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Introduction
This essay will depict ethical and legal issues involved in nursing, and each of the matters will be attributed to the provided case study to identify the ethical and legal steps that would have been taken during the scenario. The legal and federal boundaries are applicable in nursing under any circumstances. In addition to this, nurses should also act in an ethically manner to ensure the Standards of Practice, Code of Ethics and Code of Conduct. As, the medical practices and associated technologies are being updated rapidly, nurses need to take care of their decisions to prevent any risk of legal liability (Park et al., 2014). On the other hand, they should also be aware about ethical implications of their actions and inactions. Given case study involving a 70-year old patient, Mavis, it is necessary to determine the most effective actions according to the legal boundaries as well as ethically responsibilities.
Based on the provided case study, both ethical and legal limitations have been considered to assess the actions that are taken to handle Mavis. Each of the actions has also been evaluated with the help of legal or ethical standards, which are relevant to nursing, along with those that contradict it.
Ethical Issues
Situation and Possible Actions: When Mavis was attended after the second day of her operation, her conditions have worsened from the last night, and she was noticed, as she suffered from anxiousness, disorientation and confusion. She forced to go back home and think to start work, it reflected that she frustrated, which might be the effect of the drugs. In this situation, it was necessary to review her medication which was done by the in-charge nurse and was reported to the shift coordinator. When the nurse came back from reporting to the shift coordinator, Mavis left her bed and went to the visitors room. she not only opened up her gown, but also her dressing sponge was circulated from the surgical wound and faeces were smeared on it. Even, her IV cannula was opened up, and she was bleeding from there. Now, as Mavis was detected to be disoriented and confused and it was unethical to leave her unattended during the time (Cherry and Jacob, 2016). The nurse could have reported the shift coordinator by leaving someone to guard her or after providing the assurance to her before leaving the room. Moreover, as the nurse wanted to cover her and guide her to the bathroom for washing up, Mavis refused any form of assistance and even aggressively prevented the nurse from accompanying her in the bathroom. Under these circumstances, it would have been unethical to disregard her privacy and forcibly entering the bathroom even for washing her was inappropriate. However, faeces on the surgical wound can cause infection, it would also be unethical to let a delusional patient take care of herself. In this situation, it is necessary to call for additional help from other senior nurses or doctors for take care of the bleeding and wound contamination immediately.
Actions Taken: As, in-charge nurse left Mavis unattended and reported to the shift coordinator, it is considered as unethical to leave an elderly disoriented patient alone and in fact, led to further complications when the nurse returned. However, reviewing the medication and reporting it to the professional superior is part of the nursing practice and should be performed appropriately. This is a case of an ethical dilemma for the nurse as abiding by the nursing practices contradicted with the most profitable decision in that situation (Epstein and Turner, 2015). Mavis further started removing her clothes, it was responsibility for the nurse to handle the situation calmly by asking for extra help from the co-ordinators. Her hygiene needs to be maintained first to prevent further infection on the surgical wounds and the nurse should have to guide her in the bathroom. In fact, take care of the patient should have topmost priority of every nurse to prevent nosocomial infection. Despite the refusal of Mavis, the nurse wanted to accompany her in the bathroom without her consent, which was not considered ethical as per according to the age and mental condition of Mavis. So, it was necessary to provide assistance, but nurses should prioritize the goodwill of the patient over her own personal beliefs and decisions.
Implications: The actions, which was taken by the nurse needs to be evaluated based on the ethical guidelines and norms in nursing Code of Conduct, Code of Ethics and RN Standards of Practice as well as based on the need of the situation. As per Copeland (2020), the Code of Ethics for nurses consist of 9 provisions that help them to make necessary ethical decisions, when interacting with patients. The 3rd provision in the Code of Ethics states that the nurse should promote, advocate and protect the rights, health and safety of the patient. On the other hand, provision 4 states, that the nurse responsibility, accountability and authority to make decisions of nursing practices and provide optimal care to the patient (Copeland, 2020). Now, when it evaluated carefully and these two provisions are contradictory to the ethical principles of nursing, when it comes to making a decision for Mavis in the case study( Butts and Rich, 2019). The first of the six ethical decisions state that the patients autonomy and self-determination should be respected at all times. In the case of Mavis, despite struggling to go to the bathroom and wash up the wound herself, Mavis refused any form of assistance from the nurse. Now, in order to respect the autonomy of the patient, the nurse would have to consider risk of health and safety of the patient and nullify her own decision-making authority. This is indeed an ethical dilemma that nurses experience when it comes to treat patients. In addition to this, the second and third principles of ethics state beneficence and nonmaleficence for the patient, which represent doing good and avoid any harm that might occur to the patient. As, Mavis was contaminating her surgical wound with faeces and her insertion site of IV cannula was bleeding, the most appropriate ethical decision was to offer her assistance to wash up. However, Maviss refusal to accept any assistance needed to be granted to promote her autonomy over her own decision. On the brighter side, a special case could be made as Mavis was an elderly citizen and was genuinely disoriented and hence, incapable of making sound decisions. In contrary to this, when it comes to senior citizens, patient falls the 5th leading cause of death (Kangasniemi, Pakkanen, Korhonen, 2015) and Mavis clearly being old and delusional had chance to fall off in the bathroom and she had been left unattended during the wash-up. The nurse could take this into account and prioritize the nonmaleficence ethical principles over others and forcibly washed up her wound and put back the IV cannula to stop further bleeding while calling up superiors for help. The ethical principles of beneficence, least harm, respect for autonomy and justice can be explained with the help of ethical theories.
