Running head: NURSING PRACTISE CASE STUDIES 1

Nursing Practise Case Studies

Ge Yan

Flinders University
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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. As such, individual healthcare practitioners including nurses are responsible for in

maintaining an environment that promotes these goals by following the laid out clinical

guidelines, on clinical governance. These guidelines make healthcare professional accountable in

ensuring safe delivery of care by following healthcare principles, accepted ethics and the law.

Incident 1 Administration of drugs without proper procedure

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. 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 bench marks

for determining how to execute care duties especially when they involve moral issues (Ackley,

Ladwig, Makic, Martinez-Kratz, & Zanotti, 2019).

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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. Criminal negligence

prosecution in healthcare is based on the idea that practitioners have 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 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 a high risk in

comparison to the benefits of administering Panadol.

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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 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). Accroding to

Boone (2014) information disclosure can cultivate trust and fidelity between doctors and

patients. As such practitioners should undertake the ethical duty to help in the improvementof

care contrary to this case. Unless, patients are children or are incapable of making the decision,

they reserve the freedom of choice. As such, Adam disregards, the patients right to make

decisions by failing to disclose to her the relevant information .Similarly , patient’s daughter in

law also disregards her independence and intimidates her verbally. In doing so, she contradicts
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the ethical principle independence and self-determination by coercing the patient into taking the

drugs unwillingly.

According to the Australian Law Reform Commission, “At 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 take the

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

to the patient. While the practitioner does not 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

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 learnt that

following the proper procedures, healthcare practitioners can safeguard themselves 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.

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

effective framework for determining the right action.

Bonney, W. (2014). Medical errors: Moral and ethical considerations. Journal of Hospital

Administration, 3(2), 80-88.

Nationalstandards.safetyandquality.gov.au. (2019). National Model Clinical Governance

Framework. [online] Available at:

https://www.nationalstandards.safetyandquality.gov.au/topic/national-model-clinical-

governance-framework [Accessed 8 Apr. 2019].

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

Cambridge University Press.

Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M.

(2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care.

Mosby.

Hughes, R. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for

nurses (Vol. 3). Rockville, MD: Agency for Healthcare Research and Quality.

Scott, C. (2013). Ethics consultations and conflict engagement in health care. Cardozo J. Conflict

Resol., 15, 363.

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Sorrell, J. M. (2017). Ethics: Ethical issues with medical errors: Shaping a culture of safety in

healthcare [23. OJIN: The Online Journal of Issues in Nursing, 22(2).