According to Huston (2013) professional issue in nursing practice refers to a particular situation and/or issue that either compromises the care delivered to the client by placing the latter at risk, or creates an impact on the ability of the nurses to provide services that are consistent with the standards of practice. Upon encountering certain ethical dilemma under situations that lead to failure of the nurses in considering the ‘right thing’, moral distress is commonly experienced by them. Thus, a nursing professional is responsible and accountable for making certain decisions that are quite consistent with the competent, safe, ethical and compassionate practice. The first step that should be taken into consideration is the identification of the professional practice issue that is placing the patient at an increased risk (McCarthy & Gastmans, 2015). All nurses have an obligation to provide ethical care to their patients.
Taking substantial time in exploring the issue helps in gaining an additional insight and shared understanding among the healthcare team members. In other words, the obligations of a nurse are not just restricted to providing optimal clinical care to all patients. In the words of Burkhardt and Nathaniel (2013) prior to taking any action, in relation to patient care, all nurses must consider the policies of the healthcare facility, the health care laws, and the actions that will be in the best interests of the patients. Furthermore, it must also be ensured that the nursing staff act in a way that provide support to the entire team, while encouraging high level of client care. The essay will elaborate on a case study by explaining the different ethical and legal violations that occurred in the scenario, and will further illustrate the steps that could have been adopted by the nursing staff to prevent such dilemmas.
The case study involved a 46 year old woman named Jo, who had been admitted to the rural accident and emergency department, following an episode of abdominal pain. Upon admission, although she had been triaged by the RN, there was a delay in assessment by the doctor due to a road accident patient. Furthermore, the patient also vomited dark coffee ground fluid and was found to have aspirated during vomiting. A thorough analysis of the case study suggests that there were several instances of professional issues that could have been avoided by the nurse in charge of the patient. The two main ethical theories that are valid of the case study are that of utilitarianism and deontology. Utilitarianism has often been referred to as a large principle that focuses on the great good of the population. This is one of the most influential and best known moral theories that helps in establishing whether the actions are morally wrong or right.
Utilitarians are of the belief that the objective of morality is to make life healthier by growing the quantity of good things such as, happiness and pleasure in the world, while the bad things namely, unhappiness and pain. Furthermore, the theory of utilitarianism states that best actions are defined by those that are able to maximise the wellbeing. Unlike other forms of altruism and egoism, this theory considers the best interests of all person as equal (Conway & Gawronski, 2013). This theory was found relevant to the case study when the nursing staff and all healthcare professionals placed their attention in saving the life of the person who had encountered the road accident. Although Jo was suffering from tremendous abdominal pain and nausea, they decided to assess the accident victim, in the best interests of the person. Although the practice of utilitarianism benefited the accident victim, the theory also had some weaknesses such as, time consumption, lack of consent, and undefined happiness (Kahane et al., 2015). This utilitarian approach has the potential of resulting in harm to some persons, while the remaining outcome is supreme benefit (Boutilier et al., 2015). This method is usually directed by the premeditated benefits or troubles for an intervention and/or action, based on evidences. Although Jo was also aware of the accident scenario and did not decide to bother the nursing staff, they did not take her consent as to if she considered it correct to wait for few minutes, while emergency treatment was offered to the accident victim.
The deontological ethics is another normative ethical theory that elaborates on the fact that mortality of all actions must be based on determining the rightness or wrongness of the particular action, under a set of specific rules, in place of the action consequences (Paquette, Sommerfeldt & Kent, 2015). Cline (2014) opined that deontology binds a person to some obligations and rules. In contrast to the concept of utilitarianism, deontology comprises of the ethics of duty that governs the morality of actions, based on its nature. Thus, the damage is often unacceptable, regardless of its consequences. The fact that while Jo was getting increasingly nauseated, and experienced severe pain, her vital signs were assessed at regular intervals to gain a sound understanding of her physiological status.
When compared to other nursing departments, nursing professionals working in the emergency departments are found to encounter a plethora of specific and difficult issues that are related to consent for treatment, whether they act independently, or are entitled with the duty of carrying out treatment that is prescribed by the physicians. Emergency treatment is usually given, in relation to the doctrine of necessity, under conditions where the adult patients are incapable of providing consent (Gooding & Flynn, 2015). However, such interventions and treatment should not be forced on capable adults who refuse it (Caulfield & Zarzeczny, 2014). In the case scenario, the patient was subjected to endoscopy following consent approval. However, her consent was not taken into consideration before the administration of the medications. Four common ethical principles that govern the process of decision making are non-maleficence, beneficence, justice, and autonomy. The role of a nurse involves implementing actions that do not harm others. Thiessen et al. (2015) stated that the primary obligation of the nurse should have been to inflict any kind of harm upon the patient, in an intentional manner. The further sections of the essay would critically highlight the instances where the ethical code of the nursing framework was rigorously violated.
