Analysis of Nursing Professional and Legal Issues

Abstract

            The nursing profession has always been one of the more important professions in the society and will continue to be - Analysis of Nursing Professional and Legal Issues introduction. As the nursing profession continues and carries itself to the future standards have to be in place for such profession to provide the care due to the patients. The nursing profession deals with the health and life of people making it one of the more sacred professions. For all the same reasons such profession must and is safeguarded by laws and guided by codes. However, these laws and codes will mean nothing if nurses will not be able to comprehend and follow the same. This paper will therefore prove competence as it seeks to solve cases involved with the nursing profession. It will offer response to the central issues of the cases provided as it seeks the proper application of the laws and codes in order to offer the proper course of action for resolution of every case.

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Analysis of Nursing Issues 3

First Case

Patient A, a 36-year-old woman, who is admitted with a drug overdose that was an unsuccessful suicide attempt. You are assigned to care for her and during handover you learn that her condition is the result of a murder -suicide where her two young children died as a result of drugs she deliberately gave them. You don’t want to look after her.

The instant case herein provided deals with a situation where a nurse is compelled to make a decision. Such decision entails whether which between her personal comfort or her professionalism she would choose. Her subsequent acts will dictate which of the two she will take. At the outset it must however be provided that a profession such as a nursing profession is well under the dictates of a codified list of ethics. It is worth mentioning that such ethics is provided by sources like the Code of Ethics for Nurses in Australia. The said code states two principles very much related and involved with the would be decision of the subject nurse stated in the case above. In general terms such situation as the herein case may be answered by two concepts provided by the said code. First is the basic principle set forth in the said code which provides: Nurses value respect and kindness for self and other. Second is another basic principle set forth in the said code which provides: Nurses value access to quality nursing and health care for all people. (cited in: Australian Nursing & Midwifery Council. (2005). Code of ethics for nurses in Australia (Reprinted ed.) Dickson, ACT: Author.)

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Now, this paper will proceed on explaining how these two principles set forth by the code earlier mentioned are closely related to the issue at hand and why these are the two principles which should be used as a guide in deciding. On a side note the decision to be had in the instant case is whether or not the subject nurse would take care of the subject patient. The first principle, Nurses value respect and kindness for self and others, the dictates of this principle itself provide that as to other persons respect is due for patients. Note that the term patients is not exclusive. Kindness for others is a norm that dictates all professional nurses to render such kindness exclusive of the kind of patient before them. Nurses actively preserve the dignity of people through practiced kindness and by recognizing the vulnerability and powerlessness of people in their care. This by itself provides us a glimpse on how we should go about the issue discussed in the case provided above. The second principle, Nurses value access to quality nursing and health care for all people, The glaring words reflected on this second principle are the two simple words all people. The words all people clearly denotes that quality nursing must be provided to people regardless of personal characteristics such as race, ethnicity, culture, gender, sexuality, religion, spirituality, disability, age and economic, social or health status. This principle values non-harmful, non-discriminatory care and provides nursing care appropriate to the individual that recognizes their particular needs and rights. Clearly this principle enunciated in the code was meant to do away with prejudicial attitudes. These two principles having been discussed resolution of the central issue of the case before hand can now be easily provided. However before such resolution a case showing the relevance of such issue must first be provided.

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The Tribunal is concerned about the Respondent’s level of insight as indicated by her evidence particularly her lack of regard for the seriousness of medication errors. By way of example, the Tribunal refers to paragraph 31 of the Respondent statement wherein she stated: ‘I accept that I would have made some medication errors during this time’. Further the Respondent is recorded as having stated that she was of the view that her performance during a shift had been ‘OK’ when there is evidence that there had been significant deficits in her practice. Another example of the Respondent lack of insight is her comment in response to the Performance Assessment dated 19 January 2005 wherein her performance was recorded as unsatisfactory in relation to most professional competencies (see exhibit 65, annexure I).The Respondent made the following comment ‘I think I am managing with time because, I help other members of staff with bathing and doing observations of their patients and giving medications’. This is in stark contrast to the comments and ratings recorded in the Performance Assessment and the comment made by the NUM which also indicated that the Respondent was only allocated three patients. (cited in: HCCC vs. MUVIRIMI [2008] NSWNMT, 2 May 2008)

            The ruling herein provided above as cited from a ruling of the high court finds relevant in the central issues provided for the case. The herein keyword is medical insight. Medical insight and propriety dictates that regardless of the status of a person she must be given non discriminatory care. In the ruling provided above the incompetency of a nurse is stressed which must be in no way allowed in order to prevent harm like discrimination with regard to a personal status of a patient.

