Case Study of a 23 year old Canadian aboriginal woman in the healthcare facility

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT: CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author note

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Part 1: case study
Background information
X (pseudo name)is a 23 year old Canadian aboriginal women who came to the healthcare
facility’s prenatal care unit at 18:30 Hrs. after having moderate cramps and pain in her left lower
abdomen. This is her first pregnancy and no one from her family accompanied her to the
healthcare facility as she started feeling these cramps when she was en route to her workplace.
She belongs to non-English speaking background and speaks broken English. She conveyed that
her husband Y (31) is a diabetic type 2 patient and are on regular Medication. Her father and
mother both are obese and suffer from hypertension and elevated blood pressure. The patient is
also obese and performs regular activities on her own to control her elevated weight.
Presentation
02-02-19 18:30 Hrs.: patient came to visit the healthcare facility without any family member
and mentioned that she is having severe cramps in the lower left abdomen.
02-02-19 18:45Hrs.: Maternity nurse came to visit the patient and asked about the week of her
pregnancy. However the patient was not sure about her pregnancy weeks and replied: “not know,
the fifth month”. The nurse further asked about her husband’s name and contact details to which
she responded, “Heworksfar from this city and I contacted him this morning about my pain and
he said he will come soon”. Maternity nurse further asked: “is any of your family Members
suffering from any disorders or health conditions?” to which she said: “husband is diabetic and
father mother suffering from hypertension, high blood pressure. They both obese”. During this
primary assessment her obese body type, and bruises in her right knee was noted. Upon asking

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about those bruises the patient replied: “I fell yesterday climbing stairs but this not first time, I
prone to falls because my heavy weight”.
After conducting the primary assessment of the patient, the maternity nurse called the
healthcare physician to conduct further assessment and after that conducted the vital signs of the
patient. The vital signs included:
 Blood pressure: 137/87, Body temperature:37 degree Celsius
 Respiratory rate: 20 breaths per minute and Heart rate: 70 beats per minute,SpO2
levels: 97%
 External appearance of the pain site: sore and swollen appearance of the pain site
 Height: 5 ft. 8 inches, Weight: 83 kg, Body mass index: 27.7
02-02-19 19:30 Hrs.:
Healthcare physician came to visit the patient and conducted pain assessment. The
physician asked: “what do you think your pain score is on a scale of 1?” to which the patient
replied; “I think it is 9 as I cannot sit properly”. The healthcare physician further asked the
maternity nurse to conduct ultrasonography, blood test and urine test of the patient and within
this touched the lower abdomen of the patient to assess any bloating or gastric situation which
generally causes cramps in pregnant women. After conducting the assessment the conveyed to
the patient:
Doctor: “you should stay under observation of our nursing professionals overnight so that
after receiving your diagnostic reports we can assess your pregnancy condition and the reason of
your pain as well as we want to consult with your family members about your pregnancy

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complications so that you can deliver a healthy child”. To this the patient responded: “I okay
with hospital admission, but I inform my husband but do not know the current status that he is
coming”. To this the physician replied that “we will inform him regarding your condition.
02-02-19 20:30 Hrs.:the maternity nurse came to her ward with an injection. The patent
asked: “why this injection”. The nurse did not reply to her question and administered the
injection intravenously.
02-02-19 21:30 Hrs.: One bedside nurse was to the ward of the patient and she was provided
with nutritious food and milk to consume.
02-02-19 23:00 Hrs.: Maternity nurse came to the ward with patient’s report and
communicated that she is having epigastric pain and hence blood pressure has also
increased. To that the patient said: “harm to child? okay?”. The doctor came to visit the
patient and ask the maternity nurse to conduct assessment for gestational diabetes next
day. Further he also asked to provide the patient with another dose of morphine if she
requires in night.
03-02-19 2:30 Hrs.: The patient woke up with severe pain and no one was present in her ward.
She walked out of the ward and found the maternity nurse talking to another nurse. She shouted
to the nurse: “Sister!! Again pain”. After which another dose of morphine was provided to her.
02-02-19 8:30 Hrs.: patients husband came and t=found her wife sleeping in her ward with no
attendant. He went to the physician and discussed her wives health status, at 12 Hrs., she was
discharged.

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Part 2: Case study Analysis
Description and analysis of the problems
The case study of X (23) had several loopholes and problems that were associated to its
legal, ethical, cultural and maternal aspects. The patient was approximately 20 weeks pregnant
and while en route to her workplace started feeling severe pain in her lower left abdomen. Her
vital signs and background history informed that she is suffering from obesity, increased blood
pressure, elevated respiratory and heart rate, and is prone to fall. However, after she was
admitted to the healthcare facility, persons involved in the care process such as the maternity
nurse, the healthcare physician, and the bed side nurse were failed to provide her culturally,
ethically and legally compliance care.
The first problem which was identified in the care process was not including an
interpreter in the care process as the patient was unable to speak in English properly which could
hindered the accuracy of diagnosis process. Besides this, the language barrier hindered the
patient to develop trust on the healthcare facility and thereby the effectiveness of the care process
decreased (Sleptsova et al., 2014). Further, this language barrier limited the achievement of
ethical and legal considerations of the healthcare process.
The second issue which was identified in the care process was neglecting family
centered maternity care process. As per Lotto, Armstrong and Smith (2016), it is important to
provide pregnant women with family centered care and involve the mother and child as unit in
the prenatal care settings so that with care parental skills could be encouraged and family bond
among the parents could be developed. Further fathers are also included in the care setting so
that they could also be involved in the parenting process and in home, they can take care of the

