SNPG923: Legal and Nursing Professionalism in Australia - Case Study

This essay provides a comprehensive analysis of legal and professional issues within the context of nursing in Australia, using a detailed case study involving the death of an infant due to alleged negligence, poor documentation, and ineffective communication among healthcare providers. The essay begins with an introduction to the Nursing and Midwifery Board of Australia (NMBA) standards and the code of ethics, emphasizing their importance in guiding nursing practice and ensuring quality healthcare outcomes. The case study highlights a scenario where nurses misdiagnosed an infant, leading to a fatal outcome. The essay then delves into five critical factors contributing to the infant's death: negligence, poor documentation, ineffective communication, lack of knowledge, and poor judgment skills. The analysis draws upon relevant literature and legal frameworks to define negligence and its implications for nurses, emphasizing the importance of comprehensive assessments, accurate documentation, and effective communication. It explores the NMBA standards, particularly those concerning assessment and evaluation, and recommends improvements in documentation practices and communication strategies to prevent similar incidents. The essay underscores the significance of patient-centered care and the duty of care owed by nurses, suggesting that nurses who practice negligence should be held accountable. The conclusion emphasizes the need for nurses to adhere to recognized standards of care and highlights the importance of continuous monitoring, proper documentation, and effective communication to ensure patient safety and uphold professional standards.

LEGAL AND NURSING PROFESSIONALISM IN AUSTRALIA
Introduction.
According to Cashin et al. 2017, he stated that revised standards for qualified nurses were
endorsed by the Nursing and Midwifery Board of Australia in November 2015. The standards
provide a guide to all the nurses in practice in the whole of Australia. The code of ethics applies
to all nurses that have been registered by the board. The significance of the laws is fostering
translation of the knowledge and skills acquired through the theoretical learning in school into
practice for quality healthcare outcomes. Nurses can fail to practice to their level of standards as
expected because of lack of knowledge or lack of effective communication when the care
involves more than one nursing professional. This, therefore, can result into poor services
delivered in contrary to the goals of the NMBA who registered the nurses to give healthcare
services which among them includes protecting the public from harm and providing high-quality
education and training to its registered nursing professionals (Scanlon et al., 2016). If the goal of
the board is to register qualified competent nursing professional, normally done by the
accreditation of the educational facilities, if the nurses get into practice and do the contrary then
it would have failed to achieve some of its goals.
Case study Analysis.
The context will, therefore, describe a case study which shows poor nursing care provided to
an infant aged 6 months whom the nurses make a wrong diagnosis. The wrong diagnosis was due
to lack of knowledge which made the two nurses diagnose gastroenteritis instead of bowel
obstruction which was confirmed later by the pediatrician. Poor communication and poor
documentation also contributed to the poor nursing quality services provided by the two nurses.
And the final factor was the negligence of the nurses as they didn't follow up closely the situation
to monitor the prognosis of the disease and how the infant was improving in terms of signs and
symptoms. The right diagnosis was therefore done late and caused the death of the infant as he
was transferred to a tertiary hospital from the local hospital for effective medical management of
the bowel obstruction.
The death of the infant raised some allegations. The complaint alleged that the nurses failed
to manage the condition appropriately. secondly, there was poor communication between the two
nurses and the pediatrician concerning the changes in the signs and symptoms of the infant's
condition. Thirdly the complaint alleged that there was poor documentation. Circumstances
surrounding the death of the infant rose allegations which made the Professional Standards
Committee (PSC) inquired about the conduct of the two nurses who were involved in the act and
found poor healthcare service took place. Basing their argument on the code and standards of
practice for registered nurses in Australia, a finding of unsatisfactory professional conduct
against both practitioners was made. The PSC hearing also found that the practitioners did not
demonstrate their knowledge and their judgment skills as they were providing the healthcare
services as expected in the practice of nursing. the service was considered to be below compared