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            With these in mind this paper will now proceed on resolving the legal issue provided in the case herein provided. Having cited two principles enunciated by the Code of Ethics for Nurses in Australia no confusion will arise regarding the decision of the subject nurse whether or not to take care of the subject patient. Yes, in all respects regardless if the nurse does not want to take care of the patient she must take care of the same. Professionalism and the mentioned code dictates that the subject nurse cannot refuse providing care for the patient. It may be true that the patient may not be a person of strong morals she might not be the ideal patient and a person who has committed her share of mistakes. However as evidenced by the references herein provided a clear cut answer to what decision must be made can easily be provided. In the end it is not the status of the patient which qualifies them to be provided with care extended by nurses. It is the fact that the said patient too is a person who is in need of a nurse’s care.

Second Case

Patient B is a 20-year-old woman who was discharged from hospital 3 weeks ago. She receives a call from a male nurse who looked after her asking her out. He obtained her number from her inpatient history.

The case herein provided above deals with the issue of the propriety of the act of a male nurse using information from an inpatients history. The act made by the male nurse was asking the subject patient out. The information used was clearly that due to medical care previously provided to the patient the act however was totally unrelated and outside the scope of the relationship between nurse and patient. The central issue to be settled herein therefore is whether such act was professional and whether it violated any code. Before delving further it is contended that for the instant herein

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case provided the following principles would resolve such issue. For such a case two principles from two codes will be provided. First is the principle: Treat personal information obtained in a professional capacity as confidential, from the Code of Professional Conduct for Nurses in Australia. Second is the principle: Nurses value ethical management of information, from the Code of Ethics for Nurses in Australia. (cited in: Australian Nursing & Midwifery Council. (2005). Code of ethics for nurses in Australia (Reprinted ed.) Dickson, ACT: Author and Australian Nursing & Midwifery Council. (2005). Code of professional conduct for nurses in Australia (Reprinted ed.). Dickson, ACT: Author)

            To solve the central issue discussed in the herein case this paper will first proceed on discussing the relevance of the two mentioned principles how it is related to the central issue and how it will eventually resolve the central issue. For the first principle Treat personal information obtained in a professional capacity as confidential, from the Code of Professional Conduct for Nurses in Australia. The subject of the case at hand is information specifically a phone number derived from an inpatients history. There is no discourse therefore that such information is the part of the personal information being referred to in the herein mentioned first principle. The words of the principle itself provide that such information must be obtained in a professional capacity as confidential. The term professional capacity itself denotes that such information must only be used in the bounds of the patient to nurse relationship. The principle stresses such point further by indicating the term confidential. The same code provides that a nurse has a moral duty and a legal obligation to protect the privacy of an individual by restricting information obtained

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in a professional capacity to appropriate personnel and settings, and to professional purposes. This strengthens such fact because not only is it a moral duty but it is a legal obligation as well. To note it must be considered in conjunction with the National Privacy Principles Guidelines which support the Privacy Act (1994). It is clear therefore where the Code of Professional Conduct for Nurses in Australia stand regarding such matter. Now we proceed to discuss the second principle, Nurses value ethical management of information, from the Code of Ethics for Nurses in Australia. Ethical management information connotes that information derived and held by nurses be managed with utmost care and diligence. Ethics dictates that such information must not be used for any whimsical and capricious intentions that nurses may have. In fact Ethical information management requires nurses to maintain information and records needed in order to provide quality nursing care. In the context of quality nursing care such information cannot be held for personal use of the nurses. The two principles appropriate for the central issue having been discussed we would now proceed to the manifestations on the matter of resolving the issue but before such manifestation a case demonstrating relevance of the said issue will first be provided.

