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Nursing Essay: Case Study Analysis of Donaldson



Consider the case study of Donaldson and prepare a nursing essay undertaking the nursing and midwifery guidelines of Australia


Law and ethics in health care services are essential for ensuring the quality of performance and safety of patients. The nursing and midwifery guidelines in Australia undertaken in this nursing essay have strongly focused on the development of the health care planning and safety needs of patients (Yang & Hains, 2017). The current study has focused on the performance of health care service in Australia considering the case study of Donaldson. The entire essay has discussed ethical principles, decision-making framework and legal concerns regarding health care service in Australia based on the guidelines of “Nursing and Midwifery Rules”.

Main Body

Ethical Principles and application of appropriate concepts
Based on the nursing and midwifery guidelines of Australia, it is completely clear that a midwife nurse focuses on the wellbeing of women by providing safe and quality health care. Quality health care and cultural safety are two basic ethical principles that are needed to be considered by midwife nurses in Australia (Tuckett, Eley & Ng, 2017). The case study reveals that Mrs., Donaldson was affected in a blood infection and she was not treated properly by midwife nurses as a result of improper planning. Furthermore, the shortage of staff was also a reason behind this issue and Mrs., Donaldson died in the ICU. Hence, here the question would arise regarding the quality of healthcare and cultural values of nurses as Donaldson could not get high-quality treatment from the hospital. As a result of staff shortage, overtime duty was essential but that initiative was not adopted by the hospital authority. According to the view of Usher et al. (2017), midwives emphasize an economically, socially and ecologically sustainable environment for promoting the health and well-being of patients. However, in the case of Mrs. Donaldson, the lack of proper care has been found and this has deteriorated the quality of performance of nurses.

The concept of quality health care service can be implemented while infrastructural development can be made in a hospital and enormous staff nurses would be recruited. In the case of staff nurse recruitment process, the quality and experience is also an important matter. The Nursing and Midwifery Board of Australia focuses on the regulatory activities of nurses and midwives considering Health Practitioner Regulation and National Law 2009 (Fenwick et al., 2018). As asserted by Bucknall et al. (2016), regulation of NMBA is the statutory regulation process that ensures the quality of health care service in Australia and hence, it is essential to midwife nurses to abide by rules and regulations of Health Practitioner Law 2009. From the case study analysis, it is found that hospital policies are needed to be strengthened by applying national rules and a shortage of staff nurses is needed to be overcome. After the death of Donaldson, the higher management and midwife nurses have learned new areas regarding the promotion of health service in Australia.

Double Effect and Non Maleficence
As mentioned by Burrows (2018), in order to overcome the negligence in the professional nursing practice, the authority has to develop the application of double effect strategy. This is because it would help to differentiate between intended and non intended effect of action. Sometimes, it is found that midwifery nurses could not intend to treat wrongly a patient but it is happened. In case of Mrs. Donaldson it is found and hence, the major problem in the nursing practice has been identified. On the other side, the concept of non malfeasance ensures that a nurse did not conduct an unethical activity intentionally (Ong-Flaherty et al., 2016). The case study shows that the main issue was in management and hence, midwifery nurses cannot blamed directly. These two concepts can be applied after identifying intentions of nurses and health care practitioners regarding their service. In order to identify the application of double effect and non malfeasance, following concepts are needed to be evaluated.

Self: The self-concept focuses on the responsibilities of midwife nurses for adopting the right ethical decision. If each nurse along with healthcare practitioners becomes conscious regarding their duties, culture, and quality of service both can be easily developed. 

Woman and her Infant: Caring woman and her infant is the key ethics of midwifery guidelines and hence nurses have to create a positive environment regarding the health service of patients.

Community Value: The community value is needed to be focused by the midwives as it would help to implement ethical principles effectively. They provide assistance in case of keeping the community informed regarding midwifery issues.

Colleagues: Midwife nurses should respect the rights of colleagues and other members of the community in ethical decisions. This is because it can help to enhance the sustainable development of nursing care.

Partner and family members: It is the primary ethics of midwives to respect the problem of women at the time of childbearing and providing proper care. Furthermore, assistance is important in other cases also including severe diseases of women. At this moment, it is essential to provide assistance to the family members of the woman also.

In order to enhance the quality of nursing care, the application of the above framework is important. It is clear that autonomy in the decision-making process of the hospital authority can help to implement the strategy successfully. The main reason for death in the case of Donaldson was the negligence of nurses in healthcare and it can be recovered by applying the above explained ethical framework.

Application of torts and other legal concerns

Tort of Negligence
As mentioned by Henderson et al. (2018), negligence is considered as a failure in case of taking reasonable care for preventing injury to another person. Based on the midwifery rules, it has been identified that professional malpractice has been considered under the tort of negligence. This is because; it is the duty of each midwife to provide high-quality service according to the guidelines of nursing activities and national law. Hence, the activities of midwifery nurses are needed to be evaluated whether it is negligence or not and in the essential public service, it has been considered as a tort. Based on Donaldson’s case study, it can be clearly said that as a result of the negligence of staff nurses and doctors the death issue is increased. The negligence of midwives was the key reason for death and hence it is considered as a tort.

As depicted by Sweet et al. (2018), based on the midwifery and nursing rules in Australia, it can be clearly stated that a health care practitioner would try to make good relationships with their patients and it would ensure the quality of health care service. It implies that the relation of mutual trust is needed to be developed between patents and health care practitioners. The termtrust has been clearly mentioned in the midwifery guidelines and National Law of 2009 and it reveals that trust is a part of ethical practices in nursing care. Considering the case study, it can be firmly said that mutual trust has not been found between nurses and Mrs. Donaldson and hence, ethics are not properly followed by the hospital authority.