to the standard of practitioners of an equivalent level of training and experience. They, therefore,
raised questions concerning the clinical reasoning ability.
Having gone through various literature including journals and articles published before
concerning the same related topic of legal and nursing professionalism in Australia, I can
critically analyze the case study in this context basing my argument on five factors that led to the
death of the infant. The first one being negligence, the nurses and the pediatrician didn't follow
up the patient condition until it got worse. Secondly is the poor documentation which led to no
action performed concerning the infant's condition. Thirdly, it is the ineffective communication
between healthcare practitioners including the two nurses and the pediatrician. Fourthly is the
lack of knowledge of the two nurses which resulted in the wrong diagnosis. And lastly, is the
poor judgment skills of the two nurses who were caring for the infant in the local hospital.
According to Griffith & Tengnah (2017), they defined negligence as an omission to do an
action that a reasonable man would not do or to do something a prudent and a reasonable man
would not do. This is when a nursing professional or any other healthcare provider fails to
observe a standard of care that is legally recognized (Pozgar, 2018). The code of conduct for
nurses in Australia has the domain and the first one which is practicing legally, nurses should be
in apposition of practicing honestly and ethically and should not, therefore, be engaged in
unlawful behavior such as negligence (Sanderson, 2018). They should, therefore, understand that
engagement in any kind of unlawful behavior is viewed as unprofessional conduct and have an
implication in their registration (Snelling, 2016). The nurses were supposed to have been honest
in caring for the infant by following up the progress of the condition if it is worsening or not.
After they have made the first medical diagnosis of which they did it generally, they should have
gone further and taken some tests and intense assessment to rule out the differential diagnosis
and remain with the one main medical diagnosis. According to NMBA standards of practice, the
fourth standard says a registered nurse comprehensively conducts assessments (Nursing and
Midwifery Board of Australia, 2010). The conducted assessments should be holistic and
culturally appropriate. The nurse is therefore required to use a range of assessment techniques to
collect relevant and accurate information systematically. If they could have done so early
enough, they could get time to treat the infant early enough. Early diagnosis is important since
the symptoms a patient is concerned with could be of a condition that is reversible if managed
early enough. The nurses could have used the documented assessment data to develop the care
plan that its evaluation part could have been used to monitor the infant progress. Diagnosis is
also more accurate early in the disease process (Dubois et al., 2016). From the case study, it can
be noted that consequences of professional negligence, therefore, may include, decrease in
quality of life and lawsuits. Nurses, negligence caused deterioration of the health of the infant
leading to death, and what followed was the lawsuit in which they were sued and found they
have performed contrary to what they are expected. Since in patient-centered nursing care, the
main aim is to promote the patient's wellbeing, and the relationship between a nurse and a patient
is the one that gives rise to a duty of care (Haugan, Innstrand, & Moksnes, 2013). It can,
therefore, be recommended that those nurses who practice negligence while caring for their
patients be taken before the law by the board and perceive punishment. Doing this will reduce
the rates of patients being abandoned and ignored in healthcare settings.

Nursing documentation is any form of information that is written or electronically generated
describing the care or service provided to a patient. It is through communication that nurses
communicate with other healthcare providers noting down what was done or the patient (Wager,
Lee, & Glaser, 2017). The information charted helps the other medical practitioners
understanding what is going on with the patient. As it monitors the progress of the client. In the
documentation, nurses should include the notes on assessment, the plan of care, the patient’s
personal data (Kettenbach & Schlomer, 2016). Good record keeping ensures the promotion of
patient care and is a product of good teamwork and an important tool that is considered in
developing high-quality healthcare and reinforces professionalism within the nursing profession.
Documentation in nursing includes the nurse's notes where the nurses on session put a record of
the patient's healthcare that includes vital signs such as the respiratory rate, temperature, pulse
rate, and pressure. Alteration of the vital signs requires immediate intervention to manage the
abnormality. The notes may also include treatments, procedures done to the patient and patients'
response to the care given. In the case study, poor record keeping resulted in less attention given
to the patient. Abnormal observations were not correctly managed and documented. Therefore,
for the case of the infant, a breach of duty occurred where the care rendered was not consistent
with what a prudent nurse would do in a similar circumstance. This led to the death of the infant
which was directly caused by breaching the standard of care (Todd, 2014). In this case scenario,
the case required good documentation and record keeping. The nurses also had a duty to monitor
the infant closely and report any abnormal change of the observations to the healthcare provider
(pediatrician) as soon as possible. According to the NMBA standards of the registered nurses, the
seventh standard outlines that a registered nurse evaluates and monitors progress towards the
expected goals and outcome (Nursing and Midwifery Board of Australia, 2015). It is therefore
concluded that nurses are responsible for knowing and following their recognized standards of
care. For effective documentation, therefore, it is recommended that the nurses avoid failure to
communicate and monitor, the adverse events should be documented properly and immediate
action is taken, the nurse should follow his/her documentation policies, he/she should also avoid
any gaps while documenting and documentation be done at the same time of assessment and/or
treatment. When a gap is left while documenting in order to fill in the information later, squeezed
information can alert the attorney who might say the squeezed information was so just to cover
up some hidden information and he/she will actually be right unless proven otherwise. The
attorney has power over anything done to the patient (Brinkman-Stoppelenburg. et al.,2014.,
Walczak et al. 2016)
According to Adler, Rodman & Du Pré, (2016) they defined communication as a process
that leads to interaction and connectedness between human beings while exchanging
information. This information can be conveyed in written form, verbally and nonverbal. When
you consider effective communication between the patient or the attorney and the nurse, we call
it therapeutic communication. Therefore, Davis Boykins, (2014) defines therapeutic
communication as the process of face to face interaction which normally focusses on advancing
the physical and emotional well-being of the patient. Considering the case study there was no
effective communication between the two nurses, attorney of the infant and the pediatrician. It
should be noted that communication in the healthcare system is among the tools that are
important in providing great patient care and improving their satisfaction (Al-Abri, & Al-