The actions of the Respondent demonstrate a lack of knowledge regarding the appropriateness of relationships with former clients. It is difficult for the Tribunal to accept the evidence of the Respondent that she did not know that there was an issue regarding relationships with people who had come under her care, and that her knowledge was limited to the fact that relationships with current clients were inappropriate. The Tribunal has formed this view by reference to the general understanding of the profession, the Respondent’s level of education, training and experience and the public nature of cases that

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had been decided before the period of time relevant to the Respondent’s behavior.

Further, as it was the Respondent’s clear and firm evidence that she knew it was not appropriate for a nurse to have a personal relationship with a person whilst a current patient, it is difficult to accept that she had no disquiet about the commencement of a personal relationship with a patient, with whom she had had such an intense and close therapeutic/professional relationship, so soon after the cessation of the formal (cited in: HCCC v Sunjic [2008] NSWNMT 12)

            The above mentioned citation is a ruling of the high court very much related to the case before hand. The ruling was for the inappropriateness of a sexual relationship between a nurse and that of her patient. This only proves that acts must be limited to the bounds of a nurse and patient relationship. Any attempt to further this relationship through information derived from time when the patient is under the care of the nurse. Such acts will not be tolerated by the high courts as well.

            The two herein principles having been discussed the manifestation for the resolution of the issue of the herein case can easily be deducted. The fact of the matter is the act done by the subject nurse in the herein case was inappropriate and void of professionalism. Both Code of Ethics and Code of Professional Conduct for Nurses in Australia disprove the said act. There is that quality of care that kind of medical care a nurse is required to give the patient. There is also that moral duty and legal obligation in matters of handling information derived from patient. It is clear that such

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information must remain confidential and must be treated in professional capacity. Deriving a patient’s number to ask her out is in no way under the context of professional capacity.

Third Case

Nurse C works regularly on bank in cardio-thoracics where most of surgeon D’s patients are admitted post op. She, along with other staff, notes the high incidence of complications and mortality with his group of patients. They joke amongst themselves that if they get sick make sure Mr. D doesn’t operate on them. Nurse C, after a patient death that could very well have been the result of a poor decision by Mr. D, decides to speak to her Director of Nursing about hers and others concerns. She seeks support
from other staff; but no one is willing to come with her. Some say cryptically that they have been burnt before. The DON tells her that Mr. D is a well respected surgeon and that it is not a nurse’s role to question medical treatment decisions. Nurse C takes her concerns to the Medical Director who tells her the matter will be considered. After a few weeks she hears nothing, but is asked to attend an “in service” lecture by the legal department where loyalty to the hospital (employers) is stressed and where a possible consequence of failing to demonstrate loyalty could be termination of employment.
More incidents occur and Nurse C tries raising the matter again with senior people who let it be known that she is a trouble maker who has no right to judge a senior doctor’s actions and if she continues legal action may be taken. She finds herself being offered less and less shifts and when she does work she is ostracized. Despite all this, she decides she can’t keep quiet about this and makes her concerns public.

In relation to the second case the herein case provided above also involves the

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ethical management of information. The main difference is that the information subject in the herein case is not information from a patient. The subject information is the knowledge of incompetency of a certain doctor subsequently leading to poor health care before of such incompetence. To summarize the herein case is the awareness of a nurse of the incompetency of a doctor. In such case the subject nurse exercised her duty to be made known the incompetence of the doctor. However to her dismay instead of the proper actions she was instead oppressed finding herself being offered lesser and lesser shifts. The nurse however decides to pursue the pronouncement of the incompetency of the said doctor. Several references can be used to resolve the issue. To note the Code of Ethics for Nurses in Australia does not only apply to the relationship of nurses to their patients but to their colleagues as well. The central issue in this instant case is the propriety of two things. First the propriety of the act of the nurse revealing the incompetence of the subject doctor. Second is the propriety of the act of the institution itself in oppressing the subject nurse for disclosing such information. To resolve such issue this paper will now proceed to discuss the references appropriate for the matter. To note the main reference would be two principles enunciated in the Code of Professional Ethics for Nurses in Australia. The first principle would be Nurses value respect and kindness for self and others and the second principle would be Nurses value ethical management of information. It must be noted however that unlike the previous cases herein discussed such code of ethics is in reference to that aspect of the relationship between nurses and their colleagues and not nurses and their patients. In order to resolve the central issue the two principles herein mentioned must be discussed. (cited in: Australian Nursing &

