The case study is concerned about Sam. Sam is a 21 years old boy, who had been admitted to the hospital with acute abdominal pain. According to the reports he had a past medical history of drug associated psychosis. Self harming and agitated behavior of Sam have compelled the clinical staffs to put him under restraints. According to Camilla, who was the nurse attending Sam , restraint on Sam would not only exacerbate Sam’s violence and agitation, but will also put other patients and the nurse at risk.
The following essay will throw light on the different codes of ethics of nursing that have been breached in this case study. This essay will also critically analyze the nursing codes of ethics and the rights of human dignity associated to this case. The essay will further explain the utilization of the alternative methods of care for the preservation of the ethics of nursing.
Utilitarian approach- This approach assesses an action in terms of the consequences and the outcomes. According to this ethics any decision would be made for the greater good. One act can be harmful for a particular patient, but it would provide safety to the other patients (Gray & Schein, 2012).
Deontology- The deontological approach is the normative ethical position that will determine the morality of action based on the rules. As per the deontological of ethics, an action may be considered as good, because of the feature of the action itself and not because of the product of the action ( Gray & Schein, 2012).
Libertarianism- This approach emphasizes on freedom of choice, individual judgment, freedom of speech and autonomy. In this case it is evident that the clinical staffs have imposed restraints on Sam, which may be considered as the breaching of the autonomy of the patient (Gray & Schein, 2012). Even if the entire intent was for the betterment of the patient, leaving the patient out of his decisions leads to violation of the ‘self’ of the concerned patient.
Natural Law: this theory suggests that law and morality are interdependent and are interconnected. As per the theories of the Natural law, morality in human beings is derived from the nature (Chadwick & Gallagher, 2016).
Virtual theory: this approach emphasizes on giving importance to the individual character. There are 3 main virtues of ethics. They are- Ethics of care, Eudaimonism and Agent based theories (Chadwick & Gallagher, 2016).
Egalitarianism: Equity should be maintained among all the people living in the society. This concept is based on the fact that all human beings are equal. This approach is well acceptable in nursing practices, as this is one of the sole principles that a nurse should follow (Gray & Schein, 2012). In this case it can be found that if the nurse performs according to the convenience of the patient, then it can bring in harm for the other clinical staffs. Again for the safety of other patients, if the patient is applied restraint and is tied, then it will be against the nursing ethics of autonomy (Chadwick & Gallagher, 2016).
The different ethical of virtues of Principlism are Justice, Non maleficience, beneficence, respect for the autonomy of the patient and respect for human integrity and dignity (Beauchamp, 2016). The ethical principle of Autonomy refers to freedom in patients. Another ethical principle refers to Beneficence (Burkhardt & Nathaniel, 2013). This principle approaches a type of care that is best for the patient and involves good conduct of the nurses. In order to apply beneficence in nursing, nurses sometimes have to take up rude decisions which are intended for the betterment of the patient. The principle of Non maleficense follows that a patient should not be harmed at any cost (Chadwick & Gallagher, 2016). It should be made sure that the act that is being done with the patient is intrinsically not wrong and have some underlying superior effects. The concept of Justice refers to a complicated conundrum, if a patient is forcibly detained against his consent.
In this case study the different principles of ethics that has been breached are beneficence, Justice, Non maleficence and Respect for patient autonomy, respect for human dignity (Lin, Watson & Tsai, 2013).
The primary codes of ethics that have been breached in this case is that Although Sam was showing anger and aggression, he would not be harmed at any cost (Burkhardt & Nathaniel, 2013). Second ethical issue that has been breached in this case is non-maleficence shown by the nurse named Julia. According to Julia, investing time on Sam would be just a waste of time. In case of Camilla, the type of dilemma that has been faced by her is of utilitarian approach. The statements made by Julia are associated to the moral and the ethical principle of Utilitarian approach (Lin, Watson & Tsai, 2013). This kind of approach can ham the individual but it would cater to some greater good. In this case, it is clearly evident that if Sam is set free then he might harm other patients and the clinical staffs, which will reduce the maximum, benefit (Butts & Rich, 2015). Principles of maleficence indicate that no patient should be harmed in any way, thus principle of maleficence have been breached in this case (Grace, 2017).
Secondly, it can be seen from the concerned case study that Julia had expressed discontent regarding provision of treatment to Sam. Thus, the principles of Justice and Egalitarianism had been breached in this case. It is evident from the case study that Camilla is inclined to the concept of deontology and thus is perturbed about the mental condition of Sam (Beauchamp, 2016). As per the theory of virtue, it is necessary to consider the condition of the individual before judging a patient. In this case Julia is judging Sam on the basis of his attitude and action. She is not considerate about the mental health of Sam and is more concerned about their own well being.
