Legal and Professional Issues in Nursing Case Study 2022

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legal and professional issues in nursing: case study
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Contents
Introduction......................................................................................................................................2
Legal and professional issues in Nursing........................................................................................2
Ethical and legal based practice...................................................................................................2
Application of ethical decision-making model (Zhao & Liang, 2018).......................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................7

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Introduction
Nursing is the profession of high ethical values that requires nurses to be highly
committed to the organization and to their clients. It is the duty that relates to the life and death
of the client any kind of negligence could cost the death of a client. In the case study, Mary is a
75 years old patient admitted to rehabilitation center after a hip replacement. The duty to take
care of her well-being in the center has been discharged to assistant nurse. Mary died after hitting
herself on the floor due to the negligence of nurse of not keeping the door bell at the side of her
bed. The following case study deals with the legal and ethical issues that arise in nursing. The
report will be discussing about various ethical principles, theories, and professional code of
conduct of nurses.
Legal and professional issues in Nursing
In this tragic situation, Mary a 75-year-old patient got admitted to rehabilitation center
after hip replacement. The center where she was admitted was poorly equipped. It lacked proper
beds and lightning. The increased number of intensive care patients made the matter worse and
squeezed away the major portion of the staff’s time. The registered nurse had to leave Mary as
she had to cater to the other patients. In the meanwhile, the assistant nurse wheeled her to the bed
and left after documenting her activities. After a few minutes, Mary tried getting up from her bed
to lower the TV’s volume but accidently fell off and hit her head hard. After the incident, Mary
was asked the reason for getting off from the bed. She said that the assistant nurse did not leave
the call bell beside her bed. In a day’s time, the grave injury to old woman’s head caused her
death. After the death, the hospital authorities asked AIN whether she provided her with call bell
beside her bed. On this she said that she did not remember about it. her statement made hospital
authorities to pressurize her to address in the documentation that she placed the call bell beside
her bed otherwise she would be terminated.
Ethical and legal based practice
The ethics are the high-level values, beliefs and principals that guide an individual
towards a right action. Ethical standards play an important role in guiding the decision-making

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process of the nurse. There are various nursing standards that guide the nursing behavior of a
nurse. those standards include NMBA standards, UTS graduate and UTS indigenous graduate
standards. The NMBA standards lays down various standards to promote the ethical nursing
practice. The standard sixth of NMBA states to provide the responsive and quality nursing
practice to the patients. in the case study, the responsive element was missing in the care of Mary
when Mary get off from her bed to lower down the volume of tv as she did not find the call bell
beside her bed. The missing of call bell signifies the inaction on the part of nurse or hospital
staff. The standard five of NMBA require the nurse to draft an effective nursing plan for
implementing the nursing practice. In the case study, the responsibility of Mary was not fully
transferred to the other department due to time crunch. The inefficacy in the handover lead to the
inactions on the part of the Assistant nurse as she did not investigate the case diligently and
rushed over to take care of other patients. The UTS graduate attributes were also not followed by
the nurse.
One of the attributes included respecting the relationship by building trust with the
patients. In the case study, there was lack of therapeutic relationship with the patients (Curtis,
2017). The relationship with the old lady was not appropriately build that was visible through
Mary’s unwillingness to cooperate with the RN. According to the professional code of conduct,
the nurse is obliged to follow some set of professional conducts in the job (Hasbi, 2018). One of
the professional codes include legal compliance. In the case study, the Assistant nurse did not
show legal compliance with the duties and responsibilities. She was indifferent towards the
duties reimbursed by RN and did not bother to document her activity of keeping a call bell
beside her bedside. Professional behavior is the other code of conduct that requires the nurses to
maintain outmost level of integrity, honesty, and uprightness at job. When patient died, the RN
instead of keeping the exact documentation of her activities tried to reconstruct in a way that
looks sound. the action on the part of RN is reflective that she did not perform are activities with
outmost honesty because of that she has to reconstruct her chart entries. Moreover, the RN
pressurized the AIN to change her documentation, otherwise she would be terminated from the
job. Such kind of intimidation by superiors to juniors is highly unethical and not legally
acceptable.

