The case revolves around Sam (agitated drug-related psychotic-patient), Camilla (an ethical surgical unit practitioner who is concerned and respects her patients) and medical team (who orders for Sam to be put under physical restraints) and the in-charge nurse (Julia-who has no respect for the patient, not worried about patients and no ethical practice at all when dealing with Sam).
Camilla has shown a lot of respect and cares for the dignity of the Sam. Camilla is aware of the need to act ethically in caring for the patients and have concerned about patients and to help them. She has held unto her professional standards and codes and only knows that her main aim is to care for the patient. Camilla appreciates the need for fiduciary-relationship between her Sam in order that it can best care for patients and promoted their diagnosis and recovery. Camilla is careful and proactive about what consequences her actions and those of Medical Team, Julia included can cause safety-issues to Sam. This is why she is opposed to physical restraints as this will make Sam more agitated and hence harm himself. On the hand, Julia has shown a high level of unethical practice. She has no care for the patient safety or even dignity. She says that Sam orders that Sam should be placed under physical restraints even without caring for what such safety issues it would have on Sam. Further, she has no duty of care at all to Sam and she say that caring for Sam is a waste of time and that Sam should not be worried about. These are clear violations of the ethical code of conduct and even the professional standards required of an in-charge nurse. Moreover, she has ear for the Camilla who advises not to put the already agitated Sam under physical restraints. Julia does not appreciate that the nursing code of ethics requires of her to show ethical obligations and duties of each and every patient. We have seen has profile patients differently and this is a clear violation of the nursing code of ethics. Julia lacks total understanding of her own commitment to the society. Her unethical lack of appreciation for the duty of care thus makes Julia to ignore her obligations required of her to avoid acts or omissions that might be sensibly foreseen to injure or harm Sam. This is why she advises Camilla to immediately put the agitated Sam under physical restraints and ignored Camilla’s advice that this would cause harm to Sam. Julia thus fails unethically to anticipate the risk for Sam and totally failed unethically to take the least care to prevent Sam from coming to harm when she advised Camilla to place Sam under physical restraints and leave Sam alone to care for other patients she was assigned.
I can categorically state that Julia was an unethical nurse in charge through her various unethical actions and utterances unlike her junior, Camilla. While Camilla seemed to have observed her professional codes of ethics, standards and conducts, Julia was totally in contravention in every aspect. This can be seen from her negative utterances that they never had enough people to care for Sam and that caring for Sam was a waste of time. This was also apparent from her unethical action of ordering Camilla to place Sam under physical restraints without anticipating the risks attached and even caring to uphold Sam’s dignity and rights to refute/accept treatment. She did not even consult with Sam before making such decisions.
It can as well be said that Camilla is a moral and ethical nurses professional who appreciate her duty of care and obligation to always do the right thing when caring for her patients.
The patient dignity and rights were in total violation by both medical team and Julia. Sam was placed under the physical restraints even without being examined yet he was already an agitated man who need the most urgent care. Indeed, Julia unethically profiled Sam as among those patient that to her is a matter of waste of time caring for. This essence implies that Sam had no dignity and rights to be cared for in the eye of Julia. This is a clear demonstration that Julia does not treat her patients equally but profile them and those she feels are a waste of time, are left to struggle alone and even put in eminent harm. However, the Julia ignored that one of the fundamental nursing is the respect for everyone (Henry, Rushton, Beach & Faden, 2015).
A respectful nurses and subsequent respectful treatment will honor the patient alongside his family and every unique feature of the patient. It remains a duty of care for a nurse to focus on the creation of the environment which permits a nurse to provide the best feasible care to any as well as all patients without any judgments (Zahran, Tauber, Watson, Coghlan, White, Procter & Norton, 2016). A nurse should always never forget like Julia did that Sam is human being on the other bedside. She forgot that Sam was listening and thus failed to treat Sam like fellow human being thus failing to maintain Sam’s dignity and rights to treatment. Julia was never conscious of Sam’s feelings and made Sam feel embarrassed by making herself feel more comfortable at Sam’s expense. Julia never understood that it was ethical and legal for Sam to make decisions about his medical care, and that he had right to either refute or accept treatment. In this regard, Julia made a unilateral decision without Sam’s involvement to place him under physical restraints and leave him alone. Dignity observation is thus an important element of ethics as well as ethical caring. Dignity remains a fundamental aspect to Sam’s well-being and hence a basic right for all patients that Julia needed to have paid a full attention to when dealing with Sam as did Camilla. Thus Sam wanted a dignified care which implies the type of care that supports as well as promotes without undermining Sam’s self-respect irrespective of any difference. Sam needed to have been treated by Julia like somebody.
