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1. Identification of Ethical theories, need to choose 3 out of 6 theories. All 3 theories are identified and explained clearly & succinctly according to case study.
2. the main objective of this assignment is To identify, understand, analyse and resolve the ethical issues and conflicts likely to arise in the course of professional work.

3. Analysis of ethical issues as a registered nurse ( focus nursing ethic, code of conduct and principal) sophisticated, critical analysis of the ethical concepts, principles, codes and professional standards in relation to the chosen case study 

Critical analysis of the ethical issues

Each and every day, the patients, families and the health care professionals are faced with different kinds of ethical or the legal issues. These difficult dilemmas might relate to medical treatments, hospital managements, practices and other matters that might arise in the health care industry (Griffith & Tengnah, 2017). Ethical issues in health care might require an immediate response, like making the decisions for the patients. Due to the complexities of the health care, the likelihood of the near misses and malpractices are also high. This paper will discuss about the different ethical issues that can be seen in the case of Andrew , who was presented in the emergency department of a public hospital and died out of pulmonary tuberculosis. There were several questions surrounding the death of Andrews that led to legal proceedings. The ethical issues raised in this case will be discussed in the light of the nursing codes of conduct and the professional standards followed by a set of recommendations.

The first ethical issues revealed in this case is that Bill, the Triage nurses assumed Andrew to be suffering from bronchitis without any proper assessment. A contagious disease like pulmonary disease should have been taken care off more seriously. Another issue was that although Andrew was having high fever, producing sputum and experiencing shortness of breath, yet he was made to wait for 6 hours in the waiting room, while the health care staffs attended the other patients that deemed more serious to them .Hence a negligence of care and breaching of the duty of care can be seen in this case .Medical error and malpractices can bring about deaths and injuries to the patient (Griffith & Tengnah, 2017). In a study of the Australian health care, it has been found that medical negligence had occurred in 12.2% of the admissions, 51 % deaths have been found to be avoidable (Griffith & Tengnah, 2017). Medical negligence occurs when the medical practitioner fails provide care that is expected resulting in injury or death of the patient. It can be any breach of conduct of the health care professionals (Brenner, Brenner, Awerbuch & Horwitz, 2012). In medical negligence cases it is the duty of the patient to establish that it is the duty that the concerned nurse or the health care staffs of the hospital owed to the patient. This can directly bring the concerned health care professionals under the Tort of negligence, where the claimant (Andrews’s parents) would be able to show a duty of care imposed by the law (Griffith & Tengnah, 2017).  

Recommendations

A nurse is liable to use the ethical frameworks while making the decisions. It can be seen that Andrew waited in the patient for long 6 hours in the waiting room without care, which is at the same time both in human and shameful for the nursing profession. A proper RN should be able to consider and response in a timely manner to the health and wellbeing of the patient. As per the nursing codes of ethics, an RN should abide by the key ethical principles. Patient should be shown beneficence by having compassion and taking positive actions to help the others. Another ethical that can be rightfully placed in the context is the non-maleficence, which enables the nurses to remain competent in their professions and report any kind of malpractices (Grace,& DRN, 2017). Patients should be kept first for which nurses might have to push their limits. According to the Safe patient care Act, a health care organization should have a proper doctor patient ratio. Lack of staffs and too much patients are likely to cause any kind of medical errors just as in this case (Ivanov & Oden, 2013).

One of the risk factor for this condition is that during waiting in the waiting room the bacteria can also get transmitted to other patients waiting in the same waiting room and hence risking the lives of others as well. A registered nurse will be understand about the clinical symptoms and should think of some greater good, thereby keeping the patient in isolation to prevent the spread of infections (Moss et al., 2015). TB is highly contagious as it can be caught by breathing in the air that an infected person has contaminated through and might spread if not caught timely and treated easily (Izadi et al., 2012).  One of the essential things that might be noticed in the case study, that is, the triage nurse had realized that there had been crowding of patients similar to Andrews’ symptoms and often of the same school, hence he /she should have realized that the all these children might have the same origin of the disease and investigations could have been done much before. According to Oyebode,  (2013), a successful arrest or the cure of pulmonary tuberculosis depends greatly on the early diagnosis and treatment. In this case the nurse failed to perform a timely assessment of the patient, thus a direct breach of the NMBA professional standard for the registered nurses, which clearly states that RNs are accountable for assessing , analyzing the best available evidence for making decisions and provide a safe nursing care (Nursing and Midwifery Board of Australia NMBA., 2017). Furthermore nurse should be competent enough to assess the patients. In this case it can be seen that Bill, the triage nurse is not competent enough to assess the patient properly. Competency is normally understood as the attainment of knowledge, intellectual capacities, integrity, practical skills, professional and the ethical values needed for a safe and accountable care practice as registered nurse (Australian Nursing and Midwifery Accreditation Council., 2017).

Accountability and responsibility are the core elements of the nursing ethics that states that the nurses are accountable to any kind of decisions, actions and other major decisions. Hence in this scenario, the clinical organization and the organization are liable to medical lawsuit in case of any breaching of standards (Izadi et al., 2012).  Another legal issue that can be noticed in this case is that the hospital staffs were also correct in not discharging Andrews as discharging might lead to spreading of the bacteria from the corpse to the parents or other people of the family.

Nursing ethics is one of the key concepts of this career. Before discussing about the secondary ways, it should be mentioned that nurses should develop a sense of self awareness, cultural awareness, empathy, compassion, and respect for the patient, which can be done by self reflection. It is required to polish himself or herself according the National competency standard for the registered nurses should engage in a continuous professional development to improve the type of care (Grace & DRN, 2017). Nurse should be able to engage in collaborative and curative practice. Nurses should constantly strive to fulfill the duty of care. He or she should be acquainted with the actions that are needed to be taken in specific circumstances (Nursing and Midwifery Board of Australia .,2015).