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The situation can also be looked from various ethical aspects. The ethical theories include
deontology and veil of ignorance. The deontology theory strongly addresses what is a right
action or the wrong action. The theory focuses on the intention behind the action committed. In
the case-study, the actions taken by nursing staff did not comply with the theory. The actions
were not ethical in the context (Meyers, 2018). The nursing members did not stay on their
previous documentation of the activities instead they changed it to their benefits so that they do
not get blamed for Mary’s death. The veil of ignorance is the ethical theory that focuses on being
just to the society by forgetting one’s original positions. As a group forgets from where it
belongs, it gets more in the position to act with equality (Diekmann & Rauhut, 2015)y. In the
case study, the nurse and the hospital staff were aware of their original positions in the hospital.
They were aware that they would be blamed for Mary’s death if they do not take some actions on
their part so they thought of changing the documentation. If they had acted from the theory of
veil of ignorance then the nurse would have taken care of Mary from the position of
responsibility and no unethical actions would be taken around documentation. The application of
these ethical theories would have stopped such unethical acts by the healthcare staff.
The beneficence is another ethical principal that states that the nurse actions should be
focused on patient’s care (Vinnari & Kupsala, 2017). It is about taking care of the patient’s best
interest. The nurse in the given situation should try avoiding any kind of harm caused to patients.
In the case study, the nurses were shown in a rush as they had many patients to attend at the
same time. The problem can be blamed partly to the hospital administration and partly to the
time management of the nurses. Initially it was mentioned that the hospitals lacked enough
beddings for the patients thus consumed most of the staff ‘s time in arranging facilities for the
patients. Moreover, the nurses should have managed their time effectively to deliver the best care
to the patients. The principal of beneficence was not followed as the healthcare environment at
the hospital did not permit them to achieve the patient-centered approach.
Non- maleficence is another ethical principal that is doing no harm to the patients. it is
the duty of the nurse to avoid any kind of harm instead try minimizing their physical and mental
pain (Ossenberg & Henderson, 2016). The principal of Maleficence was not complied by the
nurses. Neither RN or AIN achieved the results of a good nurse (Bradley, 2017). The RN did not
responsibly shifted Mary to the ward and AIN was so careless in her duty that she did not notice

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keeping the call bell by her bedside. This act of not keeping the call bell at the side costed the life
of the patient. The nurses with their indifferent approach had exploited the life of patient
(Romero & Roche, 2017).
Application of ethical decision-making model (Zhao & Liang, 2018)
Facts of the case
In the case study, Mary is a 75 years old patient admitted to rehabilitation center after a
hip replacement. The duty to take care of her well-being in the center has been discharged to
assistant nurse. Mary died after hitting herself on the floor due to the negligence of nurse of not
keeping the doorbell at the side of her bed. As the incident happened due to the negligence of
hospital staff and nurses. RN pressurized the AIN to reconstruct the chart entries so that they do
not get blamed for the death of the patient.
Ethical issues
The ethical issues that arise in the incident was negligence in performing of the duties by
RN and AIN diligently and the dishonesty on the part of nurses and hospital administration to
reconstruct the chart entries to avoid being responsible for patient’s death.
Identification of norms and principals
The principals and code of conduct violated in the case study was of professional
behavior where the nurses were dishonest and lacked integrity in the duty. The also tried
avoiding their faults.
Alternative courses of actions
In the case study, the hospital management tried going for the unethical behavior by
letting the nurse to hide their faults in the case. The other alternative action that can be taken is
that the hospital authorities must strictly investigate the fault of the nurses with the help of the
camera installed in the ward. if found guilty, the nurse could be suspended for few weeks rather
than terminating her as they would serve as an example for other nurses to avoid any faults like
this.

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Relating norms and behaviors with the options
The first option which is unethical option will lead to non-compliance of the professional
behavior. The second option will lead to the compliance of the professional behavior and legal
laws in the hospital.
Consequences of the chosen options
The first options will lead to dereliction of duties by nurses in the future as they would
take the management of the hospital for granted. They would more likely to be unethical in the
future. the second option will serve as a final notice to all nurses that such kind of negligence
would be treated with severe punishment. The performance of the nurses will improve in the
future.
Decision taken
The final decision taken would be the second option as it is the ethical option and is
complied with all the ethics.
Conclusion
The case study discusses about the importance of having a good ethical and legal
framework in the hospital. The right ethical framework will lead to the ethical functioning in the
environment. The nurses will able to perform the duties diligently. the clients will be satisfied to
the high extent.

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References
Bradley, L. (2017). Non-maleficence: perspective of a medical student. . The British Journal of
General Practice, 252.
Curtis, M. B. (2017). National culture and ethical judgment: A social contract approach to the
contrast of ethical decision making by accounting professionals and students from the US
and Italy. . Journal of International Accounting Research, , 103-120.
Diekmann, A. P., & Rauhut, H. (2015). Lifting the veil of ignorance: An experiment on the
contagiousness of norm violations. Rationality and Society,, 309-333.
Hasbi, M. Y. (2018). THE PRINCIPLE OF NON MALEFICENCE IN RELATION WITH
CONSTRUCTION CONTRACT IN INDONESIA. Journal of Legal, Ethical and
Regulatory Issues, 21.
Meyers, C. (2018). Deontology. . Communication and Media Ethics, 136.
Ossenberg, C. D., & Henderson, A. (2016). Validation of the Australian nursing standards
assessment tool (ANSAT): a pilot study. Nurse education today, 23-30.
Romero, B. F., & Roche, M. (2017). The impact of evidence‐based sepsis guidelines on
emergency department clinical practice: a pre‐post medical record audit. Journal of
clinical nursing,, 3588-3596.
Vinnari, M. V., & Kupsala, S. (2017). Sustainability Matrix: Interest Groups and Ethical
Theories as the Basis of Decision-Making. Journal of Agricultural and Environmental
Ethics,, 349-366.
Zhao, Y. Z., & Liang, L. (2018). Study on the Theory and Practical Problem of. Chinese Medical
Ethics, , 799-803.

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