In my future professional code of ethics and professional conducts and standards, I will treat my patients with respect, equality, dignity and respect their rights to accept/refute treatment, make decision as well as always involve and engage in decisions relating to their treatments unlike the unethical Julia. I will always seek to read and put extensively what I have read on Professional Codes of Ethics and Professional Conducts and Standards into practice to help appreciate that the patients on the bedside is always a human being like and hence not allowing myself to feel more comfortable than the patients. In this regard, I will always undertake my duty of care to my patients seriously and ensure that I strictly do what I am obligated to do without profiling some patients as a waste of time when caring for them like what Julia said in this case. I will always seek to ensure effective fiduciary relationship with my patients by appreciating that the bond between the patient and myself is important to both diagnostic and therapeutic courses (Shahriari, Mohammadi, Fooladi, Abbaszadeh & Bahrami, 2016). This will be fundamental in allowing me make accurate diagnosis as well as provide optimal treatment recommendations by ensuring that my patients can communicate all the useful information regarding their illness. I will always remain obliged from divulging any confidential information about my patient by strictly adhering to the accepted professional codes of ethics that acknowledge the special patient-physician association nature. Unlike Julia, even in the case of the frustrating patient like Sam, before recommending any particular course of action/overriding the preferences of the patient, I will always assess the likelihood of an injury or harm without the therapy, while treatment carries very little risk, I will always favor attempts, without force or manipulation, to convince my patient of harmful nature of refuting treatment.
This theory is relevant to the actions undertaken by Camilla and Julia. Deontology is based on the ethical approach which emphasizes on the wrongness or rightness of the actions themselves and not the consequences’ wrongness or rightness. Here, irrespective of the situation being good or bad relies on whether an action which resulted in the action was right or wrong. Conformity with the moral norm is the basis for a right choice with right always taking precedent over good. Deontological ethics is duty-based or obligation-premised ethics since a deontologist has a belief that ethical rules always bind individuals to their corresponding duty. In this respect, it held that Julia had duty of care to Sam, but engaged in bad actions that went out of the confinement of the ethical standards required of her in the practice (Broad, 2014).
It was morally wrong for Julia to say that caring for Sam is a waste of time yet she knew clearly that her duty is to care for the patients equally and with dignity and respect at all time. Because this ethical theory is duty-based, it places some duty or obligation on the part of the nurses to care for even the worst and frustrating patients like Sam. Thus, Julia had no option but to do the right thing, do to because it us the right thing to do, do not do wrong things and avoid them because they are wrong. From this case, it is clear that Camilla unlike Julia ensured strict adherence to her ethical requirements as outlined and anchored on the professional codes of ethics, conducts and standards (Kangasniemi, Pakkanen & Korhonen, 2015). This is why when she saw Sam’s rising or worsening condition, she did what she was required to do to inform the medical team to diagnose Sam. Camilla did not even stop there since she still questioned Julia’s actions because she had a duty of care to care for Sam in strict adherence to rules and regulation guiding her practice. Under Deontological form of ethics, Julia cannot justify her actions by showcasing that it generated good consequences and hence it is called non-Consequentialist. This theory only bind Julia and Camilla to have a duty of acting accordingly, irrespective of the bad or good consequences which might be generated. In this respect, it remains relevant because Julia knew very well what she was expected to say and act like as an in-charge nurse but she failed to go overboard unethically. Julia and Camilla ought to have lived in a world of moral rules as outlined by facility in which they work. Thus, they are bound to doing the right thing like ensuring dignity and rights of the patients are held high, even where that generates more harm than doing the wrong thing (Betancourt, Corbett & Bondaryk, 2014). The right thing should always be done even if it yields wrong outcome. Thus, Julia ought to have started by considering the right actions and identify the good things which would generate maximum of such good things. Thus to deontologists, Julia should have done something good if she was doing a morally right action like equally treating her patients including Sam with utmost dignity and respect for Sam’s rights.
These principles include principle of respect (autonomy); Nommaleficence, beneficence and justice. Autonomy calls for honor to patients’ rights to make individual decisions. This was never honored by Julia at all. Beneficence calls for helping the patient advance his own good. Again this was violated by Julia as she ordered for physical restraints despite Sam’s agitation. Nommaleficence implies to do harm (Ashcroft, Dawson, Draper & McMillan, 2007). Actually Camilla observed this by questioning Julia’s actions and calling for the male team to diagnose Sam but Julia did harm to Sam by placing him under physical restraints and also saying that caring for Sam was a waste of time. Justice implies being fair and treating like cases alike. Julia seemed to have profiled patients in her facility differently unlike Camilla and this is why she commented that Sam should not be cared for but should be left alone as such was a waste of time.
It is recommended that the replace Julia’s position with a more ethical and moral nurse to ensure that the interest of the patient takes precedent in the facility. Retaining this position will not only be unsustainable to patients but also her fellow medical team and nurses like Julia who have seen her unethical actions as a threat to their professional practices and development.
Ashcroft, R. E., Dawson, A., Draper, H., & McMillan, J. (Eds.). (2007). Principles of health care ethics. John Wiley & Sons.
Betancourt, J. R., Corbett, J., & Bondaryk, M. R. (2014). Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation. Chest Journal, 145(1), 143-148.
Broad, C. D. (2014). Five types of ethical theory (Vol. 2). Routledge.
Henry, L. M., Rushton, C., Beach, M. C., & Faden, R. (2015). Respect and dignity: A conceptual model for patients in the Intensive Care Unit. Narrative inquiry in Bioethics, 5(1), 5A-14A.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Shahriari, M., Mohammadi, E., Fooladi, M. M., Abbaszadeh, A., & Bahrami, M. (2016). Proposing codes of ethics for Iranian nurses: A mixed methods study. Journal of Mixed Methods Research, 10(4), 352-366.
Zahran, Z., Tauber, M., Watson, H. H., Coghlan, P., White, S., Procter, S., ... & Norton, C. (2016). Systematic review: what interventions improve dignity for older patients in hospital?. Journal of clinical nursing, 25(3-4), 311-321.
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