Case Study: Mary is a newly qualified

Case Study: Mary is a newly qualified graduate Enrolled Nurse who is on her first medical ward rotation. Over the last three days, along with a Registered Nurse, Mary has been allocated to take care of Mrs Marcia Granger. Marcia is a 76yr old lady admitted for unstable diabetes and abnormal blood results. She lives alone in a ground floor apartment and reports being independent with her Activities of Daily Living (ADLs), however since admission her functional level has declined and she requires the assistance of one nurse for most of her ADLs. Marcia rings her bell frequently but only wants Mary to care for her as she feels Mary ‘knows what she likes’. Mary tries her best to meet Marcia’s needs but feels torn between caring for her other patients. She finds herself hurrying the other patients so that she can have more time to attend to Marcia. Mary believes she can not say no to Mary without compromising the therapeutic relationship. Today the Registered Nurse and Mary plan their patients’ care together noting a patient requires hourly BGL’s. Mary agrees with the time planner and instructions from the RN and continues her work. During the morning Marcia rings her bell and demands that Mary takes her to the toilet which Mary proceeds to do. Mary is rushing as she needs to do the other patients BGL. Whilst in the toilet Marcia nearly falls which leaves both of them shaken but not hurt. Marcia tells Mary it was not her fault and asks her “not to mention it to the Doctor in case he decides not to let me go home”. Mary reassures her and continues with her work. When she takes the other patients BGL it is 20 minutes late and high at 20mmols. Feeling frustrated and under pressure Mary writes the result in the time it was due not the time she actually took the BGL. She justifies this to herself by thinking that the BGL was within the patients limits set by the Dr and therefore can see that there was no harm done. Mary was unaware that the Doctor had since changed the patient’s prescription and should have received insulin. The RN proceeds to take the patients BGL according to the time planner and finds the patient clammy, lethargic, shaking with a BGL of 24 mmols and ketones in her urine. That night Mary feels guilty, cannot sleep and is anxious about what happened in the day. 1 Considering the NMBA Code of conduct for nurses (2018) and the Enrolled nurse standards for practice, identify four (4) issues/problems in the case study Mary is experiencing, and reflect on how Mary’s values, beliefs, and behaviours are affecting her nursing practice. Relate each issue to the specific code or standard, include the relevant indicator, and explain how Mary has not met this code or standard (at least one paragraph is required for each item). Link to NMBA codes and standards https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx a) Enrolled nurse standard for practice, domain: Provision of Care. b) Enrolled nurse standards for practice, domain: Professional and collaborative practice c) Code of conduct for nurses from the domain: Practise safely, effectively, and collaboratively – Value. d) Code of conduct for nurses from the domain: Act with professional integrity SCIENCE HEALTH SCIENCE NURSING HLT 54115

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