NUR 3020 Transition to Professional Practice

NUR 3020 Transition to Professional Practice

Assignment 2 – case study analysis

Introduction

Healthcare professionals are constantly confronted with situations in which they have to make decisions with legal and ethical ramifications. They are constantly confronted various options to choose from, leading to dilemma (Dierckx de Casterle, et al, 2008, p. 540). The choices made by a health professional may lead to conflict with the decisions of others in the same team. This paper presents an analysis of a case in which medical professions are confronted with a situation in which they are required to make crucial ethical decisions regarding the treatment of a patient.

Problems identified in the case study

Ethical Issues Concern regarding infliction of harm on patients

Concern regarding acts of disrespect for the rights of patients This is evidenced by the conflict regarding the appropriate treatment to be provided to Emily.

This is evidenced by the extent of care and support provided to Emily by Sue. .

Legal issues lack of documentation

disregard for psychosocial aspects of care

Withholding of treatment

disregard for physical aspects of care There lacks specific documentation of patient’s stages of illness

The is limited attention to emotional aspects of end-of-life care evidenced by lack of communication of patient’s health status with patient and family members

Medical tests on patients health condition are delayed

There lacks close and detailed attention to symptoms recognition and management

Adherence to the Fundamental Ethical principles

Principle Explanation

Autonomy Autonomy implies the ability to make own decisions without infringement or coercion from others to make those decisions. According to this principle, every patient has a right to choose or refuse treatment. In order to make an informed decision, this principle requires that a patient be provided with complete, understandable and accurate information on the benefits and risks of the available options of treatment (Woodward, 1998, p. 1049).

In this case, it is evident that Sue bleached this principle by failing to provide Emily with such information. She decided to treat her with painkillers and never took time to listen to what she wanted. That way, she bleached the principle of Autonomy.

Beneficence This is a principle that requires medical practitioners to act in the best interest of patients. In order to make informed decisions and choices regarding care and treatment, patients require specialized information that may be beyond their understanding and thus, they may require guidance. Medical practitioners have a moral obligation to weigh the benefits of the consequences of their decisions and those of patients against the possible costs and harms (Woodward, 1998, p. 1050). The patients should then be adequately informed and be assisted to make choices that do not adversely affect their well being.

Evidently, Sue did not act in the best interest of Emily in this case. After realizing that her temperature and pulse rate had risen, she advised Ben to giver her Panadol, a pain killer. She excused herself as being too busy to be able to make further examinations. Despite Emily’s deteriorating health condition, Sue did not take steps to inform June or the Doctor. She dismissed her as being suffering from cold. Only after Doctor’s examination that it was realized that Emily was diagnosed with urinary track infection and Septicaemia. Generally, it is clear that Sue failed to act in the best interest of Emily and thus, violated the medical principle of beneficence.

Non-maleficence This principle is embodied by the phrase ‘first, do no harm.’ This implies that it is more important not to harm a patient than to good to them. Medical personnel may sometimes be tempted to apply treatments that they think will do good to patients without evaluating them first to ensure that the treatments do not harm them. As Ferrell et al, (2001, p. 117) explains, prescribing treatment to patients without evaluating them first is ruinous to them. Sue violated this principle by assuming that Emily was suffering from cold and then prescribed Panadol, a pain killer to her. The painkillers were difficult for Emily to swallow and could harm her.

Confidentiality This principle requires medical personnel to maintain confidentiality about all patient information. Unnecessary or inappropriate disclosure of such information can destroy trust between patient and medical practitioner. Relevant information should only be disclosed to members of medical team who are directly involved in the care (Ferrell et al, 2001, p. 118). In this case, Emily’s illness is confidential and should not be inappropriately disclosed. Though this is not an issue in the case study, information regarding Emily’s health status should be limited to the relevant members of medical team and to the close family members.

Veracity All medical practitioners have a duty to honestly and respectfully provide patients with full information regarding their health status. Every person has a right to access information about their health status and treatment from health services in order for them to be able to play an active role in formulation of health policy. Such information should only be concealed if it is likely to lead to adverse effects on the health of a patient or the patient does not have capacity to make decisions (Ferrell et al, 2001, p. 118). Patients should also be given opportunity to share, discuss and make decisions with family members and significant others about their health. In this case, Sue did not disclose any information to Emily and her family members regarding her health status. septicaemia is a serious, life-threatening infection and leads to confusion and other changes in mental status of patients. This may have incapacitated Emily to the extent that she lacked capacity to make decisions. In that case, it was essential to consult the family members of Emily to give informed decision on behalf of Emily. However, Emily’s family members were not informed in time.

Adherence to Law and Professional nursing standards

Laws and professional nursing standards in Australia are developed by a national nursing and midwifery organization known as the Australian Nursing and Midwifery Council Incorporated (ANMC), in conjunction with the state organizations. The performance of medical personnel is assessed against these standards in order to obtain or retain license. Among other issues, professional standards require nurses to fulfill duty of care by performing nursing interventions in accordance with the recognized standards of practice (Dierckx de Casterle, et al, 2008, p. 541).

The standards require all licensed nurses to fulfill their duty of care by performing comprehensive and accurate assessments of patients before making any interventions. They are required to document and report complete and accurate assessments or observations of changes in a patient’s health progress. They are also required record the care provided to a patient and the patient’s response to the care. Further, the standards require every nurse to clarify their responsibility for aspects of care with the other relevant health professionals in the team. They are also required to prevent harm on patients and to adequately and accurately inform them or their family members about their health conditions progress (Dierckx de Casterle, et al, 2008, p. 541).

