NURS2002 Case Study: Analyzing Breaches in Clinical Governance

This case study examines a nursing student's experience in a metropolitan ward, highlighting breaches in cultural safety and clinical governance. The first incident involves a communication barrier with an elderly Greek patient, emphasizing the importance of cultural sensitivity and effective communication in nursing practice, recommending the involvement of a Greek-speaking nurse to bridge the cultural gap and ensure patient comfort and understanding. The second incident focuses on a lack of supervision and support for the nursing student, violating clinical governance principles and potentially compromising patient care, stressing the need for proper guidance and adherence to national safety and quality standards. The essay concludes by underscoring the impact of such breaches on patient care quality and advocating for strategies to address them, including cultural awareness and robust support systems for new nurses, ultimately enhancing the quality of care provided to patients. Desklib provides a platform for students to access similar solved assignments and past papers.

Running head: LEGAL AND PROFESSIONAL ISSUES
LEGAL AND PROFESSIONAL ISSUES
Name of the Student:
Name of the University:
Author note:

1LEGAL AND PROFESSIONAL ISSUES
Introduction
The essay focuses on the case study that involves certain breaches in the cultural
safety and clinical governance areas in a nursing profession and disturbing the principals
involved in cultural safety and clinical governance (Jabari et al., 2015). Cultural safety is
defined as the policy that focuses on respecting the social and cultural differences under
health services and clinical governance is defined as the NHS framework that aims to
improve the quality of life in patient (Farokhzadian, Nayeri & Borhani, 2018). The essay will
also focus on the strategies that will be recommended to counteract the breach present in the
case scenario that revolves around the activity of nursing student who was placed in a
metropolitan ward and was now confident in assessing and treating the patient.
Incident 1: Breach in cultural safety
Cultural safety area is chosen as the first incident because in the case study it was
clearly seen that huge cultural difference was present in between the nurse and the patient
(Johnstone & Facn, 2019). Mrs Maria was an 87 years old women who was from Greek and
could not speak English properly. She was suffering from exacerbation of COAD. The
patient’s daughter in law was also present. As soon as the nurse visited the patient, her
daughter-in-law complained that the patient was suffering from pain and required some
immediate medication. The nurse had checked the medication order and finds out that
nothing was order to relief the patient from pain hence she visited her senior doctor and took
2 Panadol to give it to the patient. The patient denied to take medicine from the nurse and
even the nurse was unable to convince her (DiCuccio, 2015). The patient’s daughter-in-law
takes the medicine from the nurse and speaks to the patient in Greek that the nurse could not
understand and explain the patient regarding the advantage of consuming the medicine. The
nurse was unable to communicate with the patient regarding her problem or concern towards

2LEGAL AND PROFESSIONAL ISSUES
her health that was a major breach in the cultural safety (Paradiso & Sweeney, 2018). There
was a major cultural and social difference between the nurse and the patient that was
restricting the nurse to communicate and explain the patient regarding her health issue and
what medicines and treatment would effectively help to overcome from her health condition.
According to Nursing and Midwifery Board of Australia (NMBA), cultural safety and
effective communication is considered as an important domain for building a therapeutic and
healthy relationship with the patient that is respectful and culturally safe
(Nursingmidwiferyboard.gov.au, 2019). Being a nurse I would ask the higher authority of the
hospital to arrange for a nurse who is Greek and could easily communicate with the patient
and could translate the conversation to the patient in a respectful manner maintaining the
cultural safety and respect of the patient. The assistant Greek nurse could easily translate the
concern of the patient to the nurse and even the patient would feel better as she could easily
convey her worries to the nurse. The assistant nurse with similar cultural background as the
patient would help the registered nurse as well as the doctors to better understand the concern
of the patient related to their health issues and effectively communicate with the patient
thereby allowing the nurse to treat the patient in a better way reducing the cultural gap and
breach (Holland, 2017).
Incident 2: Breach in Clinical Governance
Clinical Governance is defined as a system by which every organizations present
within the healthcare system are responsible for constantly improving and modifying the
superiority of the clinical services in healthcare and safeguarding high patient care standards
by producing a motivated environment that would allow the nurses and doctors to excel in
their specialty and flourish (Tuan, 2015). The staff members present within the healthcare
organization are motivated to provide their best standard of care to the patient. Clinical
governance area is chosen as the second incident because in the case study, bad clinical

