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Ethical and Legal Issues in Nursing

Introduction to Ethical and Legal Issues in Nursing

Ethics is defined as a term which is linked to morality. Ethics can be elaborated in the best possible way would be the different ways of analyzing, thinking and examining the best possible way to live a normal life (Johnstone & Hutchinson, 2015). Whereas nursing ethics can be better described as a practice that provides nursing guidance on how to adapt and act morally (Johnstone & Hutchinson, 2015).The international code of ethics for nurses was first adopted by the ICN (International Council of Nurses) (Forrestter & Griffiths, 2014). The code covers the vital points on ethical behaviour of nurses, their decision while encountering some barriers that are preventing them to perform their duties. Apart from these codes of ethics. In palliative care settings, the obligations of moral conduct and ethical actions are greater as the patients seek emotional and psychological support (Benton et al., 2013). The essay will cover the code of conduct and ethical practices which should be applied by the Registered nurses while providing care along with the special consideration of the case study of Nicole Mary Smith. This essay will also discuss the ethical dilemmas that may arise during the practice of nursing and establish suitable actions in the discourse to ensure maximum care and beneficence for the patient.

Case Scenario

Nicole Mary Smith is an 86-year old patient that has been diagnosed with ovarian cancer and has been suggested to shift in the palliative care units. Her daughter, who visits her in the care setting is anxious and distressed about the problems faced by her in the treatment of her mother and exclaims how she does not understand the point of treatment when her mother is going to die anyway.

Code of Conduct and Ethical Dilemma

The nursing and midwifery board of Australia has established a code of conduct to ensure that the patient in the care setting receives the highest quality care. The purpose off this code is to ensure the beneficence of the patient, promote patient autonomy, inculcate justice in actions by the healthcare professionals, and also assert non-maleficence in the clinical practice. The code also establishes the need for accountability and responsibility for actions with fidelity and informed consent for the treatment (Forrestter & Griffiths, 2014). The code captures the standards which are mandatory to be adopted in practice and it holds a great promise because the nurses may have their own beliefs or values and thus abiding with the mentioned code of conduct would benefit the nurse community, as a whole, irrespective of the person thinking or beliefs. The code is in accordance with the National Law and has seven principles of conduct. These principles include legal compliance, that is, abiding the national law by respecting and adhering to it. Person-centred care, focusing on providing practice that is evidence-based, person-centred and thus promoting health and well-being (NMBA, 2018).

Third, a cultural and respectful practice that asserts that the nurses must adhere to the privacy and the confidentiality by engaging in a respectful way and maintaining an honest relationship and treat all the patients with dignity and respect. Another important principle is of professionalism, that asserts in embodying integrity, compassion, respect and honesty. Another principle is to promote research. The seventh principle of the code asserts the importance of the promotion of health through health advocacy and patient education (NMBA, 2018). In the given case scenario, if the treatment of Nicole is stopped based on the concerns expressed by her daughter an ethical dilemma between autonomy, patient beneficence, and justice arises. Justice in nursing assures that every patient in the care setting must be treated with dignity and respect. This makes the treatment of Nicole justified even in palliative care with limited chances of recovery due to old age and terminal illness. Further, abortion of medication and care will worsen the health condition of the patient and affect their well being and quality of life (Chadwick & Gallagher, 2018). However, since the caretaker of the patient expresses concern about the course of treatment and its need, the autonomy must also be considered by providing proper education and assistance about the importance of treatment and ensuring dignity in the palliative care for Nicole. Further, if adequate care is not provided to Nicole it will be a breach of codes patient justice, respectful practice, and legal obligations established by the code of conduct of Nursing.

Dignity in A Palliative Care Setting

Dignity is an essential component of palliative care as it ensures that the patient is treated with respect and with justice (Butts & Rich, 2019). Patients like Nicole that are fighting with a terminal illness and old age require essential support as along with physical ailments they are also suffering from enormous psychological distress. Daughter of Nicole must be educated about the importance of dignity in palliative care and how it can help in the improvement of quality of life. Dignity ensures that a positive environment is maintained in a care setting and the overall beneficence of the patient is ensured (Butts & Rich, 2019). It also assures that the patient receives psychological assistance and support in their course of treatment and thereby maintain a possible outlook towards recovery and maintain hope. Dignified practices in healthcare for patients with terminal illness also helps in boosting their confidence and helps in the development of a positive outlook. The third principle of the Nursing and Midwifery Board of Australia (2018) also highlights the significance of dignity in the care practices and states that a positive and dignified care environment must be ensured for the highest quality of care provided to the patient.

Therefore, as a registered nurse, suitable goals for the management of the condition of Nicole in the confidence of the daughter must be established for health promotion and well-being. Primarily, the daughter of Nicole should be explained about the significance of dignified practices in the palliative care setting. Access to healthcare is a primary right of Nicole even in her terminal illness and therefore she should be receiving the highest quality and care and support from the palliative care units. Issuing of statements like “she is going to die anyway” can severely impact the psychological well being of Nicole and instil a feeling of unwantedness in her. This can have a severe impact on her health and worsen her condition as she may develop a pessimistic outlook on the care service provided (Altaker et al., 2018).

