The ethical and legal guidelines of practice are established to ensure a regulatory form of action and practice for the beneficence and well being of the community in consideration (Butts & Rich, 2019). Ethics in healthcare to provide moral guidance to the practitioners and ensure the well being of the community. Nursing in ethics is a principle that describes a moral stencil that can adhere to the directions and ensure patient justice, beneficence, non-maleficence, fidelity, accountability, veracity, and autonomy (Grace, 2017). This ensures the well being of the patient and their overall beneficence. The Nursing and Midwifery Board of Australia has also established a set of rules as guidelines to help the healthcare practitioners that allow them to work for the welfare of the patients and follow the regulations to ensure the highest quality of care. Many times, the healthcare professionals present a dichotomy of opinions deciding the welfare of the patient and this results in an ethical dilemma (Chadwick & Gallagher, 2016). Seeking the guidance of the seniors and abiding by the established code of conduct helps the professionals in these situations to make the right decision. This essay will focus on a clinical situation of a particular case scenario and outline the ethical and legal issues that may arise in nursing and determine the suitable actions that will be most appropriate for the beneficence of the patient through a detailed discussion.
The case is focused on an 86-year-old patient, Nicole Smith who has been admitted in the emergency department and has been diagnosed with ovarian cancer. The patient has been suggested to shift to the palliative care setting. The patient lives alone and her daughter has exhibited anxiousness regarding the health condition of the patient. And has expressed that the care being provided to her is time-consuming for her and cumbersome and has asked why Nicole still requires care when she is going to die anyway.
Maintenance of patient dignity at the end of life is essential and the patient in palliative care deserves to be treated with respect (Macauley, 2018). The patient requires additional support for hospice and can help in the improvement of patient dignity. This also ensures that the patient receives respectful clinical and personal care with emotional and spiritual care (Sandman et al., 2017). Nicole must be treated with the essential dignity and care. The daughter of the patient should be explained about the creation of a respectful atmosphere about the importance of dignity in palliative care. Nicole is an old patient and has been suggested to move to the palliative care setting. Palliative care is mandated in cancer care for terminal chronic illness. Palliative care helps in the controlling of the pain and symptoms. The end of life care should be used for the management of illness ethically (Hernández-Marrero et al., 2019). Palliative care experts should share the responsibilities and help the patient with honesty and dignity. The suffering of the patient in palliative care is important. The statement of the daughter of Nicole can impact the psychological health of the patient.
This can make Nicole feel unwanted and distressed and this can impact the overall health of the patient (Henry, 2016). Dignity is extremely essential for patient care and support in palliative care. Dignified care helps the patient to ensure that the patient feels comforted and safe in the hospital environment. Dignity in palliative care also ensures that there is a strong interpersonal relationship between the carer and the patient. This allows for the provision of highest quality care as the patient needs are addressed with the highest priority and person-centred care is ensured (Altaker et al., 2018). In the provided case scenario, the dignity of the patient is compromised. Access to quality healthcare is a fundamental right of all the patients with equitable availability of health resources with suitable care.
If a patient is fighting terminal illness even with minimal chances of care, the patient must be treated with dignity and the health condition must be managed adequately. The patients in palliative care require additional and psychological support as they are under extreme pain and fear of terminal illness (Muldrew, 2019). Dignity in care ensures that the patient can boost their self-esteem and confidence and helps them develop an optimistic approach. The principle three of code of conduct by the nursing and the Midwifery Board asserts that the nurses must ensure “a positive, culturally safe work environment through role modelling, and supporting the rights, dignity and safety of others” (NMBA, 2018). Hence, psychological support, dignity, and care should be provided to Nicole
The Nursing and midwifery Code of Conduct has established the principles of ethics that abide the working professionals to legal compliance, person-cantered practice, cultural practice and respectful relationships, exhibit professional behaviour, teach, supervise, and assess the practice, research, and promote health and well being (NMBA, 2018). The nurses must abide and adhere to the professional obligations under the National Law of Australia. The nurses must also ensure to provide safe and person-centred care with an evidence-based approach. The wellbeing of the patients must be ensured. The nurses must also embody integrity, honesty, compassion, and respect. The nurses must promote health and wellbeing and ensure the wellbeing of the patients (NMBA, 2018). In palliative care, compassion and person-centred care are extremely crucial. Patients in palliative acre require additional psychological support and comfort and limited scope. Care for a terminally ill patient is a specialised discipline and requires essential mental support. This support helps the patients by encouraging them to express their feelings about the illness and helps in the development of rapport with the patient (Johnson, 2017).
