Assignment on Nursing Ethics

Running head: NURSING ETHICS
Nursing ethics
Name of student:
Name of university:
Author note:

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Introduction
Healthcare ethics is responsible for guiding decision making in practice. At the core of
the healthcare ethics are the sense of wrong and right and the beliefs regarding the duties
professionals are to fulfill. In healthcare practice professionals are to make choices that are fair,
ensure justice, ethical and right. Professionals are obliged to consider ethical issues when
delegating care to those in need of it ((Fremgen, 2015). The present paper identifies the ethical
issues arising in the case scenario related to Amos where he lost his life due to breach of nursing
ethics. The paper puts forward ethical principles, concepts, codes and professional standards in
relation to the case scenario selected. Professional legislations and policies and concepts of
human dignity and human rights are also reflected upon for carrying out this critical analysis.
Recommendations for professional practice are articulated that could have led to better patient
outcomes if applied to the present scenario.
Ethical issues
The present case study is on Amos, a high school student living in a residential property
near the school in Malawi. Amos had his peers living in the school’s boarding facilities. He
suffered from cholera and was denied the treatment at the school clinic. Due to delay in
treatment he planned to visit home for care and support. However, he died due to dehydration.
His right to patient care has been denied. The nurses decided to care only for students living in
the school boarding as there was lack of resources to care for all the patients as there was an
outbreak of cholera. This was an act of discrimination in regards to health care provision. This
decision was irrational as alternate steps could be taken such as collaborating with other
governmental and non-governmental agencies for additional support. Moreover, the nurse also

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did not consult the professionals in that very organization prior to taking such decision. This
demonstrates the lack of collaboration and communication. The patient could have been
transferred to another health centre with better resources. Thus, it can be concluded as an ethical
misconduct in nursing profession (Fremgen, 2015; Gillon, 2015). Nurses are responsible for
maintaing equality and equity in care provision. In this case the nurse action and critical decision
does not promote the patients benefit. Therefore, it can be interpreted as the negligence and
breach of justice which may lead to legal implications (Griffith & Tengnah, 2017). In short the
nurses did not consider the specific needs of the patient and also did not acknowledge the
individual practice. Therefore, the ethical issues in the case study can be concluded as violation
of human rights to dignity, breach of principle of justice, and beneficence.
Analysis of ethical issues
In nursing practice beneficence is the principle of ethics, by which nurses are obliged to
promote the patient health by acting in best interest of patient. Breaching this is considered an
ethical issue. According to principle of beneficence, the acts of nurses should be weighed
against the disbenfits of violating the respect of patents and dignity. Negligence in nursing
practice refers to taking actions that does not promote greater good of patient. Such actions
despite being clinically competent, leads to adverse health effects (Cerit & Dinç, 2013, King,
2017). In case of Amos, the nurse’s decision was not evidence based. It was irrational as
alternate arrangements for Amos could have been made. He was in need of fluids to prevent
dehydration and was an emergency issue. Therefore, the nurse decision demonstrates ineffective
prioritization of care, negligence to patient’s needs and breach of principle of beneficence.

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She has also violated the human right to health care access. It is the breach of principle
of justice (Grace & DRN, 2017) as the decision was in favor of student’s living in school’s
boarding facility. The principle of justice in nursing refers to providing care in fair manner
despite competing claims and scarce resources. It helps avoid discrimination. The distribution of
health care resources must be fair and confirm to legal justice. In case of Amos who had already
presented himself to the clinic in an emergency situation, denying care was unfair. It did not
promote the patient good. On an emergency basis the nurse could have provided fluid therapy
followed by accessing help from other health care centre to transfer Amos. It would have ensured
justice. Instead focusing on specific section of the students for care delivery was a bias in care
provision.
According to UN health care provision is mandated to be universal by all the countries
under it. Malawi is bound by the UN legislations being its signatory. The nurse must be aware of
the national and local legislations in delivering the health care. The international code of ethics
mandates all the nurses to protect the patient’s rights to live and be treated with respect (Young
& Kroth, 2017, Griffith & Tengnah, 2017). In case of emergency the nurses have the autonomy
to refer the patient to bigger facility. Treatment to Amos should not have been delayed as the
mortality due to cholera outbreak is known to be high. There is a breach of international code of
ethics. Also the nurse in Malawi did not comply with the standards set by the Nurses and
Midwives Council of Malawi (nmcm.org.mw, 2018). According to these standards the nurses
must be able to manage and maximize the health care resources, rationally use drugs to improve
the quality of care. As per these standards the nurse is also responsible to respond efficiently and
effectively to disaster and emergency situations to save patients life. In this case these standards
have been breached. Further these standards mandate that the nurses must provide services in

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collaboration and coordination with other health care team members. In the case of Amos the
nurse had breached these standards as the decision was taken irrationally. Moreover, the nurse
did not collaborate or communicate with any other health care professional before denying care
to Amos. These practices and breach of ethics does not allow the formation of therapeutic
relationship with the patients. Therefore, such practices must be intervened with adequate
strategies. If not addressed such practices may lead to loss of patient’s trust and faith in health
care services.
Recommendation for professional practice
Based on the above analysis, it is suggested that the breach of the legislations and
standards should be punished severely by the health care authorities on identification. In case of
situation like Amos’s death the nurses must be charged with professional negligence. There
must be stringent actions taken like cancellation of nurse license or suspension (Carmi &
Schneider, 2012). It is suggested that the health care organizations should take initiative to train
the nurses on prioritizing the care process. They must be allowed to learn through challenges due
to allocation and distribution of resources. The nurses must learn the responsibility and
accountability for the actions and how to collaborate in multidisciplinary setting. Training and
formal education is required as there is lack of awareness among many nurses regarding the
ethical conduct and ethical issues (Cerit, & Dinç, 2013). It is recommended to conduct regular
audit to ensure the nurse’s comply with the code of ethics and standards set by the council of
Malawi. The environment of the hospital should foster courage among nurses to approach the
health care authority or any other professionals in case of ethical dilemma (Carmi & Schneider,
2012). Further, it is recommended to the nurses to reflect on their experiences with situation of
ethical issues to recognize the areas of improvement. Reflective practice is essential for

