Ethical and Legal Issues of Nursing - Case Study Example

Nursing and Ethics Introduction: Health practice is based on both professional and ethical standards that support the decisions and activities of effective practices. Healthcare workers are required to fulfil both the legal and ethical requisites of the practice in order to protect the lives and respect the rights of their patients. An assessment of the application of such ethical elements is necessary as a means of improving the practice. The case of Emily, as presented below, is the basis of this case presentation. Problems: Concept Issue Evidence Legal (this includes violations of the legal requirements of the practice). (Kerridge, Lowe, & McPhee, 2005). Inadequate patient care/false testimony; failing to make observations and lying to the doctor about making these observations. The RN, Sue, indicated that she made observations of the patient. The truth was that the observations were never made and that the cold was not a recent symptom, as Sue had claimed. Sue lied about making observations. Legal Issue Did not notify the doctor about the change in the patient’s condition. Did not appropriately delegate the duties to a competent Nurse. Emily’s condition worsened to a point where she needed medical attention from the doctor, but the doctor was not informed. Ben, an assistant Nurse, was assigned to carry out a task without supervision from Sue. The assistant was not legally allowed to carry out the intervention without nursing supervision, as he was not yet licensed to practice nursing and was only in his second year. Ethical (this includes the moral and just requirements of the nursing practice). (Staunton & Chiarella, 2007). Failure to respect the patient’s dignity. Emily was not administered care because she was elderly. As Sue said, it is best to just let the ‘oldies go when it is their time’. Legal (Australian Qualifications Framework [AQF]) Inappropriate delegation; assistant nurses carry out tasks that mostly relate to patients’ daily activities. Patients are under the supervision of registered nurses. Ben administered the patient’s medications, a task which he was not confident or familiar with. He did this without the supervision of a registered Nurse. Clinical Issue Lack of quality nursing care. Patient could not tolerate any food or fluids for days and has not been referred to the doctor for appropriate action or orders. Clinical Issue Lack of quality patient care. Patient’s fever and heart rate were elevated, but the nurse said she was too busy to address such symptoms. Clinical Issue Lack of emotional support and care. Patient was confused, agitated, incontinent and afraid. Value-laden Terms: Value-laden terms are terms that indicate positive or negative emphasis, which may then have favourable or unfavourable effects on patients (White & Duncan, 2002). These statements may also refer to good or bad things, which may be evaluated based on the viewpoint of the person acknowledging their existence. In this case study, Emily expressed that her symptoms (hot, nauseated, headache) were still persistent. When consulted about these symptoms, Sue said that the patient was likely just having a cold and that she just needed to rest. The nurse discounted the patient’s symptoms, simply deriding their seriousness. In effect, the terms used by the patient were not given much value, but the value of these terms was already very much significant to the patient. From a nursing perspective, nurses should provide value to the terms used by the patients; they should have either equal or greater value, but never lesser value because this would make the patient feel that she is not being properly cared for (White & Duncan, 2002). Fundamental Ethical Principles: Principle Explanation Autonomy: Autonomy is based on the principle of independence and self-determination. The principle of autonomy is based on the patient’s right to control his or her care, to make decisions on his or her care and even to decline care (Masters, 2009). Emily’s autonomy was violated when the nurse did not attend to health concerns (nausea, headache and feeling hot), because according to Nurse Sue, she was already old and dying, anyway. Not responding to her request for symptomatic relief meant that the nurse did not support Emily’s autonomy to demand care, regardless of her age. Beneficence: This principle indicates that Nurses have to do their best to act in the best interests of their patients; in other words, they should carry out actions that will ultimately benefit the patient (Masters, 2009). This violation can be seen in the repeated ways by which Nurse Sue hardly administered any care to the patient. Emily was not a palliative care patient, as was claimed by Sue, and she deserved care and relief