Ethical Dilemmas in Nursing Practice

This assignment presents a scenario involving a nurse who made a serious error by administering medication without a prescription and falsifying patient records. It requires students to analyze the ethical implications of this situation, considering relevant nursing standards and guidelines. The goal is to demonstrate an understanding of how critical thinking, effective communication, and creative problem-solving can be applied to resolve ethical dilemmas in nursing practice.

Course : Diploma of Nursing (Enrolled-Division 2 Nursing)
Course
Unit : HLTEN508B Apply reflective practice, critical thinking and analysis
in health
Assessment
type : Question and answers
1. Explain your understanding of the historical and current perspectives of nursing and
nurse education?
 In ancient nursing practices, certain educational qualification was not necessary and
therefore, caregivers used to acquire their learning through oral discussion, from
generation to generation. They also used to learn techniques from observing other
caregivers caring for sick patients or sometimes using trial and error technique.
 However, in current perspective nursing education, proper training and internships
are necessary so that they can provide quality care to the patient with respect to the
social and ethical boundaries.
2. Identify any 5 (five) contemporary issues in nursing and examine their impact on clients
and the health care environment.
1. Compensation- gender biasness and workplace politics has affected the nursing
compensation and this gender gap led men nurses earn more than their female counterparts.
It can affect the workplace environment as women nurses may not be able to perform
depending on their ability.
2. Workplace violence- It has been reported that violence on workplace (by co-workers or
patients) has been increased in last decade. This can hamper the workplace environment, as
nurses would not be able to work in an unsafe environment.
3. Long working hours- as the maximum of the world population is aging, the number of
people seeking care in hospitals have increased. It has led the nurses to work for extra hours
that affects the concentration of nurses on each patient.
4. Workplace hazard- nurses face many workplace hazards that expose them to blood
related pathogens, injuries, and dermatitis and flu infection. This influences their health
directly and their contribution to healthcare process is reduced.
5. Short Staffing- staffing of the nurses in one of the prime contemporary issues nowadays.
and therefore dissatisfaction among nursing staffs directly hampers the caregiving process
directly.
3. Explain in 100 words the role of regulation and professional standards of practice in
nursing. Also support your answer with an example of how you would apply the regulations
and standards in your own practice?
Professional standards is the means using which, the competency of the care giving process
can be assessed. These standards are pre-decided standards that provides the nursing
professionals with achievable and desired benchmarks and compares their performance

depending of the achieved level. Further, these standards help the healthcare organizations
to create safe employee practices, assigning tasks to the licensed personnel and take
necessary actions who violate these safety standards. These standards going to help me with
understanding my limitations and abilities as a healthcare providers. These guidelines will
assist me to identify the situations with dilemma and take necessary steps to overcome it.
Further, its ethical and professional standards will help me to develop my professional
career on moral basis.
4. As stated in ANMC National competency standards for the Enrolled nurses, "The
enrolled nurse is an associate to the registered nurse who demonstrates competence in the
provision of patient-centered care as specified by the registering authority's license to
practice, educational preparation and context of care."
Analyse the above statement and explain in 150 words, your understanding about the role of
EN, RN and other health care professionals.
RN- The Rn is responsible to provide or delegate care duty to another health professional
like EN. Further, they are responsible for making important decisions or judgements about
any care process. For example, if any care process is beyond their expertise, they can take
help from senior healthcare professionals (Nursing and Midwifery Board of Australia
2017).
EN- The responsibilities of ENs are limited as they are the associates to the RNs. they are
limited to individual scope of practice. They can administrate certain range of medication to
patient, however if ENs possess any extra training, they can assist RNs in primary care
settings as well (Australian Nursing and Midwifery Federation Standards 2018).
Other healthcare professionals (Advanced practice nurse and Nurse practitioner)- The
APNs are able to make changes in the current patient care routine and being in the general
practice team they have active roles in management, leadership, education and research.
Further, the NPs are the senior most level of nursing professional and they have the power
to provide referral to any healthcare professional in the settings (Australian Nursing and
Midwifery Federation Standards 2018).
5. What do you mean by holistic approach? Explain in 50 words the meaning of adopting a
holistic approach. Provide an example to justify how you would incorporate the holistic
approach to client care in your practice.
The holistic approach of nursing is the approach that uses mind-body-spirit-emotions-
environment approach to deal with patients and practice traditional nursing. This approach
treats a patient as a whole and tries to apply intervention that will help with overall
development.
6. Explain your understanding of a performance review? 50 words.
The process of performance review helps the nursing professionals to understand their
strength, their weaknesses and the areas in their practice that can be controlled or enhanced
through rigorous practice. A planned and structured event helps to motivate the healthcare
professional with development and appraisals. The symptoms and disease is not the concern

