Ethico-Legal Issue In Nursing: A Case Study Discussion

Key concepts of ethical practice

Discuss about the Ethico Legal Issue ATIF Bachelor Nursing.

The paper deals with the case study involving an ethico-legal issue. After a clinical placement of student nurse under a RN in busy urban hospital she was instructed to administer a patient with the insulin injection. The RN instructs the undergraduate nurse to recap the needle However; the nurse has been taught by her tutor to dispose the needle after use and is also recommended in the Australian government’s website to never recap the needle as it can cause needle stick injury. Obliged by the RN’s instruction, the nurse tries to cap the needle but accidently punctures the skin on the left thumb. Further, the RN instructs for blood test f the patient to see any contraction of rare disease due to this imbecile. In response to the case study the paper discusses the key ethical concepts, ethico-legal complexities inherent in the situation and the implications. Further, the paper discuses the importance of ethical awareness and  self reflection in nursing.

The key concepts of ethical practice in Australia are based on ethics and morality. Ethical practice is underpinned by the Consequentiality and Deontological moral theories. The former theory emphasise on actions that are morally correct and leads to positive outcomes of all the people involved in it (O'Gorman et al. 2013). However, in this situation, the action of RN did not lead to positive outcomes. These theories aligns with the concept of utilitarianism, which is to obtain the “greatest good for the greatest number”. It means that no action can be intrinsically wrong or right and depend on the produced outcomes.  In this case, depending on the outcome of infection that caused by accident, recapping the needle was not intrinsically right  act (Johnstone 2015.). 

The Deontological theory opposes the Consequentiality theory, which emphasise on the moral duties irrespective of the consequences. For instance, patient may take end of life care decision that may involve denial of end of life care. However, the physician may not want to kill the person owing to the moral principles guided by the religious texts like Bible. This forms the basis of the duty. However, in this case, the RN does not fear the consequences as she instructed the nurse to recap the needle. This act does not demonstrate morality as it caused harmful consequences (Sellman 2017).    

In addition to these single principle theories, the four principles that guide the ethical practice are beneficence; autonomy; non-maleficence; and justice. The principle of beneficence seems to be applicable in this situation. This principles guides health care professionals to take actions that are intended to benefit other people by weighing the benefit against the risks (Coombs & Grech 2016). However, in this case the RN did not weigh the  consequences of her strict rule that lead to injury of the undergraduate nurse. Similarly the RN breached the ethical principle of non-maleficence which emphasise on “do not kill” and do not cause pain”. In the given case, the RN has caused pain to the undergraduate nurse. Similarly, in this case the RN has violated the ethical principle of non-maleficence, which is an obligation to avoid harming or injuring others (Heale & Shorten 2017).  Thus, the case study shows that the RN is lacking the ethical awareness.

Ethico-legal complexities inherent in the situation

The legal complexities may involve lawsuit against the RN for not adhering to the ethical principles and nursing protocol. Under the civic law, the, the RN can be asked for compensation in the form of money for doing wrong. This course of action will have positive implications in the future, which is avoiding negligence by me as well as by my seniors. This case may be registered under civil law, as it is not a criminal case. Under the civic law, the Tort law is most applicable in this case as it is between two individuals. Tort law helps to sort the dissolute between the individuals and the group (Ferrara et al. 2016). The Torts law is commonly applied in this case as the outcome of injury to the nurse has emerged from the breach of duties of care. The act of RN can be categorised in to “negligence” (where her neighbour nurse is harmed) and foreseebility (RN fails to forsee harm. The basis of the claim of negligence is that the RN fell short of the “standard of care” in the given situation (Ferrara et al. 2016). This claim will help me go back to the situation, if the damage would not have occurred. The fundamental implication of the “duty of care and  standard of care” is that the health professionals must be highly competent in fulfilling their professional obligations. Criminal laws are applicable of the actions of health care professional leads to death of the patient. I feel it is not applicable here (Coombs & Grech 2016). 

The other ethico-legal issues arising in this case are verbal, written or implied consent. Nurses must take valid consent to medical treatment and it may voluntarily be given or given with sufficient information in relation to treatment (McLeod-Sordjan 2014). In this case RN may give implied contract that she will carry the task with due care and skill to avoid lawsuit against negligence. Further, the RN must oblige with the administrative law, which is the responsibility of the “The Council of Australian Governments that established the National Regulatory Authority”. Under this authority the nurses are registered against the same national professional standards. The RN must not breach the code of ethics under “Nursing and Midwifery Board of Australia”. The board has revised standards that implies recency of practice, continuing professional development  and other professional indemnity insurance arrangements which applies for both RN and me (Inggs & Christensen 2015).

Ethical awareness

The RN and the new nurses must be familiar with these guidelines and the implications of these actions involve avoiding professional misconduct and subsequent disciplinary proceedings. Breaching the code of ethics has serious implications as the nurses will be responsible for misdiagnosis, deaths and medical errors. The negative implications of the code of ethics are the unfulfilment of requirements of the professional organisation (Ferrara et al. 2016). It also includes damage of interpersonal relationship with clients and others staff, just as it happened in my case. I felt no harmonious relationship with my RN. Nurses should build virtuous character to make clinical decision with impartiality and obligation. I will be compassionate, empathetic, kind, honest, and have integrity. Such ethics of care if violated leads to criminal and civil law suits, breach of standard of care and professional code and competency standard (Hickey & Harrison 2013).

