Each and every profession has its own code of ethics. Likewise nursing has its own codes of ethics. The different codes of conduct for different professions may be confined to that field but all of them share a common code that is honesty and dignity towards the work and not doing things that may be harmful for someone (Johnstone, 2015). It is very essential for a nurse to maintain the codes of ethics as nurses remain in the frontline along with the doctors in providing an appropriate care to the patient. A nurse should respect the dignity and value of each and every patient irrespective of the cast and the creed (Lachman, 2012). One of the ethical responsibilities of the nurse is to provide mental and spiritual support to the patient apart from the physical support. Furthermore honesty and self integrity is another ethical value that should be maintained by the nurses. It is the duty of a nurse to be honest with the colleagues and the patient in order to maintain self integrity and good personal moral standard (Johnstone, 2015). A proper nurse should always strive to provide maximum care to the patient.
This case study focuses on the malpractices of a particular registered nurse, whose psychology has cost the life of a particular person. This essay focuses about person A. who was been admitted to the hospital with several complications like the shortness of breath, acute diabetes, leg edema, tachycardia and other ailments. It was reported that the patient failed to improve as days passed by since his admission in to the hospital. It should be discussed beforehand that patient A, before his admission into the hospital has been said to visit the hospital with the complaint of shortness of breath and on diagnosis it was found that he had fine creps at the base of both the lungs and was having high BP. At the next day he was admitted to the hospital. The patient as continuously having a feeling of discomfort due to the prolonged back and abdominal pain, but it was found that the attendant did not serve him properly. The patient was having severe abdominal pain and diarrhea but the enrolled respondent said that the patient will be attended after the locum arrived. It is the duty of a nurse to take prompt actions and in some cases push her own limits to provide care to the deteriorating patient. It was evident from the case study that the respondent personally attended the patient but she did not document the observations, in spite of the fact that his vital signs had not shown any improvement. It can be expected from a registered nurse that she should maintain all the documents so that they can be produced as and when required. As per the witnesses provided by the HCCC, the nurse should have arranged for a medical review as soon as blood pressure was 89/53 and there was a prolonged abdominal pain, which were the clear indications that the patient’s condition was deteriorating. It is evident from the situation that the nurse failed to organize the medical attendance for the patient.
Further research from the case study provides with the information that, as per the vital signs shown by patient A, he was kept in the ‘Red Zone’, which signifies ‘Rapid response’ , which means that the patient has to be monitored by a healthcare professional or a rapid response team within 10 minutes (Lachman, 2012). If any such cases arise, then the on-call medical officer should be notified immediately. But the RN did not find it important to inform the medical officer in charge, which shows her incompetency in the field.
As mentioned earlier that a nurse should assess the patient properly and should document everything clearly either manually or electronically, as per the regimen of an evidence based nursing.
It was reported in the case study that the respondent called up the clinical nurse manager to arrange for the medications for a patient older than patient A, but she did not raise any issue regarding patient A, which indicates gross negligence from her. A nurse should be upholding the highest standards of care to the patient according to the codes of ethics. But here we can find that she could not understand the credibility of the situation. After about an hour the respondent and another registered nurse completed an ISBAR form where she recommended that patient A is deteriorating and should be reviewed ASAP. It should be noted that a complaint was amended by the HCCC, which says that in spite of being a registered nurse under NSW, it is very shameful that his nursing practice has been below the standard as expected from a registered nurse. A nurse should be responsible for protecting and advocating safety and rights of the patient. A nurse should be able to maintain self moral standards (Chadwick & Gallagher, 2016). In order to thrive in her own career she is bound to perform the duties she is entrusted with.
Researches have suggested that hospital staffs often miss the signs of deterioration in patients. The key reason behind this is that they fail to fill in the charts and documents based upon the observations. It is the duty of a nurse to observe and to report the deteriorating patients. It should be always remembered that health care outcome is always proportional to the effort and care delivered by the nurses and the midwives (Russell, 2012). A nurse should be able to exhibit empathy and compassion with the patients. A nurse should be able to create mutual trust between her and the patient. We come to know from this case study that the patient is 81 years old which indicates, he was already suffering from several physical and emotional turmoil, due to ageing. It is evident from the case study the patient was continuously refusing food and medicine. Good nurse should know how to deal emotionally with the elderly patients. She should have tried some alternative methods of feeding (Christensen & Kockrow, 2013).
Researches have shown that proper nursing care has often shown improved health as compared to the one with just medications (Grace, 2017). Ethics in nursing includes fair and equal treatment for all patients irrespective of the age, gender, economic status, disability, and ethnicity. A nurse should encompass collaborative as well as autonomous care to individuals, but the above case study shows that registered nurse could not assess the importance of the condition and didn’t pay attention to the patient’s deteriorating condition (Grace, 2017).
In case a health care setting is unable to provide an appropriate care to the patient or a health care organization is not equipped with proper tools and medicines, then the deteriorating patient should be shifted any other hospitals. In case of patient A , this crucial decision was being taken at last but it was too late to save the patient. It is the duty of a nurse to monitor and document all the signs and symptoms of the patient. The conduct of the concerned nurse was below the professional code of conduct.
It was found from the case study that Patient A died of septicemia. It should be noted from the case study that the patient was suffering from a number of co-morbidities like leg edema. The infection might have spread from his leg. Proper interventions could have been taken to prevent the spreading of the infection internally. According to the accused registered nurse the concerned health care setting lacked the improved technologies and tools, in such a case she could have insisted the doctors for a handover of the patient to somewhere better, which could have at least saved his life.
Researches show that nurses have the power to recognize the deterioration in patients through intuitions. Addition of ‘worry or concern’ to the rapid response system often provides opportunities to the nurses to act upon their intuitions and obtain medical assistance at an early stage of deterioration (Christensen & Kockrow, 2013).
Patient and nurse interaction often facilitate this process. There are some general ethics of care, which are- attentiveness, responsibility, responsiveness of the nurse and competence (Christensen & Kockrow, 2013).
Attentiveness involves the detection of the needs of the patient; attentiveness refers to the stepping out from their own personal preference system to provide the appropriate care. An hourly rounding facility should be present, where the nurse would be asking the patient directly about his or her needs every hour (Butts & Rich, 2012). This ensures that the patient is not neglected. A nurse should continuously try to increase her competence. In reference to the nursing ethics, there is no vagueness that nurses have the responsibility of their assigned patients.
However it can be concluded that when a person chooses to be a nurse, she has to make a moral commitment to deliver a proper care to all the patients (Butts & Rich, 2012). Such an oath should not be taken lightly. Care should be always considered as an ethical task and should be delivered as a part of the duty, which cannot be found in the given case study.
Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., ... & FIRST2ACT™ Research Team. (2014). Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study. Nurse education today, 34(5), 691-696.
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.
Christensen, B. L., & Kockrow, E. O. (2013). Foundations of Nursing-E-Book. Elsevier Health Sciences.
Dawson, S., King, L., & Grantham, H. (2013). Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia, 25(5), 393-405.
Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 2375-2388.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Healthcare Sciences.
Lachman, V. D. (2012). Applying the ethics of care to your nursing practice. Medsurg Nursing, 21(2), 112.
Leget, C. (2013). Analyzing dignity: a perspective from the ethics of care. Medicine, health care and philosophy, 16(4), 945-952.
Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.
Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing Regulation, 3(3), 36-42.