Final Case Scenario


The following paper explores two case scenarios in the nursing field. The first one involves Drew who is undertaking his new graduate orientation. His practice brings to light a gap between what is taught in nursing textbook, hospital policies and procedures, published literature and actual nursing practice. The gap reveals a lack of communication between nursing teachers and those in the clinical setup. It also shows the complexities that characterize the clinical setting. Nevertheless, Drew has a mandate to uphold a culture of safety in the hospital. It will ensure that he sticks to hospital’s quality safety measures that are bound to improve the services administered to the patient. He also has a role in the continuous quality improvement. He should stick to the standard operating procedures that have been set in the place of work. The case of Lindsey represents a situation where the lives of the patients are at risk because of a staff. Lindsey seems to be taking the drugs meant for the patient. The first step to address the issue would be to boldly approach her and discuss the matter with her. Failing to take any action endangers the patients’ lives.

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Final Case Scenario

First Case Scenario

Significance of the Gap

The situation that Drew finds himself in is common among many students today because of the dynamic changes that have marked the past decades. Particularly, this period has been characterized by shifting the focus of nursing education from the hospital to the universities. In fact, the theoretical perspective tends to gain more popularity than the actual practice. Relevant literature shows that there is a clear gap between what is taught in nursing textbook, hospital policies and procedures, published literature and the actual practice (Agbedia, Okoronkwo, Onokayeigho, & Agbo, 2014). Nevertheless, the need to overcome the gaps remains fundamental in ensuring a standard nursing practice. The following section explores the significance of the gaps between what is taught in nursing textbook, the hospital policies and procedures, published literature and the actual practice.

Firstly, the gaps provide evidence of the lack of communication between theory and practice teaching (Agbedia et al., 2014). In essence, what a student is gets from the textbook forms the theoretical part of knowledge. It comes from past researches and findings and entails factual presentations. Nevertheless, the information varies depending on the time when these researches were conducted. The evidence of gap indicates that practitioners do not interact with the theoretical knowledge to determine the alignment of the two approaches. The two types of knowledge are independent. It is critical that nurses consider both approaches and interlink their findings both in theoretical and practical perspective.

Secondly, the gap is significant in showing the complexity of the clinical learning environment in comparison to the controlled theoretical setting. It is critical to note that actual practice provide the nurse with an opportunity to enact what they have learnt in class. Nevertheless, it is not an ideal situation as there are variations that occur in actual clinical setting. Nursing text books and published literature provide controlled environments (Agbedia et al., 2014). The differences account for the gap that exists between the four scenarios of nursing practice. Drew must realize that the preceptor tends to follow the textbooks and hospital policy guidelines. However, such an ideal nursing situation may not exist in all hospitals. Published literature are scientific evidences that have been carried out in ideal environment. Moreover, they have been controlled to attain a particular hypothesis. The gap also illustrates the lack of qualification among some nurses and practitioners. In essence, there are nurses that do not have the fundamental qualification necessary to practice nursing. They may have passed the examinations, but they cannot use the knowledge they acquired in the actual practice, and this is what creates the discussed gaps.

A Culture of Safety

A culture of safety refers to an organization’s commitment to minimize adverse events in the environment that includes the complex and hazardous risks that accompany the nursing practice. Hospitals have a task to maintain the safety at all levels. Therefore, there are elements that define the culture of safety. Firstly, every medical worker acknowledges that a hospital presupposes certain risks. They, therefore, have the determination to take safety measures continuously. Secondly, there is a blame-free environment. Every individual has the responsibility in the nursing environment to ensure safety. They can report error without fear of being reprimanded or punishment. A culture of safety also encourages collaboration across all ranks and departments. A culture of safety would benefit Drew’s case and the patients at his hospital in a number of ways. First, it will commit all nurses to considering upholding patient safety at all cost (Barnsteiner, 2011). The nurses will have to follow the vision of the hospital of providing services while considering the safety of the patient. Second, they will also stick to the standard operating procedures that are crucial for attaining the safety of the patients. A culture of safety emphasizes a good working environment where patients can interact with the staff. It will benefit Drew and the patients as the staff have the opportunity to report about areas of concern without fear of being persecuted. The patients can also report any unsafe services they have observed.