According to the facts presented by the case study, it can be mentioned here that the procedure in which the patient was administered care was not an example of an effective treatment. It has been mentioned in the case study that the Jo was administered Pethidine 100 mg and Maxolon 10 mg for her pain and nausea. It should further be critically noted that the patient had vomited coffee ground fluid prior to the assessment but no attention was paid to the issue. Also, the case study did not present any example of proving a medication or intervention for the vomiting tendency of the patient. There has been no evidence in the case study with regard to the consideration of the medical history of the client. This can be identified as a major lacuna in terms of proving positive care to the patient. The consideration of the medical records of the client was important in order to deduce an idea about the allergic reactions caused by the pharmaceutical drugs that the client is susceptible to.
Also, the administration of the drugs and the dosage prescribed clearly did not suit the patient and the vomiting of the coffee ground fluid could be considered as a major side effect of the prescribed drug. Studies reveal that, administration of Pethidine is associated with a wide spectrum of side effects that include, vomiting, pertinent nausea, constipation, dizziness, sedation and diaphoresis. In addition to this, studies have further revealed that the side-effects associated with the administration of the pharmaceutical drug, Maxolon include, restlessness, dizziness, nausea, vomiting and bowel disturbances (Eydi et al., 2014). Therefore, it can be said that the administration of the above mentioned drugs to the client at this point of time was not appropriate. Also, a consideration of the past medical history of the client in association with the possible side-effects of the patient should have been undertaken prior to the administration of the medication to the client. In addition to this, it should further be critically noted that the patient and her partner were not educated about the medical health condition of the client. The professionals did not provide any intimidation to the client or her partner about the aetiology of the health condition and the treatment intervention that would be undertaken in order to promote patient recovery. This clearly presents a violation of the non-maleficence code of nursing conduct that is expected to be stringently followed by the nursing professionals. The ethical code of non-maleficence clearly mentions ‘do no harm’ to the patient. This can be partially accredited to the fact that enthusiastic medical and nursing practitioners are disposed to using cures that they believe will do well, without assessing them sufficiently to guarantee they do no injury to the patients. Thus, the nurse should not have gone further than prescribing the two medications that are known to exert certain side effects, and treat the patient Jo, unless it was certain that the treatment was unlikely to be damaging or that the patient and her partner were well knowledgeable of the potential benefits of the medicines that outweigh the probable risks. However, the condition of the client in the case study deteriorated through the course of the medical intervention.
The term beneficence often refers to certain actions that endorse the wellbeing of others. In the therapeutic context, it often encompasses taking actions that aid in the best interests of all service users and their family members (Martela & Ryan, 2016). However, there remained an uncertainty in the case scenario, regarding the exact definition of nursing practices that could have helped the patient. Although an intravenous line had been inserted, followed by prescription of Maxolon and pethidine, Jo became drowsy and again vomited coffee ground fluid. This indicates that the nurse had the idea of benefiting the patient. However, the dilemmas could have been avoided if a due consideration was given to the previous medical history, her medicinal allergies and the demands and preferences of the patient and her partner.
The case study further mentions that on account of a motor bike accident the care- professionals were extremely busy in attending the accident casualty and the medical condition of Jo was extensively ignored and over looked. This presents another example of ineffective care being provided to the patient. This particular instance, presents a violation of the ethical code of nursing conduct in relation to patient negligence. Nursing professionals solemnly pledge to commit themselves to serve the patient at each instant and effectively provide care. However, the case study clearly revealed that the medical health condition of Jo was completely ignored. The client was not even assessed in an appropriate manner and the nursing professionals were busy in dealing with the victim of the motor bike accident. According to the ethical standards of the nursing profession, nursing professionals under no circumstances should compromise with patient priority which was completely overlooked in this case (Kangasniemi et al., 2013). It should further be noted that, the ethical guidelines of the nursing profession were violated in terms of providing effective person-centred care to the patient.
