Nurses are in the frontline of healthcare but many ethico-legal issues are faced in nursing. According to McDermott-Levy et al. (2018), the ethical consideration is – roles of all parties included, the quantity of all information provided, and patient autonomy. The main legal considerations include – supervision, the standard of care, and consent. The nurses are obliged to work professionally under the legal and ethical boundaries with adherence to the code of ethics. If ethics are not followed then it can lead to the risk of patient safety and risks to the safety of other associated health care professionals as well. This essay discusses Driscoll’s reflection about the ethical and legal complexities in the case study. The reflection in nursing helps to consciously look and think about the feelings, actions, responses, and experiences (Steven et al. 2020). This reflection included majorly 3 sections – what, so what, and now what.
I was in a placement in a hospital with a registered nurse (RN), where she asked me to help the patient in his insulin injection. I gave the patient his insulin injection but after insulin administration, I realized that I forgot to bring the kidney dish I which the used needles or injections are kept for discard. I started getting nervous and my hands started shaking. When the registered nurse saw that I have held the injection in a wrong manner she asked me to recap it but I refused. She shouted at me as if anyone does not work according to her then she gets a bit angry. The moment she shouted again I got scared a lot and recapped it. While recapping the needle pricked my right thumb and on noticing this the registered nurse turned her focus to the patient and told me that a sample of my blood will be taken to check whether I got any infection or not. I refused at that time to recap it because my tutor told many times that recapping should never be done to a used needle as it increases the chances of needle-stick injury, risks to patient’s safety and chances of transfer of serious blood-borne infections/disease like HIV, hepatitis B or hepatitis C. If after recapping that needle is used for another health care professional for any other patient then the blood transfer infections might occur and risk the safety of the patient. The patient in such cases might legally file a case that the hospital has not maintained a safe environment for him/her and did not deliver quality care. According to Handiyani et al. (2018), needle-stick injuries are hazardous for general public health and healthcare workers as well. Therefore, the nurses are supposed to follow the code of ethics and professionalism to ensure safety and prevent the cases of ethical and legal complexities in nursing.Moreover, the recapping of the needles is one of the most dangerous and health-harming interventions that result in needle-stick injuries (Chaung et al. 2017).
Initially, I was very confident that I was assigned a task of insulin administration to the patient. The patient also agreed for my help and was happy with my service. However, the moment the registered nurse shouted at me I felt so embarrassed and I felt a bit irresponsible also as I forget to bring the kidney disk. I felt concerned for myself as I got needle pricked that might lead to the development of unexpected infections or disease in me. Now, I feel much better, confident and responsible as well because I refused to recap the needle for the safety of the patient, I learned that the ethical principles in nursing like autonomy – respect patient’s wishes, non-maleficence - remain competent in the field, beneficence – take steps for good, fidelity, and justice was maintained. However, as the registered nurse behaved with me in front of the patient after I refused to recap the needle resulted in a bad scenario that disturbed ethical and can lead to legal issues on nursing. The main reason that I felt differently was I treated the patient fairly and refused to recap the needle as it could lead to serious health hazards and I felt sorry that I could not inform the nurse that I had already used the needle that’s why I am not recapping it as it might harm the patient’s safety as well mine too. The positive that emerged from the situation was that I realized that a nurse should not only have healthy interaction and communication with the patient but also with his/her colleagues as well. The RN shouted at me in front of the patient and this also harms the safe environment provided to the patient as he/she might feel doubt about his/her safety. As I was also injured with needle and patient is a prime priority of a nurse but the RN left me unattended and also did not informed other health professionals to assist me in my injury thereby, she again did not follow the ethical values and this can lead to ethico-legal issues in future if I got any infections later. The RN also did not listen to my reason for not recapping the needle and this resulted in non-collaborative, ineffective communication, and poor professionalism that can affect the safety of patients and co-workers. This again disturbs the ethico-legal issues in nursing.