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Drew has several options for managing his concerns based on what he has witnessed. First, Drew can consider raising the issue with leadership of the department. In essence, he is not putting forward a malicious report. Rather, he is raising the concern with departmental supervisor regarding his observation during his work at the unit. He should highlight the various aspects of non-observance of the hospital policies and regulations. He can choose to file a report at the end of the practice or have a face to face meeting with the nursing supervisor. It is expected that the supervisor will address the issue and discuss with the nurse the need to maintain a culture of safety within the organization. The other option that Drew has is to approach the nurse and discuss with her some of the gaps he has noted between what he learnt in class and what is happening in the actual place of practice. Respectfully, he can remind the nurse of the need to stick to the hospital policies and procedures. Drew can protect the patient from unsafe practice by taking initiative to perform sterile techniques at all times. While the procedure may be annoying, it is vital for maintaining a culture of safety. He can also protect the patient from unsafe environment by advocating for safety of the patient during staff meetings. For example, most nursing departments have weekly meetings where they raise matters arising at the work. He can use the opportunity to speak out his observation respectfully.

Role in QCI

Drew has a role in continuous quality improvement (CQI). Essentially, CQI entails the provision of services in the hospital that meets the appropriate standards and addressing departmental challenges regarding any issue at hand (Watcher, 2012). Consequently, every staff worker across the department must ensure an improvement of services they provide for the patients and other clients. Every nurse must, therefore, willingly offer services in good faith with the expectation of meeting the client’s needs. Drew has an excellent position to enhance continuous quality improvement because he offers direct services to the patient. He can, therefore, ensure that he sticks to the standard operating procedures in performing every assigned task. He should avoid using shortcuts to follow the hospital set policies and procedures. For instance, the hospital policy demands that every patient seeking intravenous or intramuscular injection must be attended to using sterile equipment. Moreover, patients are not allowed to share the syringe. Drew, as a nurse who is at the heart of the system, can work towards improving the process in healthcare setting. He can also assess the status of the service in surgical unit and come up with the areas that need improvement. Drew can use quality circles and features in monitoring quality issues in the surgical unit (Watcher, 2012). He can also attend the quality improvement forums to help in the facilitation of CQI. Besides, Drew must admit that CQI requires positive interaction among members of the department. He can, therefore, exercise good relationship and communication skills in their interdepartmental collaborations.

Second Case Scenario

Every nurse has a responsibility to provide standard healthcare for the patients (Barnsteiner, 2011), and my best friend Lindsey and I are not an exception. The hospital has the patient charter that defines the expectations of the patients. It also demands the quality services to be provided for every patient. In this case, it is evident that patients at the surgical ward who are under the care of Lindsey are not getting the appropriate services. My friend Lindsey appears to be using the medication meant for the patient. Consequently, the patients continue to complain of pain even though she proves that the drug is being administered. The first thing I would do is confirming my suspicion. It would involve approaching Lindsey privately and making an inquiry concerning the extent of her drug administration. I would boldly make her know about the trend I have observed and tell her that I believe she is using the drug. I would have an open discussion with her and request her to allow me monitor her work. In case the option does not succeed, I will proceed to the next step of informing the nurse in charge.

There may be serious consequences if I do nothing. First, the lives of the patient will be highly put at risk. Most patients who come from the theatre are directly admitted to the surgical ward for nursing care. This care involves administering pain-relieving medication that also aid in the healing of the surgical wounds. The fact that Lindsey does not administer these drugs to the patient means that most patients experience pain. Moreover, it makes some of them susceptible to nosocomial infections. In extreme cases, the patient’s condition may deteriorate and they may even die. Consequently, if I do not take any action, I put the patients’ lives at risk. The second consequence is that I am compromising Lindsey’s career. It is critical to note that she will soon be discovered by other medical workers. In such a case, she may face retrenchment. Addressing the issue helps her deal with the challenge of her employment. Finally, it is also a key to addressing the social problem she faces that has necessitated the intake of the drugs.


The paper has presented a final case scenario of two distinct people. In the first case, Drew finds himself in a conflict between what he has learnt in school and what happens in the actual nursing area. It brings to light the significance of the gap that exists between what is taught in nursing textbook, hospital policies and procedures, published literature and actual practice. It is, therefore, important that he considers a culture of safety within the hospital. It will benefit both him and the patients. Drew also has a role in continuous medical improvement. The second case regards Lindsey who seems to be taking patient medication instead of administering it to them. She is my friend, but I must act to avoid further implication. Approaching her for a discussion regarding the issue remains the most fundamental step.

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