You are on an afternoon shift and while speaking to a resident named Mary notice that she has bruising on her left arm.
Mary says she is clumsy and banged into the wall when walking to the dining room. She has no history of confusion and can walk well with a Zimmer frame.
A few days later in handover, another night nurse reports that Mary has become incontinent over-night for the last 3 nights and they are now using incontinence pads.
The next shift you notice bruising around both of Mary’s wrists. On questioning, Mary becomes teary and says she is frightened of a particular night nurse who is very impatient with her when walking her to the toilet. Mary says the nurse drags her rather than allows her to walk with the Zimmer frame and is rough with her. Mary is so frightened she does not want to call for help in the night and has become incontinent.
Mary does not want to cause a fuss, she is concerned she may be treated worse by the night nurse. She has asked you not to say anything.
Discuss your ethical, legal and professional responsibilities as a Registered Nurse using the framework below, and decide the best course of action to resolve this situation.
IDENTIFY THE FACTS
Legal, Ethical, Medical and Social
Code of Conduct, Code of Ethics, RN Standards for Practice, NSQHS Standards and any other relevant Health Department Standards
WORD COUNT 2000 words MINIMUM 10 REFERENCES
Patient safety and the nursing profession is multifaceted and centres on legal and ethical conducts. According to Jafari et al. (2019), ethical practices in nursing are core foundations for the determination of types of motivations, actions and intentions that are respected. Further, ethical behaviours shape the conduct of healthcare professionals. On the other hand, legal issues include the professional code of conduct and compliance with legal laws. This assessment aims at highlighting Mary's case study. In this case, the registered nurse has demonstrated inappropriate behaviour towards the patient leading to certain professional, legal and ethical misconducts. The other nurse notices bruising on the patient body which on evaluation found that nurse is ignorant towards patient care. Further, the paper focuses on the decision-making capacity of the patient, legal issues, ethical issues and professional issues that are evident in this case study.
Identify the facts
There are many identifiable facts in this case study. Firstly, the legal issues include the consent of the patient and non-compliance with the professional’s code of conduct (Cherry & Jacob, 2016). These are evident as the nurse did not take the patient's consent and instead dragged her to the washroom. Secondly, the ethical issues are of beneficence, non-maleficence, justice and autonomy. The nurse on duty did not meet any of the ethical principles and demonstrated unethical and inappropriate behaviour towards the patient. The acts performed by the nurse did not align with the ethical principles and hence led to health deterioration and fear among the patient (Scott, 2017).
Moreover, the medical fact identified is medical negligence. Further, the acts of bruising on patients body which increased by next day are proof of medical and clinical negligence on the behalf of nurse which is also against the code of conduct (Cheluvappa & Selvendran, 2020). The nurse did not consider the patient's situation and dragged her that becomes a major example of medical negligence in this case study and showed impractical ways of handling a patient. Next, the nurse should provide care in the social context. The social role of nurses is evident in numerous activities and is demonstrated in various ways. This includes showing attentive practice with understating of social responsibility towards the patient in terms of effective participation, giving motivation, satisfaction and social feeling of well-being (Griffith & Tengnah, 2020).
According to the Australian government common law, all capable adults can give informed consent towards medical care, and ran even refuse it (Australian government, 2020). There could be potential consequences for health practitioners if consent is not obtained. Under the trespassing rule, patients have the ability not to undertake an invasive procedure without consent or even another reasonable excuse, including a necessity or emergency (Australian government, 2020). According to this law, the consent can be given on the behalf of the patient only if he/she has some mental illness or is a child or has impaired decision making. Hence, it can be concluded that Mary does not have such ailments and can freely give her consent for all the treatments and procedures as per her care regimes. The needs of the patient are not in line with the nursing practices and the nurse has overseen some legal consequences.
In this case, the consent of the patient is not taken and has been subjected to unwanted behaviour. As per law, consent to perform any medical operation on a patient should be gotten either from the patient or the family of the patient. Legally, the actions of a medic limited to the needs of the patient. The legislation preserves the dignity and safety of the patient and mandates that all healthcare professionals retain informed consent of the patient after any interventions or care (Queensland, 2016). Also, the nurse should work in partnership with the patient to identify the effects of the care, health and well-being of the patient and determining the care priorities (NMC, 2018). In addition, nurses employ a range of evaluation methods to obtain reliable and appropriate knowledge by actively interacting and connecting with the patient. Bauer et al. (2018) state that healthcare practitioners aim at reducing risk and incorporates appropriate approaches to address serious health problems. In addition, there should be mutual decision-making on whether or not the procedure is acceptable by the patient (Penney et al., 2016). In this case, the nurse did not took and did not let her walk with the Zimmer and further dragged her which has made patient being fearful of the hospital stay and Mary has become continent.
The next legal issue is medical negligence or medical malpractice. Malpractice is described as "a violation of a moral obligation or inability to practice an ordinary level of professional competence or ability by one (such as a nurse) delivering legal services that result in harm, negligence or harm" (Grant, 2017). One example of nursing misconduct is that patient is physical harmed such as bruised in this case or injured by falling as a result of the nurse's incompetence, making a patient at a possible danger of falling without adequate monitoring or failing to implement fall procedures (Grant, 2017).
In this case study, it is among the key issues as "medical negligence" can be harmful to the patients and impedes safety of patients. The patient may blame the healthcare provider for misconduct in the case that the nurse will not obey the regulations and the medical interventions go wrong. Pursuant to the standard 1 of clinical governance of national health and safety standards it is the legal obligation of medical professionals to pay to emphasize on continual quality growth while delivering person-centred, reliable and stable care (NSQHS, 2017). In contrast to this, in this case, the nurse failed to provide compassionate care and completely ignored the patient autonomy and preference (Björkstén et al., 2016). In this case, the nurse did not notice and did not document the bruising of the patient and hence her preferences were not as per her needs.
