Ethical and Legal Issues in Nursing Essay

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Ethical and Legal Issues in Nursing Essay
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  • University/College:
    University of Chicago

  • Type of paper: Thesis/Dissertation Chapter

  • Words: 1461

  • Pages: 6

Ethical and Legal Issues in Nursing

Nurses today face many ethical dilemmas in the delivery of patient care. What can or should be done for the patient versus the wishes of the patient’s physician conflicting with the personal beliefs the nurse holds to be true. The client’s wishes may conflict with the institutional policies, physician professional opinion, the client’s family desires, or even the laws of the state. According to the nursing code of ethics, the nurse’s first allegiance is to the client (Blais & Hayes, 2011, pg. 60). The ethical ideals of each nurse must be weighed with the laws of the state along with providing the most ethical care for the patient. The advancements in medical technology make it possible to sustain a patient life where previously there was no hope of recovery. These advancements have put nurses in the forefront of decision making begging the question “just because we can, should we” to be answered. Nurses need to understand the legalities involved with these new technologies to practice safely and effectively. Scientific achievements have opened new ground for nursing exploration. In response to the need for nursing input into social and legal issues, nurses now find career opportunities as forensic nurses, legal nurse consultants, and nurse-attorneys (Blais & Hayes, 2011, pg. 75). This paper will explore the ethical and legal issues encountered by nurses in two case studies.

The American Nurses Association Code of Nursing Ethics could influence a final decision in each case study that was presented. The six caps study revealed family members to have conflict in their desires when it came time for a decision in going ahead with surgery (the father’s desire) and having a poor quality of life as the outcome (the adult children’s belief based on physicians prognosis). The adult children believe that their mother would not want to have the surgery and have a poor quality of life. The appropriate decision to involve the ethics committee shows the collaboration between health care professionals. Nurses should be aware of their own values and attitudes in order to recognize when a situation might affect the care they are able to provide (Blais & Hayes, 2011, p.52). The nurses primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA Code of Ethics for Nurses, 2014). Given the information that the adult children believe, their mother would not want to undergo the surgery, it is implied that it was the patient’s wish.

Based on the above information the ANA code of ethics can influence the final decision in that the family members would come to realize that the outcome from surgery would not be what the patient desires. A good decision is one that is in the client’s best interest and at the same time preserves the integrity of all involved (Blais & Hayes, 2011, p. 61). The critical thinking exercise gives information that a nurse is a witness in a malpractice case. The negligence resulted in harm to the client and the case is against the healthcare institution and another nurse who was overtly negligent. The nurses primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the values of the profession through individual and collective action (Blais & Hayes, 2011, p. 59). Given the above ethical codes the nurse failed to uphold and follow ethical practice which resulted in harm to the patient. It is reasonable to assume that the ANA code of nursing ethics would have a significant impact on the courts final decision, as codes of ethics are usually higher than legal standards, and they can never be less than the legal standards of the profession (Blais & Hayes, 2011, p. 58)

Registered Nurses (RN’s) are routinely faced with moral and ethical decisions concerning their patients and fellow employees. In healthcare these issues can be very complex and complicated. An R.N. must frequently challenge their own moral and ethical values when they tasked with supporting their patients and families through difficult end-of-life decision making. Additionally, they may be forced to face the ethical decisions surrounding a fellow co-worker that might be compromising patient care due to impairment, because of an addiction or sleep deprivation. As with other people, there are many issues that influence an RN’s moral and ethical decision making. According to Chitty & Black, an individual’s moral and ethical decision making process is affected by their value system which is largely influenced by their culture and life experiences (Chitty & Black, 2011). Additionally, literature states that ethical decisions are also affected by the social norm of a society or group (Chmielewski, 2013). Unfortunately, when the decision making process for moral and ethical decisions is made through this form of influence, the choices made for moral conduct may go awry.

