Legal and Ethical Issues in Nursing: A Case Study on Patient Nutrition Policy

This paper discusses ethical concerns and complications related to patients’ nutritional and dietary management in medical facilities. It advocates the need for the development of patient catering standards and conventions in the context of minimizing the risk of trauma or psychosocial adversity that might arise due to patients’ nutritional mismanagement in healthcare settings.

Legal and ethical issues in Nursing
Introduction
The presented professional practice scenario reveals the ethical controversy that arose due to the
absence of a well-defined patient nutrition policy in the general practice clinical facility. The
registered nurse (RN) Sam experiences a positive interpersonal relationship with Lee (i.e. the
treated patient). Lee received chronic leg wound dressing intervention from Sam and exhibited
the clinical history of cerebral palsy and reduced weight. Lee’s wish to walk with Sam at the
roadside for pasta consumption created an ethical scenario that requires evidence-based
resolution by the registered nurse. The presented paper discusses various ethical concerns and
complications related to patients’ nutritional and dietary management in the medical
facilities/clinics. The paper also advocates the need for the development of patient catering
standards and conventions in the context of minimizing the risk of trauma or psychosocial
adversity that might arise due to patients’ nutritional mismanagement in the healthcare settings.
The paper categorically discusses social learning, psychodynamic, and moral models and their
implications in the context of the presented ethical scenario.
Ethical Perspectives and Values
The Implications of Moral Model
The greatest moral dilemma presented in the paper relates to the deontology and
consequentialism that directed Sam’s action in response to Lee’s requirement eating requirement
(Crockett, 2013). Consequentialism is a moral attribute that determines the authenticity of
individual actions on the scale of their outcomes. The outcome of the presented scenario is based
on the accomplishment of Lee’s feeding requirement without disrupting Lee’s and Sam’s
interpersonal relationship. Contrarily, deontology approach in the presented case advocates
ethical actions based on a set of global rules and ethical conventions. Lee’s food-based outing
with Sam appears unjustified since it increases Sam’s professional liability related to any adverse
outcome that Lee might experience during traveling and pasta consumption outside the clinic.
Therefore, Sam needs to select either deontology or consequentialism based ethical approaches
for taking a moral/ethical decision in the given scenario. The Moral Model considers
unconventional behavior or addiction as a moral weakness (DOH, 2004). Lee experienced the

addiction of eating in the group despite his underweight status. The Moral Model’s conventions,
therefore, radically negate the need for Lee’s outing with Sam in the context of satisfying his
hunger. The principle of beneficence advocates the requirement of making ethical decisions in
the best interest of the treated patients in the context of minimizing the risk of adversity and
deterioration in a nurse-patient relationship (Downs, et al., 2016). Furthermore, the ethical
conventions advocate the requirement of safeguarding patient’s autonomy and self-identity
through ethical decision-making. The patient in the presented scenario shared the desire to
consume a refreshing meal outside the clinic in accordance with his dietary habit and pattern
(Entwistle, et al., 2010). Restraining the patient from an outdoor meal in the absence of any fixed
clinic policy required downgrading patient’s autonomy as well as a good patient-nurse
relationship. This ethical perspective advocates patient’s outdoor meal consumption for the sake
of maintaining the therapeutic relationship and treatment compliance.
Patient’s Preferences and Individualized Concerns
The RN in the presented scenario needs to utilize practical wisdom/ethics expertise and
neutrality notion while giving a rational advice to the patient regarding outdoor meal
consumption. The explanation of the risks associated with outdoor meals in the context of
patient’s chronic leg wound and cerebral palsy is highly needed to modify his outdoor eating
decision (Gasparetto, et al., 2018). Empirical ethics advocate the requirement of innovative
utilization of innovation and research in the context of taking calculated decisions in relation to a
given ethical scenario (Gardner & Williams, 2015). The RN in the presented scenario needs to
understand the patient’s eating requirement with respect to his healthcare status and clinical
manifestations prior to taking a final decision regarding outdoor meals. Chronic wounds
substantially elevate patient’s socioeconomic constraints a considerable extent (McDaniel &
Browning, 2014). Furthermore, the socioeconomic burden effectively elevates patient’s risk of
mental manifestations including stress, anxiety, and depression (Dorner & Mittendorfer-Rutz,
2017). Therefore, Sam’s disapproval of Lee’s outdoor meals could not only disrupt the nurse-
patient relationship but also increase the risk of adverse mental complications. The ethical
conventions necessitate the requirement of administering healthcare interventions to the cerebral
palsy patients while safeguarding their preferences and values (Larivière-Bastien, et al., 2013).
These conventions also advocate the requirement of shared decision-making with the treated