In addition to this, it should be further noted that the client was accompanied by her partner to the hospital. However the case study does not mention a single instance where the client was involved in the decision making procedure. Also, the care givers and the nursing professionals did not engage the partner of the client in the clinical decision making process and while designing a course of intervention. This presents an example of the violation of the ethical standards of nursing in terms of adapting an effective and person-centred care approach while delivering care. Also, it should be noted that the care professionals did not involve the client’s partner while undertaking the decision making process. This could be considered as an example of violating the consideration of following a family-centred approach while devising an appropriate patient intervention. The maintenance of autonomy in term of patient autonomy as well as the partner’s autonomy was not given any importance and as a result the patient was not provided an effective treatment intervention.
In accordance to the Tort’s law applicable in the nursing profession, it has been mentioned that a nursing professional must stringently adhere to the ethical code of conduct and guidelines of the nursing profession at all times (Grace,2017). In this regard, it has further been stated that the nurses could possibly encounter two torts the first being an example of the intentional tort and the second being the example of an unintentional tort. Tort can be defined as an ethical mistake committed on account of negligence (Lacobucci et al., 2013). In this case, the care givers presented an example of intentional tort where the care provided to the patient was not effective on account of negligence and malpractice. The client in the case study was not properly accessed and was not provided appropriate care. Further, the nursing professionals engaged in the care giving process did not present an example of delivering competent care to the patient or establish a positive therapeutic relationship with the client. The registered nurse and the concerned team of nursing professionals failed to engage in an efficient decision making process. Also the team failed to maintain an effective communication and coordination other associated health care professionals to provide an effective care, maintain a record of the patient documentation, assessment and evaluation of the medication administered to the patient. These instances can critically be highlighted as malpractice and violation of the ethical conduct and the professional nursing standard guidelines (Arnold & Boggs, 2015). Therefore, to summarise the entire clinical scenario, it can easily be said that the patient was denied quality medical service on account of negligence and malpractice at the end of the nursing professionals and the interdisciplinary medical experts involved in the care process.
Furthermore, the moral principles of autonomy, moral equality, and respect for humanity apply to the case scenario. According to the code of ethics, the nurse should have abided by the value statement that requires them to value the quality of care that is delivered to all people. Furthermore, the value statement 2 also requires them to value kindness and respect for self, as well as others. Valuing informed decision-making is utmost imperative in relation to the value statement 5 (NMBA, 2005). Thus, under such a situation, the nurse should have valued the interests of Jo and her partner, while making informed decisions regarding her health status. Additionally, the patient rights in South Australia entitles them with the right of being treated with utmost reasonable care and skills by experienced healthcare practitioners. They are also entitled with the right of exercising their opinions for undergoing medical treatment, following obtaining reasonable explanations on what the intervention encompasses and the associated risks (Legal Services Commission of South Australia, 2017). The duty of care refers to a legal obligation in the tort law that is generally imposed on a person who requires adherence to certain standards of reasonable care, during the conduction of actions that have the potential of foreseeably harming others. The Australian law usually determines whether the scenario being talked about is able to fit within a recognised category related to duty of care.
The Medical Negligence Law is also related to the scenario. The common principles of this law requires a patient to prove that the health professionals owed a certain duty of care, breached it by some omission or act, and resulted in financial or physical harm to the patient and family members (Solicitoradvice.com, 2016). Thus, it can be stated that there were several breaches of ethics and laws in the case scenario that violated the health and safety of the patient.
Hence, to conclude it can be said that the nursing profession has been considered to be the most novel profession that is solely based on providing care to the patients and establishing a positive therapeutic environment. The client in the mentioned case study was not served appropriately and the nursing professionals violated the major ethical considerations of the nursing intervention. To provide an effective intervention to the patient, the professionals must have adapted a person centred approach and must have thoroughly explained the medical condition to the patient before proceeding with the designing of the treatment intervention process. Further, the professionals should have thoroughly conducted an assessment and evaluate the previous medical history prior to undertaking a clinical decision. The patient as well as her partner should have been equally involved in the decision making process so as to proceed with an effective treatment care intervention. The case study typically revealed examples of failure to maintain patient autonomy, negligence and violation of non-maleficence. Therefore, these ethical considerations should be appropriately taken care of and stringently adhered to in order to promote positive patient outcome and quality patient service.
References:
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Cline, A. (2014). Deontology and Ethics: What is Deontology. Deontological Ethics.
Conway, P., & Gawronski, B. (2013). Deontological and utilitarian inclinations in moral decision making: a process dissociation approach. Journal of personality and social psychology, 104(2), 216.
Eydi, M., Golzari, S. E., Aghamohammadi, D., Kolahdouzan, K., Safari, S., & Ostadi, Z. (2014). Postoperative management of shivering: a comparison of pethidine vs. ketamine. Anesthesiology and pain medicine, 4(2).
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