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Case Study: James and Michelle 

Introduction

In nursing practice, the patients are considered as core concern which includes behaviour, demography, and other aspects. Any kind of nursing practices cannot be influenced by these kinds of circumstances of patients. In the current case, ethical and legal issues have been identified in the treatment strategies by Michelle while treating James Keren. In a multiple comorbid condition, the caregiving of pressure sore debridement was done to James who was not kept under fasting from the previous night of surgery.

However, he has felt discomfort and has asked for nursing assistance which has been not sufficiently provided by Michelle. He was still not well and asked for in-charge’s presence, but Michelle has also denied for that and instead has told about the pain and aggression of James. However, after certain clinical analysis, significant issues have been found in which bladder of James has been found full and no urinary discharge has been happened within 24 hours. In spite of checking such activities, Michelle has provided analgesic medication to him which is ethically and legally a significant issue. The aim of the assignment is to evaluate the role of ethical and legal concern in nursing for enhancing patient’s safety.

Critical Analysis of The Case

In this context, the Code of Ethics and RN Standards of Practice (2016) states a nursing professional works for patient’s safety and wellbeing in order to respect their legal position as well as autonomy. This is reflecting the nursing professionals are liable to provide complete professional guidance and services to the patients irrespective of patient’s position (NMBA, 2020). Any kinds of discrimination, negligence, avoidance and others could not have been conducted on these people. Here, in case of James, due to his aggressive attitude and disability, Michelle has ignored the clinical condition of James.

Along with this, she has completely discarded the aspect of other clinical symptoms other than the vital signs and in spite, Michelle has not conducted other monitoring or routine check-ups. Therefore, before conducting surgical session, James would not have proper check-up and this could have created unnecessary complication in health and surgery as well as can lead to death. Legal and ethical concern of the situation is quite significant as Michelle has not met any amendments of Code of Ethics and RN Standards of Practice like communicating effectively with rights, beliefs, values, culture and dignity.

On the contrary, Michelle has ignored significant signs and has not even monitored his patient and that is why any record of urinary discharge has not been noted. This is a significant issue as per this ethical code and standard which states directing and supporting patients with resources with proper health related decisions. On the other hand, as per the Nursing Codes of Conduct of Nursing and Midwifery Board of Australia (NMBA), Michelle has shown lack of care and under involvement in clinical care which should have been done by applying evidence based and person centred care approach as per principle 2.1 (RNS, 2020).

In this context of providing person centred care with inclusion of evidence based practice, it has been noticed that Michelle has certain possible action and inaction as per the Code of Ethics and RN Standards of Practice for Nurses and Midwives which is showing ethical and legal activities of nursing staffs (Griffith & Tengnah, 2020). In case of Michelle, several inactions have been noticed among them the most significant is avoiding the patient after notifying his issues. In addition to this, the person has been provided with wrong medicine instead of conducting thorough check-up of his catheter condition. This action has been conducted without proper investigation to the scenario. On the contrary, James is a patient with a permanent suprapubic catheter that needs to be checked in certain interval. Therefore, it was an inaction of Michelle for which Michelle has overlooked for James the physical issues and malfunction of urinal bladder. Along with this, Michelle has ignored the urge of James about asking about Michelle.

In nursing practice, the patients are considered as centre concern which incorporates their conditions and conduct motions. Any sort of nursing rehearses cannot be affected by these sorts of conditions of patients. Nevertheless, in the present case, moral and legitimate issues have been recognized in the treatment procedures by Michelle while treating James Keren. In a various comorbid condition, the providing care of weight sore debridement was done to James who was held under fasting from the earlier night of medical procedure (McBride et al. 2018).

On the contrary, he has felt uneasiness and has requested nursing help which has been not adequately given by Michelle. He was as yet not well and requested in-control's essence, yet Michelle has likewise denied for that and rather has told about the agony and animosity of James. In any case, after certain clinical investigation, huge issues have been found in which bladder of James has been discovered full and no urinary release has been occurred in a day. Despite checking such exercises, Michelle has given pain relieving drug to him which is morally and legitimately a critical issue.