An example of this might be a group of students that decide as a whole to cheat on an exam. In other words, if the social norm is used as moral compass, there must be an unbiased check and balance system in place. In a hospital setting, this process may involve an ethics committee, an organization’s corporate compliance, or a human resources department. For RN’s that are faced with ethical and moral dilemmas, it is also important to refer to the Code of Ethics for Nurses that has been established by American Nurses Association (ANA). The ANA has set very clear guidelines for RN’s concerning the professional ethical obligations that are expected of nurses when faced with moral decisions concerning patients, colleagues, and the organizations that they work in (American Nurses Association, 2014).

The nurse has a legal duty to assist justice as far as possible (Blais & Hayes, 2011). In the case study of the nurse who observed a nurse violating standards of care, and who was overtly negligent, the nurse has a legal duty to report the incident. The primary responsibility of a nurse is to the patient. It is vital for the nurse to report negligence on any level in order to protect the safety of patients. The nurse also has a legal responsibility to be truthful and honest when testifying as a witness in court (Blais & Hayes, 2011).

In the case study of Marianne, the responsibility of the nurse is to organize discussion between the patient and her family regarding end of life decisions. In this case, there is no advanced directive, which puts the family in a bind, not knowing exactly what to do. According to the American Nursing Association, the nurse should attempt to have the Advanced Directive signed during the admission process (“End of Life Issues”, 2014). Doing this will not only protect the patient, but will assist the family in
knowing what the patient wishes in the event that the patient cannot speak for herself. A nurse has a legal responsibility to put the patient’s needs first, protect the safety of every patient, and act as patient advocate with every patient encounter.

As stated above nurses are faced with many personal and professional dilemmas in their daily duties. The ANA Code of Ethics is intended as an aid to these difficult decisions. The danger, though, with any such “aid” is that it may be applied in an unthinking manner as simply a set of preexisting rules (Dahnke, 2014). Nurses must always keep the focus on delivering the highest quality of care to the patient.

References
American Nurses Association, Code of Ethics for Nurses. (2014). Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf American Nurses Association, End of life issues. (2014). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/End-of-Life Blais, K.K., Hayes, J.S. (2011). Professional Nursing Practice: Concepts & Perspectives. (6th ed., cpt. 6). Upper Saddle River, NJ: Pearson/Prentice-Hall. Chitty, K.K. & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.). St. Louis, MO: Elsevier Saunders Chmielewski, C. (2013). Values and culture in ethical decision making. The Global Community for Academic Advising. Retrieved from http://www.nacada.ksu.edu/Resources/Clearinghouse/View-Articles/Values-and-culture-in-ethical-decision-making.aspx Dahnke, M. D. (2014). Lippincott’s nursing center.com: The role of the American Nurses Association code in ethical decision making… Retrieved from http://www.nursingcenter.com/lnc/static?pageid=864590

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Ethical and Legal Issues in nursing Essay

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Ethical and Legal Issues in nursing Essay
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  • University/College:
    University of California

  • Type of paper: Thesis/Dissertation Chapter

  • Words: 4180

  • Pages: 17

Ethical and Legal Issues in nursing

The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. The purpose of this assignment will be to critically discuss an episode of care encountered whilst on clinical placement. The episode of care involves the covert administration of medication to an elderly patient. The decision to covertly administer the medication will be critically assessed in this assignment. The Gibbs(1988) reflection model will be used to guide the discussion. The discussion will also consider the legal, ethical and professional issues surrounding covert medication.

In the mental health sector, medication non-adherence remains a serious health-care problem with far-reaching ramifications for patients, their relatives and health-care professionals. Harris et al. (2008) found that between 40 and 60% of mental health patients fail to adhere to their medication treatment plan. This number increased to 50 and 70% for elderly patients with dementia, and between 75 to 85% among patients with schizophrenia and bi-polar disorders. In such cases, where the patient’s well being is at risk and the treatment is essential, health-care professionals may resort to disguising medications in food and drink. The medication is crushed or liquefied and mixed with foodstuff. This practice of concealment is called covert medication(NMC,2008). By covertly administering medication, the patient consumes a drug without the required informed consent. The Gibbs(1988) reflection model has been chosen for the purpose of this assignment as it allows the author to reflect and think systematically about the episode of care. The initial stage of Gibbs’ reflective cycle is ‘Description’; in which the author is required to describe the events which occurred.