The Deontology ethical theory states the upholding of duties when it comes to other individuals or society and makes consistent decisions. As mentioned, respect for autonomy and justice should be maintained by a deontologist, even if it causes harm to the patient or is least beneficial (Paquette, Sommerfeldt and kent, 2015). On the other hand, Utilitarianism is based on the consequences of action, and the one that has the greatest beneficial outcome should be pursued. The autonomy of the patient can be violated by a utilitarian if the action would yield more benefit to the patient as compared to her own decision (Wagner and Dahnke,2015).
Legal Issues
Situation and Possible Actions: Along with the ethical actions, there are some legal limitations as well that nurses have to follow when taking care of their patients. Additionally, they are legally obliged to provide some essential services to the patient to ensure their well-being and safety. It is necessary to determine the legal issues and dilemmas, when dealing with elderly patient as in the case study. When Mavis was first assessed after her operation, her vital signs were all under the normal limit, although it altered slightly during the following day. The heart rate was elevated to 92bpm, and blood pressure has decreased to 105/70. Despite looking pale, her body temperature has increased to 38 C. Although, proper medications and IV infusion were given and her health deterioration could be implied legal steps, if it was found that the medications were not appropriate. After sometimes, Mavis became aggressive and she said to attending nurse go away, she clearly looking disoriented, confused and anxious. In such scenario, the possible actions to avoid any legal implication is to review the medication and check side effect of the drugs, which were given to her. Also identify the any factors which can contribute to establish this kind of behaviour.
Next, it is necessary to inform a professional superior about the patient’s condition like the doctor or shift coordinator as the involvement of a superior would prevent any legal actions that may arise in the future regarding the health condition of the patient. However, it should be kept in mind that under such circumstances, a patient cannot be left unattended and should be guarded by some healthcare professional at all times (Griffith and Tengnah,2017). Failure to do so might result in the patient harming herself and against the nursing policy, which might even lead to the termination of the attending nurse. When Mavis started removing her clothes, it is the legal responsibility of the nurse to maintain the integrity of the patient. Covering her up with some clothes or offering her privacy inside a confined room is the ideal way to do so. As for the smearing of faeces in the surgical wound and opening up of IV cannula resulting in bleeding, this could lead to harm of the patient and considered malpractice and negligence on the part of the nurse. For this reason, based on the reports in National Association of School Nurses (2016), taking immediate actions to wash up the wound and putting back the IV cannula is important to prevent any legal actions. As she refused any assistance from the nurse, forcing her to wash up would result in a violation of the autonomy of the patient, which again might face legal steps. Attempting to assist her in the process calmly is the only way to prevent the patient from any harm.
Actions Taken: The nurse left Mavis unattended to report the medication review to the shift coordinator. While her decision to inform a professional superior about the prescribed drugs was appropriate, leaving the patient unattended in such circumstances can have legal consequences. Moreover, closing the door of the visitors room to give privacy to Mavis when she removed her clothes was also an ideal decision and immediate assistance to wash up the wound off faecal matter and stop the bleeding would ensure safety and well-being of the patient which is again legally practised ( Cowen and Moorhead, 2014).
Implications: While sources of law can vary from constitution and legislation to administrative and common law, the nursing laws are included under the legislative laws, also known as statues. All the laws related to nursing are included in the Nurse Practice Acts. Under the Tort Law, there are several unintentional torts that can account for negligence, malpractice and even professional negligence (Kass and Rose, 2016). When it comes to malpractice, there are five elements that have legal implications. They are foreseeability, causation, duty, injury or harm and breach of duty. Intentional torts can include invasion of privacy and assault. As, stated in American Holistic Nurses Association, (2018) in order to avoid any such malpractice and negligence, client safety is the topmost priority, followed by application of the five rights that include dose, client, drug, route and time. While leaving the patient unattended was professional negligence, informing the shift coordinator was the causation, which is standard practice under the NPA. When Mavis was taking off her clothes, closing the door of the visitors room prevented intentional tort of invasion of privacy. Finally, offering assistance to wash up the wound is necessary to prevent any harm or injury to the patient who is also a malpractice scenario and is subject to legal implications.
Conclusion
As evident from the case study and analysis of ethical and legal boundaries, the nurse attending Mavis acted almost ideally to treat her apart from a few areas. However, based on the legal obligations and ethical practices, some of the most appropriate actions and inactions have been discussed in the essay that would have helped the patient even more.
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