Ethical and Legal Issues in Nursing

An essay on ethical and legal issues in Nursing

Introduction          

Patients are the core of professional and ethical nursing practice. Practicing and using the professional nursing values in the clinical setting can help create a professional, ethical and legal issues to the nurses. In some instances, practicing within an ethical environment is challenging. Nurses are required to make an ethical decision that might raise ethical dilemmas. Nurses make ethical decisions in patient advocacy in planning and delivering quality and safe care. Advocate is one of the main roles of nurses. Making ethical decision-making can also arise ethical issues and legal actions to the nurses. To resolve the ethical dilemmas and problems problem-solving approaches should be used. Also, nurses must be knowledgeable about the code of ethics, ethical principles, legal obligations, and laws, governing nursing care.

Reflecting on the given scenario, Ms. Mavis 70-year-old retired nurse underwent laparotomy surgery. On her first day of post-op, her vital signs were recorded within normal limits. However, in the morning her vital signs seem to be altered and even with the IV infusion attached she has not passed urine for 9 hours. She also looks pale. While assessing her she looked confused, disoriented, anxious behavior and was refusing the care and assistance from a nurse. Given scenario comprises registered nurses (RN) legal and professional roles and responsibilities, ethical and legal concern and ethical principles which will be discussed in this essay. This essay will also explain the code of ethics, code of conduct and ethical principle conflicts and elaborate on the possible actions that could be taken by the RN in providing care to Ms. Mavis.

Ethical aspects

Ethics is the branch of philosophy that focuses on the moral life. Ethics are generally the basis of right and wrong which help in formulating the law. Also, gives emphasize whether the actions and decision making are right or wrong (Kangasniemi, Korhonen, & Pakkanen 2015). Nurses' ethics comes from medical ethics which is equally as important as medical ethics. Although ethics are considered to be a fundamental part of nurses' practice, they confront ethical questions from the clinical issues they face while treating patients and making decisions (Haddad & Geiger, 2019). Ethical questions and challenges on nurses could arise with patients, family members, colleagues or other professions. Relating to the given case scenario, there are issues raised on ethical and legal concerns from the patient's side and nurse's side as well. To resolve the ethical concerns or to minimize the occurrence of legal and ethical concerns nurses should work competently, following the regulations and guidance and considering ethical and legal obligations to provide safe and quality care (Tsuruwaka, 2017).

There are various ethical theories and approaches used in managing ethical dilemmas, conflicts, and issues. Each theory or approach acts as a moral guide in moral thinking, reasoning and decision-making. Among all the theories and approaches, Ethical principalism is one of the most commonly used approaches in nursing (Epstein & Turner, 2015). Ethical principles act as a guide that shows nurses a way to treat clients and each other. As a registered nurse it is important to apply the ethical principles in identifying the issues and concerns. While applying the ethical principle in the given scenario to identify the concerns and issues, refusal of the care could be one important issue identified which can create conflicts and result in creating a barrier in providing safe care. Whereas the patient's inability to making autonomous choices and decisions can affect the nurse's decision-making process (Tsuruwaka, 2017).

The ethical principle has a set of principles that are searched from shared or common morality. There are seven sets of principles and they are autonomy, beneficence, nonmaleficence, Justice, Veracity, Fidelity and confidentiality (National Commission on Correctional Health Care, 2019). Among these seven principles four principles: autonomy, beneficence, nonmaleficence, and justice are the most commonly used principles in nursing practice.

Autonomy

This principle involves one's legal ability and the right to making a decision. Every individual has own morals and values. Respecting the patient’s decision is one important ethical principle, nurse Mavis refused for the care by the nurse. Ethically, this is the patient's decision and nurses must respect but being a registered nurse, it is a responsibility to provide quality safe care (Bratz & Sandoval-Ramirez, 2017). In Mavis's case, despite refusing care, RN tried to provide the care and maintain her hygiene. However, in some situations, this principle can arise from conflicts. Ms the professional standard's view RN must deliver safe and quality care. In such a situation or any other situation with conflicts, clinical judgment and decision making should be used to evaluate the most appropriate ethical principle (Hain, Diaz & Paixao, 2016).

Beneficence

In nursing ethics, beneficence simply means taking an action that benefits patients. There is various nursing action that can be taken under this principle. Providing benefits to patients means facilitating in their well-being, provide safe and quality care (Ellis, 2017). Reflecting on the scenario, Ms. Mavis could have provided care based on patients’ priorities. Because her behavior was unusual and seem to be aggressive, she could have lifted side rail of the patient's bed and let her relax until she settles down. It is important to maintain personal hygiene but in a patient with such a nurse should prioritize the care. She was bleeding from her IV cannula site and her dressing was removed. Management and care should have been provided accordingly.