In order to comply with the NMC(2010) code of conduct and guidelines on patient confidentiality, the patient will be called Mr Walker. Mr Walker, an 80-year-old service user was temporary placed at the respite care home. Mr Walker had severe dementia, and was unable to communicate effectively. He frequently resisted all essential nursing care. Mr Walker’s medical history also included hypertension and angina. He was prescribed blood pressure medication (enapril tablets) to stabilise his blood pressure and to reduce the risk of stroke and heart attacks. He was also prescribed diuretics and medication to prevent further angina attacks. Mr Walker frequently refused to take his medication; spitting out the tablets and refusing to swallow. The nurse in charge, concerned about the deterioration of Mr Walker’s health, considered the option to covertly administer his medication. The MDT held a meeting and reached the decision to covertly administer Mr Walker’s medication. The second stage of the Gibbs’ reflective cycle is ‘Feelings’, requiring the author to briefly discuss her reactions and feelings. The author felt the decision to covertly administer medication was morally correct and ethically permissible. The author refers to the deontology ethical theory to support her thoughts and feelings.

The NMC code of conduct considered by Beckwith and Franklin(2011) as a model of rule deontology states that all health-care professionals should “safeguard and promote the interests and well-being of patients”. The act of covertly administering medication could therefore be deemed morally correct. The practitioners intended on acting in the best interest of Mr Walker irrespective of the consequences of their actions (breaching patient autonomy). Their actions promoted and safeguarded Mr Walker’s health and well-being. Husted (2008) argues that from a deontological point of view, violating an individual’s autonomy is sometimes necessary to promote the individual’s best interest. In this case it could therefore be ethically permissible to covertly administer medication without Mr Walker’s consent. The medication is essential and promotes Mr Walker’s long-term autonomy and safeguards his health and well-being. Similarly, the ethical principles of beneficence and non-maleficence could be used to justify the use of covert-medication (Wheeler 2008).

The principle of beneficence is an ethical principle derived from the duty to provide benefits and to consider the benefits of an action against the risk. According to Masters(2005), health-care practitioners have a professional duty and an ethical obligation to carry out positive actions with the aim of safeguarding their patient’s health and well-being. With this notion in mind, covert medication could be morally justified if it safeguards the welfare of the patient. In this case, the discontinuation of medication would have had a detrimental effect on Mr Walker. Thus administering the medication covertly was in accordance with the principle of beneficence. In this case, one could also argue that the medication was actually acting as an autonomy restoring agent (Wong et al,2005). Mr Walker’s autonomy was restored in that he was relieved of severe pain. The medication also worked by improving his quality of life. Several studies on the chemical and physical restraint of aggressive dementia patients also often show a preference to covert medication (Treolar et al,2001). Covert medication is often considered the least ‘restrictive’ and ‘inhumane’ way of administering medication when considering alternatives like physical and technical restraint to administer medication by force (Engedal,2005). Such alternatives to covert medication are unsafe and can have long lasting negative psychological effects on the patient (Wong et al, 2005).