patient in the context of enhancing the healthcare outcomes. The criticality of Lee’s case can be
understood from the fact that a denial from Sam’s front could potentially overshadow Lee’s
preferences and individualized values in the clinical setting. This might lead to
miscommunication, and deterioration of cooperation between Lee and Sam during the
prospective treatment sessions in the clinic. Contrarily, the ethical conventions emphasize the
need for maintaining the quality of life of patients affected with various neurodevelopmental
disabilities. Lee’s cerebral palsy status, therefore, requires ethical and clinical management while
maintaining his quality of life across the community environment (Racine, et al., 2013). The
outdoor visit of Lee with Sam and consumption of unhygienic meals could deteriorate Lee’s
quality of life to a considerable extent. This ethical perspective does not approve of Lee’s
outdoor meals consumption in the presented context.
Therapeutic Alliance and Application of Psychodynamic Model
Lee’s cerebral palsy manifests with the clinical complications including difficult muscle
coordination, uncoordinated movements, gait imbalance, impaired vision, and risk of brain
infections (NIH, 2018). Therefore, consumption of non-supervised outside meals might
substantially elevate Lee’s risk of somatic complications and trauma. Therefore, it would be
unethical for Sam to accept Lee’s request for an outdoor meal in the context of minimizing his
risk of infection and other health risks. On the other hand, the ethical conventions of nursing
practice emphasize the need for maintaining a therapeutic alliance with the treated patients to
improve their resilience, vitality, and overall mental health (Allen, et al., 2017). This therapeutic
alliance is highly needed with the objective improving patient’s trust in the administered
healthcare interventions. Sam in the presented scenario had worked hard to maintain a smooth
and interactive therapeutic relationship with Lee through compassionate and empathetic attitude.
The straightforward rejection of Lee’s eating request could instantly impact the process of
therapeutic communication and deteriorate the patient care outcomes in an unprecedented
manner. This created an ethical dilemma where Sam required taking an ethical decision while
considering Lee’s existing health risks and predisposition towards psychosocial complications.
Psychodynamic model necessitates the need for improving patient’s understanding of the
repetitive conflicts that prove to be the causes of psychosocial and ethical complications
(Churchill, et al., 2010). The resolution of these conflicts requires shared decision-making

through empathetic/compassionate attitude. Sam in the presented scenario needs to counsel Lee
in a manner to avoid any potential communication conflict while enhancing Lee’s understanding
of the risks associated with the outdoor eating. This might not appear feasible in the presented
scenario in a short interval due to Lee’s persistent group eating behavior. However, behavior
counseling and support interventions through interdisciplinary coordination could improve and
modify Lee’s decision of outdoor eating in the presented scenario.
Patient’s Self-Efficacy, Mind-Body Awareness, and Implications of Social Learning Model
Ethical conventions also advocate the use of mind-body awareness techniques to facilitate the
utilization of appropriate nutritional interventions in the patient population. The availability of
nutritional and flavored food in the clinical setting could have assisted Sam in modifying Lee’s
desire for outdoor meals. However, denial in the absence of an indoor meal facility could have
caused the patient’s emotional detachment from the registered nurse. Furthermore, healthcare
ethics emphasize the capacity of nutritional methods to facilitate the pattern of self-therapy in the
treated patients (Essen & Mårtensson, 2014). Lee’s acquisition of the desired food option
through Sam’s coordination and support could have improved their emotional/interpersonal
bonding and the associated healthcare outcomes. Therefore, Sam’s consideration of Lee’s
outdoor meal choice could potentially improve his mental health and overall well-being to a
considerable extent. Bandura’s social learning theory substantially extends wide ethical
implications in the presented case scenario. This theory advocates the need for developing
innovation, ethical and mediating interventions after thorough observation of the stimuli and
their respective outcomes (or responses). Social learning theory also promotes observational
learning and self-efficacy of individuals while facilitating their behavioral orientation with
environment and circumstances (Ghazi, et al., 2018). Sam in the presented scenario required to
mediate the ethical situation after analyzing patient stimuli and proactively evaluating the
expected behavioral outcomes following the ethical intervention. This proactive ethical
mediation through cognitive and behavioral interventions could effectively stabilize Lee’s
behavior and convince him to reconsider the decision of outdoor meals.
Sam’s preliminary objective in the presented scenario attributes to the mitigation of patient’s
moral distress that might emanate after receiving a denial for outdoor meals. The maintenance of
morality during patient handling is of paramount importance and warrants utmost consideration

