Cathy has been identified with bruises and asthmatic symptoms by neighbour Manuel. She has been admitted in hospital by Dr.Hing and immediate treatment is given. Once stable, she wants to leave the hospital and does not want to take antibiotics.
Did Manuel do the right thing by calling her doctor without Cathy’s consent?
Did Cathy's children, Arnold and Patra, do the right thing by informing Michael about Cathy's current health status?
Is Cathy's autonomous decision to get discharged without continuing for the treatment correct? Can it be followed?
Is Michael's suggestion that Cathy should move back with him correct?
The people involved in this case study are: Cathy Chen,
her husband Michael,
her son Arnold and
her daughter Petra.
Cathy's neighbour Manuel
Cathy's doctor: Dr. Hing
Registered nurse: RN Stephen
Cathy is a conscious person and she has a right to decide what, when and with whom her health information is shared with. She also has a right to decide whether she wanted to undergo some specific treatment or not. The patient has the right to decide whether she wants to continue the prescribed treatment or otherwise. The registered nurse may patiently describe the benefits of the treatment and facts that it poses no harm to the patient and gently persuade the patient to continue the treatment. But it is always the autonomous decision of the patient to take up the treatment.
Manuel has called Cathy’s doctor and got her admitted in the hospital for treatment without her consent, but in good interests.
Doctor Hing Doctor Hing has admitted and treated Cathy. He has informed about her admission and current status to her children, without getting her approval, but in good interest.
Arnold and Petra have shared the current health condition of their mother Cathy, with their father in best interest of Cathy.
Manuel called the doctor and got Cathy admitted so that her health doesn't deteriorate further. Manual’s decision to call the ambulance and get her admitted in the hospital without her consent would have hurt Cathy. But if Manuel had not called the doctor, that would have definitely hurt Cathy worse. If Cathy had not arrived on time to the hospital for asthma treatment, he condition might have got worse and she might have been hurt.
Arnold and Petra have been in contact with Michael even after he left home. It has got no contact with him in the past 7 years. So, informing about her current health status to him may not be liked by Cathy and she might feel offended. But Arnold and Patra called Michael just to ensure some family member was around Cathy to take care of her. Since Michael has told that he could take care of Cathy only if she moves in with him, their purpose of calling him has failed. It is exclusively in Cathy’s discretion whether she stays alone at home, or in the hospital or even to move in with Michael. Arnold and Petra are responsible for informing Michael without Cathy knowing about their decision.
Applying ICN code of Ethics to be followed by a Nurse in this situation:
1) E 1.a The nurse’s primary professional responsibility is to people requiring nursing care.
2) E 1.b
In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.
3) E 1.e
The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations.
4) E 1.g
The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity.
5) E 2.e
The nurse strives to foster and maintain a practice culture promoting ethical behaviour and open dialogue.
6) E 2.f
The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.
NMBA Codes (Nursing and Midwifery Board of Australia (NMBA), 2008)
1) Principle 6.1
To provide comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people.
2) Principle 3.7
It identifies and promotes the integral role of nursing practice and the profession in influencing better health outcomes for people.
3) Principle 2.2
Communicates effectively, and is respectful of a person’s dignity, culture, values, beliefs and rights.
4) Principle 3.2
To provide the information and education required to enhance people’s control over health.
5) Principle 2.4
To provide support and directs people to resources to optimise health related decisions.
6) Principle 2.6
To use delegation, supervision, coordination, consultation and referrals in professional relationships to achieve improved health outcomes
1) As a Registered Nurse, Stephan has a responsibility towards the well-being of Cathy and he does his best to ensure the physical wellness and comfort of Cathy.
2) Stephen could relate with Cathy's decision of not willing to stay in the hospital. He understands that it has the right to decide whether she wants to continue a specific treatment or not. He respects opinions and does not form any judgement about her decisions.
3) He also understands how it might feel when she comes to know that her children have informed her ex-husband, about her illness and also about reaction to it. But he values relationship with family members and does not reveal any information about the situation to anybody without Cathy's explicit consent.
4) In the current stage, Cathy is old and she lives in a retirement home with no immediate family to take care of her. As a registered nurse it is the responsibility of Stephen to take care of vulnerable people and he does it with utmost sincerity by attending to various means of Cathy with utmost care.
5) In order to promote healthy relationship, he should openly discuss about Cathy’s health conditions with her. He should gently explain the difficulties she may face if she does not take proper treatment and refuses to consume antibiotics.
6) He must softly insist on staying in the hospital and taking professional care because it needs attention at this point of time. While conveying his opinion, he should not be not harsh or rude. But he must be open and politely describe the situation to Cathy. Open communication between a registered nurse and a patient is highly appreciable.
7) Stephan should patiently explain the kind of treatment that would be provided to Cathy, if she consents. He should explain the benefits of the treatment and assure her that the treatments used are safe and would not harm her in anyway. Stephan should convince Cathy to extend her stay in the hospital and persuade her to take antibiotic treatment confidently and get well soon.
8) He should not bother about her using Cantonese words while responding. He should understand that she is sick and might need help. Additionally, he should inform about her absent-minded use of Cantonese while speaking, as it is a new symptom and she has never used Cantonese between English sentences before. This pointer may help the doctor to check whether this is a sign of geriatric senility or a symptom of some other condition or even a side effect of some drugs.
1) Cathy should feel that she is getting well physically.
2) Since she is conscious, her decision on continuing the treatment further or otherwise must be valued and respected. She should be given choice to use her discretionary power to decide whether her health condition is shared with anyone else and whether someone should be contacted on her behalf for making an Advance Directive.
3) Despite Cathy's vulnerability, Stephen treats her with respect and compassion. He is responsive to her needs takes good care of her.
4) A professional, trusted relationship must be maintained between the Registered Nurse and the patient. The Nurse should gain the confidence of the patient Cathy and understand that his recommendations are in the best interests of her.
5) Being in the professional relationship with Cathy, the registered nurse should value her privacy and integrity. He should provide Cathy will all possible assistance to make her feel comfortable and get well soon.
In the present work, various ethical issues in the context of the case study have been explored. Specific guidelines from NMBA codes and ICN codes are explained to handle the situation better. Before proceeding further, it should be understood, Ethical decisions are made after a systematic examination of various viewpoints related to moral questions of right and wrong decisions (Mohajjel-Aghdam, Hassankhani, Zamanzadeh, Khameneh, & Moghaddam, 2013). So, as a registered nurse it is crucial to know the laws and various rules that govern certain deeds. It is also important to abide these laws. Various guidelines that have been provided for being equitable and successful as a nurse such as the ICN and NMBA codes must be referred and the appropriate principles to follow help in understanding how should a registered nurse should operate under different situations (Nursing and Midwifery Board of Australia, 2008).
Advancecaredirectives.sa.gov.au. n.d. Advance Care Directives. [online] Available at: <https://advancecaredirectives.sa.gov.au/about> [Accessed 20 May 2020].
Mohajjel-Aghdam, A., Hassankhani, H., Zamanzadeh, V., Khameneh, S., & Moghaddam, S. (2013). Knowledge and Performance about Nursing Ethic Codes from Nurses’ and Patients’ Perspective in Tabriz Teaching Hospitals, Iran. Journal of Caring Sciences. https://doi.org/10.5681/jcs.2013.027
Nursing and Midwifery Board of Australia. (2008). Code of Ethics for Midwives in Australia. Nursing and Midwifery Board of Australia.
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