing the insulin could also have had a poor end result for Daniel. As it was not prescribed, it could have been increased too much and the blood vessels sugar level could be reduced with an unsafe level and he may suffer from a hypoglycaemic instance. Although this is unlikely, it ought to be pointed out that the mature nurses decision to alter the prescription without it being approved was wrong.
Accountability
According to the NMC's code of professional do (2008), "as a specialist, you are privately accountable for activities and omissions in your practice and should always have the ability to justify your decisions". As the mature nurses determined to alter the insulin infusion without it being prescribed, she is personally accountable to what happens compared to that patient as a consequence of doing so. On the other hand, Jo is also accountable for her omissions so that it could be observed that both of the nurses are in charge of what they do or don't do in this situation. The senior nurse may have thought she was acting in the best interests of the individual, following the NMC code of carry out standard.
Accountability is the essential aspect to professional practice (NMC 2008) and nurses need to be able to justify why they made any decision in practice. Nurses do make judgments predicated on a number of influences such as their professional knowledge/skills, information centered practice and functioning on the patients best interests. In this situation, the senior nurse might have been a nurse prescriber who had the specialist to prescribe drugs from a restricted group in the nurse prescriber's formulary (McHale 2003). This would have allowed her to alter Daniel's prescription with out a doctor. She may also have had record understanding of Daniel's condition and thought the best decision to make was to improve the insulin medication dosage so that the patient would not have deteriorated further.
The older nurse should be working within her purchased job description which could have included expectations and limitations from what she was necessary to do as part of her job. Vicarious liability comes into head in this instance; Richardson (2002) talks about that as the company is accountable for any 'torts' that happen to be committed by an employee during their occupation. 'Torts' are referred to as any legal wrongs for which the law provides a remedy. In cases like this, the mature nurse has preformed a 'tort' and the individual employing her is likely.
As Jo was the nurse who was looking after Daniel that day, she also offers responsibility to what happens to the patient whilst in her good care. This increases the question of who happens to be accountable for what goes on to Daniel; the nurse looking after him or the nurse who performed the alteration.
As it claims that Jo is recently qualified, it could be assumed that she may need support from her peers. She would experienced a supernumerary period, where she was allocated patients but support was there when she needed it. Also called preceptorship, newly certified nurses are combined with a skilled nurse who acts as a job model and source (Ashurst 2008). When the older nurse was Jo's preceptor, she would not need been setting a good example to her. The NMC code of carry out state governments that "you must work cooperatively within teams and respect the skills, expertise and efforts of your colleagues", the senor nurse was plainly not being cooperative with Jo and did not allow her to talk about her concerns. Castledine (1999) points out how newly experienced nurses are sometimes expected to fit into the system of the ward very quickly and in addition, adapt to a complete range of situations they have never experienced before. Jo might have been sensing unsupported by her older and her assurance might have been knocked due to the attitude and response of the mature nurse.
Documentation
As the senior nurse have change the prescription, it requires to be documented somewhere in line with the NMC code. In this example maybe it's questioned who documents the alteration of the insulin and where in the nursing notes it should be written. Medication administration arguably carries the biggest risk for nurses (Elliot & Liu 2010). This specific scenario is a medication mistake as the change in prescription had not been verified by a doctor. Elliot and Liu (2010) verify the fact that nurses must only administer the dose approved by the medical official, and that the nurse who administers the medication must signal the medication graph. It will also be noted in the medical notes as well as putting your signature on the chart, and really should include the reason behind administration and the desired impact (Elliot & Liu 2010). Woodrow (2007) stipulates that nurses should be aware of the legal responsibility of precision of documentation. So in this situation, the mature nurse should write in the nursing records why she provided the unprescribed dose to Daniel, and Jo should comment why she didn't, as well as outlining what took place.
Jo could think about writing an occurrence form in this situation to tone her concerns. The scenario could be observed as a 'in close proximity to pass up' as the individual may have endured dire repercussions from either of the decisions created by the nurses. The Reporting of Injuries, Diseases and Dangerous Occurances Legislation (RIDDOR 1995) places a legal responsibility to employers, self employed people and people in charge on premises, to report any dangerous incident/near neglect (Ashurst 2007). Jo could include on the proper execution that she was not happy with the older nurse's decision to alter the insulin pump, and for that reason cover herself. By doing an incident record, Jo is pursuing local and nationwide policy and it could also bring to light other problems such as rushed exchanges, doctor shortage and insufficient support. RIDDOR coordinates it's work with the NPSA.
