In the given scenario, if you come across a patient with a bruise or wound who is not willing to disclose the possible abuse, it is your ethical and professional responsibility to take action to ensure the safety and well-being of the patient. According to the provided information, consent is not required to raise a safeguarding concern. Here are the steps you should take based on the marking criteria and ethical guidelines:

MARKING CRITERIA

1. Escalate the Concern Regarding Safeguarding (Patient Consent Not Required): Since patient consent is not necessary in cases of possible abuse, you should escalate your concerns immediately. This means reporting the situation to the appropriate authority within your healthcare organization, such as a supervisor, manager, or designated safeguarding officer.

2. Communicate with Compassion and Empathy to the Patient: While the patient’s consent is not required to report the concern, it is important to communicate with compassion and empathy. Approach the patient in a sensitive and understanding manner, expressing your concern for their well-being and safety. Even if they do not want to disclose the abuse, your empathy can make them feel heard and supported.

3. Act Without Delay & Raise Concern: Act promptly without delay. Do not wait for the patient’s consent if you suspect abuse. Time is crucial in such situations, and immediate action can prevent further harm. Raise your concern to the appropriate channels within your healthcare organization, following the established protocols and procedures for reporting safeguarding issues.

4. Be Clear, Honest, and Objective When Raising Concern: When reporting the concern, be clear, honest, and objective in your communication. Provide specific details about the observed injuries, your conversation with the patient (without breaching confidentiality), and any other relevant information. Objectivity is essential to ensure that the report is accurate and helpful in addressing the situation.

5. Make a Clear Written Record of the Concern and the Steps Taken: Document the concern and the steps you have taken in a clear and detailed manner. Maintain a written record of the observed injuries, your conversation with the patient, and the actions you have taken to report the concern. Proper documentation is important for accountability, continuity of care, and legal purposes.

6. Acknowledge the Standards & Values Set Out in the NMC Code: Adhere to the standards and values outlined in the Nursing and Midwifery Council (NMC) Code of Conduct. Uphold the principles of professionalism, integrity, and advocacy for the well-being of the patient. Your actions should align with the ethical guidelines and standards set forth by your professional regulatory body.

ANSWER

I will recognize the necessity of addressing safeguarding concerns even without patient consent, in line with the duty of candour.

I will approach the patient with empathy and compassion, using appropriate language to communicate the situation.

I will identify the urgency due to potential risks to the patient’s safety, I will promptly raise the concern at the earliest suitable moment.

I will report the concern to the manager or local authority, ensuring clarity, honesty, and objectivity in explaining the reasons for my concern according to safeguarding policy.

I will maintain a detailed written record of the issue, including a body map if necessary, documenting the steps taken and noting the date and individuals involved in the reporting process.

I will uphold the standards and values outlined in “The Code,” prioritizing people’s well-being, practicing effectively, preserving safety, and promoting professionalism and trust.

DRUG ERROR MARKING CRITERIA

-Recognises the possible consequence of error and the importance of patient safety, and takes measures to reduce the effects of harm.

-Checks the stability of the patient by taking observations, informs the nurse in charge and medical team of the event, and seeks advice.

-Recognises the importance of disclosing the occurrence to the patient and apologise, reflecting duty of candour.

-Documents events, actions and consequences in the patient’s records, and completes an incident report.

-Demonstrates the importance of reflection, explores the sequence of events and factors that may have influenced the occurrence, recognises the learning opportunity, and identifies the need to revisit drug administration procedure.

-Acknowledges the need to keep to and uphold the standards and values set out in ‘The Code’: prioritise people, practise effectively, preserve safety, and promote professionalism and trust.

SCENARIO

The scenario will be you or your colleague has administered wrong medication, which is drug error. You will be asked to write down the series of actions you will take after the incident has occurred.

1. I will acknowledge the potential outcomes of errors and the significance of patient safety. Subsequently, I will take necessary steps to mitigate the impact of any harm caused.

2. I will assess the patient’s stability through observations, notify the responsible nurse and medical team about the situation, and seek their guidance.

3. I will inform the patient about the incident and offer a sincere apology.

4. I will record the events, actions taken, and their consequences in the patient’s records, and submit an incident report.

5. I will integrate this experience into my practice by analysing the sequence of events and factors that might have contributed to the incident. I will recognize it as a valuable learning opportunity, leading me to re-evaluate the drug administration procedure.

6. I will uphold the standards and principles outlined in ‘The Code,’ prioritizing the well-being of individuals, practicing effectively, ensuring safety, and promoting professionalism and trust.