Duty of Care
As mentioned by Atkins et al. (2020), the duty of care is a primary ethical activity in the nursing care and the midwifery guidelines depict that duty of care is needed to be reflected in the nursing activities. This is because it would help to enhance the quality of service in the nursing care and sustainable development in health care service can be ensured.

Conflict in ethical principles
As asserted by Gray (2019), beneficence, the duty of care and autonomy are three basic elements in nursing care and these are essential to reduce conflict regarding the implementation of ethics. The reason is the effective relationship between nurses and patients is important for getting quality service and ensuring ethics in nursing practices. On the other side duty of care is also essential as it ensures that health care practitioners and midwives are taking care of patients properly. The conflict may arise regarding the implementation of ethics in the teamwork and that can be resolved by maintaining team cohesiveness among team members. The cohesiveness can be maintained by increasing professional practices, understanding rules properly. Nursing and Midwifery guidelines in Australia have focused on the strict rules and regulations to enhance the values and quality of health care services in nursing. The principle of care can be maintained by considering beneficence as it enhances the good relationship between patients and health practitioners. In this case, the conflict may arise if a good relationship cannot be maintained between the health practitioner and the patient.

On the other side, the principle of cultural safety can be easily maintained while staff nurses and health care practitioners can ensure the enhancement of their professional and cultural values. The lack of professionalism might deteriorate the performance and the ethical principle regarding cultural safety would be hampered. Considering the example of a case study, it can be stated that the proper ethical practices are not maintained by staff nurses and in this case, the shortage of staff nurse has been considered as the main reason but it has created conflict whether it is negligence or the problem of shortage in the workforce. In order to reduce the conflict, the management has adopted the initiative to change policies.

Application of Professional Code of Conduct

Application of deontology ethical Theory
Based on the application ofdeontology ethical theory, it can be stated that duties are needed to be considered as per the ethical code of conduct. The case study reveals that improvement in ethical practices is essential in nursing care in Australia as it would ensure health care safety. If someone acts considering ethical rules, no one can make allegations at the time of any issue but the violation of code of ethics damages quality work. Donaldson's case study reveals that the professional code of conduct regarding quality care and cultural safety are not properly maintained by staff nurses. This has led the death of Donaldson in the ICU and that has been informed to the higher-level management of the hospital authority. The change in ethical policies is important to the hospital and that has been realized by the authority. In this case, the application of the deontology framework can help to enhance the quality of service. 

Registered Nurses Standard of Practice
The registered nurses' code of conduct has been developed in march 2018 and based on this revision, it is found that critical thinking is the primary duty of nurses and nursing practices are needed to exercise properly. NMBA has mentioned seven professional standards that are needed to be followed by health care practitioners and staff nurses in Australia. Furthermore, the enhancement of professional relationship is also important which implies that beneficence is needed to be ensured properly (Fenwick et al., 2018). Effective nursing practices and professional relationships can ensure the quality of nursing service and ethics in health care services would be ensured. According to the guidelines of midwives, it is important to provide safe nursing care to the patients as it would help to enhance organizational performance and professional ethics would be ensured. In the case of Donaldson's study, it is found that lack of proper planning has hampered nursing care service and based on the nursing and midwife rules it is important to formulate nursing care planning.

Based on the above discussion, it is identified that the shortage of staff and negligence of staff nurses is the key reason of the death of Mrs. Donaldson. The early precaution might provide assistance to Donaldson and she can recover herself easily. The regulations of midwifery practices and Health Practitioner regulation law 2009 are needed to be considered properly for enhancing the quality of service of midwife nurses in Australia.

Atkins, K., De Lacey, S., Ripperger, B., & Ripperger, R. (2020). Ethics and law for Australian nurses. Cambridge University Press.

Bucknall, T. K., Forbes, H., Phillips, N. M., Hewitt, N. A., Cooper, S., Bogossian, F., & First2Act Investigators. (2016). An analysis of nursing students’ decision?making in teams during simulations of acute patient deterioration. Journal of advanced nursing72(10), 2482-2494.

Burrows, D. (2018). Nurses of Australia: The Illustrated Story. National Library of Australia.

Fenwick, J., Sidebotham, M., Gamble, J., & Creedy, D. K. (2018). The emotional and professional wellbeing of Australian midwives: a comparison between those providing continuity of midwifery care and those not providing continuity. Women and Birth31(1), 38-43.

Gray, M. (2019). How Australian dual registrants identified as midwives to meet national registration-renewal requirements. Women and Birth32(1), 50-57.

Henderson, J., Blackman, I., Willis, E., Gibson, T., Price, K., Toffoli, L., ... & Currie, T. (2018). The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care. Nursing essay Australian Journal of Social Issues53(4), 355-371.

Ong-Flaherty, D. N. P., Banks PhD, A., Doyle, M. S. N., & Sharifi, C. O. (2016). The meaning of evidence and nonmaleficence: cases from nursing. Online Journal of Health Ethics12(2), 2.

Sweet, L., Bazargan, M., McKellar, L., Gray, J., & Henderson, A. (2018). Validation of the Australian Midwifery Standards Assessment Tool (AMSAT): A tool to assess midwifery competence. Women and Birth31(1), 59-68.

Tuckett, A., Eley, R., & Ng, L. (2017). Transition to practice programs: What Australian and New Zealand nursing and midwifery graduates said. A Graduate eCohort Sub-Study. Collegian24(2), 101-108.

Usher, K., Mills, J., West, R., & Power, T. (2017). Cultural safety in nursing and midwifery. Contexts of Nursing: An Introduction337.

Yang, L., & Hains, T. (2017). The plight of the perioperative nurse practitioner in Australia. Australian Nursing and Midwifery Journal24(10), 36.


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