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According to Podgorica(2020), the nurse should always follow the nursing professional standards in the workplace. The boundaries of ethical and legal practices should always be maintained in nursing duties. These actions not only ensure the patient’s safety but also ensure that the nurse is working professionally with which will never result in legal complications. In nursing there are mainly 4 ethical principles, these are as follows: justice- delivery of fair care services to the patients; beneficence – do good to others and maintenance of balance between the harm and the benefits; non-maleficence – obligation to cause no harm to the patient; autonomy – respect to patient’s rights and self-determination. The nursing standards ensure therapeutic care, comprehensive care, effective communication, effective evaluation and monitoring of the patients, and efficient planning for improved patent health outcomes (Sofronas et al., 2018). If the nursing guidelines are not maintained then the nursing will not be accountable for her actions that will negatively impact the health and well-being of the patient.In this essay, the following section will discuss professional principles, identify the ethical and legal aspects of the case study, consent, legal and professional issues in the case study as well.
In the case study, the medical problems were the bruises on both arms of the patient, the patient early had no confusion and could walk well with her Zimmer frame, but after few days she became incontinent. The social problem was the woman's abuse. In this case study, the female patient was treated in such a bad manner by the night nurse that she became frightened by her. The ethical issues in the case study were the safety of the patient was not maintained by the night nurse, as she dragged her instead of talking her carefully to the toilet, the unsafe environment was felt by the patient, inefficient delivery of safe care to the patient with unprofessional practices. As the patient was frightened, she asked not to tell anybody about her condition shows that no professional or ethical principles or values were maintained by the night nurse in her duty. So, legally strict actions can be taken for such unlawful behavior of a nurse. A patient can file a legal document in the police if she/he is not provided with safe and professional care and if she/she is harmed due to the care. Such care services result in harm to patient safety so legal action is considered in such cases. According to Rubio et al. (2020), the most common legal and ethical issues in nursing are as follows: conflicts, imbalance in safety and quality of care services, time and resources used for the care, lawless behavior, discrimination, stigmatization, disrespect to the patient, and many others. The social issues that impact nursing practices are abuse, conflicts, workforce problems, workplace hazards, staffing issues, and many others.
It is the right of the patient to either accept or refuse the care services; this is referred to as consent of the patient. The medical decision-making capacity is the ability of the patient to understand the risks or benefits of the intervention, treatment, and care services, and the basis of informed consent is capacity (Beattie et al., 2019). Under this, the patient has the right to get informed about her/his treatment and other plans so that she/he can give her/his consent for the same (Poorchangizi et al., 2019). In this case study, the patient has the full right for decision-making. She can either legally file a case against the night nurse for her lawless behavior or she can also refuse the care services delivered by the night nurse. According to the Nursing Midwifery Board of Australia (2017), the nurse should deliver safe and comprehensive care to the patient and the nurse should also work as per the nursing practices, guidelines, policies, and legislation. As the nurse did not maintain the nursing guidelines effectively and the patient got harmed and the law that was broken was the law of misconduct and physical abuse. According to Wu et al. (2019), there should be informed and voluntary consent in nursing to ensure patient safety and the laws in nursing give information about legal nursing actions. It assists in maintaining a standard of nursing practice by making nurses accountable for their actions.
The other legal issues raised in this situation were – the lawless behavior of the co-worker nurse should be immediately informed to the authorities so that patient care and safety is prioritized. Another legal issue was – the patient asked not to inform others about her condition and suffering but if it will not be informed to the authorities then fair treatment will not be delivered to her. Although, it is the right of the patient to decide and take decisions about her/his care services (Poorchangizi et al., 2019). It is her right that her decisions should be told to others without consent, but in this case, study if the right’s consent will be taken into consideration then it can harm her health. The legal legislations observed in this case study are a breach of duty, negligence to the safe care of the patient leading to damage or harm, and negligence to the emotional stress of the patient. Moreover, if the patient’s information will be told t the higher authorities then it will lead to the disclosure of information without consent. According to Aly et al. (2020), due to legal issues in nursing various factors like beneficence or non-maleficence. If the patients are not told about the harms or benefits about her decisions, treatments, or other plans then it might result in risks to the health of the patient. Moreover, it is the duty of the nurse to ensure that the co-workers are also delivering safe and holistic care services and if there is any misconduct or breach of duty then inform the authorities for the same. It is the responsibility of the nurse to stay focused, work within policies and guidelines, and supervise the junior staff with the aim to prioritize patient care and safety.