Occasionally ethical conflicts can occur while applying the principle of Autonomy and principle of beneficence. Nurses' decisions in respecting a patient's rights and decisions and their decision in providing the best care to the patient. As mentioned earlier in such a situation nurses should take action considering the patient's good rather than their autonomy (Chadwick, Tadd & Gallagher, 2016).

Non-maleficence

In the case of such patients, nurses need to realize the importance of their decision in delivering care causing no harm or injury. In Mavis's case, she didn't receive proper post-operative care which is negligence already. Secondly, she did not pass urine for 9 hours, yet no intervention or action was taken to manage it. Additionally, while reporting the situation to the co-ordinator nurse left the patient alone. These pictures that the nurse failed to deliver quality and safe care to the patient. Her action could risk the patient to the potential risk of falls or other injuries. The nurse could seek help from colleagues instead of leaving the patient alone. The nurse must ensure to create a safe environment to eliminate or minimize the harm to the patient (Hain, Diaz & Paixao, 2016).

Justice

This principle allows nurses to treat the patient fairly. In Mavis's case, it is seen that she did not receive care fairly. She did not receive proper care during her first day of post-op. Also, justice refers to the fair distribution of resources. Based on her behavior Mavis required more than one RN but she was looked by only one RN which would risk harm and injuries to the patient. It also seems that the nurse did not spend enough time with the patient to get to know her well and explain about the post-operative care. RN's time is also considered a scarce resource (Ellis, 2017). This principle is as equally important as the principle of Autonomy, Beneficence and non-maleficence are.

Fidelity

Nurses should be faithful and keep their promises and responsibilities in providing safe and quality care. To apply this principle RN should successfully apply the four major principles, which were not applied in the situation above. The nurse failed to deliver quality care to the patient and also did not maintain the standard of care as she was expected to (Chadwick, Tadd, & Gallagher, 2016).

Veracity

Nurses should be truthful to the patient and develop a trust relationship with the patient. In the scenario, RN did not maintain the communication with the patient where she did not explain the post-op care. Veracity is related to the principle of Autonomy (Doody & Noonam, 2016). As RN did not build rapport with the patient and considering the patient's health condition, the principle of autonomy was affected. This principle is important in resolving the ethical concern.

Confidentiality

This principle is about maintaining the patient's privacy.  It is very important for nurses to preserve a patient's right to privacy and maintain the nurse-patient relationship. Nurses must follow ethical guidelines to apply the principle of confidentiality in nursing practice (Airth-Kindree & Kirkhorn, 2016). Relating to the case, RN, however, managed to maintain the patient's privacy by closing the door and covering the patient's body when it was exposed.

Legal Aspects

The legal implication of nursing practice is held by licensure, law, policy, the scope of practice and expectation of nursing practice at a high professional standard. Nurse's level of knowledge, skill, registration license and nursing standard provide the framework for the nurse to practice as expected (Epstein & Turner, 2015). When a nurse does not practice as an expected standard of care and competence then the nurse is exposed to taking legal action. In the case scenario, RN touched the patient even after she refused to let her touch. According to the law, this action is considered as the tort of battery or crime of assault. But informed consent should be taken when the patient is cognitively able to make a decision. Ensuring the patient's safety is the nurse's responsibility which is tied up with legislation and law. From a legal aspect, any harm or injury to the patient while providing care is the illegal act or against the law (Doody & Noonam, 2016). The nurse left Ms Mavis alone for a certain time. In that condition, nurses' action is known as negligence. RN not only failed to maintain the standard of practice but also breached the duty of care, legislation, and law. Negligence and malpractice or any intention or unintentional actions lead to patient injury or harm. The lawsuit could take disciplinary action, cancel or suspense registration, pay the monitory fines or limits the practice in any of the mentioned actions (National Commission on Correctional Health Care, 2019).

RN Standard of Practice

Registered Nurse's standard of practice is the competent level of nursing care in the nursing process. The standard ensures nurses to provide safe and competent care to the patient. Based on the seven standards of practice for Registered nurses (Nursing and Midwifery Board of Australia, 2016), RN in the given case failed to maintain the standard of care. She was responsible to think critically and make the decision accordingly. She did not maintain a good relationship with the patient as she failed to do communication. When RN recorded the patient's vital signs being altered, she should have done further comprehensive and mental assessment. She did not provide care according to the nursing process which includes assessment, planning, and implementation. Proper planning based on assessment had to be done. Additionally, she was not aware of the type of medication used to the patient. Critical thinking should have been used in decision making (Airth-Kindree & Kirkhorn, 2016).