Balushi, 2014). However, when lines of communication are crossed (the case with the two
nurses, the pediatrician, and the infant's attorney) can lead to lower patient satisfaction scores or
worsening of the patient's condition. In a healthcare setting communication can also make the
nurse get to know whether he/she has achieved the goals she set before the implementation of the
goal. In this case, therefore, the nurses should have used the therapeutic communication
techniques effectively to seek information and getting to know the progress of the infant from
her attorney. According to (Riley, 2015), some of the therapeutic communication techniques that
could have been used include use of broad openings by using phrases like Go on…, these
phrases set the lead and would have given the attorney an opportunity to describe deeply the
history of the presenting illness of the infant. Secondly, active listening by maintaining eye
contact. This applies mostly during the assessment. Maximum concentration could have given
the nurses accurate assessment data and they could have ended up with the right diagnosis.
Effective communication also promotes a connection between the healthcare providers (Arnold,
& Boggs, 2019) and this aids in improving the patient's health status. It is evident that the fourth
standard of nursing practice outlines that registered nurses in the Australian nation work in
partnership in determining the factors that affect or potentially affect the health and well being of
the patients and to determine the priorities for action and/or for a referral. The registered nurses
are responsible for the planning and communication of nursing practice. For effective health care
outcome in the future, it is therefore recommended that nurses and the other healthcare providers
should communicate effectively and improve their partnership while caring for the patient. For
effective communication with the patients or the attorney, they can make use of therapeutic
communication techniques. This will support the wellbeing of the patient.
The national competency standards for the registered nurse work in conjunction with the
Nursing and Midwifery Authorities. This conjunction produces national standards. The national
standards ensure nurses and midwives deliver nursing care that is safe and competent (Casey et
al., 2017). Moreover, these standards are the core competency standards by which the nurses’
performance is assessed to obtain and retain their registration as registered nurses in Australia.
These standards are used to assess educated overseas nurses seeking to work in Australia. This
ensures that only knowledgeable competent nurses are allowed to work in Australia (Zasadny, &
Bull, 2015). The standards have domains of which among them is critical thinking and analysis.
Being knowledgeable enough the nurse should be in a position of thinking critically and analyze
situations requiring emergency care. Unfortunately, whatever happened in the case scenario was
the contrary. The nurses were not knowledgeable enough ending up giving a wrong diagnosis.
This led to a delay in treatment of the infant due to the time of referral after the right diagnosis
was made. The nurses, therefore, had a duty of thinking critically and analyze the situation of the
infant and implement interventions as soon as possible to save a life (Jones, Shaban, & Creedy,
2015). The nurses also lacked skills in managing patient at a critical condition hence preferred
transferring her before they could try saving the infant's life first. The nurses did not act
competent enough to provide high-quality standard nursing care to the infant (Halcomb et al.,
2016). They did not apply the clinical reasoning abilities in prioritizing which action should
come first before the other. Clinical reasoning is the process by which nurses collect cues
(data/information), they then process the information, understand the patient problem, plan and
implement interventions to manage the problem, and evaluate the outcomes. Simply it is all

about critical thinking (Pirret et al., 2015, Forsberg et al 2014). Clinical reasoning has the power
to determine the outcome of the nursing care given to the patient in question. The nurses had
poor reasoning skills which resulted in failure to deliver accurate, quality and satisfactory health
care service. For effective healthcare outcome in the future, the nurses are recommended to use
the clinical reasoning model while caring for their patients.
Conclusion.
In conclusion, the Nursing and Midwifery Board of Australia sets standards and code of
ethics for the registered nurses and Midwives in the nation. This leads to competency and the
provision of high-quality healthcare services. When nurses provide services that are not
equivalent to their expected standard, it results in failure in delivering accurate or satisfactory
healthcare. The case scenario in the context is an example of two nurses who did not work
competent enough ending up providing poor services such as giving the wrong diagnosis which
led to the death of the infant. The nurses are therefore recommended to abide by the legislation
and use the clinical reasoning skills in their nursing practice since it has powers to determine the
outcome of the patient care.

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