However, covert medication is not without its shortcomings. The team was deceiving Mr Walker, an already confused, poorly, frail, weakened and vulnerable individual. In the Dickens et al(2007) study, many patients expressed this view of covert-medication as an act of deception. They considered covert medication as an extremely coercive practice violating their personal rights. This resultantly damaged the therapeutic nurse-patient relationship and patients felt they were no longer in a safe, therapeutic environment. The nursing ethical principle of non-maleficence is similarly relevant to this discussion. It requires practitioners to safeguard their patients’ welfare by not inflicting pain or harm (Koch et al,2010). This requirement poses serious ethical dilemmas. It is difficult to uphold this ethical standard as all forms of medical intervention entail some element of harm. Koch et al,(2010) suggest that perhaps for the harm caused to be ethically permissible it should be proportional to the benefits of the medical treatment. The author thus feels that covert medication in Mr Walker’s case could be ethically justified under these ethical principles.

The author will now focus on the ‘Analysis’ stage of Gibbs’ reflection model. Here, the author will critically analyse the events which occurred including the decision making process and the decision itself. The author will firstly discuss the issue of consent in relation to covert medication. The covert administration of medication is indeed a complex issue. It derives from the essential principles of consent and patient autonomy which are deeply rooted in the UK statute, common law and the Human Rights Act 1998 (Lawson and Peate,2009). The UK law clearly considers bodily integrity a fundamental human right; a mentally competent adult has the right to refuse medical treatment regardless of how essential the treatment is to their health and well being (Kilpi, 2000).

The freedom of choice which is reinforced by the ethical principle of respect for autonomy is an important right. The NMC(2008) further highlights in the Code that it is the nurses’ professional, legal and ethical duty to respect and uphold the decision made by the patient. If a nurse administers covert medication to a mentally competent individual, the nurse will be acting unethically (disregarding autonomy) and in breach of the law which could constitute grounds for trespass, assault or battery (NICE,2014), as shown in the cases R v SS [2005] and R v Ashworth Hospital [2003]. Thus practitioners have a professional, legal and ethical duty to respect the autonomous wishes of each patient.

In Mr Walker’s case an MDT meeting was held prior to the covert administration of medication to consider Mr Walker’s lack of consent and his mental capacity to consent. The MDT consisted of: the general practitioner, psychiatrist, junior house officer, nurse-in-charge, home-manager, occupational-therapist, physio-therapist, speech and language therapist, pharmacist, dementia nurse specialist, student nurse, and two relatives. By holding an MDT meeting, the practitioners were acting in accordance with local policies and guidelines. The NICE(2014) guidelines state that health-care practitioners have a legal duty to investigate and take into account the patient’s wishes, as well as the views of their relatives, carers and other practitioners involved in the patient’s care. By consulting with the relevant parties, the decision made will be, “based on what the person would have wanted, not necessarily what is best for their physical or mental health”(Latha,2010). Latha thus argues that decisions based on the patient’s wishes show some respect for the patient’s autonomy and are much more ethical than isolated decisions to covertly administer medication.

As such, a failure to consult the relevant parties may constitute a breach of legal, professional and ethical duty as shown in the Gillick v West Norfolk Health case (Nixon,2013). However, the Dickens et al, (2007) study shows that nurses frequently administer covert medication without any prior discussion with the MDT, relatives or even the pharmacist. Such practice has led to some nurses being disciplined and charged with various offences (Wong et al,2005). Under UK law, covert medication could be legally justified and considered ethical if the patient is admitted to the hospital under the Mental Health Act (1982). It could also be justified if it is shown that the patient lacks capacity under the Mental Capacity Act(2005). The MCA(2005) introduced the 2 stage capacity test. This 2 stage-capacity-test was used by the MDT in Mr Walker’s case. The MCA test required the MDT to consider whether Mr Walker’s cognitive impairment rendered him mentally incompetent to make treatment decisions. The physician used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini-Mental Status Examination tool (MMSE) to assess Mr Walker’s cognitive function and his capacity to consent.

