Running head: NURSING PRACTISE CASE STUDIES 1

Nursing Practise Case Studies

Ge Yan

Flinders University
NURSING PRACTISE CASE STUDIES 2

Introduction

According to the National Model Clinical Governance Framework (NSQHS) (2017,)

healthcare providers are tasked with the responsibility of providing high-quality services to

patients with the aim of optimizing their health outcomes through safe practices. As such,

healthcare providers must adhere to principles that promote and safeguard the delivery of quality

and safe care to patients. Clinical governance requires individual healthcare practitioners

including nurses are responsible for in maintaining an environment that promotes these goals by

following the laid out guidelines (Leggat, Smyth, Balding, & McAlpine, 2016). These guidelines

make healthcare professional accountable in ensuring safe delivery of care by following

healthcare principles, accepted ethics, and the law (Allen, 2000).

Incident 1 Failure to follow the correct procedure in administering drugs

In Mrs. Maria Gianopolis case, there is an obvious breach of acceptable principles on

administering medications to patients. Principles for the administration of drugs hold that

administration of drugs should be preceded by the right assessment of the patient’s medical

condition by a qualified practitioner in that field (Australian Commission on Safety and Quality

in Health Care, 2018; Kohn, Corrigan, & Donaldson, 2000). In doing so, the medical practitioner

can determine the right medication, dose and identify possible drug interactions and allergies,

which protects the patient from unnecessary risks, thereby ensuring their safety (Hughes, 2008).

Practitioners should also document any drug orders after administration. On determining, right

prescription, a patient-specific order for the medicine should be placed. Besides, ethical

guidelines aimed at ensuring the provision of quality care for students should act as benchmarks

for determining how to execute care duties especially when they involve moral issues (Ackley,
NURSING PRACTISE CASE STUDIES 3

Ladwig, Makic, Martinez-Kratz, & Zanotti, 2019). Such situations are addressed in principles of

clinical governance which places collective and individual responsibility to healthcare

practitioners in ensuring the delivery of quality care. Therefore as Baker (2003) indicates, every

person in the team is accountable for the patients safety and as a student, I should have taken

steps to stop the malpractice.

Legally, healthcare practitioners are expected to act in ways that avoid endangering

patient safety by ensuring that safety procedures are followed. Thus, engaging in activities that

pose high risks with indifference amounts to negligence, which is punishable by law (Water,

2017). Criminal negligence prosecution in healthcare is based on the idea that practitioners have

a duty to provide patient’s care and should deliver care according to standards. As such, any

harm that may befall the patient as a result of non-adherence to standards in risky procedures can

be blamed on those practitioners (Atkins, Britton, & De, 2011). Therefore, as an unqualified

physician, team leader, Adam Vronsky, is putting the patient at unnecessary risk by contravening

the aforementioned guidelines. Adam is aware of the probable risks involved in administering

medication without proper assessment or qualification but chooses to ignore these risks.

Therefore he is being negligent in administering drugs in disregard of the patient’s safety.

According to Sorrell (2017), healthcare professionals must follow accepted ethical

principles which guide making decisions and acting in ways that promote the delivery of high-

quality care. These values are a background from which practitioners can appraise their actions

influencing their goals, policies, and purpose, based on adherence to moral principles of what is

considered right or wrong. Ethical principles in nursing include autonomy and right to self-

determination, beneficence, and non-maleficence, disclosure and right to knowledge; and truth,

among others. By ignoring patient-safety, this case contradicts the principle of beneficence and
NURSING PRACTISE CASE STUDIES 4

non-maleficence which calls for practitioners to optimize the patients' welfare by minimizing the

risks and maximizing the benefits. In this regard, by disregarding the patient’s welfare, Adam is

contradicting the ethical principle of beneficence by putting the patient at high risk in

comparison to the benefits of administering Panadol.

As a nursing student, I am accountable for what happens to the patient ethically obligated

to advocate for the patient's wellbeing and safety. Since the actions, in this case, contradict

ethical principles and provision of high-quality care, they are wrong and should be discouraged.

However, as Scott (2013) indicates, it is sometimes difficult for practitioners to decide on the

right actions in such scenarios, especially for junior practitioners. The fear of negative

repercussion from others and the breakdown of cohesiveness create the ethical dilemma of what

they ought to do and what they should do. As such, the most appropriate action would be to

prevent administration of the drug until the right procedure is followed and seek guidance the

supervisor Kylie Scott on the most appropriate course of action. Most importantly, my response

would be formed not by fear but by the realization that it is my duty to ensure patient safety.

Incident 2 Administration of drugs without informed consent

According to the ethical principles of autonomy and right to self-determination,

practitioners should also recognize and respect the patient's independence and respect their right

to make independent and informed decisions. As such it is imperative for practitioners to

disclose all the information required by the patient in making a decision on whether or not to

undertake treatment. This, information disclosure should include among others, which treatment

is to be administered, it benefits, sides effects or whether it is experimental (Scott, 2013).

According to Booney (2014), information disclosure can cultivate trust and fidelity between

doctors and patients as suggested by principles of clinical governance. Consequently,

NURSING PRACTISE CASE STUDIES 5

practitioners should undertake the ethical duty to help in the improvement of care contrary to this

case. Adam disregards, the patient’s right to make decisions by failing to disclose to her the

relevant information, thereby breaching principles of clinical governance. Similarly, the patient’s

daughter in law also disregards her independence and intimidates her verbally. In doing so, she

contradicts the ethical principle of independence and self-determination by coercing the patient

into taking the drugs unwillingly, and as per the principles of clinical governance, such situation

should be reported (Knox, Baldwin, Cadman, Davies, Goh, Mortimer, & Eisen, 2018).

According to the Australian Law Reform Commission (n.d.), “t common law, all

competent adults can consent to and refuse medical treatment. If consent is not established, there

may be legal consequences for health professionals.” In this case, the patient has not been

proven to lack the capacity to make a decision. Therefore, practitioners should ensure that the

patient takes the medication out of her own will as the law indicates that it is illegal to forcefully

administer drugs to the patient (Medical Bioard of Australia, 2014). While the practitioner does

not directly participate in coercing the patient into taking the drugs they have the duty to ensure

patient-welfare and should take action to ensure it is sustained. As such, as a student, I would

have stopped the administration of the drug and sought the patient's views on whether she was

willing to take the drug.

Conclusion

The case has given me a deeper insight into the importance of following proper

procedures and standards in the provision of care. From the research I conducted, I learned that

following and maintaining standards in healthcare provision is not only aimed at improving

patients' health outcomes but is also beneficial to healthcare practitioners as well. For example, I

learned that following the proper procedures, healthcare practitioners can safeguard themselves
NURSING PRACTISE CASE STUDIES 6

and the patients from prosecution involving issues such as negligence. Here is also learned of

the role of clinical governance in the promotion of better healthcare provision and my duty as a

practitioner in delivering this role by observing myself and others to help maintain and improve

service delivery. Insights in the ethical dilemma involved in clinical governance revealed that the

can be difficulties in decision making when breaches of procedure and standards occur.

Notwithstanding, I learned that following the professional principles in healthcare practice is an

effective framework for determining the right action.

References
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Atkins, K., Britton, B., & De, L. S. (2011). Ethics and law for Australian nurses. Cambridge:

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