The nursing is a complex domain wherein they are expected to work within the standards and ethics that ensures high quality and safe patient care delivery. This is the case study analysis essay that aims to describe the legal and ethical issues identified in the case study of Mrs. Mavis Donaldson. This essay will include the description of possible errors using ethical and legal principles and the duty of nurses that they should have followed in compliance with professional codes and standards. There are different ethical principles and legal principles that the nurses must follow while the delivery of high quality and safe nursing care to the patients. This will also include the use of an ethical decision-making framework while planning the work and all the possible ethical and legal professional concerns that will be identified from the case study. This case study analysis will also provide possible actions that could be taken and the implication from a legal and ethical perspective. This will also cover the torts or other legal concerns that apply to the suggested actions that could be taken to save a life. All the application of a professional code of conduct and ethics will be considered while crafting the work for this case study. The appropriate ethical decision-making model is given by the “Nursing and Midwifery Board of Australia” will be used throughout to guide the work of the nurses.
This is the case of Mrs. Mavis Donaldson who was admitted to ICU after found unconscious by a visitor on the floor. The Coroner inquest states that the nursing staff deficiencies contributed to both the fall and the failure to do observations, the total number of nurses was too low and the proportion of agency and overtime nurses and nurses from a different area in the hospital were too high and the nursing skills mix was problematic. The main issue identified as per the case study is that the nursing staff failed to perform their task with efficacy and had not done their observations as prescribed. It also states that if the nursing staff had done the observation well in time then her bleed would have been picked up earlier and the earlier treatment would also have saved her life.As per the decision making framework given by “Nursing and Midwifery Board of Australia”, only the registered nurse should make decisions on who and which health care professional is capable of doing the work (“Nursing and Midwifery Board of Australia, 2016”). They have the right to delegate the task as per the capability and the scope of practice of the subordinate nurses.
The ethical concern identified with this case of Mrs. Mavis Donaldson is the shortage of nursing staff which leads to poor patient care. A persistent shortage of nursing staff challenges the belief and values of the nursing profession (Combes, Elliott & Skatun, 2018). The insufficiency in staffing makes it difficult for the nurses to carry out their ethical obligations to the patients. The ethical concern here is that the nursing staff shortage makes them experience emotional distress and job dissatisfaction due to which they end up in the ethical dilemma of either caring for their welfare or the needs of the patients (Leung, Wu, Kwong & Ching, 2019). There is an ethical obligation that must be fulfilled by the nurses during their daily duties which are to protect the patients from any harm. The nurses must work in accordance with the ethical principle of non- maleficence which states that the medical health professionals must avoid the causation of harm (Bufacchi, 2020). No harm should be provided to the patients.
As discussed in the case study, if the nurses on duty have looked at the patient knowing the current condition of the patient and would have performed their task of observation timely then the patient’s death could have been prevented. The nursing staff finds it challenging to ensure that they protect the patients from any harm because the hospital setting assigns them the work of caring for many patients (Bucknall et al., 2019). They fail to meet unrealistic goals which become a great problem for the patients who require special attention all the time. The inappropriate staffing levels within a hospital setting increase patient mortality due to the failure of receiving the necessary care that they deserve on time. This inappropriate working environment also makes the nurses suffer from emotional distress as a result of which they do not communicate with the patients or their family members thus do not provide meaningful nursing care (Copanitsanou et al., 2017).
The legal concern of inadequate nursing staff is a major fundamental issue in the health care centers which leads to a number of consequences and dangers that are extensive in this setting. There are four legal elements in nursing that are duty, breach of duty, damages and causation (Aiken & Miller, 2019). The breach of duty refers to the act of failure of nurses to do what a reasonable and prudent professional nurse would perform under similar circumstances.
The nurses also get into malpractices that mainly occur when there is an overlapping of ethical principles. The breach of duty refers to when the nurses fail to do their duty as a result of which the ethical principle of non- maleficence is violated (Brous, 2019). In legal cases, there are specific defenses to negligence. In this case, the nurses were negligent towards their work. The hospital setting also got into this malpractice as they had inadequate nursing staff. The negligence more often results in the claim of negligent care when the illness is worsened by the inexperience of the one who is taking care of a patient (Grant, 2017).