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 Midwifery Council. (2005). Code of ethics for nurses in Australia (Reprinted ed.) Dickson, ACT: Author)

             Nurses value respect and kindness for self and others it is provided that such principle does not only apply to their relationship with their nurses but also with their relationship to their colleagues. The Code of Ethics for Australian nurses dictate that respect for colleagues involves acknowledging and respecting their knowledge, experience, expertise and insights it includes practicing kindness and modeling consideration and care towards each other. The respect due in the instant case is the respect which should have been afforded to the subject nurse by the Director of Nursing and the others that the subject nurse approached. Notable in the instant case is such lack of respect. The persons involved failed to respect the knowledge, experience, expertise and insights of the subject nurse. The knowledge of the said nurse regarding the incompetence of the said nurse must have been treated with respect. Such disrespectful act necessarily goes against this principle expressly mentioned in the code. The second principle and how it relates to the instant case value ethical management of information. Again it is worth noting that such ethical management information is not only due to a nurse’s patient it is also due to her colleagues. The subject information herein discussed is the incompetency of the subject doctor. The manner on how the subject nurse can ethically manage such information. The same code provides that nurses recognize that their colleagues enjoy the same protections as other people with regard to personal information. However such recognition cannot stand alone it must not override the responsibilities the nurses may have in reporting aspect of a colleague’s professional practice giving reasonable cause for concern. The two principles having been discussed the central issue herein is

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now ripe for resolution. However before such resolution a case will be provided to exhibit the relevance of the said issue.

That evidence having been accepted, it follows that the complaint must be dismissed. That is so because it has not been shown, clearly or at all, that, in the terms of section 42, any detriment suffered by Ms Ward, in consequence of the lodging of the complaint by Ms Linegar with the Nurses Registration Board was “on the ground that” Ms Ward’s conduct had fallen within section 42(2) of the Act. The first respondent lodged the complaint of 28 April 1997 pursuant to her responsibility, as Director of Nursing at the hospital, to maintain standards of nursing care. (cited in: Ward v Linegar [1998] HREOCA 20 (24 June 1998)
The ruling herein provided above exhibits a relevance with the central issue of the case provided. The herein ruling discusses the responsibility of the Director of Nursing. The same as the central issue in the case provided the higher court expounded on the duties of a Director of Nursing. This ruling finds relevance in the matter of responsibility of the Director of Nursing with dealing with complaints.
Resolution of the case guided by the references earlier mentioned is not a difficult task. The answer is clear respect was due to the subject nurse who disclosed the information about the incompetent doctor. The intent of the nurse was alleviate health care and protect patients from incompetency of the said doctor. The disclosure made by the nurse should have been treated with much more respect but instead the subject nurse as a consequence of her act was oppressed a clear violation of the code of ethics. It is also worth mentioning that even provided that there exists

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confidentiality with nurses and colleagues such confidentiality cannot be more superior than the safety of the patients and the condition of health care of a certain institution. The appropriate act therefore was to act on the complaint of the subject nurse instead of the oppression done to her which was in all respects unwarranted.

Fourth Case

Patient E is a 12 year old boy who has acute lymphoblastic leukaemia (ALL). He has undergone several rounds of chemotherapy without successfully going into remission. His treatment now is focused on palliation. He is refusing to have any further chemotherapy. His parents insist that he does.

In many medical cases a dilemma exists when a course of action regarding the treatment of a patient varies from that wanted by the patient himself or that of his family like his parents. Such dilemma exists in the herein case provided above. A nurse finds herself in the middle of a situation where a young 12 year old boy no longer wants to continue treatment while his parents insist on the continuance of his chemotherapy. The central issue revolves into what course of action the subject nurse in accordance with the codes and laws governing the nursing profession are appropriate. Upon careful examination of the herein sources provided  the answer to such issue was clearly gleaned on a statement made in the Code of Ethics for Nurses in Australia such statement provides that: Nurses value informed decision making. The resolution to such case is further strengthened by a principle enunciated in The Code of Professional Conduct for Nurses in Australia which provides that: A nurse must support the health, well being and informed decision-making of an individual. In order to resolve the central issue set forth in the case provided a clearer understanding

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of the two principles herein mentioned must be discussed and thereafter manifestations and resolutions with reference to the said principles will follow.

