NUR 5011 Legal And Ethical Analysis

Collecting Information and Identifying Issues

In this case scenario, the people involved are Olive (an elderly patient suffering from mild dementia) and Sue (a nurse who just graduated and is working at a public hospital).

What should Sue do as a nurse in a case whereby a dose has been wrongly administered to the patient (Olive)?

Is it morally right for Sue to withhold information about the wrong administration of medicine from Olive (the patient) and the hospital administration as well?

Is it ethical for Sue to put her professional career as a nurse before the well-being of the patient (Olive)?

Did Sue fail to abide by the nursing standards of practice by not checking the medication chart to know whether the drug had already been given or not?

Is it morally right for Sue to firmly request the patient (Olive) to stay in bed without informing her about the reasons?

Legal Issues

Should Sue’s misconduct of not informing the hospital about the wrong administration of a dose to Olive be punishable by the law?

In case Olive’s condition worsens can she take a legal action against Sue of the negligence of duty of care owed to patients?

Code of ethics

There are certain codes of ethics that have been developed to guide nurses in their profession in Australia. The codes have been shaped to meet the standards and principles of international conventions such as the World Health Organization and the International Covenant on Civil and Political Rights. The code of ethics outlines nurses’ commitment to the provision of high-quality nursing care and health care to people, management of information ethically, making evidence-informed decision making and respect for the essential rights of the providers and recipients of health care services  (Waubra Foundation, 2015). Ethics is an important part of nursing and the code of ethics helps nurses take care of the ethical questions on the practice that arise every day when incorporated into practice (Bell, 2015). Nurses are expected to have a sense of morality whenever they cary out interventions or care for patients. The code of ethics ensure that nurses have the professional knowledge that helps them when making moral judgements.

Nurses and People

 The nurses’ first priority is to put the interests of those who require nursing care at heart. Sue’s primary obligation is to offer quality nursing care to Olive. Considering that Olive is also very old, Sue should be careful when administering doses to her. The fact that Sue did not bother to check Olive’s medical chart before administering the dose which happened to be accidental shows that she does not have the patients’ interests at heart.

 Nurses should very sensitive to the ethical issues and challenges that arise at work that might jeopardize the inviolability of their profession (F Zahedi, 2013). The nurse should come up with an appropriate and effective solution. For instance, when Sue administers a second dose to Olive and later finds out that it is wrong, she should have consulted a senior health worker or doctor instead of firmly stating that Olive should stay in bed for six hours. Such a minor mistake could escalate to a major problem by affecting the patient’s condition. Withholding the information from the hospital administration wasn’t the best thing for Sue to do. Moreover, Sue did not inform Olive about the situation at hand thereby betraying the confidence the patient has in her as a nurse. The professional values of concern and truthfulness required of a nurse when dealing with patients were not upheld by Sue in this case.

Nurses are expected to pay good attention to the vulnerable groups of people, for instance, the elderly (Gallagher et. al., 2014). The fact that Sue administers a wrong dose to Olive clearly shows that she is less concerned about the fact that she is an elderly patient. Sue was expected to act accordingly after the error but instead chooses to withhold the serious issue from both the patient and her co-workers. Elderly people are very delicate when it comes to immunity, therefore, nurses should be more than careful when dealing with elderly persons. As a nurse, Sue failed in her duty in this case, the duty to pay attention and be concerned about Olive’s state as an elderly person. Even though mistakes are always inevitable, not checking a patient’s medical chart is negligence of duty.

Nurses and the Profession

Nurses should effectively note responsibilities regarding ethics in addition to legal and professional obligations during nursing interventions and clinical decision making (Kleinpell et. al., 2014). An accurate, efficient and timely care should be provided to patients. Nurses are expected to check a patient’s medical chart at all times for updates as well as when administering care. When Sue overlooks that duty and assumes that Olive had not been given her dose and goes ahead with administering a second dose, she fails her professional liabilities. Sue puts the safety of Olive at risk by not performing her professional duties efficiently.

The nursing profession’s code of ethics requires nurses to honestly and truthfully explain to the patient in case of a mistake in interventions (Canadian Nurse Association, 2018). Nurses are also required to report medical and professional errors. In this situation, however, Sue chooses not to notify Olive (the patient) about the administration of a wrong dose. It is quite clear that Sue took advantage of Olive’s old age since Olive is too old to realize that she had been given the same dosage twice. Not reporting the incident to the senior hospital workers amounts to probable damage to the patient who in this case is Olive. Instead of firmly requesting Olive to stay in bed for 6 hours, Sue should have been honest that would ensure the patient’s compliance.

