• Internal Code :
  • Subject Code : NURS2004
  • University : curtin university
  • Subject Name : Nursing

Case Study: Nurses Decision Making 

Nurses have the responsibility of taking care of the patients. They have to provide the diseased individuals with support and motivation so that their health status could improve. With that, nurses have to assess and analyze the patient condition so that the correct diagnosis of the disease could be made. They also help the patients with their treatment plan and monitor their progress. In addition to that, it is embedded in their role that they cannot mishandle the patient or work while compromising the safety of the patient (Kieft et al., 2014). Therefore, this assessment is made to identify the ethical, legal and professional responsibilities of a registered nurse in the given scenario with the help of multiple relevant sources and guidelines. The best course of action would also be recognized to solve the problems that are known in the case study. The medical, social and legal issues first would be identified and patient consent will also be discussed. After that, the legal and ethical issue will be highlighted with the usage of relevant legislation. Registered nurse professional issues will also be talked about with the aid of various standards and guidelines that are set for them and then a clear action that could be taken by nurse student will be mentioned.

People living in residential care are mostly emotionally or physically incapable of taking care of themselves. Thus, they need help from other people who could help them with their impaired functional decline, strength and mobility. They also need assistance in doing physical activities (Farrell & Vellinga, 2019). Therefore, the medical issue that is faced by Mary in this scenario is incontinence. Incontinence is the loss of urine which is involuntary which causes hygienic and social problems. Because of incontinence, Mary has to stay in an unhealthy condition and this causes a decrease in the quality care and her quality of life (Farrell & Vellinga, 2019). The other problem which is faced by Mary is with the use of a Zimmer frame. Zimmer frame helps the patient in walking from one place to another. It helps them to support themselves and reduce the risk of falling (Thies et al., 2020).

In the case of Mary, she utilizes the Zimmer frame to go to the bathroom at night but the nurse does not allow her to use it. This causes problems for her in walking and thus she could not stand. She also has injuries because of dragging which causes her pain and discomfort. Mary was a patient who does not have any history of incidents related to confusion or confused state, therefore, she was mentally competent to make her own decision to use Zimmer frame or not but because the nurse is forcing her to stop using her is causing her injuries which could also have severe implication on her physical and mental health. The fears which have been generated by another registered nurse have caused a lot of fear in her which ultimately results in incontinence. Therefore, the life quality of Mary is in danger because of these issues as they can have severe consequences on her mental and physical health.

Due to the rude and inconsiderate behaviour of the night nurse, Mary could also develop psychosocial issues. Those could be depression, anxiety, insomnia and so on. The incorrect behaviour of the nurse could affect her emotional functioning, well-being, communication, interpersonal relationships, self-esteem and social functioning. Therefore, she would not be able to express her feelings and ideas properly (Fan et al., 2017). With that, Mary would also feel embarrassed to meet and interact with nurses because of the problem of incontinence which is because of fear of the nurse. The legal issues in this case study are that duty of care is not provided to the patient. She was manhandled by the nurse and was not given quality treatment. She was not treated in a respectful and dignified way and was told to keep quiet about the happenings. Her consent was also not taken by the nurse before taking her to the bathroom without the use of a Zimmer frame. Mary has to drag with the nurse to go to the bathroom. This shows that nurse did not work with the accordance of legal guidelines. Ethical issues which need to be addressed in this case are beneficence, non-maleficence, autonomy and justice as the night nurse was not working for the benefit of the patient and was causing injuries and harm to her. Patient's autonomy was also compromised and she was not treated fairly and equally.

Consent in healthcare is a very crucial part. Consent is an ethical and legal concept which states that all the information has been provided to the patient so that he can make a correct decision for his healthcare. Consent helps in securing the rights of the person so that no ill-treatment could be done to him in the healthcare facility (Hall, Prochazka & Fink, 2012). There are policies which look after the consent of people so that their rights are protected. Consent also makes sure that the care is safe, appropriate and effective to their requirements and needs and that they are provided with help in the efficient and timely manner (Government of Western Australia, 2020).

