Discuss about the Professional and Ethical Issues in Nursing.
There are several legal and ethical issues which are abundant in the nursing practices. Nurses are responsible to take care of their client by providing them with best quality care, keeping personal data of the clients confidential, ensuring a planned and legal approach towards decision making and working towards the best interest of the patients (Johnstone, 2015). These ethical issues may also arise from the concept of equity, justice along with cost and time of care. It is the duty of nurses to make ethical decisions with respect to their patients and also to ensure that they support the patients with best of their effort to ensure that they are able to take their decisions appropriately. Nurses should follow the code of practices along with legal principles in order to ensure that they adequately address such issue and are able to provide quality care to the patients.
Models designed for the purpose of making decisions with respect to nursing practices supports the process of decisions making by nurses along with providing them with few extra benefits. In the case of nursing no answer can be held as a right answer, a right answer is an answer which is supported by the strongest possible reason. A systematic approach which guides a person towards what to do and what not to do is known as ethics. There are several laws like the Mental Capacity Act 2000 in Singapore and other common law principles of equity, autonomy, beneficence and obligation which guides the nurses with respect to decision making for their patients (Jackson, Girvin & Davidson, 2014).
In the first scenario the patient is a 56 year old man who is suffering from terminal illness and is on a heavy medicine dose. The extra pain reliving dosage provided to him is not liked by him and he wishes the doctors to stop such dosages as he thinks that they are pointless anyways (Jackson & Hutchinson, 2015).
The major issue which the nurses face in this case is to determine that whether such treatment should be provided to the patient against his will or not. The few regulatory guides provided by the the nursing boards in Singapore and Australia include the concept of Autonomy of decisions, obligation and working towards the best interest of the patient.
The concept of independence is addressed through the principle of autonomy (Cleary et al., 2013). Applying the principles of autonomy in this case it can be determined that independence of decision making has to be provided to Mr. B in accordance with his wish. According to the ethical code of practices for nurses, the patient has to be provided with all information which would help him determine his condition and subsequently make a decision which addresses the problem. However if the principle of autonomy is applied in this case the patent will be vulnerable to more pain and distress (Kangasniemi, Stievano & Pietilä, 2013).
According to the ethical principle of beneficence it is the duty of health care practitioners to build a good relationship with the patient so that he develops a sense of trust and bestows his faith in the service providers (Burkhardt & Nathaniel, 2013). However if the principle of beneficence is applied in this case it than the practitioner would have to compromise on the principles of obligation and acting towards the best interest of the clients (Jones & Kelly, 2014).
According to the principle of obligation and best interest action it is the duty of the nurses to ensure that the best quality treatment is provided to the patient by ensuring that he receives treatment which is necessary for him (Blais, 2015). In this case the doctor thinks that it is necessary to continue the extra dosage of medication as it would cause pain and distress to Mr. B otherwise. However if in this case these principles are applied it would defeat the principles of independence and Beneficence.
This contradictory problem faced by nurses in the course of their duty is one of the most significant issues which arise out of the professional practices (Burkhardt & Nathaniel, 2013). Nurses are in a dilemma of understanding what the right approach towards addressing the problem is. In this case the reason provided by the doctor towards continuing the medication cannot be judged as a right or a wrong decision. However it has to be analyzed that how strong is the reasoning behind such a decision. Mr. B is aware that he is suffering from a terminal illness and any treatment to him is just a temporary relief.
In this case if such illness would not have been terminal than the reason behind the doctor’s decision would have been strong enough however in the present condition importance has to be given to the wish of the patient. The nurses may support him to understand the problems with his decision but the final decision must be in accordance to his wish.
In this case RN Z has committed a fatal error which has led to a cardiac arrest to of of the patients. In this scenario the primary issue is question would be the concept of negligence and the duty of care which a nurse owes towards the patient. R N Z has negligently interchanged the required medication which has resulted in fatal consequences for the patient. It has to be noted that she was not accompanied by ED to the cubicle so as to ensure appropriate administration. The patient is the only earning member of the family and has two daughters.
Nursing malpractice and nursing negligence is the situation when harm is sustained by the patient because of the failure of the nurse to comply with her duty (Engel & Prentice, 2013). Making it simple, nursing negligence occurs when there is a breach of duty of care owed by the nurses towards their patients and such harm caused to the patient was foreseeable (DiCenso, Guyatt & Ciliska, 2014). In Australia and Singapore nursing negligence is much more than a mistake or an error. The Singapore nursing board provides a code of conduct for the nurses to follow towards the quality of care provided by them to the patient (Cole, Wellard & Mummery, 2014). Professional conduct standards are also provided by the the Nursing and Midwifery Board Australia.
The duty of care which a nurse owes towards the patients is of utmost important. Any small mistakes and errors can result in fatal circumstance like what can be seen in this case. Nurses are liable to be held accountable for any of their actions towards providing best quality care to the patients. It is the duty of the nurse to ensure that she seeks advice from the charge nurse or the supervisor before she continues to provide care towards the patient. It is the duty of RN to follow the guide and action plan provided to them by their superiors without any mistake. Nurses frequently proceed with their duties without waiting for proper supervision and this subjects the patient to the risk of negligence. Nurses must wait till they do not receive proper guidance and advice from their supervisors with respect to their actions when they are doing an act which requires supervision. According to NBV guidelines for delegation and supervision it is the duty of the nurse to delay the treatment till the supervisor is free to assist them. The guidelines also provide that midwives and nurses should be held accountable for actions and decision which they inherit in the course of work. These actions include personal efficiency of nurses towards providing care. The concept of accountability provided by the code is both ethical as well as legal.
