NUR244 - Mr R's Case Study - Post-Operative DBS Complications - Nursing Assignment Help

Assignment Task

Prelude:  
Rita is a registered nurse with advanced expertise in psychiatric ward, and she works as a  member of a multidisciplinary team looking after Treatment Resistant Depression (TRD)  patients. Rita oversees patients discharge from the hospital. Prof S, the leader of her team,  heavily relies on her reports before making discharge decisions. Mr R, one of her patients,  died by suicide when he jumped from the 8th floor of an hotel adjacent to the hospital, after  having been discharged.  
Mr R’s family raised several concerns about his treatment to the Coroners Court. These  included:  
• Appropriateness of the qualifications of the treating nursing team and their  assessments of Mr R and role in the decision to discharge Mr R from Hospital;  • A lack of an appropriate consent process for the implantation of a Deep Brain  Stimulator1 technology (DBS) and particularly, a failure to advise Mr R that suicide  and reversible changes in mood/personality were risks associated with DBS surgery;  
• Lack of communication by the clinicians with Mr R’s family;  
• Post-operative DBS complications;  
• Management of his physical concerns in Hospital;  
• The management of his mental health;  
• The death could have been avoided had his medical advice and treatment been  different.  

Case:  
Mr R, a twenty-seven-year-old patient, received the diagnostic of depression when aged  fifteen. When Rita first met Mr R, he self-reported more than 30 ineffective and/or poorly  tolerated medication trials and an ineffective course of electroconvulsive therapy which  have lead him to seek last recourse treatment. During their first meeting, Rita suggested to  Mr R to consider the possibility of enrolling in a new experimental DBS trial for TDR, where  she sits as co-researcher with multiple colleagues, under the leadership Prof S.  
One week following Rita first meeting with Mr R, he consulted Prof S to undergo an  experimental usage of DBS targeting TRD. During the consultation, Mr R was accompanied  by his brother. Prof S advised Mr R that DBS was an experimental treatment potentially  targeting TDR symptoms. Prof S says that he advised Mr R that the potential risks of the DBS  surgery include death, permanent disabling stroke, infection of the brain or the IPG, seizure  disorder, and reversible changes in mood/personality. Mr R was also told that DBS therapy may not help his symptoms. However, retrospectively, Mr R’s brother disputes that Mr R  was told about reversible changes in mood and personality.

In Mr R's case it is apparent that the standard of care provided is not optimised properly which resulted in his pain and suffering which may have indirectly contributed to his death.  The Registered Nurse Standard 6 in which nurses are expected to provide comprehensive, quality practice to achieve agreed goals and outcomes that are responsive to the needs of the patient, is not upheld by Rita and other health professionals involved in Mr R’s care (Nursing and Midwifery Board of Australia, 2018; Lyons & Bliss, 2019).  This is evident during the initial meeting of Mr R  and Rita where the suggestion to enroll for the DBS surgery was first made and subsequently after the surgery was performed.  However, simply suggesting and not providing comprehensive information and explanation regarding DBS procedures including its outcomes which one would normally expect of Rita given her extensive experience as a psychiatric nurse indicates inadequate care.  Furthermore, collaborating before and after treatment with other healthcare professionals to discuss care plans including side effect management, treatment goals as well as  exploring other treatment options for the benefit of Mr R are paramount to patient care was not demonstrated in this case by Rita and other health professionals involved. Complying with nursing standard 6 is not only limited to duty of care but it is also about upholding beneficence (acting for the benefit of the patient) and non-maleficence (doing no harm) which are pivotal in Mr R’s case given his vulnerability (Lyons & Bliss, 2019; Beauchamp & Childress, 2018).

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