Case Study Analysis: Joey Slater’s Discharge and Readmission
Scene 1 Questions
a. Primary Violation of the Code of Ethics in Nursing
In Scene 1, the primary violation of the Code of Ethics in Nursing is the failure to ensure comprehensive patient education and the continuity of care. The Code emphasizes the importance of providing patients and families with sufficient information to support their health decisions and ensure safe home care practices (ANA, 2015). By delegating the responsibility of discharge teaching about cast care to Stacey, the LPN/LVN, Charlotte may not have ensured that the education provided met the complexity of Joey’s needs, especially considering his recent surgery and blood transfusion.
b. Evidence of Proper and Improper Delegation by the RN
Proper Delegation:
Charlotte, as the RN, appropriately called home health care to arrange a follow-up visit, indicating she recognizes the need for ongoing care and support for Joey after discharge.
Improper Delegation:
The improper delegation occurred when Charlotte allowed the LPN/LVN to handle all aspects of discharge teaching about cast care without verifying that Stacey was adequately prepared to educate Joey’s mother on the specificities of cast care related to Joey’s condition. Discharge education involves not only knowledge but also the ability to assess understanding and readiness for home care, which is a critical responsibility for an RN.
What I Would Have Delegated:
As an RN, I would have retained the responsibility for discharge education regarding complex care needs, such as cast care, while delegating tasks that are routine or basic care-related duties to the LPN/LVN. For instance, I would have asked Stacey to assist with preparing educational materials or demonstrating basic cast care techniques while I led the conversation with Joey’s mother to ensure her understanding and address any concerns.
Scene 2 Questions
a. Evidence of Potential Professional Negligence and Malpractice
The potential for professional negligence and malpractice in Scene 2 is evident through the following issues:
– Inadequate Education: There was a lack of proper instruction regarding cast care, leading to Joey’s worsening condition with maggots in the cast and skin breakdown.
– Failure of Home Health Services: The home health agency’s inability to successfully contact Joey’s family for follow-up care suggests a breakdown in communication and coordination of care.
– Failure to Assess: The readmission indicates that there was no proactive assessment of Joey’s condition at home after discharge, contributing to his deterioration.
These failures highlight a breach in the standard of care that could lead to legal liability due to negligence.
b. Liability on Either Party
Liability may rest on multiple parties:
– Home Health Agency: They may be liable for failing to establish effective communication with Joey’s family, which prevented necessary follow-up care.
– Charlotte (RN): Depending on her specific actions and documentation regarding discharge education and coordination, she may bear some responsibility if her actions contributed to inadequate patient education or failed to ensure proper follow-up.
– Mother: If she did not engage with home health services or follow up on discharge instructions, there may be a shared responsibility.
The extent of liability would depend on the specifics of communication records, discharge documentation, and whether all parties acted within their scope of practice.
c. Code of Ethics Provisions Upheld by the Registered Nurse
In Scene 2, several provisions from the Code of Ethics for Nurses were upheld by Charlotte:
– Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Charlotte showed concern for Joey’s well-being during their conversation.
– Provision 2: The nurse’s primary commitment is to the patient. Charlotte advocated for Joey by delaying his discharge until further assessments could be made.
– Provision 6: The nurse participates in establishing, maintaining, and improving healthcare environments conducive to the provision of quality health care. By calling social services, Charlotte aimed to improve Joey’s situation concerning his home environment and support system.
References
American Nurses Association (ANA). (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: ANA.
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