from her symptoms. For AIN Ben, however, he tried his best to protect the interests of the patient by telling the doctor about Nurse Sue’s lies. Nurse Sue, however, violated such principles by failing to act in ways that would benefit the patient. Non-maleficence: This principle is founded on a statement in the Hippocratic Oath that says not to cause any physical or emotional harm to the patient (Masters, 2009). Nurse Sue ignored the patient’s complaints about unrelieved symptoms. She also assigned the task of medicine administration to Ben, who was not qualified to do so, and failed to supervise his administration. Veracity: This refers to the need to convey accurate and honest revelations to the patients as well as their families, not withholding any pertinent information from them, especially misleading information (Shives, 2008). Nurse Sue made inaccurate representations of the patient’s care, indicating that proper observations were made when they were not; she also indicated that Emily was a palliative care patient when she was not. Emily was relatively healthy and was not suffering from a terminal or chronic illness. Advocacy: This refers to the patient’s right to some form of protection from other people who may cause them harm, and to be defended against such individuals (Earp, French & Gilkey, 2008). AIN Ben was able to uphold the patient’s rights by expressing to the doctor that Sue did not actually make patient observations that the patient was not simply suffering from a cold (as Sue claimed). He also acted as a patient advocate by repeatedly consulting with Nurse Sue about Emily’s worsening condition. Legal Principles: It is clear that various standards of the nursing profession have been violated by Nurse Sue. Based on the Code of Professional Conduct for Nurses in Australia (ANMC, 2006), nurses may not act in ways that violate the standards of competency. RN Sue violated the code in various ways, primarily, in not informing the doctor of the patient’s worsening condition. The Code indicates that nurses must practice in a safe and competent manner (ANMC, 2006). RN Sue compromised her patient’s safety by not referring her to a doctor, especially when her condition was already worsening. Such safety was also compromised when Nurse Sue asked AIN Ben to administer a medication without her supervision. Conduct Statement 1 of the ANMC (2006) also indicates that where an aspect of care would be delegated, Nurses must ensure that the task does not compromise the safety or the quality of care administered to the patient. The delegated task was beyond AIN Ben’s expertise, especially as he had never administered medication, and was unsure of how to carry out such an order. To make matters worse, he was unsupervised while he carried out this order. Nurse Sue should have made sure that the delegate was competent in the task, that he had legal authority to carry it out and that he would be supervised in the process. The Code of Ethics for Nurses (4.3) also indicates that they must avoid making racist, sexist, homophobic or ageist remarks to their colleagues or to patients under their care. Nurse Sue believed that Emily was old and dying, and therefore did not need the kind and quality care that the other adult patients received. This is an unethical attitude because although Emily may have been old, she was not terminally ill. The ageist comments made by Nurse Sue were unethical and discriminatory towards Emily. Conduct Statement 6 also indicates that Nurses must express impartial and honest data in relation to the patient’s care. Nurse Sue lied to the doctor about her patient observations—which she never carried out—and also about her declarations about her own patient’s symptoms. She also lied to AIN Ben in saying that Emily was under palliative care. Gaps in Emily’s care ultimately caused the gradual and inevitable deterioration of her health. Such deterioration was made worse by Sue’s negligence, negligence which may have given rise to rightful legal action (Westrick & McCormack, 2008). The basis for the legal action would be the failure of the nurse to deliver quality patient care, which is part of her basic and legal function as a nurse (Staunton & Chiarella, 2007). The danger to the patient’s life, the risk to her safety, and any possible negative outcomes the she had experienced could be actionable causes against Nurse Sue and also against the hospital. Stakeholders: Stakeholders are individuals who are concerned about the patient’s case, and can contribute to the patient’s case in either a positive or a negative way (Pera & van Tonder, 2005). In this case, the stakeholders include patient Emily, Nurse Sue, AIN Ben, Nurse June, the doctor, and the hospital. Emily is the primary stakeholder in this case because she is