Case Study Analysis: Identifying Nursing Practice Breaches in NURS2002

This case study analyzes a scenario involving a nursing student on a professional placement in a hospital ward. The student is presented with a case involving an 87-year-old Greek patient, Mrs. Gianopolis, where two breaches of nursing practice are identified. The first breach involves the team leader's directive to administer medication without consulting the doctor, violating principles of clinical governance, accountability, and patient safety. The second breach concerns cultural safety, as the nursing student fails to address the patient's refusal of medication due to a language barrier and potential cultural beliefs. The paper discusses the incidents, the author's response if involved, and the impact of these discussions on future nursing practice, emphasizing the importance of accountability, interprofessional collaboration, and cultural sensitivity in providing quality patient care and improving clinical outcomes.

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

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Introduction: 100 words approx
In the field of health care, excellent quality of care is dependent on the values of
accountability, safeguarding patients from risk and following all relevant standards for practice.
However, breach of conduct may occur when any nursing staff is involved in an incidence which
goes against the professional values and principles of care. The main purpose of this paper is to
analyse a case study of a nursing student and identify any two breaches of practice. The two
incidence of breach of practice will be discussed and response will be provided regarding the
actions taken by me if I was involved in such issue. The paper will also give an insight into the
impact of the discussion of the two incidences on nursing practice.
Incident 1: 450 words approx
The first incident related to the case scenario where a breach of conduct has been seen is
the incident where Mrs. Gianopolis’s daughter-in law asks for pain medication and the team
leader Adam Vronsky ask the nursing student to provide Panadol to the patient without
consulting the doctor in charge of the patient. Even when the nursing student came to check for
the medication, Adam did not cared and asked the nursing student to stop checking and give the
medication. This incident breaches the principles of good clinical governance in care. This is said
because as a health care staff, it was the duty for the team leader to demonstrate accountability
for practice, involve the patient in care, demonstrate evidence based care and enter into effective
partnership with the multi-professional team as per the principles of clinical governance Van
(Zwanenberg & Edwards, 2018). The Australian Commission on Safety and Quality in Health
Care (2018) emphasizes on patient safety and effectiveness of clinical performance to

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demonstrate clinical governance. However, all these principles were not followed by Adam
while supporting nursing student in care.
The above incidence is said to be breach of clinical governance because Adam did not
consult the doctor in-charge to ensure that the medication was safe for patient. Hence, he ignored
the value of accountability for practice. Accountability is a professional attribute needed by
health care professionals to protect client or staffs from effect of negligent and unsafe practice
(Drach‐Zahavy, Leonenko & Srulovici, 2018). However, Adam did not demonstrate any
willingness to consider whether Panadol was safe to be administered to Mrs. Gianopolis or not.
In addition, willingness to work in partnership with other discipline is vital for health care staffs
to fulfil the principle of clinical governance. However, Adam did not took the approach to
consult involved staffs neither support the nursing student to ensure that safe medication is
provided. The right of safe medication administration was also violated thus increased risk of
safety issues for patient. According to Wilson et al. (2016), collaborative practice is critical for
safe medication prescribing, dispensing and administration as miscommunication or
communication gaps between health care professional lead to medication errors and poor patient
outcome.
If I were in a similar situation above, I would have avoided breaching the principle of
clinical governance by calling the doctor in charge of Mrs. Gianopolis and reporting that no
medication order for pain is there for the patient. Next I would have enquired whether providing
Panadol is effective for patient or not as I have no knowledge about the patient health history or
current medications that she is taking. This action would have supported me to be accountable
for the safety of patient, enter into effective partnership with multiprofessional team to improve
the quality of care and promote health and safety of patient.