The MacCAT-T interview tool was used to assess Mr Walker’s ability to (1) understand his medical condition and the benefits/ risks of the medical treatment (2) his ability to appreciate this information (3) his reasoning ability and (4) his ability to communicate and express his decision. The results showed Mr Walker as mentally incompetent and lacking the capacity to consent. Mr Walker was (1) unable to understand the information given to him regarding his treatment (2) he was unable to retain or weigh up the information given to reach a decision (3) he was unable to communicate his decision effectively even when encouraged to use non-verbal communication such as blinking or squeezing a hand. The Mini-Mental Status Examination (MMSE) tool was also used by the physician to assess Mr Walker’s cognitive function. Mr Walker following the assessment scored a low score of 12 on the MMSE. The MDT provided further clinical evidence (screening tools, clinical data, memory tests, medical imaging results).There were some disadvantages associated with using the MacCAT-T assessment tool. The MacCAT-T tool itself does not give ‘cut off scores’ to clearly ascertain the boundary between capacity and incapacity.

This is certainly a limitation. As shown in the Palmer et.al. (2002) study, this can lead to some patients with low scores being wrongly assessed as lacking capacity. The MacCAT-T tool also fails to recognise the emotional aspects of decision making (Stoppe, 2008). It assumes that people only rely on a rational, analytic, rule-based thought process to make decisions. Breden and Vollman (2004) thus argue that, “the restriction to only logical rationality runs the risk of neglecting the patient’s normative orientation”. Other factors including situational anxiety, severity of the medical condition, medication could also impact on a person’s ability to articulate their decision making process. Furthermore, assessment tools like the MacCAT-T tool, largely depend on the clinician’s ability to carry out a clinical interview with the patient. It requires the physician to make an isolated evaluation and decision. Isolated judgements and evaluations can be unreliable as they can be influenced by factors such as subjective impressions, professional experience, personal values, beliefs and even ageism as shown in the Marson et.al. empirical study (Sturman,2005). In the study only 56% of physicians who participated in the capacity assessment of patients were able to agree on a capacity judgement.

Many physicians found that they were unable to agree due to differences in medical experience, personal beliefs and subjective impressions. Such empirical evidence certainly questions the reliability of capacity assessment tools. Following on, effective communication skills were essential at this first stage of the capacity assessment as the team was required to consider whether Mr Walker was likely to recover capacity. Effective communication is certainly important in such MDT settings as, “effective communication, which is timely, accurate, complete, unambiguous, and understood by the recipient, reduces errors and results in improved patient safety” (Bretl,2008). Several studies have shown ineffective communication as a contributing factor in medical error cases (Rothschild, 2009). Through effective communication, each member of Mr Walker’s MD team understood the discussion at hand and was thus able to contribute new suggestions and solutions. The team implemented communication skills such as negotiation, listening and goal setting skills.The MDT with input from Mr Walker’s relatives concluded that a best interest decision would have to be made on Mr Walker’s behalf. The general practitioner made it clear that the best interest decision would have to comply with the UK legal framework.

The European Convention of Human Rights (ECHR) requires the medical treatment given to be respectful to the patient (Pritchard, 2009). In discussing Mr Walker’s case, it was firstly established (during the medication review), that the treatment in question had both ‘therapeutic necessity’ and ‘therapeutic effects’ for the patient. The MDT when making a best interest decision also considered the risks and benefits of treatment in accordance with the ECHR requirements. The ECHR states that the medical treatment should not be given in a sadistic, inhumane or degrading manner (Human Right Review,2012). Similarly, the NICE(2014) guideline states that the harm that would be caused by not administering the medication covertly, must be greater than the harm that would be caused by administering the medication covertly. This requirement was satisfied by the practitioners in Mr Walker’s case. An in-depth risks and benefits assessment was carried out. The pharmacist’s input was essential at this stage. The pharmacist presented an evidence-based argument; discussing the essential medication with medical necessity.