as the nurses are focused on the entire body for the treatment.
For example, the nurses while diagnosing a patient may ask about the social faith and
mental situation rather than only the symptoms and effects. this is the holistic approach of
nursing.
7. "It is important to promote and support individuality of clients when implementing
planed care."
Analyse the statement and interpret in your own words. (50- words)
This statement determines the fact that according to the nursing principle of non-
maleficence, it is the duty of the care provider to take care of patient’s need and should not
hurt patient intentionally or unintentionally. Therefore, while providing planned care to any
patient, they should take care of the patients social, religious, nutritional and personal
preferences.
8. As an Enrolled nurse how would you share your professional knowledge and skills with
others. List at least 2 (two) examples.
1. While practicing or working, if I will acquire new skills that I can share with my co-
workers I will definitely arrange a small training discussion. Explaining a skill can affect a
fewer mind, however, explanation with demonstration will enforce the knowledge to every
individual in that training.
2. Further, I can share my knowledge through narrating that important piece of information
informally. This will help the other person understand my concepts and apply to his/her
practice.
9. Propose 2 (two) examples of how would you promote a positive image of nursing as a
profession and support the role of other health professionals?
1. By maintaining positive attitude and behaviour- As in this tech-friendly era, the image of
healthcare facilities depends on the customer reviews and ratings; I will try to behave
positively while providing care to the patients.
2. Establishing good work habits- I will abide by the workplace ethics and professional code
of conduct. Further, I will try to help my co-workers to deliver quality care.
10. Explain the significance of professional development in nursing practice. Enlist 3
(three) ways of maintaining professional development.
It is very important for nurses to continue their professional development throughout their
career as the skills and interventions of patient care changes almost every day. New
researches develops a new theory about the same practice and modifies the process
therefore, it is important for the nursing professional to be up-to-date every day.
Three ways that helps the nurses to stay updated are- continuing education, upholding
competency, and assessing their learning needs.

11. Identify 3 (three) professional organizations and explain their roles.
1. Academy of Medical-Surgical Nurses- It helps to promote and create excellent
professionals of medical-surgical nursing.
2. Academy of Neonatal Nursing- It helps to promote neonatal care process and creates
professionals having expertise in neonatal care.
3. American College of Nursing Practice- This organization helps to establish quality
standard for nursing education and supports professional nursing education and practice.
12. As an Enrolled Nurse it is part of your job responsibility to work with in a
contemporary health care environment. To ensure this you are require to fill out below
areas;
Analyse and explain in 100 words on each area to provide support to your answer.
12.1 Achieve work outcomes and demonstrate good time management with in prescribed
periods.
Pace with accuracy bears very much importance in the career of nursing professionals.
Therefore, while assisting a registered nurse, the enrolled nurse should apply their
knowledge and skills to achieve faster outcomes. This can be achieved with the application
of proper time management skills and using skills that can provide faster results within a
prescribed time. This is important for the enrolled nurses as their working boundaries are
restricted and time management will help them to assist the registered nurse with multiple
number of patients that will enhance their skills and knowledge about the care giving
process.
12.2 Manage resources according to health environment guidelines.
As per the health environment guidelines, it is important for the enrolled nurses to be aware
of the environmental resources and the guidelines provide by the government, as the
government according to the locality of the healthcare settings publishes these guidelines.
For example, if the water of that locality is not appropriate for the patient to consume, it is
the responsibility of the enrolled nurse to provide the patient with appropriate water for
his/her consumption (Australian Nursing and Midwifery Federation Standards 2018).
12.3 Utilise contemporary health informatics systems to gather, collate and document data.
The modern healthcare system is focused on using technologies and software to store
patient data, as it will be helpful for the patient to access his/her data from anywhere in the
world and seek healthcare assistance. Therefore, the enrolled nurse should be competent
enough to use these modern healthcare systems to analyse, collect and store patient data
without any further mistake (Australian Nursing and Midwifery Federation Standards
2018).
12.4 Work within context of practice and within boundaries of work role.
It is important for an enrolled nurse to work within the set boundaries and practice roles as

