Nursing Reflection: Improving Practice Through Case Study Analysis

This nursing report reflects on a case study involving a registered nurse, Michael, who performed an intimate examination on an Aboriginal woman without obtaining explicit consent, leading to a complaint. The reflection uses Gibb’s model to analyze the situation, focusing on cultural sensitivity, communication, and ethical considerations. It emphasizes the importance of informed consent, patient autonomy, and adherence to the NMBA codes of conduct. The analysis highlights the need for nurses to respect cultural differences, ensure clear communication, and advocate for patient rights. The report concludes with an action plan for the nurse to improve future practice by enhancing knowledge of legal and ethical guidelines, remaining calm during examinations, and always prioritizing informed consent to empower patients in their healthcare decisions. The paper emphasizes the importance of cultural safety and ethical nursing practice.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Introduction
Informed consent provides autonomy to the patient for a shared decision making. It helps
in preserving the rights of the patient and is an important element of shared decision making.
This report will reflect upon my actions that I would take in order to prevent the occurrence of
such cases in my future nursing practice. I will use Gibb’s model of reflection to reflect on my
actions to prevent the occurrence of the incidents.
Gibb’s Reflection
Description
This report is based upon a case study where Michael is a registered nurse working at the
health care facility. Michael was working when an intimate examination of the patient was
needed. The patient had been an aboriginal woman. Although Michael examined why the
examination has been done but did not ask for a consent before the examination has been taken
place. However, the women was uncomfortable with Michael doing the examination. The
women being helpless complained to the facility manager about Michael doing the examination
and that he has not taken any consent from the patient.
Feelings
I have always believed that cultural sensitivity in our profession is important as we come
across several ethnic minorities, while caring for the, who have entirely different beliefs and
different cultures. Modes of communications works differ with new patients, with diversified
cultural background (Lamson, 2013). I was well aware of the fact that consent from the patient
can be given as verbally as well as non –verbally (Vučemil et al. 2017). Hence, at first , I would

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have greeted the patient, would try to develop a rapport of trust, so that it become easier to
describe about the procedure and would asked her permission before touching her. Had the
person being unable to give consent, the same would have been got from a family member or if
language was the barrier, I would have used an interpreter to convey the permission to the
patient. If the nurse is male, then the procedure could have been done in front of a female nurse
(Fitzpatrick et al., 2016). Gender matching could have been ensure, respecting the decision of the
patient at the first place. A competent nurse should be carefully while checking some the
previous studies and would then stick to the school and the activities (Vučemil et al., 2017). I was
well aware of the fact that aboriginal people follow some specific gestures of communication
that might not be accepted in other cultures. In such situations, especially while dealing
aboriginal patients the one has to be very careful in choosing the words and the gestures, such
that they don’t hurt their dignity and respect (Bar-Zeev et al., 2016). At first I would have
accompanied a female nurse while the follow up. Then I would have taken either a verbal
consent or a non –verbal consent positively from the concerned children.
Evaluation
While I was thinking about this patient and was reflecting on my own perception, the first
thing that came to my mind is that the patient belonged to an aboriginal back ground Reflecting
on one of course modules, that dealt with cultural safety, I was surprised to find that the
aboriginals are likely to get physically or sexually abused, 5 times higher than that of the non-
aboriginal counter parts. Cultural safety concept can be defined as the empowerment of the
patient and the health practitioner that ensured the acceptance of all the cultures and care.
Effective communication has been referred to as the third most important element of a culturally
safe care (Taylor, Nicolle & Maguire, 2013). The way, the aboriginal communicates can be