The pharmacist also provided guidance on the most appropriate form of administration; for example he suggested prescribing enapril in its liquid form (enaped). The pharmacist also provided guidance on the most appropriate method of administration; for example; not mixing the medication with large portions of food or liquid. Following this discussion with the pharmacist, a best interest decision was made to covertly administer Mr Walker’s medication. It was important for the MDT to consult with the pharmacist. The method of crushing, smashing tablets or opening capsules which is a commonly used when covertly administering medication is an unlicensed form of administration (NMC, 2008). It can inflict harm by altering the therapeutic properties which can cause adverse reactions and fatalities. When using this unlicensed method of administration, the practitioner is also unable to establish whether the patient has received the prescribed amount. If the patient is not receiving the correct dosage required for his treatment, the treatment is ineffective (Wong et al,2005).

The pharmacist should therefore be consulted with. However, as demonstrated by the McDonald et al,(2004) study pharmacists are rarely consulted with. In the study, 60% of nurses working in UK care homes admitted to crushing tablets on each drug round to help patients with swallowing difficulties without firstly consulting with a pharmacist. Fortunately, in Mr Walker’s case, the pharmacist was able to provide guidance on the most appropriate method of administration. Following on, in such cases where the patient is proven to lack capacity to consent to medical treatment, the Mental Capacity Act promotes the use of ‘best interest decisions’. In Mr Walker’s case, the MDT reached a ‘best interest’ decision to covertly administer his medication. However, there are some problems associated with the practice of relying on ‘best interest decisions.’ Baldwin and Hughes (2006), highlight the numerous problems associated with making best interest decisions. In their empirical study, Baldwin and Hughes found that practitioners and relatives often evaluate a patient’s quality of life differently. The results showed the poor performance of relatives and practitioners at predicting patients’ medical treatment preferences. Differences in cultural backgrounds, professional experiences, values and beliefs mean that decisions made may actually go against what the patient would have wanted.

The failure to consider the patient’s values and believes was found to be a common occurrence in the Dickens et al,(2007) study. In this study, 18% of the nursing staff interviewed admitted that they would be willing to covertly administer medication to even those patients with capacity to consent, regardless of their values and beliefs, if the treatment was essential for their well-being. The legal framework in the UK was indeed established with the aim of safeguarding the welfare of the incapacitated person. However, with such results, it remains unclear the extent to which health-care professionals are actually adhering to the legal requirements. The Mental Health Foundation(2012) argues that the MCA, “needs revising to enable more effective ‘best interests decisions’ by health and social care staff.” In its investigation, the Mental Health foundation found that although a large number of health-care staff found the MCA to be an effective tool in balancing the ethical principle of autonomy and safeguarding patients lacking capacity, 63% of health-care practitioners felt the definition of mental capacity was not made clear, with many expressing the view that the legal framework does not “encompass the complexity of capacity assessments in practice” (MHF, 2012).

The Griffith (2008) study and the Roy et al. (2011) further found that due to this lack of understanding, a large number of mental-health patients were wrongly assessed as lacking capacity, depriving them of their personal rights. These results suggest that health-care professionals perhaps require further training and education about the legality and practicalities of covert medication. When used without the correct legal safeguards in place, covert medication undoubtedly becomes an extremely paternalistic unlawful and unethical practice. Following the anonymous ‘best interest’ decision to covertly administer Mr Walker’s medication. The decision making process was clearly documented; the mental capacity assessment, the best interest decision, method of administration (stating explicitly that the least restrictive method will be used) were all documented in Mr Walker’s care-plan and medication-chart. Accurate documentation and record keeping is essential as it safeguards service users’ human rights and ensures that health care professionals follow the legal framework as well as local policies and guidelines.

Article 6 of the HRA, ‘right to a fair and public hearing’, also requires clinical records to be comprehensible, clear and concise so that they can be referred to if needed in a fair and public hearing. Following the MDT meeting, Mr Walker’s care plan was frequently discussed and reviewed by the MDT in monthly formal review meetings in compliance with local policies and guidelines. NICE (2013) guidelines state that it is important to frequently review covert medication decisions. Each individual is different and an individual’s mental state and capacity can change over time. By carrying out the monthly formal review meetings, the practitioners safeguard their client’s rights by ensuring that covert medication is still the most appropriate, lawful and ethical method of administration.