A nursing proficient supporters in the interest of licenses so as to regard their lawful situation just as self-governance. This is mirroring the nursing experts are subject to give total proficient direction and administrations to the patients independent of patient's position (Ingham-Broomfield, 2017). Any sorts of separation, carelessness, evasion and others could not have been directed on these individuals. Here, the nurse has resistance about James, because of his aggressive mentality and inability, Michelle has overlooked the clinical state of James. Alongside this, she has totally disposed of the part of other clinical indications other than the fundamental signs and in show disdain toward, Michelle has not led other observing or standard registration (Savage, 2017).

Legitimate and moral worry of the circumstance is very critical as Michelle has not met any alterations of Code of Ethics and RN Standards of Practice like discussing viably with rights, convictions, qualities, culture and respect. In actuality, Michelle has disregarded noteworthy signs and has not checked his patient and that is the reason any record of urinary release has not been noted. This is a noteworthy issue according to this moral code and standard which states coordinating and supporting patients with assets with appropriate wellbeing related choices.

Michelle has indicated absence of care and under association in clinical consideration which ought to have been finished by applying proof based and individual focused consideration approach. In this setting of furnishing individual focused consideration with incorporation of proof based practice, it has been seen that Michelle has certain conceivable activity and inaction according to the Code of Ethics and RN Standards of Practice for Nurses and Midwives which is demonstrating moral and lawful exercises of nursing staffs.

In the event of Michelle, a few inactions have been seen among them the most noteworthy is keeping away from the patient in the wake of telling his issues. However, the individual has been given wrong medication so as to give him sedation. This activity has been led without legitimate examination to the situation (Ross et al. 2019). James is a patient with a perpetual suprapubic catheter which is the obligation of nursing staff to check appropriately. In this way, it was an inaction of Michelle for which he has disregarded the physical issues and breakdown of urinal bladder. Alongside this, he has disregarded the desire of James about getting some information about Michelle.

Legally and ethically, the issue can be analysed with the help of two major theoretical classification of nursing ethics. These principle ethical theories are deontology and utilitarianism. As per the theory of Utilitarianism, the end goal of caregiving must rely with means whether they are moral or not. On the other hand, as per Deontology theory, most of the end goals are required to be ethical as well as moral. Therefore, inclusion of Deontology theory must have been complied in the current scenario. In case of Michelle’s strategy of caregiving, the nursing code of conduct has not been identified in an effective way that must be complied with the following ethical positions (Donnelly et al. 2017).

One of the most significant is justice by which Michelle should have been provided with proper care in fair approach without concerning about James’s aggressive attitude or could morally convince him to keep calm. on the contrary, beneficence is another approach which must be taken by Michelle that allows him to take right decision (Subedi, Timalsina & Bhele, 2018). However, these decisions have been taken by in-charge when proper clinical adherence has not been conducted by Michelle. Despite of giving him treatment, the ethical issues of no-maleficence have not been conducted as health of James could be degraded and life harm was possible due to lack of urination before surgery.

In addition to this, lack of accountability has been also noticed for which Michelle has not accepted the irresponsible diagnosis done by him to James and in spite of taking proper care or seeking further guidance from the in-charge, he was trying to cover up the issues. Similarly, the issue of Fidelity has been also eradicated from the service and caregiving (Campbell, 2017). Additionally, the autonomy and determination are also avoided in a significant way which cause breach of the tort. Issues in own decision, values and perspective have been also identified and as Michelle has withhold the whole truth from the client, issues of veracity have been also identified. for this reasons, the ethical and legal issues have been predominantly noticed.

Accordingly, consideration of Deontology hypothesis more likely than not been gone along in the present situation. If there should be an occurrence of Michelle's procedure of providing care, the nursing set of principles has not been distinguished in a compelling manner that must be agreed to the accompanying moral positions. In order to avoid the aggressive behaviour of James, Michelle has completely ignored to take proper care of him and provided wrong medication and decision. Along with this, preventing the in-charge to take action was also a significant ethical dispute which has caused by Michelle.