This paper will now proceed to discuss the two principles necessary to resolve the central issue. First principle Nurses value informed decision making the code clearly provides that not any simple decision making is due to the patient and their family what is due to them is an informed decision making. Informed decision making suggests that a reasonable decision is made based on all the accurate information provided to the patients and there family. According to the code nurses value the legal and moral right of people including children, to participate whenever possible in decision making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. Second principle: A nurse must support the health, well being and informed decision-making of an individual this principle serves to strengthen the first mentioned principle it in fact is very much related to the first principle. Repeated in this principle is the fact that an informed decision making is due to every individual. With these two principles in mind the resolution to the central issue of the case is apparent. (cited in: Australian Nursing & Midwifery Council. (2005). Code of ethics for nurses in Australia (Reprinted ed.) Dickson, ACT: Author, Australian Nursing & Midwifery Council. (2005). Code of professional conduct for nurses in Australia (Reprinted ed.). Dickson, ACT: Author)

The Tribunal is concerned about the Respondent’s level of insight as indicated by her evidence particularly her lack of regard for the seriousness of medication errors. By way of example, the Tribunal refers to paragraph 31 of the Respondent statement wherein she stated: ‘I accept that I would have made

Analysis of Nursing Issues 16

some medication errors during this time’. Further the Respondent is recorded as having stated that she was of the view that her performance during a shift had been ‘OK’ when there is evidence that there had been significant deficits in her practice. Another example of the Respondent lack of insight is her comment in response to the Performance Assessment dated 19 January 2005 wherein her performance was recorded as unsatisfactory in relation to most professional competencies (see exhibit 65, annexure I).The Respondent made the following comment ‘I think I am managing with time because, I help other members of staff with bathing and doing observations of their patients and giving medications’. This is in stark contrast to the comments and ratings recorded in the Performance Assessment and the comment made by the NUM which also indicated that the Respondent was only allocated three patients. (cited in: HCCC vs. Roberts [2008] NSWNMT May 19, 2008)

            The relevance of the cited ruling finds its relation with the central issue of the case in the following ways. First, it deals with the nurse’s level insight with this in mind a nurse as dictated must have such level of insight in order to allow the patients and it’s family to make an informed decision. Second the incompetence of the nurse in such ruling was discoursed was by the higher court. It finds relevance in the central issue in that such competence would be used in allowing the child and the family to make an informed decision.

            Upon careful review a resolution can be made with reference to the two principles earlier mentioned. The proper course of action for the nurse is to involve the 12 year old child with the informed decision making process. The code, the law and even morals dictate that this is the proper course of action. Children although

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minors must be able to participate in a decision making process involving their life. The decision making cannot be left for the parents alone. The 12 year old child must have an active participation in such decision. The principles earlier discussed clearly support this view. The resolution to the issue of this case is the inclusion of the 12 year old child in the decision making in order that there be a valid informed decision appropriate for the case at hand.

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References

Australian Nursing & Midwifery Council. (2005). Code of ethics for nurses in Australia (Reprinted ed.) Dickson, ACT: Author.
Australian Nursing & Midwifery Council. (2005). Code of professional conduct for nurses in Australia (Reprinted ed.). Dickson, ACT: Author.
Australian Nursing & Midwifery Council. (2005). National competency standards for the Registered Nurse. Dickson, ACT: Author.
Australian Nursing & Midwifery Council. (2006). National competency standards for the midwife. Dickson, ACT: Author.
Required for Bachelor of Midwifery (BM) students only. BM students should also use the Code of Ethics for Midwives. (see http://anmc.org.au and go to Publications). These are still being developed, but there is information about them on the NBV website.
www.austlii.edu.au
anmc.org.au
www.deakin.edu.au
cappe.edu.au
www.nhmrc.gov.au
www.nbv.org.au
www.publicadvocate.vic.gov.au
www.rcna.org.au
www.vic.gov.au
www.health.vic.gov.au/nursing/index.htm
www.legislation.vic.gov.au
Analysis of Nursing Issues 19

HCCC vs. MUVIRIMI [2008] NSWNMT, 2 May 2008
HCCC v Sunjic [2008] NSWNMT 12
Ward v Linegar [1998] HREOCA 20 (24 June 1998)
HCCC vs. Roberts [2008] NSWNMT May 19, 2008

 

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