In conclusion, the nurses of today certainly practice in a complex health care system. It is thus essential for nurses to have a good understanding of the ethical principles which underpin good nursing practice. In the nursing literature, nurses are often described as the “moral agents” of the health-care system (Sellman,2011). This means that nurses should value ethical reasoning; acting in such a way which balances good intentions against risk and the best outcome. Through good ethical reasoning nurses are able to promote patient comfort, patient’s safety, ease suffering, and promote patient welfare to enhance recovery. The covert administration of medication should therefore not be an isolated decision, it should comply with the legislation, ethical principles, local policies and guidelines.

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Dickens, G., Stubbs, J. and Haw, C. (2007). Administering medication to older mental health patients. Nursing times, 103(15), pp.30-31.Engedal, K. and Kirkevold, O (2005). Concealment of drugs in food and beverages in nursing homes: cross sectional study. BMJ, 330(7481), p.20.Equality Human Rights (2012). Article 3: Freedom from torture and inhumane and degrading treatment or punishment. [online] Available at: http://www.equalityhumanrights.com/uploaded_files/humanrights/hrr_article_3.pdf [Accessed 12 Apr. 2014]. Gibbs, G. (1988). Learning by doing. 1st ed. [London]: FEU. Griffith, R. and Tengnah, C. (2008). Mental Capacity Act 2005: assessing decision-making capacity 2. British journal of community nursing, 13(6), pp.284-293.Harris, N., Baker, J. and Gray, R. (2009). Medicines management in mental health care. 1st ed. Chichester, U.K.: Wiley-Blackwell. Hughes, J. and Baldwin, C. (2006). Ethical issues in dementia care. 1st ed. London: Jessica Kingsley Publishers. Husted, J. and Husted, G. (2008). Ethical decision making in nursing and health care. 1st ed. New York: Springer Pub. Co.Koch, S., Gloth, F. and Nay, R. (2010). Medication management in older adults. 1st ed. Totowa, N.J.: Humana. Latha, K. (2010). The noncompliant patient in psychiatry: The case for and against covert/surreptitious medication. Mens sana monographs, 8(1), p.96. Lawson, L. and Peate, I. (2009). Essential nursing care. 1st ed. Chichester, West Sussex, UK: Wiley-Blackwell. Leino-Kilpi, H. (2000). Patient’s
autonomy, privacy, and informed consent. 1st ed. Amsterdam: IOS Press. Macdonald, A., Roberts, A. and Carpenter, I. (2004). De facto imprisonment and covert medication use in general nursing homes for older people in South East England. Ageing clinical and experimental research,16(4), pp.326-330. Masters, K. (2005). Role development in professional nursing practice. 1st ed. Sudbury, Mass.: Jones and Bartlett. Mental Health Foundation, MCA Code of Practice needs revising to enable more effective best interests decisions to be made. (2012). MHF News Archieve, [online] p.1. Available at: http://www.mentalhealth.org.uk/our-news/news-archive/2012/12-01-31/ [Accessed 12 May. 2014]. Nixon, V. (2013). Professional practice in paramedic, emergency and urgent care. 1st ed. Chichester, West Sussex: Wiley-Blackwell. NMC, (2008). Standards for medicines management. [online] Available at: http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf [Accessed 16 Apr. 2014]. Palmer, B., Nayak, G., Dunn, L., Appelbaum, P. and Jeste, D. (2002). Treatment-related decision-making capacity in middle-aged and older patients with psychosis: a preliminary study using the MacCAT-T and HCAT.The American journal of geriatric psychiatry, 10(2), pp.207-211. Pritchard, J. (2009). Good practice in the law and safeguarding adults. 1st ed. London: Jessica Kingsley Publishers. Rothschild, A. (2009). Clinical manual for diagnosis and treatment of psychotic depression. 1st ed. Washington, DC: American Psychiatric Pub. Roy, A., Jain, S., Roy, A., Ward, F., Richings, C., Martin, M. and Roy, M. (2011). Improving recording of capacity to consent and explanation of medication side effects in a psychiatric service for people with learning disability: audit findings. Journal of Intellectual Disabilities, 15(2), pp.85-92.Sellman, D. (2011). What makes a good nurse. 1st ed. London: Jessica Kingsley Publishers. Stoppe, G. (2008). Competence assessment in dementia. 1st ed. Wien: Springer. Sturman, E. (2005). The capacity to consent to treatment and research: a review of standardized assessment tools. Clinical psychology review, 25(7), pp.954-974. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of
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Ethical and Legal Issues in Nursing Essay