Code of conduct and Code of ethics

Code of ethics draws the nurse's commitment to respecting, promoting, protecting and upholding the patient's fundamental right (Nursing and Midwifery Board of Australia, 2016). While, code of conduct outlines the nurse's legal requirements and professional behavior in the practice (Nursing and Midwifery Board of Australia, 2016). These codes provide the guidelines and standard which should be followed by the nurse. Comparing the code with the scenario, RN did not follow the standard and guidelines of codes effectively. Her actions in the scenario did not meet the standard of care which is expected from RN. She did not fulfill her duty by failing to provide person-centered care. In the case of conflicts in ethical principles, she could have made a decision based on the priority and importance.

Conclusion

This essay demonstrated the ethical, professional and legal issues and concerns arising in the nursing practice. Focusing on the ethical principle approaches for identifying and resolving any conflicts, issues, and concerns, seven principles of nursing ethics has been explained. Nurses need to know ethical principles, legal obligations, and laws. Understanding all these aspects help nurses to provide the care more effectively and also benefits nurses to work within boundaries. Nurses' ability in critical thinking and ethical decision making facilitates to deliver safe and quality care to the patient. This will also minimize and eliminate the occurrence of concerns, issues, conflicts, negligence, and malpractices.

References

• Airth-Kindree, N, M, M., & Kirkhorn, L, C. (2016). Ethical Grand Rounds: Teaching Ethics at the Point of Care. Nursing Education Perspectices, 37(1), 48-50. doi: 10.5480/13-1128
• Bratz,J, K, A., & Sandoval-Ramirez, M. (2017). Ethical competences for the development og nursing care. Thematic issue: Education and teaching in Nursing. DOI: http://dx.doi.org/10.1590/0034-7167-2017-0539
• Chadwick, R., Tadd, W., & Gallagher, A. (2016). Ethics and Nursing Profession. London: Palgrave. Retrieved from https://books.google.com.au/books?hl=en&lr=&id=vG6CDAAAQBAJ&oi=fnd&pg=PP1&dq=autonomy+ethical+principles+in+nursing&ots=_JgdqZD0fi&sig=bijGcOa0aCwRfnlioVeba6Om22Q&redir_esc=y#v=onepage&q=autonomy%20ethical%20principles%20in%20nursing&f=false
• Doody, O., & Noonam, M. (2016). Nursing research ethics, guidance and application in practice. British Journal of Nursing. 25(14). Doi: https://doi.org/10.12968/bjon.2016.25.14.803
• Ellis, P. (2017). Understanding Ethics for Nursing Students. Sage Publication. Retrieved from https://books.google.com.au/books?hl=en&lr=&id=SiElDwAAQBAJ&oi=fnd&pg=PP1&dq=autonomy+ethical+principles+in+nursing&ots=tGlpPDzFXr&sig=_8a7_NAUU8nvdV1lY394ljCvmU0&redir_esc=y#v=onepage&q=autonomy%20ethical%20principles%20in%20nursing&f=false
• Epstein, B., & Turner, M. (2015). The Nursing Code of Ethics: Its Value, Its History. Online Journal of Issues in Nursing. 20(2), 4. doi: 10.3912/OJIN.Vol20No02Man04
• Haddad, L, M., & Geiger, R, A. (2019). Nursing Ethical Considerations. Treaseure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526054/
• Hain, J, D., Diaz, D., & Paixao, R. (2016). What are Ethical Issues When Honoring an Older Adult’s Decision to Withdraw from Dialysis?. Nephrology Nursing Journal. 43(5), 429-450. Retrieved from https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&sid=b62f8380-9f8f-4cc5-9023-2ec5e85ef1cd%40sessionmgr4006
• Kangasniemi, M., Korhonen, A., & Pakkanen, P. (2015). Professional ethics in nursing: An integrative review. Journal of Advanced Nursing, 71(8) doi:10.1111/jan.12619
• National Commission on Correctional Health Care. (2019). Ethical and Legal Issues. Retrieved from https://www.ncchc.org/cnp-ethical-legal
• Nursing and Midwifery Board of Australia, (2016). Code of Ethics for Nurses in Australia. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
• Nursing and Midwifery Board of Australia, (2016). Code of conduct for nurses. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
• Nursing and Midewifery Board of Australia, (2016). Registered Nurses Standards for Practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
• Schick-Makaroff, K., & Storch, J, L. (2019). Guidance for Ethical Leadership in Nursing Codes of Ethics: An Integrative Review. Nursing Research. 32(1), 60-73. Retrieved from https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=1&sid=5fbe029d-b506-41ba-af91-be3fdf16315b%40sessionmgr4008
• Tsuruwaka, M. (2017). Consulted ethical problems of clinical nursing practice: perspectice of faculty members in Japan. BMC Nursing. 16(23). Doi: 10.1186/s12912-017-0217-3