The patient in the case study that is Mary have the capacity to make sound decisions as there were no signs of the cognitive defect in her. Her participation is necessary because it is important in sharing of data and information. With that, the decision-making of the patient is also related to better treatment results and outcomes. Therefore, it can be said that patient here meet the criteria of making her own decision but the night nurse disregarded this which causes legal issues. According to the Nursing and Midwifery Board of Australia, code of conduct (2018), the nurse needs to respect the person-nurse professional relationship and should work according to the legislations and authorization. The nurse should also not engage in any unlawful behaviour with the patient receiving care. Thus, it can be said that night nurse behaviour was unlawful (Nursing and Midwifery Board of Australia, 2018).

The first legal issue involves the nurse who was told by Mary to not to report about the misconduct. The nurse has the legal responsibility for mandatory reporting. Nurses have the duty of caring for the patients and they have to identify the vulnerable people and protect them from any harm that might be caused to them. For that, they need to report about any nursing practice which might cause damage to the person who is receiving care. The nurse also has to take responsibility for the people in aged care and see that no one is neglecting them who may be at the risks (Nursing and Midwifery Board of Australia, 2018). The other legal issue was that night nurse showcase professional negligence and did not provide care to Mary. The nurse assaulted her and makes her crawl to the bathroom for urination at night.

It is also mentioned in the Health Practitioner National Law Act, (2010), that a healthcare professional should not conduct below the standards and should work with their experience and training (Health Practitioner National Law Act, 2010). The other legal issue in the case scenario was that Mary's consent was not taken by the nurse to inhibit her using the Zimmer. She was forcibly made to go to the bathroom with the use of her helping aids. This shows that her consent was not regarded by the night nurse while taking care of her. In the Criminal Code Compilation Act (1913), it is mentioned that a person who touches, moves, strikes or apply any kind of force onto another person with taking his permission or consent then it would be considered as assault and if they try to threaten them with the help of bodily gestures than also, the person has to face legal consequences. This kind of behaviour shown by healthcare professionals will come under assault and will be regarded as unlawful (Criminal Code Compilation Act, 1913).

Four fundamental ethical principles that could be related to the case of Mary would be beneficence, Non-maleficence, Autonomy and Justice. According to beneficence, the healthcare professional needs to promote the well-being of the patient and others. They have to benefit the diseased individuals and have to prevent them from any harm that might be caused to them. For benefiting the patient, the nurse could use evidence-based approach and thus make use of critical thinking before making any decision (Stone, 2018). In the principle of non-maleficence, it is stated that healthcare professional would never harm the patient or cause them any trouble. The nurses should also not have any intention to bring danger or harm to the diseased individual (Stone, 2018). Autonomy states that the patients' rights and consent will be regarded before making any medical decision about their healthcare. It also involves telling the patient about the data and information and making him a part of decision-making processes. The autonomy validates the personal rights and dignity and thus protects them from unnecessary harm (Stone, 2018).

By justice principle, the healthcare professional will do their duty fairly and properly by not involving any wrongful act or procedure that could be harmful to the patient. Therefore, in Mary's situation, the night nurse did not behave with her in a manner that would do benefit to her. Instead, she did try to harm her by using force. Her rights to consent were also not identified by the nurse and she did not do any justice or fair treatment with Mary (Stone, 2018). The first set of conflict which arises in the case was that the other nurse has the responsibility of mandatory reporting but she was told by the patient herself to keep quiet and not to tell anybody as going against her will, would be considered as disregarding her autonomy (Nursing and Midwifery Board of Australia, 2018). The other set of conflict is that while reporting about the misconduct, harm could be done to mental status of the patient but it is also significant because it will benefit her from getting rid of the night nurse (Stone, 2018).

