Reference no: EM133924180

Question

At the time of the incident, the Nurse K. charge nurse was working a night shift in a geriatric psychiatry unit (the "Unit"). It was a busy night and they had 2 sick calls that were not covered. Patient M. was 83 years old with moderate to advanced dementia. Occasionally at night she could be challenging, call out for her husband and getting out of bed wandering the unit upsetting other patients, and often challenging and aggressive during the evening and night.

Nurse K. and three nursing colleagues transferred Patient M. who appeared calm, from a wheelchair to a Broda chair in the Unit's dining room. Nurse K. and her colleagues applied a pelvic restraint to the patient without a physician's order. Neither the nurse nor her colleagues documented the application of the restraint or the rationale for applying the restraint. The patient was left restrained in the Unit's dining room for approximately 5.5 hours. During this time, the Nurse K. and her colleagues failed to appropriately observe and monitor the patient, or continually assess the ongoing need for restraints.

Between approximately 12:30 am and 5:30 am, Patient M. was sitting in a Broda chair in the Unit's dining room. Despite expressing distress, including removing her gown and exposing herself, the nurses did not observe or provide care to the patient. Nurse K. falsely documented that the patient had fallen sleep and was transferred to her bedroom despite remaining in the Broda chair in various states of distress in the dining room.

Upon observing the patient in the early morning, Nurse K. believed that Patient. M. was deceased. The nurses did not call a Code Blue, take the patient's vital signs, or ensure that her colleagues follow the organization's policy. Instead, the nurse delegated a colleague to wheel the patient to her room. They placed the patient in her bed with the collective intention to make it appear as though the patient had died in bed or more recently than suspected. They falsely documented that the patient was in bed during the time that she remained restrained in the Broda chair. They later provided inaccurate information during the facility's investigation into the patient's death.

Adapted from the College of Nurses of Ontario. (2022). CNO Disciplinary Hearing. 

1. List and describe practice standards that were not followed. What are the examples of negligence in the case study?

2. Describe the correct and professional course action and care that should be provided.

3. What can nurses do to prevent negligence in nursing practice?

4. What disciplinary action should be implemented for the nurses involved?