AN ESSAY ON ETHICAL AND LEGAL ISSUE IN NURSING

Introduction

Nurses have obligation to work in compliance with the composite web of state and federal statutes in order to make decisions in an ethically responsible way, due to progress in medical technologies and procedures on many occasions nurses experience challenges in making decisions, it is vital for nurses to work in compliance to organization policy and procedure prioritizing patient need and exercise caution when making decision to avoid risk to ensure patient safety. In this essay, we considered the scenario of patient James Karen who has been admitted to the hospital complaining about pressure injury unstageable, and has a history of spinal cord injury, and is paraplegic with a permanent suprapubic catheter, and has a history of aggression. James is assisted by Nurse Michelle, considering the scenario how lack of monitoring and other incompetence in the situation was the reason of patient getting angry, this incompetence might have put James at higher health risk. We will discuss the code of conduct, code of ethics, and other relevant standard that are applicable in the scenario, in end, a conclusion relevant to it will be given.  

Discussion

Legal and ethical concerns in the scenario

In the given scenario, James Karen has been admitted to the hospital complaining about pressure injury unstageable, having a history of spinal cord injury, and is paraplegic with a permanent suprapubic catheter, and has history of aggression assisted by Nurse Michelle. It is identified that lack of monitoring skills, lack of therapeutic skills to comfort patients, incompetence in obtaining consent, etc. are some common issues in the given scenario, I believe that this issue could have been avoided by nurses using therapeutic skills, considering legal and ethical responsibility, such as-

Showing attentiveness: nurse have ethical obligation to understand/attend need of their patients, colleagues, and community. In relation to James scenario, I believe that showing attentiveness toward checking medical record to monitor fluid intake, catheter, and body language of patient showing discomfort would have been supportive in avoiding the issue and ensuring patient safety.

Responsibility:  nurses need to understand that their decision directly affect the patient health and wellbeing (Murray, Sundin & Cope, 2018), thus it vital that nurses work in obligation to code of conduct, and other ethical legislation to avoid the situation to that can adversely affect patient. Working in obligation to defined policy and procedure will support nurses to work competently and avoid breaching the standards.

Competence:  nursing practice require high knowledge and skills to support best practise of their professional. Demonstrating therapeutic skills help in building rapport with the patient that help in patient sharing their feelings and concerns that can support nurses to provide better care to the patient to meet their need. In consideration to James scenario, Michelle demonstrated incompetence and lack of therapeutic skills that cause agitation in James, use of these skills would have support in dodging the issue in the situation.

Patient responsiveness:  in multi-disciplinary team nurses are the one who generally spend most time with patient, therefore nurses have the ethical responsibility to monitor the patient behaviour (both verbal and non-verbal) to monitor sign and symptoms or patient response to the treatment/intervention.  In James scenario, lack of monitoring is key reason of James discomfort.

Michelle could have handle the situation more effectively is she has worked more competently in compliance to code of conduct.   For nurses code of conduct provide a guidance about legal requirements, work expectation, and behaviour that is ethical and professional to work competently in meeting patient need (Ramadan & El-Demerdash, 2017). It basically provide instruction for behaviour that ensure safe work practise. As we know that every individual have their own personal value and beliefs that they implement in their working practise, but the code of conduct highlight specific instruction/rules that all nurses need to incorporate in work practise and work in compliance to these standard to work effectively.  Nurses have responsibility to understand the code of conduct standard and stand by it (Forrester, 2018). As we know that in healthcare to attain better patient health outcome it is vital to make patient interests first concern, ensuring their safety without being bias or judgemental.  There are seven code of conduct that consistent with the national law, and grouped into domains.

Importance of code:

  • The code will support nurses in ensuring safe practice and fulfilling their professional obligation.
  • Provide guidance about behaviour and conduct expected from the nurses
  •  Ensuring effective and safe nursing practice
  • In evaluation of professional conduct of nurses
  • If nurses work significantly different from value/process outlines in the code nurses should explain and justify their action and decision.
  • Serious or failure to follow the code might have consequences for nurses, nurses may considered to demonstrate unprofessional behaviour/conduct/performance (Schmidt, MacWilliams & Neal-Boylan, 2017).

.