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continuous professional development (Thompson & Pascal, 2012). It will allow the nurses to
take right action based on increased awareness of the ethical issues. The heath organizations
must conduct regular surveys to assess the nurses’ knowledge and understanding of the ethical
standards and consequences of ethical issues. Along with this a support of nurse ethicist is
recommended in hospital premises (Brown, Kitson & McKnight 2013).
Conclusion
All civilizations from the ancient times have faced the health care challenges since
ancient times. It is disappointing to see that it persisting till date. Health care sector is dynamic
in nature and there are different needs of each patient. Therefore, ethical issues are inevitable in
nursing, right from consent, allocation of resources to organ donation. Ethically incompetent
decisions pose various health care challenges. In such cases merely formulating policies and
keeping legislations or standards in place will not suffice. In case of Amos, there was the breach
of principle of justice, beneficence, violation of human rights and dignity. The nurse also
violated the standards set by the Nurses and Midwives Council of Malawi as well as breached
the international code of ethics. However, these ethical issues are preventable. There is a need of
greater awareness among the nurse to deal with the ethical issues by strictly complying with the
code of ethics and nursing standards. There is no protocol to do this but adherence to the theory
of utilitarianism will be fruitful.

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References
Brown, J. M., Kitson, A. L., & McKnight, T. J. (2013). Challenges in caring: explorations in
nursing and ethics. Springer. Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=tM69BwAAQBAJ&oi=fnd&pg=PP6&dq=respect+to+autonomy,
+beneficence+nursing+&ots=Q5FeThJ92E&sig=iUIRH1jIybq6LosaFQAyzzJbp84&redi
r_esc=y#v=onepage&q=respect%20to%20autonomy%2C%20beneficence
%20nursing&f=false
Carmi, A., & Schneider, S. (Eds.). (2012). Nursing law and ethics (Vol. 4). Springer Science &
Business Media. Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=Ky4pBgAAQBAJ&oi=fnd&pg=PT13&dq=+cancel+nurses+license+base
d+on+breach+of+ethics+&ots=et4XdlW-Ln&sig=dEOiwb5H9Yy56QOZ55E9nv-
juj0#v=onepage&q&f=false
Cerit, B., & Dinç, L. (2013). Ethical decision-making and professional behaviour among nurses:
a correlational study. Nursing ethics, 20(2), 200-212. Doi:
https://doi.org/10.1177/0969733012455562
Fremgen, B. F. (2015). Medical law and ethics. Prentice Hall. Retrieved from:
https://testbanktop.com/wp-content/uploads/2016/12/Downloadable-Test-Bank-for-
Medical-Law-and-Ethics-3rd-Edition-Fremgen_irm_fm-1.pdf
Gillon, R. (2015). Defending the four principles approach as a good basis for good medical
practice and therefore for good medical ethics. Journal of medical ethics, 41(1), 111-116.

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Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in
advanced practice. Jones & Bartlett Learning. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=1OQlDgAAQBAJ&oi=fnd&pg=PR1&dq=principle+of+ethics+in+nursin
g&ots=eMJCE2Dtq9&sig=9c7uIm35F3AE2JP5pfdhVN2ZLO4#v=onepage&q=principle
%20of%20ethics%20in%20nursing&f=false
Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning Matters.
Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=z_X-
DQAAQBAJ&oi=fnd&pg=PP1&dq=Lack+of+awareness+of+the+ethical+and+legal+iss
ues+nurse+&ots=UF54FVOo9L&sig=fSjqrDXn8eZCCxwIr7xhJ3-
POlQ&redir_esc=y#v=onepage&q&f=false
King, C. A. (2017). Clinical ethics: Patient and provider safety. AORN journal, 106(6), 548-551.
DOI: 10.1016/j.aorn.2017.10.003
nmcm.org.mw. (2018). Nurses and Midwives Council of Malawi. Retrieved from
http://www.nmcm.org.mw/standards/NMCM%20Professional%20Practice%20Standards
%20for%20Registered%20Nurses%20(Nov%202012).pdf
Thompson, N., & Pascal, J. (2012). Developing critically reflective practice. Reflective
practice, 13(2), 311-325. DOI: https://doi.org/10.1080/14623943.2012.657795
Young, K. M., & Kroth, P. J. (2017). Sultz & Young's Health Care USA. Jones & Bartlett
Learning. Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=wx8CDgAAQBAJ&oi=fnd&pg=PP1&dq=Sultz+%26+Young
%27s+Health+Care+USA.+Jones+

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%26+Bartlett+Learning.&ots=3Cvyb0mFat&sig=SmSe-
3raZ9sWyAbAHZ8iCvp4VoM#v=onepage&q=Sultz%20%26%20Young's%20Health
%20Care%20USA.%20Jones%20%26%20Bartlett%20Learning.&f=false