It is clearly evident from the case study that Camilla has been showing concerns for Sam as well as her peers. Therefore it can be said that Camilla is adopting the egalitarianism theory that believes on equality among the all human beings. It is proved from the case study that Camilla’s mind set is directed by the ethical principle of liberty (Grace, 2017, Kangasniemi, Pakkanen & Korhonen, 2015). Only Camilla has identified that although application of restraint would bring about positive impact on other patients and nurses, this would be against the rights of liberty of Sam.
There are certain codes of professional conduct that needs to be upheld by the nurses during their nursing regimen. A nurse should be able to provide care to the patient that is culturally safe and competent. A nurse should be able to provide a quality nursing care to all the patients (Grace, 2017, Kangasniemi, Pakkanen & Korhonen, 2015). Nurses should be able to value the culturally diversified people and would be able to provide a care that is patient centered. As per the nursing codes of conduct it is necessary to rule out the determinants of poor health such as race, psychosocial and the cognitive disability, socio economic statues (Grace, 2017, Kangasniemi, Pakkanen & Korhonen, 2015). It is essential to built up a socially, economically and ecologically sustainable ambience to mitigate the harmful effects of these social determinants.
Human dignity is an individual’s sense of self worth and self respect (Grace, 2017, Kangasniemi, Pakkanen & Korhonen, 2015). Every patient has been entitled to get some basal level of care, which includes food, shelter and personal safety. The human rights in nursing practice involves respect, proper recognition, protection of economic, civil, cultural and political rights in human beings (Curto et al., 2016). It should be noted that there are certain episodes of care that may appear to be frightening for the patient and can conflict with the ethics of human dignity. In this case Sam has been applied restraint, so that he does not harm himself and others, but such an action can lead to further agitation and annoyance in Sam and erosion of his dignity.
The practice of nursing is something beyond delivering care to the patients. It includes provision of maleficence, beneficence, patent advocacy, justice and integrity to the patient(Chadwick & Gallagher, 2016). It is evident from the case study that the medical team had ordered restraint on Sam. As a nurse it is essential to understand the physical and the emotional burden in Sam, which is acute abdominal pain and his psychosocial dysfunction (Ivanov & Oden, 2013). Therefore as a nurse my first recommendation can be to adopt alternative techniques which would be safe and would not harm the integrity of the patient. It should be mentioned that application of restraint may be dangerous for mental patients. A patient with psychosocial problems should be dealt holistically, such that an ambience of trust generates between the patient and the nurse. Sam could have been left alone for some times unless he settled down them he could have convinced regarding is treatment. It is known from the case study that apart from Camilla, the other clinical staffs were resentful in attending Sam. Instead of doing this, all the clinical staffs could have utilized a collaborative approach and would have acted as a therapeutic team in care of Sam.
The above mentioned case study provides us with a vivid idea regarding the nursing codes of ethics and also determines the ethical codes that have been breached in this case. Thus it can be concluded that non-maleficence, beneficence, dignity and integrity in patients should be considered critically while dealing with patients like Sam. However keeping his aggression and agitation in mind, restraints would support the law of deontology but can have negative impact on mental patients.
Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer International Publishing. 27 September 2016
Buchanan, A. (2010). The egalitarianism of human rights. Ethics, 120(4), 679-710.
Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Nelson Education.
Butts, J., & Rich, K. (2015). Foundations of Ethical Nursing Practice. Role Development in Professional Nursing Practice, 117.p.p. 117
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.
Curto, M., Masters, G. A., Girardi, P., Baldessarini, R. J., & Centorrino, F. (2016). Factors Associated with Costs of Hospitalization of Severely Mentally Ill Patients. Bipolar Disord, 2(104), 2. DOI: 10.4172/jbd.1000104
Gray, K., & Schein, C. (2012). Two minds vs. two philosophies: Mind perception defines morality and dissolves the debate between deontology and utilitarianism. Review of Philosophy and Psychology, 3(3), 405-423. https://journals.sagepub.com/doi/abs/10.1177/0969733012458609
Ivanov, L. L., & Oden, T. L. (2013). Public health nursing, ethics and human rights. Public Health Nursing, 30(3), 231-238. DOI: 10.1111/phn.12022
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757. DOI: 10.1111/jan.12619
Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient safety: Implications for nursing management. Nursing ethics, 20(8), 904-916. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0969733013484488
Lin, Y. P., Watson, R., & Tsai, Y. F. (2013). Dignity in care in the clinical setting: A narrative review. Nursing Ethics, 20(2), 168-177.retrieved from https://journals.sagepub.com/doi/abs/10.1177/0969733012458609
Taylor, R. M. (2013). Ethical principles and concepts in medicine. Handbook of clinical neurology, 118, 1-9. DOI: 10.1016/B978-0-444-53501-6.00001-9
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