NURSING 7: Case Study Analysis of Ethical and Legal Violations

This essay provides a detailed analysis of a nursing case study involving Mrs. Donaldson, focusing on the ethical and legal violations committed by nursing staff. The essay identifies breaches of the duty of care, ethical principles like beneficence, and professional standards of practice, particularly concerning the failure to provide immediate medical attention after a fall and inadequate patient monitoring. It explores the implications of these actions, including the patient's death, and discusses potential interventions, supported by relevant ethical theories and evidence-based practices. The analysis highlights negligence, legal violations, and the impact of organizational factors like staffing shortages on patient safety. The essay concludes by emphasizing the importance of adherence to organizational policies, professional standards, and risk assessment processes to prevent adverse patient events and legal actions. References to relevant literature and professional guidelines are included.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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All nurses are confronted with various ethical challenges in their practice and the Code of
ethics and professional standards give them the guidance to display ethical conduct and reducing
any moral distress in practice (Zahedi et al., 2013). However, despite development of ethical
principles and professional standards, ethical and legal violation of care occurs. This essay will
look at similar incidence of violation of ethical and legal responsibilities in care. The aim of this
essay is to identify legal and ethical issue in the case study of Donaldson and discuss how the
action of the nurse violates the duty of care, ethical principles and professional standards of
practice. The essay will first identify all the ethical and legal/professional concerns and then
discuss about the possible implications of the action. This will be followed by a discussion on
possible actions that could have been taken and the support the action with relevant ethical
theories.
The video of Mrs Donaldson showed that she was mother of two children. She was in
good health. However, she started feeling dizzy and she witnessed a fall at home. She was
hospitalized two days ago for bladder infection and fell from her bed during hospital stay. Her
daughter was informed that her mother fell during the hospital.. When she fell, one staff noticed
it and put her back to bed. However, inappropriate professional action was demonstrated by the
staff as he did not informed anyone about the fall nor did he conducted any assessment to find if
fall resulted in any injury or harm for Mr Donaldson. According to Kwan and Straus (2014),
assessing the level of consciousness, vital sign assessment, monitoring of the skin for abrasion
and bruising and central nervous is extremely important after a fall. This helps to take immediate
action in response to fall injury. However, no such initial step was taken for Mr. Donaldson.
The situation was a case of extreme negligence and poor implementation of approach to maintain
patient safety. The consequence of this negligence was that she had to be finally admitted to the

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intensive care unit. During inspection of the patient post her fall, the nurses were instructed to
conduct half hourly assessment of Mr. Donaldson. However, only two observations were
recorded in two hours. In the ICU, she never regained consciousness and died. The inquest into
the death revealed that poor nursing staffing resulting in fall as well as poor patient monitoring.
The above case study and its consequences will be explored based on ethical and professional
principles.
Firstly, the incidence of fall and no attention of staff’s immediately after her fall is a case
of professional negligence in care as well as violation of the ethical principle of beneficence. The
ethical principle of beneficence states that all nurses have the duty to take all nursing actions to
promote good of patient and ensure that negligible harm is caused to patient (Haddad & Geiger,
2019). However, this principle was violated as Mr. Donaldson did not received any immediate
medical attention post her fall. Hence, ethical concerns were seen. She was attended by staff after
two hours. The registered nurse had the responsibility to provide ongoing assessment and support
to her after fall. However, they failed to realize the significance of the fall event resulting in
delayed care and death. By such negligence, they failed to adhere to professional standards of
nursing practice too. The registered nurse standards of practice state that all nurses have the
responsibility to provide safe and responsive quality care to patient (Nursing and Midwifery
Board of Australia, 2017). This could have been done by immediately attending to Ms
Donaldson post her fall. Even if she had not fallen, they must have used comprehensive
assessment to identify her risk of fall and provided fall prevention interventions like bed railings
to eliminate any risk of fall. This is part of evidence based intervention as Phelan et al. (2015)
states that all clinical guideline recommends screening all adults for fall risk. Hence, this shows
that the nursing staffs had to take action much before the fall. An event of fall was not necessary

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to take appropriate action for patient. Fall risk assessment would have helped to fulfil the ethical
principle of beneficence too and ensured high standard of care.
The evidence by Kwan and Straus (2014), supports that fall prevention intervention is
extremely important for elderly adults because of ageing related issues such as cognitive
problem, balance problem and effect of acute illness. Various fall prevention intervention like
risk assessment and environmental modification is done for such patient. Mr. Donaldson was
experiencing symptoms of dizziness. Her age and symptom of dizziness were cues to implement
fall prevention intervention. Sherrington et al. (2015) acknowledge gait problem, dizziness,
previous falls and increasing age as some risk factors of fall. Hence, the current symptom of Mr
Donalson and her previous history of fall was good evidence for the RNs to implement fall
prevention intervention. But inability to do the same is an example of negligence and legal
violation too. This is said because no proper action was implemented even post fall and Mr
Donaldson was left unattended till two hours. The situation is linked to the tort of negligence as
the situation is a severe incidence of breach of professional nursing responsibilities. A health
care organization or a health care staffs can be sued for breach of duty or ignorance of care when
they fail to prevent causing damage or harm to patient. All such breaches come under the tort of
negligence, it gives Australian the government the right to sue that person or organization
(Australian Law Reform Commission, 2017). Hence, the involved staffs or the organization can
be severely penalized for breach of duty. Realizing their duty of care and striving to provide
appropriate medical attention even in times of adversity would have helped to prevent the death
of Mr Donaldson. According to Raveesh, Nayak and Kumbar (2016), failure to identify a
complication is an example of medical malpractice and this could be prevented by adhering to
clinical guidelines and fulfilling expectation of patients and their families.