The National Patient Safety Company (NPSA) was produced in 2001 following two publications of patient protection in the NHS. These contained research conducted by Vincent et al (2001) which revealed that 10% of patients accepted to hospital suffered some kind of patient safety incident. The NPSA has produced helpful information to good practice called "Seven Steps to Patient Basic safety" (NPSA, 2003) Steps include; creating a safer culture, leading and encouraging your practice team, integrating your risk management activity, promoting reporting, involving and connecting with patients and the public, learning and showing protection lessons and putting into action solutions to prevent harm. Dimond (2002) explains how the NPSA aims to ensure that adverse occurrences will be diagnosed, reported, examined and recorded to make a change to local and nationwide policies and types of procedures. Jo could make reference to this guide and also make others alert to it and enhance the patient basic safety of not only Daniel but every patient on the ward.
Inter-professional Working
There are several benefits associated with inter-professional working, the mature nurse and Jo should be aware of these in order to interact and offer effective care. Benefits of inter-professional working which were identified in a report by Make meals et al (2001) demonstrated that the associates had more assurance in their decision making as they had encouragement and support off their fellow workers. This allowed associates to make better contributions to the overall service where they were a part of, consequently providing a more effective service to the patients in their care and attention. Jo could have increased her self-assurance in dealing with similar situations in the foreseeable future if the senior nurse possessed spoke to her and answered her questions.
There is a great deal of books which discusses the obstacles and challenges associated with inter-professional collaboration. It should not be assumed that simply instructing professionals to interact will be sufficient to result in effective teams which provide improved services with their patients. A variety of barriers to interdisciplinary working are present that postpone the trends of close collaborative working relationships. Hudson (2002) describes some barriers to effective inter-professional employed in terms of romantic relationships between participants of different occupations such as nurse and doctors. One barrier that he records is that the type of professional identity is such that where customers of a certain occupation have similar or shared values, perceptions and encounters, there will be more agreement between members of a profession than between participants of different professions. This 'disagreement' patterns inter-professional relationships, and will probably cause problems within multi-disciplinary team working.
In Jo's case, she can have bleeped the physician herself and asked him about the prescription, but as stated if he was active he may have been unwilling to take the decision. The older nurse's a reaction to Jo proven the hierarchical have difficulties between a far more older nurse and a very junior employee. Although inter-professional working has much potential to enhance care, additionally, it may produce tensions and concerns within medical care and attention team (Peate 2006). Additionally it is important to note that some barriers are organisational or structural such as merging or Trusts, relocation and drawback of services. With this scenario, the main barrier is that there are two different skill mixes with conflicting ideas.
Irvine et al (2002) also consider some organisational challenges and barriers to the potency of inter-professional practice. They see that distinctions in working hours may hinder the introduction of close working connections between pros. Also enough time different professionals try carry out particular work may cause difficulties. For instance doctors may be making decisions regarding clients on the day-to-day basis whereas social workers need to undertake long run casework to meet their clients' needs. Also, financial constraints can impact the ability of an team to apply effective collaborative working. McCray records that when finances and resources are limited, the issue of who will pay for the treatment can also create anxiety within teams. Even when practitioners desire to work collaboratively, their professionals may be less in a position to facilitate this scheduled to budgeting constraints, and may therefore place constraints on the quantity of collaboration that can take place.
Irvine et al (2002) considers that differing value systems between professions may also contribute to problems with the determining of concern of certain situations. The older nurse may are determined that she would prioritise Daniel's well-being within the worth of Jo. Different professions or grades will see patients needs to be at different degrees of importance as their seeks and goals for the patient will be dissimilar. This may create problems and sources of discord between different levels of nurses plus some, like the senior nurse may feel as though their patient's needs are being dismissed or devalued mainly in this situation by Jo or the physician who is looking after Daniel.
Hudson (2002) also explains that issues relating to professional status also have implications for inter-professional connections. Health and interpersonal care professions in particular have very different levels of training, education and legal restriction. In cases like this, it appears that the senior nurse is devaluing Jo's opinions and knowledge and sticking to her own.
All the obstacles reviewed can create stress and stress between associates. Irvine et al (2002) state that 'professional constructions are differentiated by demographics; the size of the occupation's account; gender structure; the school of origins of its users; educational attainment; status and the relative size and source of primary income. ' These distinctions are quoted as obstacles to inter-professional working.
What have I learnt?
By analysing this circumstance I have learnt many characteristics which contribute to effective patient health care and employed in a team.
