Case Study Analysis: Approaches to Professional Nursing Practice

This essay presents a case study analysis of a nursing incident involving a 97-year-old patient, Mrs. Anderson, who experienced a medication error. The analysis details the incident where a nurse administered crushed oral tablets intravenously, leading to the patient's death. The essay explores the consequences of the nurse's actions, including ethical breaches of beneficence and non-maleficence, as well as violations of NMBA and NSQHS standards. It discusses an action plan for improvement and incorporates a reflective model to examine the nurse's negligence. The essay highlights the importance of critical thinking, adherence to nursing guidelines, and effective communication within healthcare settings to prevent similar errors and ensure quality patient care. The analysis emphasizes the need for nurses to uphold ethical principles and engage in evidence-based practices.

Running head: CASE STUDY
Case Study
Name of the student
Name of the university
Author’s name

1CASE STUDY
Table of Contents
INTRODUCTION...........................................................................................................................2
DISCUSSION..................................................................................................................................2
Description of the incident...........................................................................................................2
Consequence of the incident........................................................................................................3
Nursing action description and improvement..............................................................................3
Reflective model of reflection.....................................................................................................4
CONCLUSION................................................................................................................................5
REFERENCES........................................................................................................................6

2CASE STUDY
INTRODUCTION
The case study discusses about Mrs. Anderson who is a 97 year old patient. She was
hospitalized in St George Hospital because she was having nausea, vomiting, a urinary tract
infection, angina and dehydration. She has medical histories related to hypertension and severe
heart disease. During her hospitalization stage she was having difficulty in swallowing, due to
that Ms. Lopez a 44 year old nurse administered few oral tablets by crushing them and delivering
them through IV. The nurse is accountable for their own nursing practice, and for maintaining
the competence of continual learning. In the further section there is a description of the nursing
incidence, consequences for the nurse, patient, and patient’s family, action plan to improve the
incident, and personal reflection on the incident has been discussed.
DISCUSSION
Description of the incident
In the mentioned case study the accused individual, Ms. Lopez is subjected to charges of
manslaughter on the grounds of acute medical negligence. The case study provides a clear idea
that Mrs. Anderson had complex medical history (hypertension, severe heart disease) and was
reported that she had difficulty in swallowing. In order to administer the medication, Lopez
crushed 3 oral tables and mixed it with 10ml saline and injected it in 100ml intravenous drip of
the patient. The medicine was administered without the advice of the senior registered nurse
(RN). Furthermore, the enrolled nurse (EN) was pleading in the court as not guilty. Lobiondo-
Wood and Haber (2017) suggested that evidence based practice (EBP) is a very important aspect
in nursing where the individual combines one’s clinical expertise with scholarly evidences, and

3CASE STUDY
perform effective practice. The above incident is an example, where the EN not only breached
the standards and ethics of NMBA, but also failed to perform EBP, while enforcing oral
medicine through IV.
Consequence of the incident
The immediate consequence of wrong administration of the medication resulted in death
of the patient. Citing example of nursing ethics of beneficence and non-maleficence, it can be
seen to do what is best for the patient without harming the patient. While one may say that Lopez
exhibited empathy towards the patient as she faced difficulty in swallowing the medication. On
the other hand, it can be stated the act of empathy can lead to ethical conflicts with beneficence
and non-maleficence. Thus, Lopez was subjected to ethical confrontation of beneficence and
non-maleficence wherein she failed to balance the possible risks against the benefits.
Nursing action description and improvement
The incident similar to the case study can lead to exposure of gap in care of the hospital
settings. A research based study, conclusively stated the fact that, error in medical setting
especially medicine administration is not due to result of incompetent healthcare professionals.
Instead, medical negligence can be rightly explained through the breakdown in process that can
work on guiding the delivery of patient care. The errors related to medical administration are
seen to fallunder the sphere of nursing practices. Thus, it is the ethical obligation of the nurses to
prevent medical errors. However, Lopez pleaded not guilty to the charges stating that the
condition of the patient was already critical when she was bought to the hospital. However, the
mentioned statement cannot conceal the negligence exhibited by Lopez.

4CASE STUDY
The NMBA standard 6 suggested that a nurse must conduct comprehensive assessment of
the patient before intervening therapeutically (nursingmidwiferyboard.gov.au, 2017). It was the
duty of the RN to assess the whole method of treatment, but when the EN was administering the
medicine, the RN was absent from the scene. It was the duty of the RN to lead every action of
Lopez, but the RN was not present. When Mrs. Anderson was facing problem with swallowing
the medicine, Lopez decided to administer via IV. This is against the medication safety standard
of National Safety and Quality Health Service Standards (NSQHS) published by Australian
Commission on Safety and Quality in Healthcare (NSQHS Standards, 2017). It clearly states that
medication must be administered through the prescribed route safely for better patient outcome.
The effect of the drug is altered when an oral med is administered via IV, because the IV
medicine localizes in the muscle, and an oral med is mixed with blood directly. Here, it can be
commented that Lorenz violated a range of nursing standards. The standard 1 of the NMBA was
breached which guides the nurse to analyze the situation and think critically
(nursingmidwiferyboard.gov.au, 2017). Lorenz did not think critically in the situation and
decided to intervene without further consultation with the RN. This violated the standard 2 which
revealed that a nurse must engage in therapeutic and professional relationship with colleagues,
and collaborate together for better health outcome of the individual. Lorenz was presenting in
court as not-guilty, which was again a violation of standard 3.4, which stated that a nurse must
seek responsibility for all his actions. The RN did not intervene in the situation and showed lack
of leadership which was clearly against clinical governance standard of NSQHS (NSQHS
Standards, 2017).

5CASE STUDY
Reflective model of reflection
Based on the reflective model, it can be easily pointed out that negligence of the nurse is
a prominent scenario in the mentioned case. However, I did not expect that being a certified
nurse, Miss Lopez would commit such an act of carelessness. The thing I learnt from the case is
the importance of ethical principles while administering a patient. I additionally understand the
importance of developing awareness, maintaining the consciousness level in regards to provision
of nursing care. I would always communicate with my supervisor and maintain a record of the
medicine administered and will ask for proper guidelines during tough situations. In addition to
that, I plan to keep a check on the vital signs for understanding the impact created by medication
and perform evidence-based practice and would also I will be destined to follow all the nursing
guidelines properly and will motivate others to follow nursing guidelines and ethical principles.
CONCLUSION
The discussed case scenario provided a clear idea about the aspects of patient advocacy
that should be deeply engraved in professional nursing practices which is found to be missing in
the current case study. Hence, it can be concluded; there is an increase in the gap of care that
needs to be addressed through timely intervention, ensuring quality care for better health
outcomes.

6CASE STUDY
REFERENCES
Nursing and Midwifery Board of Australia - Registered nurse standards for practice. (2017).
Retrieved 16 August 2019, from https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards/registered-nurse-standards-for-
practice.aspx
Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical Reflection for Nursing and the Helping
Professions a User's Guide.
THE ICN CODE OF ETHICS FOR NURSES. (2012). Retrieved 16 August 2019, from
https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_
%20eng.pdf
The NSQHS Standards | Australia Commission on Safety and Quality in Healthcare. (2017).
Retrieved 16 August 2019, from
https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-
Quality-Health-Service-Standards-second-edition.pdf