In this case study, the 4 ethical principles are autonomy, beneficence, non-maleficence, and justice. In this case study, as per the ethical principle of autonomy, the patient’s right to take own decisions. However, the patient was not respected in this case and was treated unlawfully. As per the ethical principle of beneficence, there should be maximum benefits and minimum harm to the patient; but the care that was delivered to the patient harmed her as she got bruises on her hands. The patient in this case study was dragged disrespectfully and the environment provided to her made her health worsened and she became more frightened. This also shows that justice and fair treatment was not delivered to the patient. Moreover, as the patient was harmed and abused physically so, the principle of non-maleficence was also not maintained. It is also the duty of the nurse to inform the unprofessional actions of the co-worker so that the ethical principle of justice, beneficence, and non-maleficence is maintained. The 2 ethical conflicts are the unlawful and unprofessional behavior of the night nurseand the other is the privacy and confidentiality issues faced when the patient asked not to inform authorities about her condition. It is that duty of the nurse to ensure patient care and safety with high importance, but if the patient has taken a decision about her care services then the nurse should respect it; but in this case, study if her decision will be respected then she might get more harm (Rubio-Navarro et al., 2019). Therefore, it arose as an ethical issue in this case study. It is the duty of the nurse to follow nursing practice standards always and inform the patent about the harms and benefits of her/his decisions, such actions can result in resolving various ethical and legal dilemmas in nursing (Zakaria et al., 2016).
In this case study, the professional issues that were faced are as follows: nursing practice standards, code of ethics, and conduct were not maintained. It was found that the night nurse did not maintain any of the ethical principles. According to the Nursing Midwifery Board of Australia (2017), the nursing practice standards ensure effective care to the patient, but in this case study, many standards were not maintained. As per the standard 1 - the patient was not assessed for her hand bruises and no care services was delivered for it; standard 2 - no effective communication and disrespectful care; standard 3 – no professional engagement and no feedback measurement; standard 6 - safe and responsive nursing practice standards were not maintained; standard 7 – the nurse also did not document the patient’s health outcome. Moreover, the National Safety and Quality Health Services (NSQHS) standards were also not maintained. The following factors show that NSQHS standards were violated: clinical governance standard - no safe environment, no patient safety, no support to the patient in her health care services and planning, no comprehensive care, no communication for safety and medication safety standard were also violated (Australian Commission on Safety and Quality in Health Care, 2017). As the patient had bruises due to a fall, but it was not documented and no medication was provided for the same. This might result in infection and other issues to the health of the patient. It is very important to evaluate and document the patient frequently.According to Browne et al. (2018), in nursing, with appropriate and updated documentation of the patient’s records then the chances of errors, ensure evidence-based, patient-centered care, and maintenance of professionalism. If there is the maintenance of documented in an updated manner then there will effectively transfer of patient information to all the associated health professionals. This will result in effective and fats health recovery. With effective evaluation, there is effective decision-making, improved treatment plans, improved patient health, identification of associated health problems, and many others. Evaluation increases the effectiveness of the nursing care, improve service delivery, meeting and achievement of the nursing goals, and many others. All these can be achieved with frequent monitoring of the patient and effective communication using non-verbal and verbal forms for feedback so that patient-centered care plans can be prepared or advanced care planning can be started, if required (Browne et al., 2018).
It is the duty of the nurse to inform the higher authorities if any co-worker is crossing the boundaries of nursing practice standards or professionalism. As a student nurse, the patient should be advocated for her rights and she should be encouraged to inform the authorities and speak for her rights. She should be taught that it is her right to maintain her consent in her care. As s student nurse, the nursing standards and code of ethics will be followed in the future for professional delivery of care services to the patients. As per the ethics, justice and autonomy will be ensured in this case with such actions. Safe care and the environment will be ensured by informing the authorities to take legal actions against the night nurse. The standards of comprehensive care will be maintained by asking the patient for her consent and feedback. The standards of professional nursing practice state that the nurse should ensure a safe environment for the good health and well-being of the patient. So, a new professional nurse should be provided to the patient in the case study, so that there are no law violations like earlier - the negligence of the care or breach of duty.
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