Health care strategies are central to patient life in various clinical settings where nurse care has a pivotal role to play. Efficient nursing skills and an overall soothing hospital atmosphere contribute to the conduciveness of various departments. This may require a harmony between the working schedule of nurses and the concerned authorities. An alteration in this specific area of management could lead to adverse outcomes that could interfere with the lives of patients. The reason may be due to inadequate staffing and severe workload. The present description highlights a case where a patient’s death was reported to be linked with understaffing and overworking. This case report needs to be validated keeping in view the available literature.
Firstly, the reasons that led to staff inadequacy may need to be clear. Here the patient may be staying for long time which was not mentioned accurately, except for two indications of “8 days” and “prior to the allergic conditions”. If the patient has received attention from nurses, other conditions need to be ruled out which were also not highlighted.
According to a study, long-stay nursing home residents are at risk for pressure ulcers (Horn et al., 2005).This was revealed when 1,376 residents of 82 long-term care facilities with a long stay of more than 14 days have developed pressure ulcers (Horn et al., 2005). In the present case, there is no information regarding such complaints. In addition, there is a need to emphasize the dependant and independent variables.
Dependent variables include urinary tract infection (UTI), weight loss, ability to perform activities of daily living (ADLs) and independent variables include demographics, severity of illness, nutritional and incontinence interventions, medications, and nurse staffing time (Horn et al., 2005).
These parameters are more likely to be associated with the patient outcome with regard to the nurse staffing. Hence, hospital-induced infections like UTI and weight loss might have also deteriorated the patient’s condition. As these are not mentioned in the present case, a direct relationship between the patient’s death and the nursing schedule seems feeble.
However, it is also reasonable to assume that the patient death has links with the poor staffing of nurses. This is because poor staffing might have contributed to mental distress and loneliness that might have significantly affected the outcome. It seems that understaffed nurses have not reorganized their schedules according to the patient’s needs. This would require a thorough understanding between nurses and the authorities.
Timely payments and increments up to 40 minutes per resident per day were reported to minimize pressure ulcers, hospitalizations, and UTIs (Horn et al., 2005). Hence, staffing of nurses has no direct role to play with the patient’s lives but it is the authority that should monitor the patient’s conditions in the presence and absence of nurses. In case there is a patient death, a detailed investigation may be carried out with regard to the nursing assistant and licensed practical nurse time that was reported to be associated with fewer pressure ulcers (Horn et al., 2005). Therefore, an ideal work plan needs to be fixed for the nurse. Therefore, patient death could be attributed to nursing schedule.
Further as mentioned, the patient has developed allergic reactions to a medication, found with cardiac arrest and brain dead. These potential life-threatening complications may also have contributed to the patient’s death as they could have become further aggravated with the negligence of nurses.
Next, in the present case there is no concrete evidence regarding the department and type of hospitals where the patient died. Cho, Hwang, and Kim (2008) reported that staffing of nurses influences patient outcomes especially in intensive care units and mortality was believed to be associated with tertiary and secondary hospitals.
It seems that the patient’s death could have occurred in tertiary hospital where there is a great chance of dying according to a study (Cho, Hwang, & Kim, 2008). This could be due to absence of board-certified physicians or otherwise nurses (Cho Hwang & Kim, 2008).There is no chance of deaths in a secondary hospital as it is less likely to contribute to mortality (Cho, Hwang, & Kim, 2008). Hence, the present case could be supported with assumptions keeping in view of the literature.
Next, the patient death could not be solely attributed to nurse experience as it was reported to be irrelevant and insignificant to the outcome (Cho, Hwang, & Kim, 2008).However, problems may likely arise if an inexperienced nurse was staffed with no superior assistance.
This could greatly enhance the chances of leaving the patient alone, on the grounds of fear and inefficiency to manage the otherwise complicated case. This could also enable to development of mental stress and the associated symptoms like pressure ulcers as reported previously (Horn et al., 2005).
Further, the location of hospital i.e., metropolitan city vs. province, is another important parameter that may influence the outcome (Cho, Hwang, & Kim, 2008). In the present case, it is reasonable to assume that the patient’s death could have occurred in a province-based hospital. Here, it can also be assumed that province-based hospitals may not be fully equipped with nurses who need to travel from remote places in contrast to a metropolitan city where there would be better basic amenities. However, this aspect may need further investigation to make the present case more sounding.