The RN should have shown the code of ethics to ensure that the issues do not lead to any legal complexities. The patient has the right of no harm so to maintain non-maleficence she should have shown patience despite anger to listen to my explanation and help me in my blood sampling to ensure that I do not get any blood-borne infection. She should have informed immediately other health professionals to bring take my blood sample for the same but she did not. This can lead to an ethico-legal complexity in the future if an unexpected result arises. Moreover, I should have immediately called other co-workers for a kidney disk to ensure no harm environment. There should be no shouting among the co-workers in front of the patient as it might create a feeling of doubt regarding safety in hospital and lead to harm to the respect or dignity of co-workers in the field (Parizad et al. 2018).A nurse shows never show anger or loud/aggressive behavior to the patient or other health professionals as this might cross the boundaries of professionalism in nursing and thereby leading to ethico-legal issues as such behavior is unacceptable professionally and legally as well. If such actions are not altered then it can lead to several ethico-legal issues in nursing resulting in harm to patients and co-workers. So in the future, if such situations arose I will confidently explain my part to the RN and ensure that all codes of ethics are followed fairly. According to Salminen et al. (2016), if the nurse faces ethical issues, then it can lead to stress and this might affect his/her performance. This will ultimately affect the safety and care services as well. The young nurse has less experience so they might face stress issues more and this might lead to job dissatisfaction. The senior nurses should encourage their young nurses by helping them and assisting them in their tasks to boost their confidence and establish a healthy environment in the hospital. The ethics like autonomy, nonmaleficence, fidelity, beneficence, justice, and principles of totality and integrity – are of high significance in nursing (Yıldız 2018). If these are not met then various serious complexities can arise leading to legal issues at later stages.
The nurses are obliged to work professionally under the legal and ethical boundaries with adherence to the code of ethics. While nursing they face many ethical and legal issues due to the patient’s behavior or due to the behavior of co-workers. However, these can be easily tackled if they remember the code of ethics and follow them to ensure that there are no complex issues with patient’s respect, dignity, or with co-workers' respect, dignity, and everyone’s safety. A used needle should never be recapped and a co-worker should never use a loud voice in front of the patient. If after recapping that needle is used for another health care professional for any other patient then the blood transfer infections might occur and risk the safety of the patient. The patient in such cases might legally file a case that the hospital has not maintained a safe environment for him/her and did not deliver quality care.
Chaung, S.K., Choi, M.J., Park, J.H., Kim, H.J. and Song, K.Y., 2017. Nursing students’ exposure to needlestick and sharp injuries, faculty’s stress and necessity of informed consent in fundamental nursing practice. Journal of Korean Academy of Fundamentals of Nursing, vol. 24, no. 4, pp.277-285.
Handiyani, H., Kurniawidjaja, L.M., Irawaty, D. and Damayanti, R., 2018. The effective needle stick injury prevention strategies for nursing students in the clinical settings: Aliterature review. EnfermeríaClínica, vol. 28, pp.167-171.
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Parizad, N., Hassankhani, H., Rahmani, A., Mohammadi, E., Lopez, V. and Cleary, M., 2018. nurses’ experiences of unprofessional behaviors in the emergency department: A qualitative study. Nursing & Health Sciences, vol. 20, no. 1, pp.54-59.
Salminen, L., Stolt, M., Metsämäki, R., Rinne, J., Kasen, A. and Leino-Kilpi, H., 2016.Ethical principles in the work of nurse educator—A cross-sectional study. Nurse Education Today, vol. 36, pp.18-22.
Steven, A., Wilson, G., Turunen, H., Vizcaya-Moreno, M.F., Azimirad, M., Kakurel, J., Porras, J., Tella, S., Pérez-Cañaveras, R., Sasso, L. and Aleo, G., 2020. Critical incident techniques and reflection in nursing and health professions education: Systematic narrative review. Nurse Educator.
Yıldız, E., 2019. Ethics in nursing: A systematic review of the framework of evidence perspective. Nursing Ethics, vol. 26, no. 4, pp.1128-1148.
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