beyond that, their action may harm the patient and the care providing process. According to
the practice, standards of nursing, enrolled nurses are associates of the registered nurse and
their duty is to acquire the care providing process and observe the unique skills. Therefore,
the enrolled nurse should work according to the tasks assigned to them and maintain the
ethical consideration of not working beyond the boundaries (Australian Nursing and
Midwifery Federation Standards 2018 2018).
13. Differentiate between critical thinking, creative thinking and problem solving.
Critical thinking Creative thinking Problem solving
This process is used in
nursing practice to provide
quality care and safe
practice
Creative thinking is
important for creative
thinking
It is the implementation and
putting a course of action in
response to the emerging
problem.
It helps to adhere to
intellectual standards and
code of conducts and ethics
It helps the nurses to utilize
their creativity to fasten any
critical care giving process
for the benefit of the
patient.
It helps to assess, diagnose
and identify the outcomes
of any nursing intervention
prior to the implementation.
It helps to create traits and
habits of thinking and
applying those thinking in
nursing practice.
It helps to understand the
cognitive thinking ability of
the nurses to find a way out
in any problematic situation
It helps to understand the
course of action that need to
be taken for patient’s
concern.
14. Research and list the characteristics of problem solving. Also explain how you would
apply it in the steps of the nursing process and development of a nursing care plan? (70
words)
1. Assessment- This helps to collect and interpret data acquired from nursing diagnosis.
This helps to direct the focus of the nursing practice on the patient’s problems such as if the
patient is having myocardial infarction, then the diagnosis should be done for dyspnoea and
chest pain.
2. Diagnosis- This helps to develop the plan of care after the diagnosis and data collection
classification is done. It helps to understand the patient outcomes
These aspects will be applied to understand the patient requirement and further research
about these aspects will be done with the help of registered nurses to stay updated.
15. As an Enrolled nurse how would you apply reflective practice within your role? Also
explain the process and benefits of reflective practice in your work role
Reflective practice is the means to reflect on others as well as own actions that helps to
engage the person to the activity. This helps to critically evaluate the everyday works and
examine the loopholes that can be amended through rigorous practice. As an enrolled nurse
reflective practice could help me to critically analyse my role in healthcare facility and
understand the faults I have made. Further, take necessary actions so that those mistakes
cannot be repeated again.
Benefits:
1. In helps to understand and experience any situation,.

2. It promotes better and deep learnings.
3. It identifies the educational requirements to fulfil knowledge.
4. Helps to acquire new skills and knowledge.
16. Provide 5 (five) examples of the issues that may produce a detrimental view of nursing.
1. Environmental factor can produce detrimental views of nursing care. Economic factors
that leads to shortage of staff and fragmented care ultimately leads to patients
dissatisfaction.
2. Communication gap- if there is a communication gap or coordination problem between
two healthcare professionals of any organization, then it can lead to detrimental views about
nursing in the patients.
3. Organizational factor- if the organization is situated in the area, where environmental
factors are affecting patient safety and security, then It may lead to negative thoughts in the
population out there.
4. Ethical disruption- If the healthcare facility is unable to maintain the autonomy of
patients then patients are not going to rate the healthcare facility with positive comments.
5. relationship between nurses and patients- if the nurse caring for patients, do not behave
properly then the patient may think negatively about the caregiver of that organization.
17. Explain how you would evaluate the effectiveness of self reflection on yourself and
others (80 words).
As the self-reflection process possesses importance in the nursing practices, the evaluation
of such practice becomes important to understand the effectiveness of the process.
However, the evaluation process should comply with the previous process depending on
which the reflection was done (Thompson and Pascal 2012). For example, if the reflection
was done on administrating a patient with, analgesics and the difficulties were faced while
doing such practice; the evaluation should be done on the same situation. The evaluation
process of others should also be done similarly or by filling a questionnaire about the
process, they want to evaluate their learning on.
18. As an enrolled nurse what are some of the educational and career opportunities. Provide
at least 5 (five) examples.
1. The first opportunity is becoming a registered nurse. This will the nurse to acquire more
experience and knowledge to apply critical and creative thinking in medical interventions.
2. Advanced practiced nurse- After completing duty as a registered nurse for few years can
register themselves for advance practices, as it will help them to acquire more control and
knowledge in the caregiving process.
3. After becoming an advanced practice nurse, they can implement their ideas and after
becoming APN, the nurses who are registered by the NMBA, can apply for nurse
practitioners.
4. After understanding the ethical and professional standards, the enrolled nurse can play an