by the registered nurse. Furthermore, the incapacity of the nurse or physician in handling the
ethical dilemma might also induce moral distress in the concerned nurse/physician (Newson,
2015). Therefore, the registered nurses need to undertake medical and ethical interventions while
safeguarding their own mental well-being and conscience. This step is substantially required to
effectively maintain the quality of patient care interventions in the clinical setting. Sam’s
coordination in with the treated patient require professional orientation while minimizing the risk
of ethical and moral dilemmas and associated patient care adversity. The management of ethical
concern in the presented case scenario by the registered nurse necessarily requires discussion
with other experienced colleagues and healthcare professionals (Doran, et al., 2015). Sam in the
presented scenario therefore needs to telephonically coordinate with other healthcare
professionals before taking a decision to accompany Lee to Vinny’s pasta.
Sam requires evaluating the medicolegal aspects of Lee’s health risks while taking an ethical
decision regarding the acknowledgement or rejection of the outdoor meal request. Sam also
needs to understand Lee’s nutrition risk facts before approving/disapproving the outdoor meal
request. Lee experiences elevated risk of malnutrition because of pre-existing cerebral palsy.
This indicates that Lee might experience overnutrition or undernutrition in the absence of
appropriate dietary regimen (Verschuren & Peterson, 2016). Sam needs to evaluate Lee’s risk of
nutrition-based medical emergency while accepting or denying the request of an outdoor meal.
Lee in the presented scenario experiences the risk of collapsing under the impact sustained
hunger or weakness in the context of his existing physical and mental health. The reduction in
blood glucose level due to sustained hunger/lack of eating could drastically deteriorate Lee’s
health in the clinical setting. These facts categorically warrant the comparative analysis of Lee’s
health risks, mental health factors, and expected adverse outcomes that might immediately occur
in the absence of meals consumption. Sam could allow Lee to consume roadside pasta if the
benefits of the same overweight the associated risks in the presented scenario. Furthermore, Sam
needs to theorize and speculate the extent of psychosocial deterioration that Lee might
experience after receiving a denial for the outside meal. In summary, the assessment of
medicolegal complications, ethical concerns, psychosocial dilemmas, and healthcare
discrepancies is substantially required while resolving the ethical concerns and issues related to
the presented patient scenario. The case findings necessitate the requirement of configuring

policies and procedures to guide the registered nurses and other healthcare professionals in the
context of addressing patient’s individualized concerns and challenges in the clinical setting.
Conclusion
The presented case scenario presents a range of ethical and moral conflicts that require
categorical resolution by the registered nurse. The configuration of a rational decision regarding
the patient’s roadside meal requirement appears highly challenging in the absence of an
appropriate patient care policy in the clinical setting. The registered nurse in the presented
scenario must keep in mind the requirement of administering holistic and person-centered ethical
interventions while safeguarding the dignity, integrity, confidentiality, perceptions, cultural
beliefs, and perspective of the treated patient. Contrarily, the consideration of medicolegal
aspects of patient care interventions is also needed while catering to the individualized needs and
nutritional requirements of the clinical intervened patient. The benefits and risks of patient’s
outdoor meal in the presented scenario counteract each other, thereby creating the state of an
ethical and moral discrepancy. The registered nurse finally requires taking an action in the best
interest of the patient while mitigating the associated risk factors up to the feasible extent. The
sustenance of a dynamic nurse-patient therapeutic relationship is highly required to maintain the
patient’s trust and confidence in the recommended therapeutic approaches. This will not only
improve patient’s treatment compliance but also minimize the overall healthcare burden of the
clinical setting.

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