Therefore, as per the Midwives and Nurse Practitioners Act 2010, this is a serious breach of code of conduct and for this reason significant actions can be taken (health.gov.au, 2020). despite what might be expected, helpfulness is another methodology which must be taken by Michelle that permits him to take right choice (Trollor et al. 2016). Notwithstanding, these choices have been taken by in-control when appropriate clinical adherence has not been led by Michelle. In spite of giving him treatment, the moral issues of no-perniciousness have not been directed as soundness of James could be debased and life hurt was conceivable because of absence of pee before medical procedure.

Moreover, absence of responsibility has been likewise seen for which Michelle has not acknowledged the contest directed by him to James and notwithstanding taking appropriate consideration or looking for additional direction from the in-control, he was attempting to conceal the issues (Schiller et al. 2019). Correspondingly, the issue of Fidelity has been likewise killed from the administration and providing care. Moreover, the self-governance and assurance are likewise maintained a strategic distance from in a noteworthy manner which cause penetrate of the tort. Issues in own choice, qualities and point of view have been additionally distinguished and as Michelle has retain every bit of relevant information from the customer, issues of veracity have been likewise recognized. for this reasons, the moral and lawful issues have been also conducted by Michelle with James.

Conclusion

Henceforth, it can be concluded, with the inclusion of more legal framework as per the nursing code of conduct as well as Code of Ethics and RN Standards of Practice, legal concern can be increased among nursing staffs. Along with this, it could be also possible for the patient to get ethical and proper diagnosis. In case of Michelle, he must provide proper decision by ignoring the behavioural constrains of James. This action has been conducted without proper investigation to the scenario. On the contrary, James is a patient with a permanent suprapubic catheter which is the duty of nursing staff to check properly. Therefore, it was an inaction of Michelle for which he has overlooked the physical issues and malfunction of urinal bladder.

References

Campbell, L. (2017). Clinical and organisation ethics: Implications for healthcare practice. In Key concepts and issues in nursing ethics (pp. 207-221). Springer, Cham. 

Donnelly, M. B., Horsley, T. L., Adams, W. H., Gallagher, P., &Zibricky, C. D. (2017). Effect of simulation on undergraduate nursing students’ knowledge of nursing ethics principles. Canadian Journal of Nursing Research, 49(4), 153-159. Retrieved on: 3 May, 2020, From: https://journals.sagepub.com/doi/abs/10.1177/0844562117731975

Griffith, R., &Tengnah, C. (2020). Law and professional issues in nursing. Learning Matters. 

health.gov.au (2020), The Department of Health, Retrieved on: 3 May, 2020, From: https://www1.health.gov.au/internet/main/publishing.nsf/Content/work-nurse

Ingham-Broomfield, R. (2017). A nurses' guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, The, 35(1), 40. Retrieved on: 3 May, 2020, From: https://search.informit.com.au/documentSummary;dn=509772218688556;res=ielapa

fMcBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. OJIN: The Online Journal of Issues in Nursing, 23(1). 

NMBA (2020), Professional standards, Retrieved on: 3 May, 2020, From: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

RNS (2020), Registered nurse standards for practice, Retrieved on: 3 May, 2020, From: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Ross, S., Naumann, P., Hinds-Jackson, D. V., & Stokes, L. (2019). Sexual harassment in nursing: ethical considerations and recommendations. OJIN: The Online Journal of Issues in Nursing, 24(1). 

Savage, T. A. (2017). Ethical issues in school nursing. OJIN: The Online Journal of Issues in Nursing, 22(3). 

Schiller, C. J., Pesut, B., Roussel, J., &Greig, M. (2019). But it’s legal, isn’t it? Law and ethics in nursing practice related to medical assistance in dying. Nursing Philosophy, 20(4),

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