• Subject Name : Medical Sciences

Ethical and Legal Issues in Nursing

Nurses are subjected to a variety of ethical and legal duties and when these ethical and legal duties are breached during the provision of health care they are termed as ethical and legal issues. The results of breaching of ethical and legal duties leads to the declination in the quality care that has to be provided to the patients, challenging clinical relationships, moral distress, and poor health outcomes of the patients (Kadivar et al, 2017). This essay will focus on the ethical and legal issues related to the given case scenario, along with focusing on the competencies as well as the codes that are associated with that scenario. The nurses must act and work ethically and should maintain the nursing standards of practice along with respecting the rights of the clients. The codes used in this particular scenario actually refers that a nurse should work in order to benefit the patient and should avoid any type of potential harms involved to ensure patient’s safety. For this, maintaining the standards during the professional practice is necessary.

In this case Mrs. Ramirez is making constant requests to not to take aspirin and prednisone and the nurse respected this decision of the patient and holds her medication for three days. Later on, after three days the patient again refused to take prednisone along with coversyl and the nurse again accepted her refusal and did not administer the medication. As the patient was consuming prednisone since past five years, sudden stoppage of this, adversely affected her that leads to acute adrenal insufficiency. The nurse didn’t document that the patient is not administering with proper medication and is not taking prednisone from past 3 days. So, this essay will be concerned with the identified ethical and legal issues regarding the given case scenario.

The potential legal and ethical concerns that are raised in the case scenario of Mrs. Ramirez are Beneficence, Non-malfeasance, and documentation. Beneficence highlights the moral duty of the nurse to perform for the benefit of patient. In this case, when the patient refuses for taking prednisone, the nurse accepted that which is right from the perspective of Autonomy but, this act is not benefiting the patient in either ways. There are two aspects i.e., benefiting the patient along with balancing between the benefits and harms. There are certain obligations or moral rules that have been supported by the principle of beneficence and they include protecting and defending the rights of the patients, prevention from the incidence of risks and harm to the patient, removing the stipulations that are potential in causing harm, rescuing the patient from danger, and helping the disabled ones (Doody & Noonan, 2016). On the other hand non-malfeasance is the procedure that does not wreak or cause any type of harm to the patients. While, in this case when nurse allowed Mrs. Ramirez to not to take her medications later on becomes the reason for the potential harm that has happened the patient. The principle of non-malfeasance has some norms that states to not cause any suffering or pain to the patient, to not incapacitating the others, not killing and causing offense to the patients. However, in this case this has been violated.

Another aspect of ethical concern is documentation; Documentation is the written record of the interventions that are concerned with the patient. This includes the whole series of processes that have been used for the patient. The significance of documentation in nursing is neuralgic and without documentation a complete qualitative nursing intervention cannot be come into consideration (Tamil, 2017). However, in the given case scenario nurse neither documented nor informed anybody about the medications scenario of the patient which is something that has to be documented, shared, and informed with the doctor in order to provide the best and suitable care to the patient.

The possible actions that could be taken in this case could be the use of effective therapeutic communication. By this, nurse could have made the patient understand the importance of taking prednisone in her case even if the patient is denying. Showing empathy and using effective therapeutic communication never goes in vain. She could have told her even if she feels fine and does not think that she needs medication but her body needs it. Telling the adverse effects that could be faced by the patient if she does not take these medications might have made the situation better. However, Respecting and showing compassion by the means of effective therapeutic communication would have helped her in such conditions because, Therapeutic communication is considered to be the foundation of synergistic relationship between the nurse and patient ().

However, there are also some ethical principles that conflict each other. In this case, patient’s autonomy and beneficence; and non-malfeasance and autonomy are conflicting each other. If the nurse would have forced the patient to take her medications then, this action of her would have breached the principle of patient’s autonomy while respecting the patient’s autonomy would have breached the principle of beneficence. Similarly it is with non-malfeasance and autonomy; if the nurse would have forced the patient for taking medications then, this action of her would have breached the principle of patient’s autonomy and if the nurse considers patient’s autonomy this breaches the principle of non-malfeasance as it is causing harm to the patient.

There are also some torts and legal concerns regarding the scenario and they are negligence and malpractice. Negligence is a non-intentional tort and can be described as the failure of the nurse to take standard care practice to prevent the patient from any loss or injury. it occurs generally, when the nurse does not get succeed in following the established standards, processes, and policies () while in Mrs. Ramirez’s case negligence could be seen twice; firstly, while not thinking even once to document the necessary aspects of the case or to informed anyone regarding the same and secondly, when she fell down and was found injured. Along with negligence, malpractice has also been seen as the nurse has breached her duty, and is associated with the patient’s injury has taken place, even though it is unintentional but the patient was harmed.