• Preparation and Introduction:
• Ensure scene safety and privacy.
• Practice hand hygiene if necessary.
• Introduce yourself to the patient, state the purpose of your visit, and gain consent.
• Patient Comfort and Pain Assessment:
• Check if the patient is comfortable and assess their pain level.
• Dressing Removal and Examination:
• Explain the wound assessment process.
• Remove any dressing covering the wound.
• Assessment of Wound Area:
• Look for erythema (redness) around the wound.
• Describe the area around the wound, noting any oedema, scaliness, lesions, excoriation, maceration, or dryness.
• Exudate Examination:
• Describe any exudate, such as purulent, hemoserous, serous discharges, or offensive odour.
• Closure and Wound Bed Examination:
• Assess the closure of the wound, noting if it’s well closed or broken.
• Evaluate the condition of the wound bed, including its colour, presence of sloughy or necrotizing tissue, and epithelization status.
• Tenderness and Pain Assessment:
• Examine for tenderness and assess any pain experienced by the patient.
• Conclusion and Further Action:
• Conclude about the wound condition and state your awareness of the need to collect a swab if necessary.
• Mention sending the sample to the lab and referring the patient to the medical team for further evaluation and treatment.
• Provide health education as needed.
• Patient Comfort and Communication:
• Reiterate the importance of the patient’s comfort and their ability to use the call bell if needed.
• Address any concerns the patient may have.
• Hand Hygiene and Conclusion:
• Remove apron and gloves
• Practice hand hygiene again.
• Conclude by stating that you’ve completed the procedure, discarded used items according to hospital policy, documented as per NMC guidelines, and ensured the patient’s comfort.

ROLEPLAY

Nurse: I enter the room, looking for scene safety, and confirm that the scene is safe for me to approach my patient.

Nurse: I ensure privacy and dignity by closing the doors and drawing the curtains.

Nurse: I perform hand hygiene using hand rub, following the 7 steps of WHO.

Nurse: “Good morning, my name is Isaac Makponga, and I am a registered nurse here. I’m here to assess your wound at the surgical site. Is it the best time to proceed?”

Patient: “Yes, you can.”

Nurse: “What is your name and how may I call you?”

Patient: “My name is Elizabeth; you can call me Lizzy.”

Nurse: “Lizzy, do you have any pain?”

Elizabeth: “Yes.”

Nurse: “Could you please score it between 0 (the least) and 10 (the worst)?”

Elizabeth: “It’s 3.”

Nurse: “Oh, it’s mild. Do you need medication?”

Elizabeth: “No, I don’t. Thank you.”

Nurse: “Are you in a comfortable position?”

Elizabeth: “Yes, I am.”

Nurse: “Can I proceed with your wound assessment?”

Elizabeth: “Yes.”

Nurse: “(I perform hand rub, wear apron & gloves) Can I expose your wound?”

Elizabeth: “Yes.”

Nurse: “Are you okay for me to proceed?”

Elizabeth: “Yes.”

(Nurse removes old dressing prior to the assessment) “

Look for erythema around the wound

Nurse: “I can see mild redness around the wound.”

Describe the area around the wound

Nurse: “I confirm that the wound and its surrounding area look healthy. There is no oedema, excoriation, maceration, dryness, or scaliness around the wound.”

Describe any exudate

Nurse: I can confirm that there is no haemo-serous, serous or purulent discharge or any offensive odour from the wound

Describe the defect of the wound closure

Nurse: “I don’t see any defect in the wound closure; this wound is closing properly.”

Describe the condition of the wound floor

Nurse: “The wound bed appears pink in colour, indicating it is in the healing stage. It is epithelializing properly without any granulation, necrotizing, or sloughy tissue.”

Enquire about pain or tenderness on the wound

Nurse: “Lizzy, do you have any pain or tenderness when I am touching the wound?”

Elizabeth: “No, I am alright.”

Nurse: “So overall, the wound looks healthy. If any abnormality occurs, I will collect the wound swab and send it to the lab. The report will be escalated to the medical team.”

Elizabeth: “Ok.”

Nurse: “Lizzy, are you comfortable?”

Elizabeth: “Yes.”

Nurse: “Do you need anything before I leave?”

Elizabeth: “No.”

Nurse: “Excellent. If you require anything, please call me by pressing the buzzer.”

Elizabeth: “Ok.”

Nurse: “Remove the gloves and apron. Perform hand rub.”

Nurse: “Assessor, I have conducted a wound assessment for Ms. Lizzy. Now, I will document all the findings and discard the waste according to the NMC guidelines and policies.”

In the given situation, where a colleague has posted confidential information or pictures on social media, my course of action would be as follows: I will;

– Recognize that sharing sensitive information or posting pictures of patients/people receiving care without their consent is inappropriate.

– Understand my responsibility to report any safety concerns regarding public well-being or patient care. Failure to report such concerns could jeopardize my fitness to practice and put my registration at risk.

– Acknowledge that engaging with or commenting on someone else’s post can be perceived as endorsing or supporting their viewpoint.

– Approach my manager at the earliest suitable opportunity, either verbally or in writing, to raise my concerns.

– Document the incident by completing an incident report, outlining the events and the steps taken to address the issue, including the date and the person with whom the concern was shared.

– Adhere to the standards and values outlined in the NMC code, ensuring ethical conduct and professionalism in my actions.