In this scenario the best approach which would have been taken by the RN Z is that she should have delayed the treatment till she received supervision by the ED. In case where such delay was not possible it was the duty of RN Z to ensure that she commits no mistake towards here activity and understand the degree of seriousness involved in the activity. RN Z actions have proved to be fatal for the patient who is the only earning member of the family therefore RN Z has to be held accountable for breach of duty of care and subsequently negligence.
The main issue which has to be analyzed in this part of the assignment is about reporting of professional malpractices within the system. In this scenario substantial evidence is present against nurse B which signifies that she has been involved in professional malpractices which can have significant ill effect on providing quality care. In the present scenario Nurse B is a single mother who needs the job to look after her children and if evidence is provided against her she would lose the job.
According to the Conduct statement 2 of the Code of Professional Conduct for Nurses in Australia nurses should base their practice on professional standards along with broader health system (Ion & Lauder, 2015). Explaining this code of conduct further it can be determined that it is the duty of nurses to protect the interest of their colleagues, partners along with their family members in accordance with broader standards of safety, quality and accountability in health care (Gastmans, 2013). These practices may involve incident reporting, open disclosure procedures, documentation and information management (Huber, 2013). The most important responsibility which a nurse has is to provide competent and safe nursing care. Any situation which might have an ill effect on the professional standards, or situation where one observes unlawful, unethical and questionable practice has to be reported to the authority or the concerned person (Hood, 2013). However if the issue is still not solved it is the duty of nurse to intervene in the process to protect the rights of the patient and ensure quality care. The nurses in this situation can notify the issue to an external authority if it is not solved by the internal process. Similar provisions are also provided in the conduct statement 4 of the Code of Professional Conduct for Nurses in Australia.
In the given scenario controlled medication which is very essential for the patients and belongs to them is evidently stolen by Nurse B. These kinds of practice will not only effect the health of the patients and the quality of care provided to them but also to the trust and faith which services users have on nursing practices. Now in this case it is know that if evidence is provided against the nurse she will surly looses the job. Nurses also have the duty of safeguarding the interest of their colleagues and in the given circumstances if evidence is provided the single mother would lose the job and she would not be able to look after her children. Therefore there is a clash between ethical, professional obligation and personal duties. These kinds of situation subject the nurses to an ethical dilemma about how to proceed with the situation.
In this situation the nurses have to give priority to professional ethics over personal obligations. No matter what impact it would have on the personal life of Nurse B , the issue she has been involved in has to be reported. In this case it was also seen that she had been approached with respect to the issue but she denied her involvement in the situation. This was enough to ensure that she is given a warning about the issue and if the problem continues in future it has to be reported to the higher authority at any cost. Moreover nurses have the obligation of abiding by the professional standards provided to them by the code.
The major issue which has to be determined in this case is that when medical practitioners should take decisions for a patient against his will. In this scenario Mr. D has been brought to the hospital will chest pain by his son, he claims that it is merely a digestive disorder. Upon diagnosis it was found out that he was actually suffering from a cardiac disease. However even after attempts to explain him about his condition he does not want treatment.
While taking a decision about the patient who is unwilling to subject himself to medical treatment the medical practitioners have to ensure that best effort is made to make the patient understand the impact of the disease or treatment on him so that he himself is able to take the decision about whether or not to undergo the treatment. The Mental capacity Act 2008 provides guideline for individuals in Singapore who are in a position to take decision for others who are suffering from temporary or permanent medical incapacity (Parahoo, 2014). The act provides that decision taken towards other must be in best of their interest and before such decision is taken the best effort has to be made to make the individual understand the situation and take the decision himself (Potter et al., 2016).
Medical practitioners have difficulty towards understanding which decision would be regarded as reasonable and which would not (Lillemoen & Pedersen, 2013). They are bound by the principle of autonomy along with the principle of obligation and working towards the best interest of the individual. No decision in these kinds of situations can be consider being correct as it would have a different point of view for both the patient and the medical practitioners (Grace, 2013). Practitioners have to ensure that they act is best interest of the patient along with keeping in mind that they do not have to incur additional time and cost in relation to treatment. Finding the balance between these two principles is not easy and the practitioners are subjected to legal action more than often if they take a decision which is against the will of the patient. Moreover the burden of proof is on the practitioners to provide that the decision taken towards the patient was supported by strong reasons.
In this scenario it is evident the the patient is suffering from a serious heart disease but still he is not agreeing that he needs proper medical treatment in relation to the disease. In this case the doctor has taken all reasonable approaches to make sure that the importance of such treatment is conveyed to Mr. D. in the given circumstances knowing that if treatment is not done than it would result in significant harm and injury to the Mr. D the doctors have the right to take a decision in favor to the treatment. It is to be noted in this case that a carers or family member of the patient is also explain the relevancy and importance of such decision which in this case has been done to the son of Mr. D.
Conclusion
Concluding this paper it can be stated that there are several issues which health care professionals are subjected to. These issues may arise out of both nurse patient relationship and intra personal relationship between nurses. The most important issue which medical practitioners face with respect to their practice is taking decisions for the patients who are not mentally capable of taking their decision at a specific situation. It is the duty of health practitioner to maintain the balance principle of autonomy and the principle of best interest and obligation towards the patients. The nurses according to the professional code of conduct must also report any action which they think is questionable or may hamper the image of nursing towards the general public. Medical practitioners also have a duty of care towards their patients and such duty have to be complied by with utmost importance. The nurses should also accept accountability towards their action, they must be held responsible for any negligent act committed by them which causes harm to the patient or the nursing profession as a whole.
Nurses should also ensure that they take support of the supervisors when they are doing a particular act which would primacy require supervision. In case if support is not available than it is the duty of nurses to delay the treatment till they receive proper supervision. The nurses also have to get authorization before doing any act which is complex and requires support.
References
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