Ethical Dilemma Faced by a Nursing Student in Providing Care to a Mentally Ill Patient

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s notes

1HEALTH CARE
What?
During my placement in a busy medical ward of a regional hospital as an undergraduate
nursing student, I was asked to care for Shelly, a 27 years old female with suspected case of left
lower lobe pneumonia. She also had acquired brain injury and she was in respite care. She was
dependent on activities of daily living and mostly required supervision because of her tendency
to abscond from the hospital. One day, Shelly was found to be wandering few blocks from the
hospital and she was returned by local police. Due to her running tendency, the issue that I faced
was that I was advised during handover that Shelly should be restricted to her bed all the times
and her bed rails should be raised too. I was also given the order to give regular dose of sedative
medication the patient.
So what?
It was an ethically challenging situation for me as I felt the order was too harsh for the
patient. On entering the room, seeing Shelley screaming to be let out of bed and her complete
refusal of medication create ethical dilemma for me. I faced challenge in completing my advised
routine because the order violated patient’s autonomy. I was confused whether the clinical order
should be prioritized or the patient’s autonomy should be prioritized in such situation. It
seriously challenged my values of respecting and maintaining dignity of patient. During my
theoretical classes too, I had learnt that all nurses need to abide by the principle of patient
autonomy that obliges all health professionals to respect the decision of patients and obtain their
consent before initiating any treatment of intervention (Cook et al. 2015). However, the clinical
order mandated me to go against Shelley’s wish and implement harsh intervention without taking
her consent. Hence, I was surprised by the handover instruction. I was confused as I thought I

2HEALTH CARE
would be legally at risk because legal tenets also favour respecting the inherent rights of patient
(Sinclair, Papps and Marshall 2016).
In response to above dilemma, I followed the handover order despite the dilemma in my
mind. I administered the order forcefully and the patient was left screaming. On reflecting on
action now, I think I had not taken an ethically sound decision. I should have been mindful of
other alternative options in such scenario. For example, I should have analysed the decision
making capacity of the patient and understand if Mrs. Shelley could understand the risk and
benefits of the treatment or not. According to Latha (2010), use of sedative and antipsychotic
drug is very frequent in mental care setting as it eases the difficulty level of caring staffs.
However, this may not be always in the best interest of patient. Hence, if any mentally ill patient
refuses treatment, the necessary ethical action that is needed is to assess the capacity of patient to
follow and understand risk and benefits of treatment. If the patient is found to lack capacity, then
in such scenario it would be lawful to give such medications to patients provided the treatment
can prevent deterioration of health in patient and is within the best interest of patient (Tunzi and
Spike 2014. However, no such action was taken.
However, it cannot be completely denied that the order given during handover was
irrational. This is because based on Shelley’s tendency to abscond, restricting her to her bed
could promote beneficence and reduce harm for patient. However, the only ethical issue was that
the treatment was being given without Shelley’s consent. How far the decision would reduce
harm was a critical question to be considered by the health care team. Giving Shelley sedative
medication forcefully without taking her consent can induce more harm as the patient may lack
trust with the care staffs and may become more aggressive (Ye et al. 2018). In such situation,
another ethical consideration that was necessary was to involve family members as they can help