important role in the assessment services.
5. The nurses can utilize the opportunity and use self-reflector studies to become a trainee
for undergraduate nurses for further development of their career.
19. Ethical guidelines include confidentiality, duty of care and public liability Explain each
individual term (50 words each).
Confidentiality- on ethical grounds, in nursing profession, confidentiality is the primary
principle that should never be violated by the healthcare professionals. Confidentiality
related t patient information, patient’s health status, patient’s personal history and their
current difficulties should be maintained properly according to the ethical code of conduct
guidelines.
Duty of care- it is the legal obligation, that states that nurses should always provide best
possible care to the patients and their action should not harm anyone. The nurses should
accept the task, they think they can perform without any hurdle and therefore, it helps to
provide best possible care to the student.
Public liability- In healthcare, public liability is prepared to interact with the patients and
understand their difficulties and problems, depending on which they can take legal actions
to protect themselves from injuries and harms.
20. Propose your understanding about the role of Evidence based practice in nursing (50
words).
The primary and most important goal of the evidence based practice or EBP is to update the
healthcare service with the help of evidences from authentic researches. This helps the
nursing professionals by providing them chance of professional development and keep
themselves aware of the recent findings in the world of nursing. These findings can help
them to sharpen their skills and emerge as a better healthcare professional to provide better
care to patients.
21. Review and critically analyse some recent articles and list 3 topical issues identifies.
After searching for recent journals, it was understood that the three prime topics in nursing
research nowadays are healthcare reforms, emerging global health concerns and eliminating
barriers in the way of nursing practices. According to Kolstad and Kowalski (2012),
Nursing practice is an issue, which need to be evolved every moment as every individual
reacts differently to same intervention. Therefore, modification of interventions are
necessary for the development of nursing practice. However, Kirch, Henderson and Dill
(2012) states that nursing study modification can lead to generate loopholes for future
healthcare experts as they will not trust the ancient medical techniques.
As the global warming is emerging as the most important issue of the world, it has started
showing effects like modified diseases and barriers in the healthcare sector as well.
Therefore, researchers are keen to find newer techniques or skills that can change this
difficult situation (Jamison et al. 2013). Thirdly, the researchers are searching for ways that
can remove the barriers of nursing practice for RNs and this will help to generate newer and
efficient RNs that will provide quality care in future (Romp et al. 2014).