For the nurses’ professional competency, ethical sensitivity is an essential component that measures their ethical performance and interpersonal relationships. According to Milliken and Grace (2015) nurses face ethical dilemmas in their everyday practice and therefore, ethical awareness is important for the ethical decision-making. This ethical awareness is important for ensuring patient safety by recognizing the wishes and unique interests of individuals in accordance with the ethical line of care. Understanding of ethical role and awareness is an obligation based nursing practice outlined by reasoning and practice recommendations vital for nursing education and practice.

Inadequate ethical awareness and interpretation can lead to wrong interpretation of respect for autonomy and violation of individual rights. According to Rahmani, Ghahramanian and Alahbakhshian (2010) misunderstandings regarding patient’s rights where nurses have to respect their rights and provide adequate information so that they make decisions on their own. The ethical principle of non-maleficence states that nurses have the responsibility to do well and avoid intentional wrong acts. In the given case study, the RN lacked ethical awareness, violated the principle of non-maleficence, and as a result I harmed myself. She was not aware of the fact that injection should not be re-capped after use rather to be disposed into a designated sharp container. RN intentionally made me panic and accidently the needle got  injected. This was case of violation of non-maleficence where there was intentional harm and might result in transfer of serious blood-borne diseases in my body from the patient. Therefore, nurses should develop knowledge and ethical awareness and promote them to understand ethical values and provide high quality and safe ethical care.

Apart from ethical awareness, self-reflection is also important for informing nursing practice and relationships with others. Various models of self-reflection enhance nursing practice through self-conversation, one’s behaviour and one’s self that acquire meaning. This reflective thinking on nursing practice would me to accept individual experiences and be connected while questioning about their feelings, thoughts and preconceptions about their nursing practice. John Driscoll Model of self-reflection is a significant model that helps nurses to attain knowledge and gain understanding that reflect on their experiences whether negative or positive allowing scope for self-criticism. According to Nursing and Midwifery Council (NMC), practicing self-reflection allow nurses to explore through their experiences and provide scope for development to provide high quality of care. Moreover, self-reflection in nursing practice also helps to examine relationships with other members of the healthcare team and to understand their contribution to the team (Bulman, Lathlean & Gobbi 2012).  

Through the Driscoll model of reflection, I will help to analyze the given situation through what, so what and now what steps.

The incident took place when I started my PEP in a busy urban hospital. During the placement, RN instructed me to inject insulin. After the needle injection, as I was about to dispose the needle to the nearest sharp container, RN instructed me to re-cap it. I refused and finally she screamed at me to re-cap it. I was very distressed and in panic, I punctured my left thumb. Then, RN looked at the patient and said that now they have to take patient sample to look for rare diseases this imbecile may have contracted.

The incident made me realize that there was lack of ethical awareness in the incident. The RN violated the ethical principle of non-maleficence and that resulted in injection of the needle on my left thumb. Firstly, I was bit nervous, as RN was critical if things are not done in correct manner. After refusal, she screamed and ou of panic, I injected myself. There is lack of ethical awareness in RN as she intentionally made me harm myself even after knowing that re-capping should not be done after injection. Therefore, ethical awareness is required in the nursing practice.  

This experience made me realize that ethical awareness and assertive skills is important in nursing practice. I have to develop my assertive skills to stand for my own as well as for the patients to ensure safety and high quality of care without being aggressive or accepting wrong. Moreover, I will create awareness among my colleagues regarding ethical principles and its application in nursing practice. 

Conclusion

The case study was useful in learning ethico-legal issues in nursing and the implications of the various actions that can be taken against the breach of code of ethics. This assignment provides deep insights into the significance of the duty of care, and other key concepts of the ethical practice.

References

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Coombs, M. & Grech, C., 2016. ‘Ethical issues in critical care’. ACCCN's Critical Care Nursing, p.106.

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McLeod-Sordjan, R., 2014. ‘Evaluating moral reasoning in nursing education’. Nursing ethics, vol. 21, no.4, pp.473-483.

Milliken, A. & Grace, P., 2015. Nurse ethical awareness: Understanding the nature of everyday practice. Nursing ethics, p.0969733015615172.

O'Gorman, C.S., Macken, A.P., Cullen, W., Dunne, C. & Higgins, M.F., 2013. ‘What is the difference between deontological and consequentialist theories of medical ethics?’.

Rahmani, A., Ghahramanian, A. & Alahbakhshian, A., 2010. ‘Respecting to patients’ autonomy in viewpoint of nurses and patients in medical-surgical wards’. Iranian journal of nursing and midwifery research, vol. 15, no.1, p.14.

Sellman, D. 2017. ‘Virtue Ethics and Nursing Practice’. In Key Concepts and Issues in Nursing Ethics (pp. 43-54). Springer International Publishing.