The second major contributor that influences the patient outcome, after nurse staffing, is the workload. This factor was also reported to play important role in intensive care units (Spence et al., 2006). Working in various departments could lead to multifunctional activity that might deteriorate individual capabilities (Spence et al., 2006).This may ultimately enhance the workload on nurses and subsequently leaves a negative impact on staffing. There is a need for the nurse’s assessment of the intensity of care and the organizational factors that could serve as important components of workload estimates (Spence et al., 2006). This strategy although implicated in neonatal intensive care units may also work well if implemented in other departments like ICU’S in an evidence-based approach.
In the present case, there seems to be a lack of workload measurement that might have contributed to the patent mortality. This could be because timely assessment or monitoring of working schedule by the concerned authorities might have reflected the perfect scenario of workload susceptibility. Hence, a death case may clearly indicate a total negligence emanating from the workload. Similarly, the degree of complexity or a work demand involved in handling a case can also be considered as the risk contributor (Spence et al., 2006).
Therefore, it can be inferred that workload would vary with the department and case.
The present case could have appeared a difficult job for a nurse who might have been receiving pressure from multiple angles like case complexity, care of other hospitalized residents and management and maintenance of hospital records. Hence the present case seems sounding and could be supported with viewpoint of workload.
In view of the above findings, it can be inferred that there is no conformity between the nurses and the physicians as far as the patient safety is concerned. Initially, staffing hours of nurses could have been streamlined that would be beneficial to good number of potentially ill patients who resemble the present case conditions. A thorough monitoring of patient condition from the earlier stages of stay could have made the situation easier and manageable. It seems that the patient with the life-threatening cardiac problem and brain injury might have been subjected to negligence even by the superior medical staff. Their appropriate interference could have regulated the nurse care and the deteriorating patient condition.
Hence, the present death of patient could not be solely attributed to staffing that may have a suspicious connection with the physician’s role. There seems to be a vague timetable of nurses as far as the working schedule is concerned. This may lead to improper understanding of clinical signs and a gradual indifference over the patient.
A communication failure is more likely to stem from this defect and the patient may be subjected to immense mental stress on the grounds that hospital staff may take up their lives.
The ultimate result is that patients may lose confidence and faith in the nursing staff. These consequences might have affected the patient to a maximum extent that made her reveal them as worst hospital experiences ever met.
Workload is a potential risk factor that could worsen the condition of patients as seen in the present case. Regular assessment could have influenced the patient life with positive signs.
Therefore, it can be concluded that the present case is absolutely strong keeping in view of the description built.
Summary
Patient deaths have become major concerns in hospitals due to negligence from the nursing staff. There seems to be inadequacy in proper orientation as far as the interaction among the staff is concerned. This defect was reported to contribute to the death of a 59-year-old woman.
Here, although the duration of stay in the hospital was unclear, the patients’ condition may indicate a reasonable period of time being spent enough to develop the hospital stress.
The development of pressure ulcers, (UTI), weight loss, could have made the case more interesting. As such, their role needs to be clearly mentioned. But, nurse staffing may interfere with the outcome in case there is weak attention on their timely payments and increments. Therefore, this could indicate that death could have occurred due to lack of ideal work plan and indifference in patients which may be considered as the key elements of the nursing schedule.
The department and type of hospital like ICU and tertiary or secondary hospitals, respectively, could play vital role in influencing the mortality. Hence, the present case may be strengthened in view of this assumption. Inexperienced staffing with no authoritative monitoring is likely to be associated with the present case which could have also initiated the mental stress and fear.
The admission of patient could have occurred in a hospital located in a province rather than the metropolitan city. Province-based hospitals may run the risk of poor nurse staffing in contrast to a well-organized metropolitan hospital. Hence, this could be considered as another risk factor of patient outcome and could support the present case.
Nursing workload could also become a hurdle in the smooth management of patient safety especially in intensive care units. In the present case, patient death could be associated with workload as there are chances of nurses concentrating on various activities in addition to ICU. In addition, there seems to be a lack of assessment of nurse’s workload that might have contributed to the patient’s death.
A minimum registry of earlier patient deaths could have made the situation better studied. This may clearly indicate a lack of evidence-based approach in these types of hospitals which are at great risk of registering patient mortalities. Hence, there has been a total fault of nurses since the time the patient was admitted to the hospital that ultimately led to death.
References
Horn, S.D., Buerhaus, P., Bergstrom, N., Smout, R.J. (2005). RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care. Am J Nurs, 105, 58-70
Cho, S.H., Hwang, J.H., Kim, J. (2008). Nurse staffing and patient mortality in intensive care units. Nurs Res, 57, 322-30.
Spence, K., Tarnow-Mordi, W., Duncan, G., Jayasuryia, N., Elliott, J., King, J., Kite, F (2006). Measuring nursing workload in neonatal intensive care. J Nurs Manag, 14, 227-34.