The law of contract, which includes negligence, imposes duty of care on medical personnel for patients since their relationship is understood to be contractual in nature. Duty of care is also a requirement under tort law, which includes trespass to persons and negligence. Climinal law also imposes the same duty and is concerned with interference with an individual’s person (Toren & Wagner 2010, p. 393).

In this case, Sue bleached the above standards by failing to conduct comprehensive and accurate assessment of symptoms of Emily’s illness. She did record observations of stages of her illness. She also failed to inform June and the Doctor regarding Emily’s deteriorating health condition. On top of that, Sue administered wrong treatment to Emily, which could cause harm. She ignored informing the family members of Emily about her health status. Generally, Sue’s conduct constitutes negligence and malpractice and may be sued in a court of law, under the aforementioned laws.

How the problem would look from another perspective

In this case, Sue believes that Emily is in the face of inevitable death given her age and thus, further medical care is futile. She believes that Emily only requires comfort and pain killer to keep her alive. The professional standards of care allow for futile medical care for patients who are in the face of inevitable death, but some guidelines are provided (Curtin, 2005). In such situation, choosing and informing the patient and the family members or significant others is not easy and may require procedure. Confidentiality should also be observed and the patient’s health status should not be inappropriately disclosed. This may justify the conduct of Sue by withholding information from the other health professionals, Emily and her family members.

Apart from Sue, there are other stakeholders who have interest to Emily’s health condition. They include Emily herself, her family members, nurses and doctors. All of them are interested to understand cause of the deteriorating health condition of Emily. Their concerns are significant since they have right to be informed. They are also legally allowed to access information about Emily’s health condition. From an ethical point of view, the conduct of Emily would be acceptable to the extent that she plan the procedure to inform other health professional involved in her care and family members.

Ethical conflicts identifiable in the case study

In the case study, June faces ethical conflict from Sue, who holds different values regarding the care and support that should be provided to Emily. As well, there is ethical conflict between Ben and Sue regarding the quality of overall care administered by Sue to Emily. There is also ethical conflict between treatment options, whether to provide Emily with medical care of futile medical care. This is brought about by the conflicting values of the care providers.

These conflicts may be resolved if all the parties involved accept to be guided by the ethical principles of nursing including beneficence, autonomy, non-maleficience, confidentiality and veracity (Toren & Wagner 2010, p. 393). These principles can guide nurse managers to make solutions when nurses collide and to ensure that the rights of patients and those of nurses are respected.

The relevant legal concepts in the case study are negligence and malpractice. These concepts are expressed by the tort law, the law of contract and in the criminal law, both at federal and state level. These laws can help nurse managers to ensure that the rights of patients to care are observed and the rights of nurses are also observed (Toren & Wagner 2010, p. 396).

Ethical-legal decisions

In the case study, the decision that needs to be made is to compel all health professionals in the nursing home to respect and conform to the ethical, legal and professional standard guidelines of medical practice (Curtin, 2005). In this case, the guidelines were balanced eventually. Sue’s conduct in her care for Emily seemed to contradict these guidelines initially but this perspective changed after it was realized that Emily has a serious disease that can lead to her death.

The first step in communicating the aforementioned decision is to ask the health team in the nursing home to reach consensus issues regarding the range of appropriate treatment. The responsible physician, in collaboration with the other health professions involved should inform the patient and the family members and then seek their wishes for treatment. They should inform the patient and family members the need for withholding or continuing with medical treatment. They should describe palliative care measures which can help in keeping the patient as comfort as possible and with dignity. The physician should then negotiate an acceptable plan of treatment with the patient and family. They should then be given chance to seek second opinion in case of need.

Conclusion

In conclusion, the case study demonstrates how health professionals are confronted with situations in which they are bound to make choices among various ethical decisions. They are faced with dilemma due to the huge impact of any decision made. Some times, they make decisions that are contrary to ethical, laws and professional standards of care. This may lead to conflicts with the stakeholders involved. In such situations the requirements of ethical legal and professional standards should prevail.

References

Curtin, L., (2005), “Patient wishes and futile interventions” Accessed 11, October 11, 2012 from

http://healthcaretraveler.modernmedicine.com/healthcaretraveler/FAQs+about+Healthcare+Travel/Patient-wishes-and-futile-interventions/ArticleStandard/Article/detail/154100

Dierckx de Casterle´, B., Izumi, S., Godfrey, N. S. & Denhaerynck, K., (2008), “Nurses’

responses to ethical dilemmas in nursing practice: meta-analysis.” Journal of Advanced Nursing Vol. 63 Iss. 6, Pp. 540–549

Ferrell et al, (2001), “Ethical Dilemmas in pain management,” The Journal of Pain, Vol 2, Iss. 3,

pp 171-180

Toren, O. & Wagner, N., (2010), “Applying an ethical decision-making tool to a nurse

management dilemma.” Nursing Ethics, Vol. 17. Iss. 3. Pp. 393-402

Woodward, V. M. (1998), “Caring, Patient Autonomy and the stigma of paternalism,” Journal of

advanced Nursing, Vol. 28. Iss. 5. Pp. 1046-1052