First Incident of Breach of Practice
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.
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 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.
The Second Incident of Breach in Principles of Cultural Safety
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.
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 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.
Actions to Prevent Breaches of Practice
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 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.
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.
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.
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