22. Scenario
A Nurse Provides prescription medicine without authority
A Nurses Board received a complaint concerning allegations that a nurse (medication
endorsed), whilst working in the emergency department of a hospital, practiced outside the
scope by knowingly providing prescription only medication to a patient without the
authority of a medical officer.
When interviewed, the nurse stated the patient attended the emergency department for
treatment and the department was busy at this particular time and the patient knowing this
stated that they were not prepared to wait for treatment. The nurse made enquires of the
patient's allergies and responses to medication and then consulted a doctor. The nurse then
obtained a packet of antibiotics and provided them to the patient. The nurse also made
false entries in the medical record of the patient.(Adapted from Nexus, NBV, November
2008, Volume 16 Issue 2).
Key points to elaborate (addressing performance criteria)
22.1 Discuss and explain how the nurse failed to use critical thinking and analysis skills
effectively in this situation leading to unprofessional conduct? (150 words)
In this discussed case study, the nurse failed to use critical thinking while providing
the packet of antibiotics to the patient. As per her interview, the patient attended the
emergency department however, as the department was busy, the patient was not been
able to wait for the patient. Therefore, the nurse provided the patient with medication,
without any physician’s prescription and authorization from medical officer, which
was against the nursing standards. She could have critically analysed the situation and
consulted any senior nurse or physician of other department for the check-up of the
patient. This situation was supported by the nursing principle according to which,
nurses can discuss any difficult situation with other healthcare professionals.
Secondly, her action of entering wrong data in the register about the patient was more
crucial as the hospital would not be able to track the patient in future, in any adverse
situation (Australian Nursing and Midwifery Federation Standards 2018).
22.2 Reflect on the scenario and explain how the nurse failed to apply the foundations of
contemporary nursing practice? (150 words)
According to the contemporary nursing practice, described by the Australian Nursing and
Midwifery federation standards, the nurse did not followed the ethical code of conduct. As
the standards explain the nursing practice as a safe and efficient career, the nursing
professional should work to make the nursing profession as well as the organization
stronger. The enrolled nurse are bound by the nursing standards as they are unable to
perform works that are beyond their working capacity, however, the nurse in the case
study violated that and hence, her action was not compliance with the Australian nursing
standards for enrolled nurses (Australian Nursing and Midwifery Federation Standards
2018).
On the other hand, she also made fake entry in the official patient register and therefore
her action was punishable according to the ethical code of conduct and professional code
of conduct of Australia (Australian Nursing and Midwifery Federation Standards 2018).
22.3 Analyse and state the relevant legislation and professional regulations related to this

case (Quote examples on how the nurse failed to follow those legislations and
regulations).
The first legislation that the nurse violated was the Australian Health Regulatory
Authority or the AHRA. As per the given standard, the nurse should not work beyond
her nursing aspects and boundaries, as her minimal knowledge can hamper the plan of
care as well as the health of the patient could be at risk (AHPRA 2018).
The second law the nurse broke was the ethical code of conduct, according to which,
the action of employee should never hamper the image of the organization. However,
by making fake entry in the register, she hampered the organizational code and
violated the professional code of conduct.
The third legislation she violated was the health practitioner regulation national law
2010. according to this, health professionals, who are not authorized to do a specific
work, should maintain the boundary as it is important for the safety and security of the
patient (AHPRA 2018).
22.4 Propose 3 types of professional development you would recommend for this nurse
to undertake and to prevent future such incidents and why?
The first professional development this nurse will be provided is study of the ethical and
professional duties a nurse should do or should not perform, while serving in the
healthcare service. This will help to develop morality in that nurse and it will be easier for
the nurse to understand his/her limitation while working in the healthcare facility.
The second development goal would be making the nurse aware of the organizational
rules and responsibilities. For this purpose, the nurse will be provided with opportunities
so that she/he can grasp the knowledge properly.
The third professional developmental process will be assigning the nurse with an
experienced registered nurse so that she can understand the duties and responsibilities
under experienced supervision (NMBA 2018).
22.5 Explain and justify the seriousness of this issue in 150 words. Analyse and state how
you can promote reflective practice of self and others.
The issue, mentioned in the case study is very serious in every aspect such as personal
aspect, professional aspect and moral aspect. While providing care to a patient, a nurse
need to be aware of all these factors, as this profession not only affect a person physically
but mentally. Therefore, The nurse should think prior making any action. In this case,
study; the nurse gave a patient a crucial medication that should not be provided without
any prescription. Further, she made false entry in the patient register, in spite of accepting
her own fault. This scenario will help me to understand that while facing a dilemma, we
should apply our critical thing, effective communication skills and creative thinking to
solve any issues (Thompson and pascal 2012).

References
AHPRA 2018. Australian Health Practitioner Regulation Agency - Legislation. [online] Ahpra.gov.au.
Available at: https://www.ahpra.gov.au/about-ahpra/what-we-do/legislation.aspx
Australian Nursing & Midwifery Federation 2018. Australian Nursing & Midwifery Federation.
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