In this case, there was an RN Coordinator, and only six other nurses working in the busy ward of thirty-three patients. There were some patients who were critically ill and required a lot of attention. The nursing team was made up of enrolled nurses, agency nurses, one from a different department and one that had been called for an OT shift. The nurses should use a decision-making framework to allocate the work to different nurses as per their scope of practice. The “Nursing and Midwifery Board of Australia” gives a decision-making framework that states only the RN has a right to delegate the tasks and this framework can be used to initiate the discussion about the professional issues and to raise awareness in relation to the scope of practice and decision- making (“Nursing and Midwifery Board of Australia”, 2016).
The nurses should make decisions about everyday practice and the change to practice over time that prioritizes meeting the health needs of the community. In this case, the RN Coordinator was present and it was his duty to use a decision-making framework to manage the nursing staff shortage. Their main goal should be to meet the health care needs of the patients and this should be always done by using a decision-making framework. The nursing management should have taken different steps to attend the patients and nursing shortage so that patient safety can be achieved. The possible actions that could be taken are the ones that have the implication from a legal and ethical perspective. The nurses should always work in compliance with the ethical principles of autonomy, justice, beneficence and non- maleficence.
Even when there is a shortage if nursing staff, they should always give their best of work so that patient safety is achieved. The RN should use the decision-making framework to delegate the tasks as per the qualities and capabilities of different health care professionals so that the work overload can be reduced from the nurses and be share with others who are capable of doing things. This would help them to work in accordance with non- maleficence principle which states that the health care professionals should work in a manner that causes no harm. The delegation of tasks to an appropriate person will cause no harm to the patient. They should serve justice to all the patients and no patient should be prioritized over the other. There are ethical implications if the RN uses delegation for different tasks which are within the scope of practice of enrolled nurses and agency nurses.
A tort is a civil wrong committed against a person or a property and is punishable by the damage rather than imprisonment(DeMarco, Jones & Daly, 2019). There applies a negligent tort in this context. Negligent tort refers to a tort committed as a result of a failure to act as a reasonable professional to someone that is patients in this case, to whom he/she owns a duty (DeMarco, Jones & Daly, 2019). In negligent torts, there must be damage that results from the breach of duty. The medical malpractices fall into this negligent torts. Under these same circumstances, the other nurses would have also performed their best for patient safety. So, if the assigned workers fail to work with their best efficacy, they will fall into negligence torts. The hospital setting in the case study was a victim of gross negligence that is severed form of negligence in which the intentional omission of proper care was done that is the improper care of delivery (Keatings & Adams, 2019). The mentioned possible actions are highly relevant and the people who will be delegated tasks will be considered under ordinary negligent tort if they will fail to do what a registered nurse and prudent person would do under the same circumstances.
The nurses who have been delegated tasks by RN along with other health care workers must work in compliance with the code of ethics and standards given by NMBA. The RN should be able to provide a positive staffing environment in which the clinical practice is delivered. Nurses are the main professional component of the front line staff in most of the health systems and the nursing shortage is considered as an organizational challenge. This organizational challenge can be best met by RN delegating the tasks to different health care professionals as per their duty and by conducting a training session for two days in which all must be taught the basics of clinical practice. A positive working environment should be made for the nurses working in health care organizations so that they are motivated to work their best and to reduce the emotional distress they go through (Rankin, Matthwes, Russell & Pollard, 2016). The causes of nurse shortages are multi-faceted but this can be best managed through nursing staff members. The RN should identify the 'best practice' evidence so that patient safety can be ensured. There is a requirement of policy attention in this case but the hospital settings must ensure that the nurses ensure a good working environment like flexible employment opportunities, retention of nursing staff and patient care.
There can be implications of the professional liabilities if the people do not follow the instructions of the RN. There is a professional liability of “The Doctrine of Respondeat Superior” under which a hospital brings to a lawsuit about the negligence act of its nurse employees (Driscoll & Masters, 2018). In the case study also, the nurse did not perform her task well of taking observation, otherwise the life of Mrs. Mavis could have been saved. There are many areas under “The Doctrine of Respondeat Superior” like the failure to report significant changes in the patient’s condition and so on (Broadway, 2018).
The conclusion drawn is that the fault was of a nursing management system in which they failed to provide a sufficient number of nurses to the patients as a result of which one of the patients Mrs. Mavis fell down to death under the negligence of the working staff. The RN should take some measures while working with the staff members when there is a nursing staff shortage so that the patient's safety is confirmed. They must work in compliance with the code of conduct, standards of practice and legal and ethical considerations so that the worst can be avoided. Patient safety should be a priority for all and the RN should put all the efforts to maintain a good working environment for all the staff members. No one should breach their duty of care and should involve themselves at their levels best for the care of patients so that their lives can be saved.
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