Nurses should be capable of offering accountable, efficient and safe nursing care, without supervision, to patients without their proficient reliability and integrity being put to question (O’Connell et. al., 2014). In this case study, however, Sue acts contrary to this professional obligation. It is evident that Sue cannot successfully offer quality and safe nursing care to patients without being supervised. Sue’s credibility is very questionable considering that she is capable of making errors and instead of finding a proper solution, she chooses to keep the information to herself. Therefore, Sue has failed the nursing profession as a registered nurse.

Nurses and Practice

Nurses should showcase gentle behaviors and good verbal communication skills to gain the patient’s confidence and trust in them, this will ensure that the patient abides by their requests (O’hagan et. al., 2014). When Sue administers a wrong dose of anti-hypertensive medicine to Olive and firmly requests her to stay in bed for six hours, she does not display a gentle behavior. Being the wrong party, Sue should have gently and honestly explained her mistake to the patient (Olive). That is what a good nursing practice expects of a nurse. In this case, Olive is most probably not going to have confidence when talking to Sue since she was not very gentle to her initially.

Nurses should ensure that the well-being of patients is not put at risk by ensuring that nursing interventions do not harm the patients and if they need assistance they should consult other healthcare co-workers (Bowling, 2015). Sue, on the other hand, chose not to consult her colleagues after wrongfully administering an anti-hypertensive dose to Olive. This not puts the safety of Olive at risk but also defies the nursing code of ethics. In this case, Sue violates the high standards of care owed to Olive. Not looking at a patient’s medical charts before administration of a dose was initially deficient of ensuring the safety of a patient.

Nurses are also required to avoid, at all costs, any action that violates the ethical obligations of the nursing practice (Epstein & Turner, 2015). Nurses should ensure that whenever they offer nursing care to patients, they do not violate the ethical obligations of the nursing practice. In this case study, Sue administers a wrong anti-hypertensive dose to Olive simply because she did not look at Olive’s medical chart. Aside from putting the patient’s safety at risk, Sue violated the standards of care for the nursing practice.

Nurses and Co-workers

Nurses should co-operate with their colleague health workers and share their thoughts on the appropriate nursing interventions when they are not sure about the right action to take (Lachman et. al., 2015). This helps to avoid errors and mistakes during the administration of nursing care. If Sue had asked the nurse in charge of Olive at the hospital whether Olive’s dose had already been administered she would not have administered the second dose to her. Or rather if Sue had informed her colleagues about the error, the risk of the patient’s safety being compromised would have been taken care of professional. Sue, however, chose not to consult the other healthcare workers thereby not abiding by the particular code of ethics which demands utmost co-operation between healthcare workers.

Nurses should consult the committee in charge of ethics in their specific hospitals when they are faced with ethical challenges (Holloway & Galvin, 2016). In this case, Sue was worried about the evaluation of her performance after administering a wrong anti-hypertensive dose to Olive and instead of informing the hospital’s ethics committee she chose to keep the information to herself. If the committee in charge of ethics in that hospital eventually finds out about the issue, Sue faces disciplinary actions. Sue should have reported the wrong administration of a dose to Olive to the committee since it was created an ethical dilemma which not only puts the safety of Olive at risk but also violates the nursing standards of action when faced with such challenges.

Ethical Principles

Nurses incorporate certain ethical principles in conjunction with the code of ethics in their practice while performing their designated roles (Judkins-Cohn et. al., 2013). These principles enable nurses to provide quality care to patients.

Autonomy refers to the capability of nurses to implement their professional knowledge when administering nursing care and interventions (Kumar & McHugh, 2017). However, autonomy also refers to the freedom of consent accorded to patients that enables make decisions before being subjected to certain nursing care and interventions (Leung, 2014). Autonomy is a fundamental aspect in the nursing practice that helps nurses to provide quality care to the patients (Twigg & McCullough, 2014). When the principle of autonomy is not heeded, the safety of patients is not assured. In this situation, Sue does not act accordingly to the medical error of wrong administration of the second dose to Olive. Instead of thinking critically and reasoning with the situation in order to avert the risk of health deterioration, Sue firmly asks Olive to stay in bed for six hours. Exercising professionalism in autonomy affects the attitudes and behaviors of nurses in providing health care to patients (Iranmanesh et. al., 2014). Since Sue did not exercise professional autonomy, she ended up not speaking gently to Olive. Olive was also not accorded freedom of consent in this case study. After administering a wrong dose of anti-hypertensive medication to Olive, Sue should have gently asked for Olive’s opinion in finding a solution for the matter at hand, Sue firmly stated that Olive should stay in bed for six hours. Therefore, the principle of autonomy was completely violated in this case study.