Ethics are the principles that exhibit what is correct and what is incorrect in terms of behavior. These are very essential pillars of a healthcare system and are world widely accepted norms. These are the code of conduct that helps in provision of a realistic groundwork for the classification of different types of actions and intentions that has to be respected. They administer the healthcare professionals, staff members, and the whole association about their conduct of health care services. The main point of focus entails the right & wrong of the proceedings that have been taken along with the decision making process. This also takes consideration on the determination of the consequences that can occur eventually because of the actions that have been taken (Haddad & Geiger, 2020).

Nurses have been gradually blatant out with the intricate disquiets in their practice. Codes of ethics help in providing the primary scaffold for nursing and other professions. The code of conduct enlightens the legal needs, trained actions, and conduct outlook of all nurses. This provides the guiding principles for the professional behavior that result in the safe practice (Nursing and Midwifery Board of Australia, 2017).

The codes play an important role in the field of nursing profession, this is so because it helps in offering safe practices along with providing guidance on peculiar issues that are important and need to be focused. Professional nursing standards helps in describing the practice and behavior of the nurses. It also offers a framework of the commitment of the nurses to show reverence, sentry, endorse and sustain some of the basic fundamental rights of the patients as well as their families and all in all this encompasses the codes of conduct, codes of ethics, and standards for practice (Park et al, 2014).

It has been expected that all the patients must be treated with somberness and they should be sheltered from any potential harm that has the possibility to deteriorate their health. However, in the given case study, it does not happen. Neither Mrs. Ramirez was treated with solemnity nor she was being protected with any potential harms. So, there was a strong need to get sticked to the ethical and legal values by the healthcare providers so that they could have easily identified the possible safety failures and would be able to prevent the patient from falling incidents accordingly. While evaluating the ethical issues and implementing the suitable framework could help in scrutinizing the clinical scenario and severity of the patient so that it could be resulted into the provision of patient-centered clinical care (McBride, 2018). Also, whenever there is such a conflicting state of selecting between the autonomy and the beneficence and non-malfeasance, patient’s safety should be the first priority of the health care giver without compromising his autonomy. This could be done by making the patient understand along with negotiating and harmonizing the whole situation.

The significance of ethics in the field of healthcare system entails the patients and their wellbeing. It focuses on the ways to prevent harm during health care service. These approaches lead to the prevention of errors and promote patient safety. The significant role of the ethical considerations in patient care suggests that an individual nurse, as well as the nurse in-charge & healthcare organizations where the case is taking place, holds the accountability for developing the imperative skill. There is a need to intensify the ethical awareness in the healthcare system and this could be done by developing ethical competence and an overall ethical understanding along with the skill-set for individual nurses (Kulju et al., 2016). Active participation of nurses in ethics-related discussions and learning to develop extensive knowledge regarding the available ethics resources leads to the development of ethical competence.

The code of conduct regarding the giving scenario includes the delivery of safe practice, ethical and legal consideration, and identification of potential harms along with fulfilling their professional roles. This also comprises of patient-centered practice as in the given scenario nurse should have been more pro-active and could have taken care of documenting every single thing related to the patient. In addition to this, according to the Nursing and Midwifery Board of Australia, 2018 quality nursing care, respecting and showing compassion, ethical management of information, and promotion health and wellbeing also contributes in getting the desired health outcomes of the patients.

This essay provides a concise reflection of Legal & ethical issues regarding the given scenario. Legal, ethical, and professional guidelines direct the conduct of professionals to ensure mistakes do not occur. Ethical issues are based on patient profiles, development, medical technology, & healthcare specialties. Being aware of the ethical issues involves the rational reflection regarding what action or inaction should be taken in a particular scenario or a case study, and afterward adhering to the principles to guide this behavior.

References for Ethical and Legal Issues in Nursing

Doody, O. & Noonan, M. (2016). Nursing research ethics, guidance and application in practice. British Journal of Nursing, 25(14), https://doi.org/10.12968/bjon.2016.25.14.803

Haddad, L. M., & Geiger, R. A. (2020). Nursing Ethical Considerations. StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK526054/

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: a clinical case report. Journal of Medical Ethics and History of Medicine, 10, 15.

Kulju, K., Stolt, M., Suhonen, R., & Leino-Kilpi, H. (2016). Ethical competence: A concept analysis. Nursing Ethics, 23(4), 401–12. doi:10.1177/0969733014567025

McBride, S., Teitze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and Addressing Ethical Issues with Use of Electronic Health Records. The Online Journal of Issues in Nursing, 23.

Nursing and Midewifery Board. (2017). Registered nurse standards for practise. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Nursing and Midewifery Board. (2018). Registered nurse standards for practise. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Park, M., Jeon, S. H., Hong, H. J., & Cho, S. H. (2014). A comparison of ethical issues in nursing practice across nursing units. Nursing Ethics, 21(5), 594–607. https://doi.org/10.1177/0969733013513212

Tamil, S. S. (2017). Documentation in nursing practice. International Journal of Nursing Education, 9(4),121-123. https://doi.org/10.12968/bjon.2016.25.14.803

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