The professional issue that is raised in the case was that the night nurse did not engage with the patient professionally and therapeutically and also was not able to form mutual respect and trust with the patient. The nurse was not respectful and was not behaving correctly. She also did not consider the patient's dignity, values and beliefs (Nursing and Midwifery Board APHRA, 2020). The other issue was that the night nurse did not promote a safe environment of care to Mary and also not supported her. She also did not demonstrate compassion, trustworthiness and responsiveness towards Mary Nursing and Midwifery Board APHRA, 2012). The third problem was that Mary did not receive person-centred practice from the night nurse. Mary's decision and consent was also not regarded by the nurse (Nursing and Midwifery Board of Australia, 2018). The fourth problem which can be observed in the scenario was that nurse did not take patient safety into the consideration. Incidents that happened with her highlighted that she has several injuries on her body. The nurse also did not take care of injuries while taking her to the bathroom at night. Thus, Mary's safety was compromised (National Safety and Quality Health Standards, 2012).

The best course of action that should be chosen by the nurse ethically involves treating the patient in a manner which would benefit her. The nurse should work in a way by which the patient would have better health outcomes. The nurse should work by keeping the principle of beneficence in her mind (Stone, 2018). Legally the nurse should report about any misconduct that is happening with the patient so that she could be protected and prevented from the severe risks or complications (Nursing and Midwifery Board of Australia, 2018). According to a professional standard, the nurse should provide safe, responsive and appropriate nursing practise to the patient. The nurse should also form relationships with Mary that ensures Mary's rights and dignity. The nurse with that involves in a therapeutic relationship with Mary so that better health outcomes could be reached (Nursing and Midwifery Board APHRA, 2020).

References

Criminal Code Compilation Act. (1913). Available at https://www.legislation.wa.gov.au/legislation/statutes.nsf/main_mrtitle_218_homepage.html

Fan, S. Y., Lin, I. M., Hsieh, J. G., & Chang, C. J. (2017). Psychosocial care provided by physicians and nurses in palliative care: A mixed-methods study. Journal of Pain and Symptom Management, 53(2), 216–223. https://doi.org/10.1016/j.jpainsymman.2016.08.019

Farrell, K., & Vellinga, A. (2019). Interventions for treating urinary incontinence in residential care: A narrative review. Geriatric Medicine and Gerontology, 5(4). DOI: 10.23937/2469-5858/1510078

Government of Western Australia. (2020). WA health consent to treatment policy. Available at https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Clinical-Governance-Safety-and-Quality/Mandatory-requirements/WA-Health-Consent-to-Treatment-Policy

Hall, D. E., Prochazka, A. V., & Fink, A. S. (2012). Informed consent for clinical treatment. CMAJ: Canadian Medical Association Journal, 184(5), 533–540. https://doi.org/10.1503/cmaj.112120

Health Practitioner National Law Act. Available at 2010https://www.legislation.wa.gov.au/legislation/statutes.nsf/law_a146782.html

Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. BMC Health Services Research, 14, 249. https://doi.org/10.1186/1472-6963-14-249

National Safety and Quality Health Standards (2012). Available at https://www.safetyandquality.gov.au/standards/nsqhs-standards

Nursing and Midwifery Board APHRA. (2020). Registered nurse standards for practice. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Nursing and Midwifery Board of Australia. (2018). Code of conduct. Available at file:///C:/Users/acer/Downloads/Nusing-and-Midwifery-Board---Code---Advance-copy---Code-of-conduct-for-nurses---Effective-1-March-2018.PDF

Nursing and Midwifery Board. (2012). Code of ethics. Available at https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf

Stone E. G. (2018). Evidence-based medicine and bioethics: Implications for health care organizations, clinicians, and patients. The Permanente Journal, 22, 18-030. https://doi.org/10.7812/TPP/18-030

Thies, S. B., Bates, A., Costamagna, E., Kenney, L., Granat, M., Webb, J., ... & Dawes, H. (2020). Are older people putting themselves at risk when using their walking frames?. BMC Geriatrics, 20(1), 1-11. https://doi.org/10.1186/s12877-020-1450-2

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