Beneficence

Beneficence refers to the ability of nurses to maximize good in nursing interventions and ensure that no harm comes to the patients. Nurses to be very committed to caring for their patients as they put into knowledge that every decision they make affects their patients (Ingham-Broomfield, 2017). Nurses are often forced to make certain ethical or moral judgments in practice due to certain ethical dilemmas. These judgments are, however, influenced by certain ethical standards of practice (Health Care Ethics, 2013). Before making judgments or deciding on anything, nurses should put into consideration the ethical principles of nursing. The nurses should ensure that no harm comes to the patients due to the actions are taken or decisions made by the nurses. For instance, Sue’s actions should aim at promoting the safety of Olive.

However, Sue does not ensure the safety of Olive in this case. She failed in her professional line of work in several ways. Sue did not inform Olive about the wrong administration of an anti-hypertensive dose. Beneficence expects nurses to maximize not only by administering quality health care but also by being truthful to and honest with their patients (Chagani, 2014). By withholding the information, Sue puts the safety of Olive at risk and the possibility of Olive suffering harm increases. Sue should have also informed the other health workers and the hospital administration about the administration of a wrong dose to Olive. This would have enabled the hospital staff to jointly find a solution to the ethical and medical problem that arose.

Non-maleficence

Non-maleficence is an ethical and legal obligation of nurses to avoid causing harm to patients when planning for the nursing intervention and treatment measures (De Angelis, 2010). It also refers to not causing harm to a person by maintain confidentiality and not revealing important information that could cause harm to a person. Nurses are expected not to cause harm to patients during treatment even if the intention was to cure the patients. The harm should totally be avoided and it should not be obvious. In this case, Sue administers an anti-hypertensive dose to Olive since she was suffering from mild dementia. Unknown to her, Olive had already been given the dose according to her medical chart. Sue’s intentions were to do good however, she ended up causing harm. Nurses are often expected to take a look at the patient’s medical chart and records in order to be up to date with the patient’s condition; therefore Sue acted on assumptions and negligence.

Non-maleficence expects nurses not to do something wrong while practicing even if the outcome is positive. The positive outcome should not be an effect of a bad act (Study.com, 2018). For instance, if Sue’s action would have led to a good outcome such as Olive recovering quickly, it would still be criticized since nurses ought to look at patients’ medical charts before administering doses. On a different perspective, if Sue had administered the dose as a first dose without looking at the medical chart, her credibility would still be questioned since nurses should not act on assumptions but rather they should act professionally.

Providing justice in a healthcare organization refers to the equitable distribution of resources in addition to equity in the access to health care services (Shahriari, Mohammadi, Abbaszadeh, & Bahrami, 2013). Nurses should ensure that every decision they make or actions they take are fair to the patients involved. Justice in nursing does not only involve the equitable distribution of healthcare resources but also it is the act of being fair to the patients when providing nursing care and intervention. In this case study, Sue was not fair to Olive. Sue administered a wrong dose of anti-hypertensive medicine to Olive and instead of being honest and informing the patient as well as the other health workers so that a solution can be arrived at, she chooses to keep the information to herself. Justice expects nurses to uphold all the laws that are applicable in nursing every time before making decisions (How the Four Principles of Health Care Ethics Improve Patient Care, 2017). Nurses are required by the regulations of nursing care and standards to check the medical charts of patients before administering any care. However, Sue did not look at Olive’s medical charts before administering the anti-hypertensive dose. Therefore, Sue did not act fairly to Olive as expected of her.

There are laws that guide nurses in their profession. The Health Practitioner Regulation National Law (Victoria) Act 2009 outlines the various health practices, committees, and provisions that are relevant to the nursing practice and profession (National Health Practitioner Ombudsman & Privacy Commissioner, 2018). The Health Practitioner Regulation National Law (Victoria) Act 2009 is the law enacted by the Australian government to guide and direct nurses in Victoria in their duties and obligations.

The law of torts is a civil wrong that causes injury to a person and as an effect, the person who causes harm leads to a legal accountability. The intentional torts are assault, battering and false detention (Atkins, de Lacey, Ripperger, & Britton, 2017). The law of torts that is applicable in this case study is the negligence tort. A negligent tort is not an intentional act but it takes effect when a person responsible to care for something fails to adhere to the duty of care assigned to him or her and causes personal damage to another person (Balkin & Davis, 2013). Neglecting a duty entrusted to you not just by the patients but also by the law is illegal. Sue was entrusted with the duty of caring for Olive considering that Olive is an elderly person but she failed in her duty. Sue was expected to correctly administer the anti-hypertensive dose to Olive but she4 failed. Sue administered a wrong dose of medicine to Olive simply because she did not bother to look at Olive’s medical chart. Sue, therefore, neglected her legal and professional duty as a nurse by not looking at the medical chart and administering a wrong dose.