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different from that of their non-aboriginal counterparts (Bar-Zeev et al., 2016). Some of the traits
involves less eye contact. The person might take some more time to compose himself and take
health care decisions. The person might not trust the westernized modes of treatments owing to
its association with the racism and discrimination, this ethnic minority has been facing since time
immemorial. Again aboriginal women might feel uncomfortable to engage in conversation with
a health care professional of opposite gender. Hence, I believe, that my viewpoint has been
correct about this patient.
According to the NMBA codes of conduct, the nurses should advocate people’s right to
be fully involved in decision about the care. It is necessary to provide adequate information to
enable them to refuse their treatment. Also the NMBA codes states that it is necessary to respect
and support the right of the patient. If a patient feels that the information provided to him or her
is not sufficient, then he/she can refuse their treatment. A patient can lodge complaint to the
NMBA in order to complain or to take the legal actions (Lamson, 2013). Surprisingly, the
majority of the legal actions are on the basis of the allegation of negligence because the nurses
should ensure the share information in a way by which they can understand and wanted to know
about their health. It is the fundamental rule to seek consent from the patient before any
treatment (Vučemil et al., 2017). As I have already stated earlier, that patient might give consent
in any ways. On the other hand patients will also have the right to refuse for any treatment. The
health care is becoming complex day by day and the clients are likely to pay to receive health
care service, hence they are in the vulnerable side to receive any harm. There had been many
instances where patients had been exploited by the health care workers. A written consent form
is sometimes important, as it acts as a legal document, during the conduction of a legal lawsuit.

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Analysis
According to the nursing codes of conduct there are three professional responsibilities
that ensured that the patients understands their rights for making the informed consent. Nurses
are accountable to maintain a crystal clear accountability and the can even record any kinds of
medical decisions, while obtaining the consent. For example, after the doctor had discussed with
the patient, the patient can be asked some open ended question for ascertain their understanding.
If the nurses finds things unanswered or thinks that the patient was having any sort of
misconception, it is the responsibility of the nurse to alert the doctors to prior to them. A
competent patient on the other hand should not be treated without a clear consent. According to
Taylor, Nicolle & Maguire, (2013) patient autonomy is important in the field of medical science,
but is challenging to the professional medical ethics. Individual patients would have a freedom of
choice to decide on their life including the medical matters. Since the introduction of The
Principles of Biomedical Ethics in 1977 by Beauchamp and Childress, autonomy has been
widely accepted as one of the four principles of ethics - beneficence, non-maleficence and
justice. In spite of all these we find medical paternalism embedded in this profession (Murgic et
al., 2016). I has already been mentioned that aboriginal women often might feel uncomfortable
to consult with a male doctor, especially while exchanging birthing examination or while
assessing the intimate parts, like a vaginal examination. In such cases, the hospital organization
should arrange for a doctor or a health care professional of the same gender.
Conclusion
In conclusion, it can be said that it is the responsibility of the nurses to provide a
culturally appropriate and safe care to the patient. I believe that Michael would have avoided this

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consequences by seeking permission from the patient or the family. Informed consent is one of
the prime step towards the provision of autonomy to a patient, to refuse or initiate a treatment as
per the will of the patient. Informed consent also might act as legal evidences against any kinds
of medical lawsuits. Informed consent is one of the important step of nursing ethics and
breaching of the codes might bring a criminal law prosecution against a doctor or a nurse. Failure
to obtain consent might amount to the crime of negligence against a common law offence.
Action plan
Informed consent is essential in the health care sector. It is essential that all the health
care professionals understand the importance and the effectiveness of informed consent. It not
only preserves the right of the patient but also have some legal implications. Clarity of the
information required to make everything transparent. Guidance to informed consent has been
clearly mentioned in the practice standards of the registered nurses (Taylor, Nicolle & Maguire,
2013). In future, I intend to brush up my knowledge regarding all the legal and the ethical
guidelines of nursing. I would remain calm and content while examining a patient and would
certainly check whether all the procedures had been done. It should be remembered that seeking
consent increases the patient’s power to make an informed choice regarding their critical health.

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References
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Fitzpatrick, E. F., Martiniuk, A. L., D’Antoine, H., Oscar, J., Carter, M., & Elliott, E. J. (2016).
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