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mother and child. However, in this case study, maternity nurses did not informed any family
member of the patient regarding her health condition and without any documented consent from
the family members, provided the patient with interventions and medications, thereby violating
family centered care associated regulations (Clifford et al., 2015).
Third aspect of care lacked in the care process was ability of the maternity nurse to take
holistic care of the patient. There were several instances in the care process, where the maternity
nurse did not took proper care of the patient. Primarily, despite of the language barrier observed,
she did not include any interpreter to prevent the patient from developing any stigma or
consciousness because of her cultural background and language (London et al., 2014). Moreover,
while providing food to the patient, she did not asked her diet and cultural preference due to
which the care did not complied with the cultural competence care. As per Lotto, Armstrong
and Smith (2016), maternity nurses are responsible for the holistic care of the patients and care
for the physical and mental needs of the patients as they suffer from emotional and mental
concerns, however it was not provided in the care process.
Finally, the legal aspect of care was also not achieved. As per Lotto, Armstrong and
Smith (2016), taking proper care of patients, maintaining security and safety is the responsibility
of the healthcare facility and the associated nursing professionals. However, in this care process
for the patient involved in this case study, the bed side nurse was found absent from the ward of
the patient, and hence the patient was left unattended in the crucial situation. As per the Canadian
nursing regulation, it is the responsibility of the nursing professionals to take care of the patient
in such situation and hence, it affected the legal aspect of the care process (Government of
Canada, 2019). Besides this, there was another situation, which violated the legal aspect of the

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care process and this was associated with the medication administration (Ccnsa-nccah.ca, 2019).
The patient was provided with morphine twice within the healthcare facility however, she was
not asked for consent or informed about the medication and hence, affected the legal aspect of
care and avoided the patient centered care associated regulation. Moreover, as the patient was
aboriginal, the healthcare facility did not follow the aboriginal and indigenous care associated
Laws and regulations (Hale et al., 2014). Therefore, in the care process, above-mentioned aspects
of the care and rules and regulation were affected.
Solutions and implementation
If I was involved in the case study as the maternity nursing professional, then I would
have been implementation evidence based practice in the care process of the patient. It was
identified from the analysis of the problems that the care lacked major aspects of care such as
legal aspect of care, evidence based care, patient centered and family centered care, and
culturally competent care with complete compliance to the role of maternity nurses in fulfilling
the needs of women and child as a couplet (Lotto, Armstrong & Smith, 2016). The interventions
or strategies I would implement to reinforce holistic care for the aboriginal patient will be as
follows:
 After identifying the patient, her cultural background and her lingual barrier in the
primary assessment of the care, I would involve a language interpreter for the
patient so that she can share her concerns and health issues without any stigma, or
consciousness and accurate assessment could be carried out. Further, as per
Clifford et al. (2015), it would make the care process culturally competent and her
diet, and cultural preferences could be taken care of.

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 After understanding her pain associated complication, her patient or family
members would be informed so that they could be involved in the care process
(Hale et al., 2014). If they are unable to join the process within time, through the
interpreter, complete details of the interventions and medications would be
informed to the patient so that patient centered care could be conducted and
consent for the healthcare process could be collected from the patient. This will
also help to improve the legal aspect of care (Lotto, Armstrong & Smith, 2016).
 As the maternity nurse, it would be my duty to take complete care of my patient
and check her status every hour to understand her vital signs and her health
improvement (London et al., 2014). Further, I would take proper vigilance that the
bed side nurse is present in her ward every time so that if she faces any
complication, she could contact the healthcare professionals around her. This will
maintain the legal aspect of the care process (Ward, S., & Hisley, 2015).
 In Canada, while involved in the care process for aboriginal and indigenous
people, it is important for the healthcare professionals to comply with the
Aboriginal health legislation and policy frame work so that while treating their
medical conditions, their ethics, culture and preferences could also be addressed
and through the compliance of these, holistic care could be provided (Ccnsa-
nccah.ca, 2019).
 Besides these, as per the research evidences collected from the paper of Sleptsova
et al. (2015), I would involve the patient in her diet and nutrition planning process
so that with controlled diet, her obesity could be controlled and nutritional lack
for the baby could also be addressed.

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References
Ccnsa-nccah.ca. (2019). the aboriginal health legislation and policy framework Canada.
Retrieved from https://www.ccnsa-nccah.ca/docs/context/FS-HealthLegislationPolicy-
Lavoie-Gervais-Toner-Bergeron-Thomas-EN.pdf
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural
competency in health care for Indigenous peoples of Australia, New Zealand, Canada and
the USA: a systematic review. International Journal for Quality in Health Care, 27(2),
89-98.
Government of Canada. (2019). Indigenous health - Canada.ca. Retrieved from
https://www.canada.ca/en/services/health/aboriginal-health.html
Hale, N., Picklesimer, A. H., Billings, D. L., & Covington-Kolb, S. (2014). The impact of
Centering Pregnancy Group Prenatal Care on postpartum family planning. American
journal of obstetrics and gynecology, 210(1), 50-e1.
London, M. L., Ladewig, P. W., Ball, J. W., Bindler, R. M., & Cowen, K. J. (2014). Maternal &
child nursing care. Pearson.
Lotto, R., Armstrong, N., & Smith, L. K. (2016). Care provision during termination of pregnancy
following diagnosis of a severe congenital anomaly–A qualitative study of what is
important to parents. Midwifery, 43, 14-20.

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Sleptsova, M., Hofer, G., Morina, N., & Langewitz, W. (2014). The role of the health care
interpreter in a clinical setting—a narrative review. Journal of community health
nursing, 31(3), 167-184.
Ward, S., & Hisley, S. (2015). Maternal-Child Nursing Care Optimizing Outcomes for Mothers,
Children, & Families. FA Davis.