The autonomy in ethical consideration ensures that the patient has the right to choose and or refuse medical treatment. Beneficence in ethical consideration ensures that a doctor should be able to act in the best interest for the patient. Practising non-maleficence ensures that the patient will not experience any harm. Justice in ethical considerations ensures that the health resources are distributed to the patients with equity (Harstäde et al., 2018). The ethical consideration in healthcare, dignity ensures that the patient has the right to dignity. Informed consent is also one of the essential considerations of ethical guidelines. The ethical and legal considerations may often give rise to a dilemma in practice. In the given case scenario, the daughter of Nicole is expressing an anxiousness and is expressing that she does not understand why she is still receiving care when she has no scope of further recovery. This presents a conflict for the nurse between the autonomy, beneficence, and the dignity of the patient. The legal and ethical considerations in nursing in the given case scenario is focussed on decision making, strong communication, and development of rapport with the patients and their allies. The autonomy and beneficence in patient care can sometimes pose a conflict in nursing care (Akin Korhan et al., 2017)..
As the daughter of the patient is asserting on abortion of care services to the patient but this will be a violation of the primary access to patient care and dignity in healthcare. Further, abortion of care services can also cause severe harm to the patient and can be considered as the act of maleficence. Therefore, as a registered nurse, the primary goal should be to educate the patient and her daughter about the importance of care in terminal illness. The daughter of the patient should also be explained that patients in the palliative care setting must be provided dignity and respect. Patients with a terminal illness and in palliative care especially vulnerable, adequate informed consent should be taken, risks and benefits of palliative care should be considered (Ferrell et al., 2018).
The first principle of the nursing code adheres the nurses to have legal compliance. The nurses must respect and follow the professional obligations that are established under national law. The obligations assert that the nurses must that the nurses (DeLaune et al., 2019). The healthcare professionals are obliged to ensure beneficence of the patient under the sections of 129,130,131, and 141 of the national law (NMBA, 2018). The Australian Health Practitioner Regulation Agency (AHPRA) has also established the regulations that abide by the healthcare practitioners that outlines the legal or suspension, limitations, and undertakings of the practice (AHPRA, 2016). Any practice that may pose a health risk can be accounted to be as unprofessional conduct or misconduct can lead to suspension of practice or termination of the healthcare practice. The NMBA registration nurse standard has also been developed to ensure that the nurses can practice the established code. Further, the lawful behaviour by the code of conduct assures that the nurses must adhere to the nurse-person professional relationship, comply with the established legislation, policy, scope of practice (NMBA, 2018).
In the given case scenario, the major ethical problem that is arising is a conflict between the patient beneficence and the autonomy of the family. The principle of the code of conduct by the nursing and the midwifery Board of Australia highlights the significance of health advocacy. As a registered nurse, health advocacy becomes of prime importance. The nurse must educate the importance of care for Nicole to her daughter and explain her the consequences of termination of care practices so that an informed choice can be made. The nurse must educate the patient and her family about the importance of care services and how they will benefit her and her longevity (DeLaune et al., 2019). Further, since the daughter has expressed that the commute and care services are being difficult for her, the nurse must suggest suitable alternatives and palliative care settings that are near the family to make the visits and care for Nicole more feasible.
The nurse should also assist the family with the care schemes and medication services that are subsidised by the government to minimise the economic load of care and enhance the involvement of the family (Muldrew, 2019). The family of the patient must also be educated about the importance and significance of family support in a palliative care and how positive environment and optimistic approach can serve to be of essential importance at the end of life care services (DeLaune et al., 2019). If the suitable actions are not taken, the care of Nicole may eventually get aborted that will lead to faster progression of her cancer and worsen her health condition. This can also result in limiting her overall longevity and can cause severe harm to her beneficence and wellbeing.
This essay summarises the ethical and legal obligations of a nurse in a medical setting where dilemmas and conflicts may often arise. This essay focuses on a particular case scenario of an eighty-six-year-old patient, Nicole who has been diagnosed with ovarian cancer and has to be shifted to a palliative care setting. However, daughter of Nicole does not see the importance of this action as she perceives that this care is of no use as eventually, her mother will die. This essay highlights the importance of dignity in palliative care to assert that even when the patients are fighting with a terminal illness, it is their fundamental right to be treated with dignity and health equity. This essay also asserts that caring with dignity helps in the development of an optimistic environment and provides psychological support impacting the quality of life of the patient when in care. The legal and ethical codes by the government of Australia have also been explained in this essay to assert the obligatory actions that must be taken by the registered nurse to ensure the well-being and beneficence of the patient. The code of conduct and the national law along with guidelines by NMBA and AHPRA have been identified to be of prime importance. The suitable actions that the nurse should take to resolve the conflict in the case scenario have also been provided through an evidence-based approach.
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