Duty of Care

The duty of care is a legal obligation to provide quality care and not to cause harm to any person whatsoever. Health care practitioners have a duty of care to their patients. When nurses do not abide by the nursing standards of care, they neglect their duty of care owed to patients. Nurses are other health care practitioners are expected to make necessary arrangements and consultations before making difficult decisions in order to minimize the risk of harm to patients (Trueman, 2018). In this case study, Sue administered a wrong dose to Olive and instead of seeking clarification on how to handle the issue; she decided to keep the information to herself. This is not only a negligence of duty but also an illegal act. Sue faces a legal action in court since she put the safety of Olive at risk. Withholding important information that could affect a patient’s health from both the patient and health practitioners is illegal. It portrays the negligence and ignorance of duty by the nurse (Sue).

Ethical and legal theories in nursing

Utilitarianism refers to acts that bring happiness to the society in general and greatly benefits the society (Mandal, Ponnambath, & Parija, 2016). According to this theory, nurses and other health workers should work towards maximizing benefits to a patient and limit causing harm (Johnstone, 2016). Sue did not intend to cause harm to the patient but she was however not intent in maximizing good as she did not check the patient’s medical chart before administering the dose. Not informing the patient and the hospital administration about the wrong dose risks the reputation of the hospital being destroyed. Therefore, this act was unethical and illegal.

Deontology focuses on the ability of nurses to responsibly execute their duties and moral obligations accordingly without causing harm to patients (Acosta, 2017). Sue’s duty and moral obligations require her to report errors and challenges to the hospital administration, however, Sue chooses to withhold the information after administering a wrong dose to Olive. Sue thus failed to uphold the ethical and legal obligations entrusted to her.

Code of Conduct

These are the legal requirements, professional behavior and how nurses are expected to conduct themselves in all sets of practice. This code of conduct seeks to explain that nursing ethics is not only restricted to the provision of quality care but also in leadership and management of the hospital environment.

Nursing and Midwifery Board of Australia

The NMBA has a mandate of protecting the health of the public. The NMBA therefore develops certain codes of conduct and sets up standards that should be met5 by nurses in order to ensure the safety of the public’s health. This code of conduct is however subject to the National Law in Australia.

Nurses should be conscious of their obligations as outlined in the National Law and the NMBA guidelines. The prime duty of nurses is to immediately report to the hospital administration about any information that is important to the management of a patient’s health. This reporting obligation has been outlined in sections 129, 130, 131 and 141 of the National Law in Australia. There is a possibility that Sue might not be informed about her obligations as outline in the National Law and NMBA that is why she chose to keep the information about the wrong administration of a dose to Olive to herself. Sue might also have chosen to ignore her obligations to patients and that is why she kept the information to herself.

Nurses are also expected to behave lawfully not just in the vicinity of their supervisors but also when they are alone. Nurses should ethically and truthfully practice their duty and avoid unlawful behaviors. Sue administered a wrong dose of anti-hypertensive medication to Olive and instead of consulting her colleagues and informing the patient as well she chose to keep the issue to herself. That administration of the dose was obviously not recorded in the medical chart. Therefore, later if a different nurse goes to administer a dose to Olive she would have put her safety at risk again due to overdose because of Sue’s mistake. Sue’s prime error is not only a wrong administration of medicine but also the unethical and unlawful behavior of withholding important information that might affect the patient’s health outcome.

Nurses’ obligation of mandatory reporting is necessary in the protection of the vulnerable groups of people such as the aged (Nursing and Midwifery Board of Australia, 2014). Sue did not report the wrong administration of a dose to Olive despite the fact that Olive is aged. This puts the safety of Olive at risk as Sue’s actions were very unprofessional.

Nurses are expected to make evidence-informed, safe and person-centred decisions. The decisions made my nurses during interventions should be for the well-being of the patient. When an action that should be taken is not within their mandate nurses should refer the patient to another health care practitioner. In this case study, Sue should have made a decision that favoured the Olive’s welfare and not her professional performance. Sue did not report the wrong administration of the dose to Olive to the hospital administration since she feared it would reflect negative performance on her role. The decision she made was not intent on protecting the patient’s health as required by the NMBA standards of practice.

Nurses are also required to recognize the fact that sometimes substitute people are needed to help make decisions (Nursing and Midwifery Board of Australia, 2014). When Sue administered a wrong dose of medicine to Olive she did not know what action to take. An ethical and medical challenge arose at the same time since Sue also feared getting a negative reflection on the4 performance of her role as it would put her job at risk. Sue has a family and a loan to pay so she needs to keep the job. However, since the issue was complicated Sue should have accepted that the issue was not within her scope to make a decision.

Evaluation

This involves undertaking serious education and supervision of nurses during practice, especially nurses who recently graduated like Sue. An experienced nurse with years would have avoided the error made by Sue and in case of the ethical challenge; he/she would have dealt with the issues accordingly. Therefore, senior healthcare workers should be assigned to recent graduates in order to assist in the ethical and legal development skills of graduate nurses.

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