Negligence in nursing care might include lack of responsibility, incompetence without lack of decision making, and neglect, which may be considered inappropriate actions regarding patient-specific situations (Sultana, 2018). In this case study, Nurse did not take the recommendations of the patient and becomes a significant example of medical incompetence and dragged the patient being rough with her. Health care providers and representatives should evaluate, implement and assess actions to mitigate clinical complications in compliance with Standards 4 of national health and safety standards, and should improve patient safety and wellbeing (NSQHS, 2017).
When ethically assessing the case study, due to the evident principles of beneficence, non-maleficence, autonomy and justice, the rights of the patient have not been upheld. The nurse failed to comply with ethical issues and the conflicts are discussed below:
The first ethical issue is beneficence. Butts and Rich (2019) put forth that all care providers have a basic moral responsibility to do what is right. The practitioner is obligated to encourage the well-being and consideration of the patient without exceptions in the context of the nurse-patient relationship. Beneficence displays compassionate treatment and fosters a persistent pursuit of competence (Kumwenda et al., 2017). Irrespective of this patient was dragged and ignored which disrupts the ethical obligation of beneficence. Hence, the patient was not benefited from the care instead was harmed in terms of physical health. The ethical conflict arises as the patient does not want the scenario to be revealed but for the benefit of the patient the incident has to be reported and it becomes a conflict between ethical conduct and legal reporting.
The second principle requires justice to promote healthcare practitioners to cooperate with laws and guidelines to ensure that resource distribution ensures services inclusively (Salminen et al., 2016). Furthermore, in one aspect, however, the nurse could not assist the patient and specifically eliminated the clearly defined right of ethical behaviour of beneficence and non-maleficence. This brings in a conflict between the principles of nursing care and the privacy of the patient (Sari et al., 2018). Here also being a registered nurse it is an ethical responsibility to serve advocacy and justice for the patient but the patient denies of any complaint and is fearful that the nurse might harm her more which again raises a conflict between consent and justice for the patient.
In this situation, therefore, Mary's autonomy is not valued. Freedom of speech or self-determination is a fundamental human right (Bourgeois et al., 2017). According to this principle, the key requirements are the autonomy of the patient and informed consent. When the patient refuses the treatment, procedure or cares it is the legal duty of a nurse not to compel the patient to obtain the procedure. If informed consent is not obtained until delivering care, it becomes a breach of the patient's rights (Taylor, 2018).
According to Jafari et al. (2019), to reach a beneficial outcome, non-maleficence suggests non-harming or unleashing the least potential risk to the patient. Non-maleficence has four factors namely a provision that is not necessarily false, it is directed at having a positive result, the good impact is not only a by-product of a bad effect, and the good outweighs the bad. But the decisions made in the case study are obvious examples of behaviour that did not help patient Mary, resulting in bruises, fear and incontinent.
The first professional issue is that nurse did not communicate appropriately with the patient. Insufficient communication is an example of failure to addressing effective patient care including, improper documentation, patient condition and conveying the patient health outcomes (Myers et al., 2020). Following standard 5 of NSQHS, it is the legal obligation of the nurse to maintain and plan fall prevention strategies thus avoiding harm and complying with legal, ethical and professional issues (NSQHS, 2017).
Case study highlights that patients dragging or bruising was not mentioned in the patients’ documents. As per standard 4 of NSQHS standards for patient safety all healthcare practitioners and licenced nurses are responsible for monitoring the risk involved with the wellbeing of the patient (NSQHS, 2017). When communicating and documenting specific patient records, diagnosis findings, and interpretation of treatment given, medication management, the instruction given, and the following summarizes, nurses must be comprehensive and systematic (Bookey et al., 2017).
Pursuant to the standard 1 of nursing and midwifery standards for registered nurses the nurse's legal responsibility is to document every single alteration in the patent health evaluation and outcomes (NMBA, 2017). But in this case, the nurse failed to do so. Further, pursuant to standard 1.6 of nursing and midwifery standards it is the nurse’s obligation to bring constant, correct and timely reports for patient heath assessments (NMBA, 2017).
Due to the legal concerns found in the case scenario, nurses are expected to conform to standard 2 of the codes of nursing and midwifery, which means that all registered nurses must participate in therapeutic and professional relationships (NMBA, 2016). In addition, when delivering treatment, the nurse should engage adequately with the patient and therefore should value his/her dignity and interests, but in this situation, due to his violent tendencies, the nurse did not communicate with the patient and made unethical and illegal behaviours (NMBA, 2016). The healthcare sector assists the staff in developing relationships with patients and carers in order to better involve patients in their own care (NSQHS, 2017).
My decision would have been based on the evidence and testimony presented by the patient. If the organization presents evidence beyond reasonable doubt proving the actions of the defendant, then my ruling would have favoured them. However, the evidence in the case by the nurse outweighs the speculations and suspicions of the institution, and as such, I will not allow the institution to go ahead with the suspension of the student nurse. But, the institution should make the student nurse compensate for the costs of the case with regard to legal fees and other costs. I would hold the student nurse liable for breach of the code of ethics of nursing practitioners based on the fact that she had caused physical and emotional harm to the patient.
Further, the student nurse should first reflect on this situation to know what went wrong and how the situation could be improved. Second, the nurse should learn to comply with the professional ethics and standards and the next nurse should learn the four-step decision-making process. As according to standard 1 of registered nurse and midwifery standards, a nurse should think critically and make an ethical decision based on reflecting on experiences (NMBA, 2017).