Formative Assessment on Ethical Issues in Nursing Practice

1) Formative assessment – Vignette
(Scenario Situation)
500 words (maximum)
The formative assessment should be presented in Ariel (12 point) font and 1.5
line spaced.
Name of Student: _________________________
Scenario Topic: _________________________
Description of a situation which raised ethical issues in your practice (please
ensure you maintain confidentiality/privacy at all times and do not use any
patient identifiers)
According to Judkins-Cohn et al. (2013), ethical standards form an important aspect
of the nursing profession. It is important to understand that nursing professionals
must comply with the professional standards of practice in order to ensure safe care
delivery. Also, it is mandatory for the care professionals to exhibit competence in
terms of ethical considerations and quality and safety standards so as to exhibit
effective care delivery. This section of the paper intends to discuss a clinical
scenario which triggered an ethical dilemma to me as a care professional. My
speciality area of nursing care practice is aged care. The incident can be described
as one of my clinical experiences in my previous placement within an elite aged care
facility of Singapore (XYZ residential care facility). The residential care facility hosted
the old age citizens who were aged 60 years and above and had made a valuable
contribution to the society by their services but presently were affected with limiting
illness that deteriorated their quality of life. The residential care facility was
committed to delivering an excellent quality of care service based on a person-
centred approach in order to improve the standard of living of the old age citizens. It
is important to note in this context that the staffing ratio compared to the patient load

is extensively low which hampers the smooth provision of the care process. This
leads to curtailing time in terms of attending the patient which leads to compromise
of care quality. Mrs. D had been admitted to the residential care facility by her son
Mr.J. On presentment. Mr.J had stated that Mrs. D had been diagnosed of
symptoms of Dementia and that she would require specialized care services. The
administration of the residential care facility had committed to provide efficient care
services so as to promote holistic wellness of the patient. 15 days post the
admission to the care facility, the symptoms of Dementia started deteriorating and
the patient had become difficult to manage. The patient had been experiencing
symptoms of anxiety. In order to manage the symptoms of the patient, the
supervisor instructed the team of care professionals to administer high doses of anti-
psychotic medication. As a nurse, I was aware that the administration of anti-
psychotic medication to the patient without the consent of the patient or without
informing it to the family members of the patient was against the ethical code of
conduct. However, I was instructed by my supervisor to administer the medication
and I was expected to comply without questioning the decision. This can be defined
as the scenario that triggered an ethical dilemma in my scope of clinical practice. In
other words, I was obliged to comply with my instructor’s command. However,
consciously I was aware that the course of action undertaken by me was not correct
and was against the code of ethical conduct. The quality of care provided to the
patient was deprived of the elements of consent and patient autonomy. In addition to
this, the privacy and confidentiality of the patient was also breeched. Also, neither
the patient nor the family members of the patient was involved in the decision
making process which led to poor quality of care provision.
Identification of the ethical issues within the situation, include references
(minimum of 2) using APA 6th citation method; Please justify the importance of
the ethical dilemma and use suitable legislation or healthcare references that are
relevant to your scenario/situation (not included in word count)

The clinical scenario that has been described involved administration of anti-
psychotic medication in order to manage the symptoms of anxiety of a patient Mrs.
D who was diagnosed with Dementia. It should be noted here that neither the
patient nor the family members of the patient was informed about the administration
of the antipsychotic medication. In addition to this, the consent of the patient was
also not sought before administering the medication. The patient was also not
educated with the rationale for medication administration. Typically, the clinical
scenario highlighted a breach of patient autonomy and patient privacy. Further, the
incident also exhibits an ethical issue of maleficence. According to Kangasniemi et
al. (2013), nurses and care professionals are expected to comply with the ethical
principle of non-maleficence which refers to meaning no harm to the patients. Care
professionals are expected to put the patient at the heart of the treatment process
and devise a holistic care plan that yields positive outcome and act in the best
interest of the patient. Research studies suggest that there are four principles of
healthcare ethics that comprise of autonomy, beneficence, nom-maleficence and
justice (Gastmans, 2013, P. 144). Autonomy can be defined as the right of the
patient to possess control over their body (Judkins-Cohn et al., 2013, P.37). This
refers to the fact that a care professional can either suggest or advise but cannot
undertake any actions that seem to persuade the patient to take a decision that is
against their will. It should be noted in this regard that care professionals might take
a decision to act in the best interest of the patient but that does not authorize the
professionals to act against the personal values and beliefs of the patient and
impose their decision on the patient. The second ethical principle includes the
principle of ‘beneficence’. This states that care professionals at all times must act in
the best interest of the patient and the clinical decisions undertaken for the patient
must be after the evaluation of the positive and negative outcome of the clinical
event. Also, care professionals are expected to make use of their skills and
expertise in order to ensure that the decision suits the best interest of the patient.
Lastly, the ethical principle of non-maleficence mentions causing no harm to the
patient. This ethical principle is also considered as the end goal evaluation for the
care professionals, where in they are expected to consider the decision in order to

assess that whether or not the patient, the family members of the patient or the
immediate society associated with the patient is affected with the decision
undertaken (Urden et al., 2017). Justice forms the last ethical principle which
suggests that the decision taken by the medical professionals must be fair so as to
promote equitable use of medical treatment services for the patients across the
healthcare organizations. On closely, assessing the clinical scenario, it can be
mentioned that the ethical principles of patient autonomy, justice and non-
maleficence was breached. In other words, the patient was deprived of a fair and
effective treatment care. In addition to this, the Singapore ethical and regulatory
provisions of the professional practice code was also violated in the patient case
scenario.
Reference List (Minimum of 2 – please use the APA 6th citation method)

2) PORTFOLIO OF EVIDENCE
3500 words (maximum)
Matriculation Number
Word Count
Date of Submission
date / month / year
Resubmission
(Yes / No)
Formatting and Presentation
 Line spacing: 1.5
 Text aligned: Left

 Font type: Arial
 Font size: 12
Cover Sheet
Please use the coversheet when you have completed your learning portfolio to
ensure you have included all the required information and it is correctly formatted
using the guidelines below.
Learning Portfolio Assessment
Introduction
Provide an introduction to topic and state the importance of law and ethics in
nursing practice (300 word). The chosen situation should be adapted on the
basis of the work you have already done for the formative assessment (please
ensure you maintain confidentiality/privacy at all times and do not use any patient
identifiers).
According to Preshaw et al. (2016), ethics can be defined as a
fundamental element within the nursing profession practice. Nurses and care
professionals must treat the patients with utmost care and dignity and at the
same time ensure that the rights of the patient are protected. The evidence base
suggests that nurses and care professionals must reinforce an environment that
is favorable to dispense optimal care and establishes respect and mutual trust
between the patient and the nurses. It is extremely important to build a positive
therapeutic relationship with the clients based on the elements of mutual trust
and respect so as to render effective and positive care services to the patients. It
is the primary responsibility of the nurse to actively listen to the concerns and
consider the wishes of the patient so as to devise an appropriate treatment plan