Code of conduct:

Domain 1

Principle 1: legal compliance: nurses must adhere to national law, and relevant laws (Schmidt, MacWilliams & Neal-Boylan, 2017). Nurses have obligation to work in compliance to national law that comprise necessity of reporting, and meeting registration standards. Nurses need to demonstrate lawful behaviour as it directly affect their reputation and practice, nurses need to respect nurse and person professional relationship by not taking any property/possession of the patient and or their family.  Comply with own scope of practice, monitoring, administrating, etc. do not participate in unlawful behaviour or make vexatious complaints, as it is considered as unprofessional conduct and may have consequences on the registration of nurse.  For nurses caring for others bring legislative responsibilities comprising necessity for nurses to work in adherence to relevant mandatory reporting requirements and stand by it to protect others (patient, colleagues and community) that are particularly at risk, reporting obligation comprise reporting about abuse, neglect, aged, infant or new-born who at risk of physical and sexual abuse and nurses need to act on welfare concern where appropriate.

Domain 2: practice safely, effectively, and collaboratively.

Principal 2: person centered practise- nurses need work ensuring person-centered and evidence based care to help nurses to make effective decision to ensure safe and quality care (Forrester, 2018). In James scenario, Michelle was unable to act in accordance to this principle, working in compliance to this principle would have supported Michelle to identify patient responsiveness toward the treatment and James concern related to it, to effectively manage the situation. However, these obligation were followed by another nurse who assisted James later, nurse checked the patient catheter and medication document (fluid chart), and took immediate action by doing immediate scan to check bladder condition, taking James consent to change catheter as it was blocked. Code of conduct principle 2 comprise necessity of sharing information and taking consent from the patient about their care in way that is understandable for patient this includes information on investigations and examinations, as well as treatments. Also if something goes wrong nurses have obligation to recognise and reflect on incident and act immediately to rectify the issue is possible however, Michele by referring to another nurse was right decision and that why Michelle complied with this principle one way. 

Principle 3: Cultural practice and respectful relationships- Nurses must engage with people as individuals in a respectful and culturally safe way, and obey their obligations about privacy and confidentiality of the patient (Forrester, 2018). Respective individual culture, beliefs, experiences of people including colleagues, acknowledgement of factors effecting health. The nurse needs to support an inclusive environment for the wellbeing and safety of the individual their family and other in workplace. Effective communication help in building positive professional relationships with patient that help in patient to feel comfortable with the nurse and this will support inpatient sharing their feelings and concern with the carer, thus, in relation to James, effective communication must have been supported in Michele to provide effective care immediately.

Domain: Act with professional integrity

Principle 4: Professional behavior Value Nurses embody integrity, honesty, respect, and compassion- this principle provides instruction to nurses to maintain professional boundaries that allow nurses to maintain professional boundaries and relationship that promotes the person-centered practice. This help in actively manage the individual’s expectations, care objective, care procedure, etc.  That helps in avoiding the potential conflicts, risks, and complexities of providing care.

Principle 5: Teaching, supervising and assessing- training and supervising through obtaining feedback from colleagues and other significant parties, this will help in developing the skills that are essential in managing conflicting situations (Bryce, Foley & Reeves, 2017) . In relation to given scenario, Michelle through reflecting on this incidence can learn from this, such as what goes wrong, what action could have supported in managing the situation, what I learned from this, etc. to avoid this mistake in future and show competence in practise. 

Principle 6: Research in health Value Nurses recognise the vital role of research to inform quality healthcare and policy development, conduct research ethically and support the decision-making of people who participate in research (Schmidt, MacWilliams & Neal-Boylan, 2017).  Rights and responsibilities of nurses comprise process of organising, conducting and reporting health outcome, being aware of ethical responsibilities for better application of evidence-based decision-making for delivery of safe and quality care.

Domain: Promote health and wellbeing

Principle 7:  promoting health and wellbeing of patient and other in community- nurses have an obligation to sustain their mental and physical well-being to work safely and effectively (Cusack, 2018).

Ethical responsibility:

Ethical responsibility comprise need of respecting person dignity and value of colleagues and patients, treat everyone equally, and provide commitment to patient to ensure patient safety and rights, and maintaining patient privacy and confidentiality (Cusack, 2018). Nurses have ethical obligation to be honest and maintain high personal and professional standards, demonstrate professional competence to provide quality care to patient (Davidson et al., 2018). Professional Responsibilities of nurse to improve both care environments to maximize the quality of care delivery. In James scenario, considering these ethical responsibility I can say that nurses were able to work in compliance to ethical obligation of maintaining dignity and value of patient, maintaining patient privacy and confidentiality. The only non-compliance to ethical obligation occur when Michelle lack of demonstrating therapeutic skills and monitoring to deliver quality care to patient immediately, however, asking another nurse to attend call bell was right decision taken by Michelle at that point considering the best interest of the patient to ensure the patient need are met.