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From the inquest into the death of Mrs Donaldson, the violation of the duty of care and its
impact on patient outcome has been identified too. This is said because as per professional
standards of practice, the RNs at the hospital had the duty to comprehensive conduct assessment
and use appropriate systems to identify and prevent any risk related issue (NMBA, 2017). The
duty of care has legal, ethical and professional aspects. Dowie (2017) explains that duty of care
involves not just professional duty, but also ethical and legal duty. The study defined duty of care
as the nurses responsibility to make patient’s care and safety their top priority and effective
assess and respond to patient needs. This also means that even if nurse does not have
professional or legal duty, they must follow the ethical duty to assist patient in all emergency
situation. However, the nursing staffs at the hospital did not follow the above definition. They
violated professional, legal as well as ethical duty in the event of the emergency case of fall for
Mrs Donaldson. The RN neither followed the instruction of conducting half hourly assessment of
the client post her fall nor took the responsibility to display empathy during fall. Instead of
caring for her after fall and giving immediate attention, the visiting staff left without notifying
any other person. This violation of duty of care was the main reason for Donaldson’s
deterioration of condition. She was bleeding and this became the cause of her death. This could
have been avoided if the staffs considered the situation to be urgent and realized the priorities
while caring for the patients. Bryden and Storey (2011) mentions the principle of duty of care is
to take reasonable care to avoid unforeseeable events for patient. The medical duty of care is that
when a patient is admitted to the hospital, a duty of care relationship is created between staff and
patient. This mandates the staffs to take all actions to prevent patient for any preventable harm.
This duty of care was not practiced by the nursing staffs who were caring for Mrs Donaldson.

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The issue of the violation of the duty of care in the case study of Donalson could be an
due to the poor support from the organization or lack of safety culture in the organization too.
This is said because the inquest into the death revealed a severe nurse staffing crisis. The number
of nurses available in the hospital was not sufficient as per the patient load. Moreover, adequate
skill mix issue was also found as her the ward nurse coordinator was dealing with the challenges
of workload and inability to delegate nurse to care of all patients. Poor hospital policy was one of
the causes behind staffing shortage during that time, the hospital staffs removed some staffs from
nursing management and delegated them in general management. Hence, because of the failure
of the organization to provide additional staffing support during the time of crisis, repeated
observation of Donaldson could not be carried out. According to Andri and Soewondo (2018),
safety culture strongly influences nurse’s perception of duty of care and their commitment to
prevent adverse risk event for patient. Rosenberg (2019) argues that nursing shortage damage
professional relationship with patient and lead to high number of patient event. Hence, this is an
area where organization leader and process plays a crucial role in eliminating ethical and legal
issues in care. Thus, Donaldson’s death could have been prevented if the hospital authority paid
more attention to staffing issues and realized that better staffing is crucial for quality care. Their
prioritization of staffing issue would have helped to maintain appropriate staff patient ratio. In
such situation, it would have been possible for nurse to regularly inspect Mrs Donaldson and
conduct risk assessment and vital signs assessments in a timely manner. Cherry and Jacob (2016)
acknowledge too that nursing shortage is responsible for greater likelihood of errors, malpractice
and negligence. Thus, to ensure that nurses adhere to high standards of accountability, they must
be supported with good support from the organization.

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To conclude, the analysis of the inquest into the death of Mrs Donaldon suggests that her
death occurred due to violation of professional, ethical and legal responsibilities in care. The
ethical issues linked to the death were violation of patient beneficence, ignorance of duty of care
and negligence to implement expected standard of care. Professional violation was seen due to
poor adherence to professional standards of practice and inability to complete accurate and
timely risk assessment of patient. Moreover, legal issues were identified due to violation of the
tort of negligence and duty of care post admission of the client to the hospitals. The analysis
revealed that poor staffing issue along with negligence of care resulted in the risk event. The key
lesson from this analysis is that to prevent legal actions due to adverse patient and negligence of
the duty of care, all nurses must be encouraged to comply with current organization policy, code
of practice, professional nursing standards and evidence based risk assessment process to reduce
any preventable adverse event or even death of any patient.

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