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Ethical and Legal Issues in Nursing Essay
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  • University/College:
    University of Arkansas System

  • Type of paper: Thesis/Dissertation Chapter

  • Words: 696

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Ethical and Legal Issues in Nursing

Throughout a nurse’s professional career, many difficult ethical and legal situations will arise. Since nurses are given the unique privilege of caring for patients and their families, it is important to uphold certain professional standards. The American Nursing Association (ANA) Code of Nursing Ethics provides a foundation on which a nurse should conduct her professional life. In addition to the Code of Ethics, nurses must also balance their personal values along with legal standards to make the best decisions for their patients. A nurse’s first priority is to the patient and providing safe and competent care. According to the ANA (2001), Provision 1 of the Code of Ethics states “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”(p.1)

The nurse is bound by duty to respect the wishes of the patient and family in regards to end of life decisions. In the case of Marianne, a committee is forced to help a family make a difficult decision regarding the life of a loved one. Since the patient is unable to express her wishes and had no advance directive, the nurse has an obligation to ensure that the family is informed and knowledgeable on her care. The nurse needs to support the family in the decision-making process and refer the family to other resources to assist in the decision making process. Taking an interdisciplinary approach, such as consulting with an ethics committee, is one resource that is available to the family to assist in the decision-making process. In addition to difficult end of life decisions, the Code of Ethics can be used to guide decisions in cases of malpractice. Provision 3 states, “ The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (ANA, 2001).

In other words, the Code of Ethics leads the nurse to address practice that is substandard and may jeopardize patient care. The nurse should follow policy and procedures of the facility to report such behavior, but if measures are not taken to ensure the integrity of nursing practice then the nurse may report to outside agencies, such as state departments. The nurse also has an obligation to ensure that the proper assistance or treatment is provided to assist in the impaired nurse’s recovery. While the Code of Ethics provides an important foundation on which to base behavior, any ethical decision involves an evaluation of one’s set of personal and societal values. According to Uustal (1993).“Nursing is a behavioral manifestation of the nurse’s value system. It is not merely a career, a job, an assignment: it is a ministry” (p.10).

Nurses need to be aware of their beliefs so that they can recognize and accept that a patient may have different values and beliefs. The nurse needs to interact with the patient and the family in a nonjudgmental, caring way. The nurse needs to take care not to influence the patient in making choices based on her beliefs or what she believes is right. The nurse’s role is to be supportive to patients and their families in actions that are congruent with the code of ethics. Some conflicts that may compromise the nurse’s personal beliefs may include end of life decisions, abortions or refusal of medical treatment. For example, a nurse may support pro-life decision-making but is bound to respect the patient’s wishes if they seek a legal abortion. Furthermore, a nurse needs to honor a patient’s decision to forego treatment, even if the nurse believes that that treatment represents the best option for the patient.

References
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/ethics/code/protected_nwcoe303.html. Uustal, D. (1993). Clinical ethics and values:issues and insights in a changing healthcare environment. Educational Resources in Healthcare, 12 (2), 10.

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