On the contrary, having the support of family and close associates has been found to effective in the improvement of quality of life of a patient suffering from a terminal illness. Therefore, dignity in the care of Nicole should be ensured and provided in the palliative care setting. Dignified practices in nursing also help in rapport building and assist in the development of strong communication and interpersonal skills between the carer and the patient. This helps in addressing the care needs more effectively and precisely improving the overall quality of care. Dignified practices are also the health right of patients like Nicole as it entitles them to have quality care and effective management of health condition in hospital settings. Therefore, as a moral and well as a legal obligation, the patient dignity must be restored and ensured for further practice and care of Nicole

Legalities and Actions

According to the Australian Commission on Safety and Quality in Health Care, it depends on the patient being treated to refuse to accept the treatment and the nurse should respect it with consideration of different cultural aspects and beliefs. The code of conduct establishes the primary principle as legal compliance that abides working health professionals. The healthcare professionals are obligated under the sections of 129,130,131, and 141 of the national law of Australia to ensure the beneficence of the patient (NMBA, 2018). The Australian Health Practitioner Regulation Agency (AHPRA) (2016) also underlines the statements which decide the course of action taken against the legal obligations and issues statements regarding the following of the systems. These guidelines assert that any action taken in a healthcare setting that may pose to be a health risk for the patient shall be considered as a violation of the code of conduct and professional misconduct. This misconduct can eventually cause termination from the healthcare practice and cancellation of practitioner license. In the case of Nicole, If the health is neglected by the registered nurse, it will be a violation of the legal obligations and can cause severe actions.

Therefore, to prevent such an incident, a following course of action should be considered (AHPRA, 2016). First, as suggested by the doctor, the patient must be shifted to the palliative care setting. Secondly, the daughter for Nicole must be helped and educated about the importance of dignity and care for Nicole. She should be explained about the importance of palliative care and why this will be essential for the quality of life and longevity of Nicole. Moreover, as a registered nurse, the family of Nicole must be assisted with finding a suitable palliative care centre for the transfer of care so that the visiting is less time consuming and feasible for the family. Monetary assistance should also be provided and suggested through the government-subsidized schemes that can help in the care of Nicole without making the family feel that it is a burden of some kind (Hernández-Marrero et al., 2019).

By taking these suitable actions, the quality of life of Nicole can be improved and holistic care can be ensured. In the given case scenario, the conflict has arisen between autonomy, justice, and patient beneficence. Therefore, the principle pf code of conduct that ensures dignified practice and health advocacy must be applied by the registered nurse. Through leadership and conflict resolution frameworks the family of Nicole must be educated about the importance of palliative care and how quality healthcare is her fundamental right must be asserted (Mendes et al., 2017). Moreover, the patient must be informed about the importance of dignity in care must be illustrated by the registered nurse to ensure that the patient demands are met with justice and a person-centred approach. Failure to meet these needs and causing any intentional or unintended harm to the health of the patient can give rise to several legal complications like termination of license and abandonment of practice and hence should be avoided (Gielen et al., 2016).

Conclusion on Ethical and Legal Issues in Nursing

This essay focusses on the case of a particular patient, Nicole, an 86-year-old patient diagnosed with ovarian cancer who has been suggested to move to the palliative care setting. The daughter of the patient is anxious and doesn’t understand the point of treatment as she exclaims that her mother is going to die anyway. This essay thus explores an ethical dilemma that arises in this situation between the principles of justice, beneficence, and autonomy. The ethical code of conduct established by the government of Australia has been discussed in association with the case where the concepts of patient dignity, lawful behaviour and health advocacy have been explored. Further, this essay also highlights the legal obligations under the national law and AHPRA that abide the healthcare professionals and the registered nurses under lawful conduct to ensure the beneficence of the patient. The importance of dignity in palliative care has also been discussed in this essay The suitable actions that should be taken by the registered nurse have been discussed in this document that asserts that along with information about the importance of palliative care for Nicole, transfer of care to a nearby palliative care centre and the subsidized treatment options can be considered for the improvement in the health of Nicole. These cations have been suggested to provide maximized quality and care experience in her palliative setting with the support of family and her associates to ensure her physical as well as psychological well being.

References for Ethical and Legal Issues in Nursing

AHPRA (2016) Nursing guidelines. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwif8bXQyMDqAhUH4jgGHZfjB_8QFjABegQIBBAB&url=https%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fcodes-guidelines-statements%2Fprofessional-standards%2Fregistered-nurse-standards-for-practice.aspx&usg=AOvVaw3buIZe8QnrdvQrpIyKcNzd

Altaker, K. W., Howie-Esquivel, J., & Cataldo, J. K. (2018). Relationships among palliative care, ethical climate, empowerment, and moral distress in intensive care unit nurses. American Journal of Critical Care, 27(4), 295-302.

Benton, D., Gonzalez-Jurado, M., &Beneit-Montesinos, J. (2013). A structured policy review of the principles of professional self-regulation. International Nursing Review, 60(1), 13—22.

Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Australia: Jones & Bartlett Learning.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. United Kingdom: Macmillan International Higher Education.

DeLaune, S. C., McTier, L., Tollefson, J., Lawrence, J., & Ladner, P. K. (2019). Fundamentals of Nursing: Australia & NZ Edition 2e. Australia: Cengage AU

Forrester, K., & Griffiths, D. (2014). Essentials of Law for Health Professionals-eBook. Elsevier Health Sciences.

Gielen, J., Bhatnagar, S., & Chaturvedi, S. K. (2016). Spirituality as an ethical challenge in Indian palliative care: A systematic review. Palliative & supportive care, 14(5), 561-582.

Hernández-Marrero, P., Fradique, E., & Pereira, S. M. (2019). Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis. Nursing Ethics, 26(6), 1680-1695.

Johnstone, M. J., & Hutchinson, A. (2015). ‘Moral distress’–time to abandon a flawed nursing construct? Nursing Ethics22(1), 5-14.

Mendes, J., Wool, J., & Wool, C. (2017). Ethical considerations in perinatal palliative care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 367-377.

NMBA (2018). Code of Conduct.

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