receiving the care and is the one ultimately affected by the Nurse’s actions or inactions (Pera & van Tonder, 2005). The nurses, the doctor, and the assistant nurse are all stakeholders because they are assigned patient care, were delegated to carry out specific nurse functions, and because they failed supervise patient care (Pera & van Tonder, 2005). The hospital and the Nurses, even the doctor, may be sued for their failure to protect patient rights and for failing to deliver quality patient care. Ethical Conflicts: The ethical conflict in this case is founded on the varying perception between Nurse Sue and the other health professionals (Fry & Johnstone, 2002). Sue believes that her patient is old, under palliative care, and is about to die. Under these perceptions, she believes that there is no need to attribute more care than necessary to ensure the patient’s comfort. These perceptions are in contrast with the perceptions of other hospital staff who did not consider Emily to be a palliative care patient and who did not believe that she did not need quality care. These differing perceptions guided their actions—with Nurse Sue largely ignoring and failing to administer quality patient care—and AIN Ben, Nurse June, and the doctor believing that Emily needed quality care. The ethical conflict was faced primarily by the AIN nurse who made the decision to administer the medication without any previous experience or supervision, and who ultimately chose to reveal Nurse Sue’s lie to the doctor. These ethical conflicts can be resolved in the health practice by ensuring vigilance within the nursing profession in the ways in which errors and gaps in the practice can be avoided (Fry & Johnstone, 2002). Ethical Concepts and Management: In order to manage these ethical violations, the patient, Nurse June, AIN Ben, and the doctor can file an ethical complaint with the hospital management against Nurse Sue for her failure to follow the principles of ethical practice (Johnstone, 2008). Legal Concepts and Laws/How to Guide Management: Legal violations can be dealt with through actual lawsuits filed by the patient against Nurse Sue and the hospital, mostly for their negligence (Staunton & Chiarella, 2007). The fact that AIN Ben was allowed to administer the medication without supervision was a violation of legal principles. In accordance with the legal repercussions of Nurse Sue’s actions, she may be terminated or suspended from the hospital; in the worst case scenario, she may even be stripped of her license (Staunton & Chiarella, 2007). A malpractice suit may also be filed against Nurse Sue, especially for failing to supervise AIN Ben’s actions, for failing to monitor the patient, and for lying to the doctor about monitoring the patient (Staunton & Chiarella, 2007). Conclusion: The different legal and ethical issues that were seen in the case of Emily mostly pertained to violations of her legal right to be administered with care, which was violated when Nurse Sue did not administer the necessary care that Emily needed, when she assigned AIN Ben to carry out tasks beyond his legal qualifications, in lying to the doctor and in failing to notify the doctor of changes in the patient’s condition. Ethical issues related to age discrimination and failing to respect the patient’s dignity, especially as the patient’s age was used as an excuse in not administering care and respect to the patient. In effect, Emily is entitled to a legal recourse against Nurse Sue and the institution for their neglect. References Australian Nursing and Midwifery Council 2006, Code of Professional Conduct for Nurses in Australia, Australian Nursing and Midwifery Council, Dickson, ACT. Daniels, R 2004, Nursing fundamentals: Caring & clinical decision making, Cengage Learning, Sydney. Earp, J, French, E & Gilkey, M 2008, Patient advocacy for health care quality: Strategies for achieving patient-centered care, Jones & Bartlett Learning, New South Wales. Fry, S & Johnstone, M 2002, Ethics in nursing practice: A guide to ethical decision making, John Wiley & Sons, Sydney. Johnstone, M 2008, Bioethics: A nursing perspective, Elsevier Australia, New South Wales. Masters, K 2009, Role development in professional nursing practice. Jones & Bartlett Publishers, New South Wales. Pera, S & van Tonder, S 2005, Ethics in health care, Juta and Company Ltd., Sydney. Shives, L 2007, Basic concepts of psychiatric-mental health nursing, Lippincott Williams & Wilkins, London. Staunton, P & Chiarella, M 2007, Nursing and the law, Elsevier Australia, New South Wales. Westrick, S & McCormack, K 2008, Essentials of nursing law and ethics, Jones & Bartlett Learning, New South Wales. White, L & Duncan, G 2002, Medical-surgical nursing: An integrated approach, Cengage Learning, Sydney. Read More