Another recommendation is regarding the recruitment of a competent workforce to disseminate the workload among the nurses (Grace & DRN, 2017). The strength of the nurse in the ED should be increased. This will avoid the near misses and will also facilitate quick assessment leading to prompt treatment.

The third recommendations include the appointment of medical officers and special nurses to handle any critical case. Proper incident report should be maintained in order to keep a record of the near misses.

Government should make the accreditation policies stricter; if a nurse is found to breach the standards frequently leading to serious complications, then as per the policies the licensure of the nurse can be cancelled (Griffith & Tengnah, 2017).

Finally, nurses should engage themselves in lifelong learning and should be able to reflect their practice, obtain feedback from the patients and the families to remain updates about the loops and the gaps left in healthcare (Bradbury, Frost, Kilminster & Zukas, (Eds.). 2012).  

Conclusion

In conclusion, it can be said that the ethical issues related to this case study is mainly negligence of care, improper early assessment of the patients and the keeping the patient waiting for long hours. All these medical negligence can be directly brought under the tort of negligence as it clearly states breaching of the basic nursing codes of ethics and the professional standards. In order to avoid any kind of medical errors and negligence emphasis should be given in the recruitment of the health care staffs where the crowding is much more, especially in the primary care areas. Furthermore the recommendation section has also described about the development of the self awareness regarding their duty. It also emphasizes on the stringency of the government policies regarding the accountability of the nurses, such that medical errors do not take place.

References

Australian Nursing and Midwifery Accreditation Council., (2017).National competency standards for the registered nurse, Access date: 6.10.2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/search.aspx?q=competency%20standards%20for%20rn

Bradbury, H., Frost, N., Kilminster, S., & Zukas, M. (Eds.). (2012). Beyond reflective practice: New approaches to professional lifelong learning. Routledge. https://books.google.co.in/books?hl=en&lr=&id=kYnYfUwvXWEC&oi=fnd&pg=PR3&dq=life+long+learnimng+in+nursing&ots=7uj9UCq8KD&sig=ZF5q1FD5XkJ51xHYIchs5d6kVqc#v=onepage&q=life%20long%20learnimng%20in%20nursing&f=false

Brenner, L. H., Brenner, A. T., Awerbuch, E. J., & Horwitz, D. (2012). Beyond the standard of care: a new model to judge medical negligence. Clinical Orthopaedics and Related Research®, 470(5), 1357-1364. https://doi.org/10.1007/s11999-012-2280-0

Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning. https://books.google.co.in/books?hl=en&lr=&id=1OQlDgAAQBAJ&oi=fnd&pg=PR1&dq=nursing+ethics+nonmaleficence&ots=eMKEL7Brx2&sig=DV9oWIuRisgYhjdEINU1dBuR2qM#v=onepage&q=nursing%20ethics%20nonmaleficence&f=false

Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning Matters. https://books.google.co.in/books?hl=en&lr=&id=z_X-DQAAQBAJ&oi=fnd&pg=PP1&dq=legal+issues+in+nursing&ots=UF67GTRk8I&sig=hFIxjj0iVwbNB5tiZDLiMJHgNQs#v=onepage&q=legal%20issues%20in%20nursing&f=false

Ivanov, L. L., & Oden, T. L. (2013). Public health nursing, ethics and human rights. Public health nursing, 30(3), 231-238. https://doi.org/10.1111/phn.12022

Izadi, M., Ayoubian, A., Saadat, S. H., Zarnaq, R. K., Abbasi, S., Moein, N., & Hekmat, M. (2013). Medical travel: the ethical and legal challenges. International Journal of Travel Medicine and Global Health, 1(1), 23-28. https://www.researchgate.net/profile/Rahim_Khodayari_Zarnaq/publication/283733839_Medical_Travel_The_Ethical_and_Legal_Challenges/links/5646498308aef646e6cda9e4.pdf

Moss, C., Nelson, K., Connor, M., Wensley, C., McKinlay, E., & Boulton, A. (2015). Patient experience in the emergency department: inconsistencies in the ethic and duty of care. Journal of clinical nursing, 24(1-2), 275-288. https://doi.org/10.1111/jocn.12612

Nursing and Midwifery Board of Australia (NMBA)., (2015).Registered nurse standards for practice. Access date: 6.10.2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes.../professional-standards.aspx    

Oyebode, F. (2013). Clinical errors and medical negligence. Medical Principles and Practice, 22(4), 323-333..Access date: 6.10.2018. Retrieved from: https://doi.org/10.1159/000346296

Pegalis, S. E., & Bal, B. S. (2012). Closed medical negligence claims can drive patient safety and reduce litigation. Clinical Orthopaedics and Related Research®, 470(5), 1398-1404. https://doi.org/10.1007/s11999-012-2308-5

Rao, S. J. (2012). Medical negligence liability under the consumer protection act: A review of judicial perspective. Indian journal of urology: IJU: journal of the Urological Society of India, 25(3), 361. doi:  10.4103/0970-1591.56205

Shin, K. A., & Cho, B. H. (2012). Professional self-concept, critical thinking disposition and clinical competence in nursing students. Journal of Korean Academy of Fundamentals of Nursing, 19(1), 46-56. 10.7739/jkafn.2012.19.1.046

Singh, J., & Bhushan, V. (2014). Medical Negligence & Compensation. Bharat Law Publications.

Sohn, D. H. (2013). Negligence, genuine error, and litigation. International journal of general medicine, 6, 49. doi:  10.2147/IJGM.S24256

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