3LEGAL AND PROFESSIONAL ISSUES
governance practice was clearly seen in between the nurse and the high authority of the
organization (Donaldson, 2018). In the case study, it was evident that the nurse was new to
the morning shift and required guidance from her allocated registered nurse as she was just a
nursing student studying in second year. The nurse was allocated with four different patient
and was supposed to be supervised by a registered nurse named Kylie. Her team leader stated
that Kylie won’t reach the hospital before 9 am and the nurse has to manage herself but in
case of any issue she can reach out to her team leader. This kind of behaviour was unethical
and demotivating for the nurse as she was new and not aware of the rules and regulations of
the hospital and required guidance or assistance from her registered nurse that was lacking
(Bishop, 2017). Hence this was a major breach in the clinical governance of the organization
that resulted in poor health outcome and bad quality of care. While assessing a patient the
nurse was confused with the medication as no medicine was noted down or given to the
patient according to medication order and hence she visited her team leader who ask what
medicine should she give to the patient. Without checking any background medication
history of the patient, her team leader asked her to give 2 Panadol to the patient to resolve her
pain complaint (Sundean et al., 2019). The nurse was still not satisfied and confident with the
medicine and she again took the medicine to the team leader who was very rude towards her
and said her to proceed with the medicine he will check the patient later and also asked her to
not bring every little concern checked to him. This was very demotivating for the nurse and
was also violating the national safety and Quality health service Standard (NHQHS) that aims
to provide best quality of care to the patient by improving the standard of practice and
motivating the staff members to deliver best care (Safetyandquality.gov.au, 2019). Effective
guidance from the registered nurse is required that can help the assistant nurse to understand
the rules and regulation of the hospital and under proper guidance from the higher authority
can effectively treat the patient.

4LEGAL AND PROFESSIONAL ISSUES
Conclusion
From this essay it was concluded that any breach in the nursing practice can affect the
quality of care given to the patient and appropriate strategies can be adopted that will help the
nurse to overcome the breaches and effectively treat the patient. A proper nurse should be
allocated for the patient with different cultural background in order to prevent any cultural
safety breaches and the patient is treated with dignity and respect. This would allow the nurse
to treat the patient in a better way and explain the patient regarding their health condition and
treatment procedure. Effective guidance should be provided to the new nurse in order to
assist the nurse in understanding and assessing the patient’s need and health condition. The
above mentioned strategies to overcome the breaches will help the nurse to pursue her
nursing career in a better way and she can effectively treat the patient under proper guidance
that will in turn enhance the quality of care given to the patient.

5LEGAL AND PROFESSIONAL ISSUES
References
Bishop, V. (2017). Clinical Supervision: Functions and Goals. Clinical Supervision in
Practice: Some Questions, Answers and Guidelines for Professionals in Health and
Social Care, 27.
DiCuccio, M. H. (2015). The relationship between patient safety culture and patient
outcomes: a systematic review. Journal of patient safety, 11(3), 135-142.
Donaldson, L. (2018). Clinical governance: a quality concept. In Clinical governance in
primary care (pp. 1-16). CRC Press.
Farokhzadian, J., Nayeri, N. D., & Borhani, F. (2018). The long way ahead to achieve an
effective patient safety culture: challenges perceived by nurses. BMC health services
research, 18(1), 654
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text.
Routledge.
Jabari, F., Ooshaksaraie, M., Azadehdel, M., & Mehrabian, F. (2015). Relationship between
patient safety culture and professional conduct of nurses in context of clinical
governance implementation. Journal of Holistic Nursing And Midwifery, 25(3), 27-
33.
Johnstone, M. J., & Facn, P. B. R. (2019). Bioethics: a nursing perspective. Elsevier.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - NMBA
and CATSINaM joint statement on culturally safe care. Retrieved from
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/position-
statements/joint-statement-on-culturally-safe-care.aspx

6LEGAL AND PROFESSIONAL ISSUES
Paradiso, L. A., & Sweeney, N. (2018). The Relationship Between Just Culture, Trust, and
Patient Safety.
Safetyandquality.gov.au. (2019). Australian Commission on Safety and Quality in Health
Care. Retrieved from https://www.safetyandquality.gov.au/
Sundean, L. J., White, K. R., Thompson, L. S., & Prybil, L. D. (2019). Governance education
for nurses: Preparing nurses for the future. Journal of Professional Nursing.
Tuan, L. T. (2015). Nursing governance and clinical error control. International Journal of
Pharmaceutical and Healthcare Marketing, 9(2), 136-157.