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Incident 2:
The second incident that is linked to breach in the principles of cultural safety includes
the incident where Mrs. Gianopolis looks at the nursing student blankly while providing
medication and the patient says no. The patient is a Greek woman who does not speak very much
English and she took the medication only when her daughter speaks very strongly to her in
Greek. It is breach of cultural safety principles because no action was taken by the nursing
student to eliminate language gap in practice and understand any cultural values or behaviours
that made Mrs. Gianopolis to say no to the medication. As the medication was provided without
taking patient’s preference or opinion regarding saying no to the medication, it violates the
cultural safety principle. To achieve cultural safety in practice, it is necessary to demonstrate
cultural awareness, cultural sensitivity and cultural safety while delivering care (Pauly et al.,
2015). However, no such action was taken.
As per the cultural safety principles, health care staffs need to respect cultural diversities
of people and be aware of their cultural beliefs related to treatment, prescribed medication or
other care regimen so as to improve their satisfaction with care. It is a common practice for
patients coming from different cultural group to refuse medication based on cultural ground or
belief (Fernández et al., 2017). In such situation, it is the responsibility of the nurse to ask
question from patient and better understand their reason behind not taking the medication. This
can enhance their cultural awareness knowledge and negotiate with patient to identify whether
traditional treatment can work for them or not (Yilmaz et al., 2017). However, the nursing
student did not take the initiative to inquire the patient regarding why she was refusing to take
the medication. Lack of communication skills and language gap also prevented her from
inquiring about cultural beliefs related to medication for patient. Hence, as not respecting

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patient’s preference may lead to breach of cultural safety principles and poor care experience for
patient, the incident demonstrate that the nursing student lacked skills to promote cultural
sensitivity.
I was in the same situation, I would have taken the approach to interrupt Mrs. Gianopolis
and her daughter and inquire why she is saying no to her medication. As Mrs. Gianopolis spoke
in Greek, I would have made her daughter-in law as the mediator during the communication to
understand whether she has problem with the medication because of any cultural beliefs or not. If
any such issue was the reason for her to deny her medication, then I would have used my clinical
thinking to understand whether traditional medicine will work for her or not. My critical thinking
and cultural sensitivity would have helped to effectively negotiate with patient and improve
compliance to treatment (Darnell & Hickson, 2015). This action would have helped me to
respect cultural values of patient and demonstrate cultural sensitivity while providing care.
Conclusion:
To conclude, the analysis of the case scenario revealed how principles of clinical
governance and cultural safety have been violated by the nursing student. By engaging in the
activity of identifying breach of practice in relation to the topic, I have gained knowledge
regarding the core components of clinical governance and cultural safety. This experience is
useful for me as I have learnt about the role of principles of clinical governance and cultural
safety in increasing patient satisfaction, improving clinical outcome and reducing adverse event.
This knowledge will help me in my future nursing practice as I would focus on using
accountability, interprofessional collaboration and patient engagement to influence patient care.
By reflecting on the actions that I would use to counteract the breach, I have learnt about the

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ways to practically apply the principles of clinical governance and cultural safety in nursing
practice. This knowledge will enhance my professional competency needed for future nursing
role.

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References:
Darnell, L. K., & Hickson, S. V. (2015). Cultural competent patient-centered nursing
care. Nursing Clinics, 50(1), 99-108.
Drach‐Zahavy, A., Leonenko, M., & Srulovici, E. (2018). Towards a measure of accountability
in nursing: A three‐stage validation study. Journal of advanced nursing, 74(10), 2450-
2464.
Fernández, A., Quan, J., Moffet, H., Parker, M. M., Schillinger, D., & Karter, A. J. (2017).
Adherence to newly prescribed diabetes medications among insured Latino and white
patients with diabetes. JAMA internal medicine, 177(3), 371-379.
Pauly, B. B., McCall, J., Browne, A. J., Parker, J., & Mollison, A. (2015). Toward cultural
safety. Advances in Nursing Science, 38(2), 121-135.
The Australian Commission on Safety and Quality in Health Care (2018). National Model
Clinical Governance Framework. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Model-
Clinical-Governance-Framework.pdf
Van Zwanenberg, T., & Edwards, C. (2018). Clinical governance in primary care. In Clinical
Governance in Primary Care (pp. 17-30). CRC Press.
Wilson, A. J., Palmer, L., Levett-Jones, T., Gilligan, C., & Outram, S. (2016). Interprofessional
collaborative practice for medication safety: Nursing, pharmacy, and medical graduates’
experiences and perspectives. Journal of interprofessional care, 30(5), 649-654.

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Yilmaz, M., Toksoy, S., Direk, Z. D., Bezirgan, S., & Boylu, M. (2017). Cultural sensitivity
among clinical nurses: A descriptive study. Journal of Nursing Scholarship, 49(2), 153-
161.