There is seven standards in registered nurse standards for practice:

  • Think critically and analyse nursing practise
  • Engage in therapeutic and professional relationship
  •  Comprehensively conducts assessments.
  • Sustains the capability for practice.
  • Develops a plan for nursing practice.
  • Provides safe, suitable and responsive quality practice
  • Assesses results to inform nursing practice

(Ingham-Broomfield, 2017).

Michelle in working to following standard in future will help in delivering more effective care and avoiding the medical error, Michelle considering patient medical history, current patient need, prioritising those need to deliver quality care/treatment, conducting assessment, monitoring, using verbal and nonverbal communication skills to monitor patient responsiveness for treatment or any other concern (Ion, 2019), building relationship with patient by demonstrating therapeutic skills such as active listening, effective communication skills, showing empathy, competence, etc. so that patient can share their concern without hesitation,  also therapeutic skills can support in avoiding issue of agitation in patient. Working in obligation to federal and organization policy and procedure to ensure safe and quality care is delivered to meet the expectation (Cashin et al., 2017). Thus, following standards can support nurses to work more effectively in delivering person-centered care.

Conclusion

In scenario of James Karen who admitted due pressure injury unstageable, having history of spinal cord injury, and is paraplegic with a permanent suprapubic catheter, and has history of aggression assisted by Nurse Michelle. It is identified that lack of monitoring skills, lack of therapeutic skills to comfort patient, incompetence in obtaining consent, etc. are some common issue in the given scenario, I believe that these issue could have been avoided by nurse using therapeutic skills, considering legal and ethical responsibility, such as showing attentiveness by checking medical record to monitor fluid intake, catheter, and body language of patient showing discomfort would have been supportive in avoiding the issue and ensuring patient safety, working in obligation to defined policy and procedure will support nurses to work competently and avoid breaching the standards, demonstrating competence, to the patient to meet their need, considering ethical responsibility to monitor the patient behaviour (both verbal and non-verbal) to monitor sign and symptoms or patient response to the treatment/intervention, as lack of monitoring is key reason of James discomfort. Michelle could have handle the situation more effectively is she has worked more competently in compliance to code of conduct, ethical obligation, and nursing standard, however by asking another nurse to attend the call bell Michelle has one way obey the obligation, however, nurses who substituted Michelle has worked in obligation the nursing standard effect to meet patient need and ensure patient safety and wellbeing. 

 

References:

Bryce, J., Foley, E., & Reeves, J. (2017). Conduct most becoming. Australian Nursing and Midwifery Journal, 25(6), 25.

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.

Cusack, L. (2018). Changes to code of conduct and code of ethics new code of conduct for midwives now in effect for all midwives. Australian Midwifery News, 18(1), 14.

Davidson, P., Rushton, C. H., Kurtz, M., Wise, B., Jackson, D., Beaman, A., & Broome, M. (2018). A social–ecological framework: A model for addressing ethical practice in nursing. Journal of clinical nursing, 27(5-6), e1233-e1241.

Forrester, K. (2018). Codes of Conduct-A New Era for Nursing and Midwifery in Australia. Journal of law and medicine, 25(4), 929-933.

Ingham-Broomfield, R. (2017). A nurses' guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, the, 35(1), 40.

Ion, R. (2019). Raising concerns about poor nursing care: the moral and professional responsibility of nursing students and registered nurses (Doctoral dissertation, Abertay University).

Murray, M., Sundin, D., & Cope, V. (2018). New graduate registered nurses’ knowledge of patient safety and practice: A literature review. Journal of clinical nursing, 27(1-2), 31-47.

Ramadan, A. H. A., & El-Demerdash, S. M. (2017). The relationship between professional values and clinical decision-making among nursing student. Environment, 7, 8.

Schmidt, B. J., MacWilliams, B. R., & Neal-Boylan, L. (2017). Becoming inclusive: a code of conduct for inclusion and diversity. Journal of Professional Nursing, 33(2), 102-107.

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