Nursing Ethics and Patient Care Dilemmas

This assignment presents a first-hand account of a nurse encountering an ethical dilemma in a clinical setting. The nurse describes a situation where they felt obligated to help a patient despite their leader's reluctance. The experience highlights the conflict between doing good for the patient and adhering to established rules, emphasizing the influence of moral obligation and ethical principles on nursing practice. The narrative also reflects on the importance of effective communication with leaders and collaboration in providing optimal patient care.

Running head: NURSING LEADERSHIP 1
Nursing Leadership
Institution’s Name
Date

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Introduction
In hospitals, various systems shape up the quality of care that patients receive.
The policies in place, governance, the medics, rules, and regulations put in place by the
state may all influence the type of service that a patient receives (Lamont, Stewart, &
Chiarella, 2017). Therefore, it is important for nurses to use a reflective model in their
clinical experiences to analyze their performance with patients in a broader perspective
(Winslow et al., 2011). This paper tries to explain, by using an example of a clinical
placement, or rather an experience in handling patients which can be used to
demonstrate practices of nurses and the governing of hospitals on the services that
patient’s receives. Specifically, the example will try to answer five basic questions in
regards to patient care, that is, the effect of nurses following policies in hospital.
Secondly, the case example will give an illustration how nurses respond to regulations
in hospital in regards to the provision of services. In addition to that, the essay will look
at the context of it in relation to patient-focused care and human rights of patients. Thus,
the essay demonstrates the best practices that one can experience, the worst, and the
lesson or how one can improve and learn from those two experiences.
The Clinical Placement Example
In one of my clinical placements in a given hospital, I encounter three patients
who are complaining that a patient next to them has revealed that he is suffering from
tuberculosis. Thus, they are worried by the belief that being close to him, in the same
ward, may facilitate the transmission of the disease from him to them. However, they
narrate that they had told a nurse in charge in the afternoon and were told it is only the

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doctor in charge who can relocate a patient based on his condition but not based on
patients suggestion. However, noting the potential of the risk, I try to reach out our team
leader in charge who advises me to wait for the doctor since relocating a patient or
rather isolating him needs approval from a doctor after examination. However, at
midnight, the doctor in charge arrives, and after explaining to him, he says that the
hospital does not have such arrangements; however, he relocates the patient next to
the window where there is adequate ventilation but still, inside the same ward.
Later during the day, there was an audit where each nurse was to record a form on the
activities of the day. It is in this form that I was able to record the incident explaining
some of my dissatisfactions. Moreover, the doctor gave us the latest manure on the
right procedures in handling hand tools. He suggested that we follow the guideline to
stay on course in delivering our services.
Analysis
In the clinical experience, it is clear that there are concerns that the patients
address. Firstly, tuberculosis is an airborne disease and putting a patient in the same
room with other patients not suffering from the same ailments possess a risk of infection
through airborne transmission. In many cases, such like this one, the act of nurse
following leadership policies stipulated by the hospital can pose a risk to patients
(Botterill, & Hindmoor, 2012). For instance, even though it is true that the one patient
appears to risk transmitting an infection to other patients, the nurse is reluctant to
transfer him or her as it is the doctor who is entitled with the responsibility of making
such a move or recommendation of the same. However, this is worrying to me in that I
try to reach out to the team leader in charge who suggests that there must be approval

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from a doctor. By standing there and doing nothing, for the sake of rules, it poses
danger to patients who risk contracting tuberculosis. The policies that hospitals put in
place must be geared towards solving problems that arise from patients but not to
maintain the hierarchy. A study conducted in 2014 regarding infection control and
hospital epidemiology suggests that hospitals must inculcate evidence-based approach
in coming up with policies regarding the responsibility of each medic. This can make it
easier in helping patients should there be an emergency (Aiken et al., 2014). In addition
to that, embracing autonomy and access to resources is important for all staff members
to improve productivity in healthcare settings. Another research carried out in 2014 on
leadership style for nursing demonstrates that autonomy makes members feel
empowered to carry out activities on their own unlike when it does not exist (Gardner,
Gardner, & O'connell, 2014). In addition to that, the same study states that where there
is good leadership between a top and junior staff, it is easier to increase performance
due to motivation that is being generated.
Secondly, the clinical experience example indicates that both the patient choice
and risk need to be looked into. The nurse leader in charge fails to offer assistance to
the patient who threatens risk of infection to other patients. In addition to that, their
choice to have the patient being transferred to a different place is not affected for some
time due to leadership problems that exist in the hospital. However, I try all I can;
including raising the concern to my leader who does nothing than saying that it is out of
her responsibility. In addition to that, I reach out to the doctor when he arrive who then
sort out the problem based on the hospital regulations. Infection of tuberculosis can still
be transmitted to patients in the same room where there is poor ventilation, in the

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clinical placement example; relocating the patient to the window may or may not help to
solve the problem. In a hospital, evidence suggests that it is not always the case that
safety is guaranteed (Stalpers et al., 2015). The same study recommends that routine
audit is supposed to be carried out to ensure that the environment that patients or even
health care workers perform their duties is well situated to cater for the safety of all that
work in it. However, the study demonstrates that various parameters make it difficult to
attain that degree, one of which is sufficient health care practitioners to serve patients.
On the other hand, my leader appears not to take proper consideration of the
concerns raised by the patient and the nurse other than answering to demonstrate
where she is allowed to work. Such a move of nurses in turning down duties by using
rules laid down by the hospital or any other healthcare center but to the detriment or risk
to patients are common in most healthcare settings. Even though it is not her role to
relocate patients, she should have tried to elaborate further on other avenues that the
nurse concerned can use to solve the puzzle. In effect, she fails to act as a leader who
should give direction, mentorship, and advice to her subjects. In healthcare, it is
essential for medics to improve their leadership qualities and skills. One way of doing
this is leaders involving themselves in solving problems with junior staffs (Reem,
Kitsantas, & Maddox, 2014). A study conducted in by 2010 reveals that there is a poor
relationship among junior and senior staff in health care which is undermining the
provision of health services and in effect, the quality of healthcare that a patient
receives. In the same study, it recommends that an integrated approach is used and be
carried out at intervals to determine satisfaction of both junior and senior staff in helping

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one another (Cummings et al., 2010). By doing this, the loopholes that exist on either
side may be solved for the betterment of the hospital in achieving its objectives.
In addition to that, medics need to work in favor of patients as their work wholly
relies on helping patients. However, hospital dynamics possess a threat to what is
popularly known as patient-focused care (Scholl et al., 2014). The settings in a hospital
are such that they are diluting this aspect by going to the extent of risking the health
status of a patient. Unlike in the past, where a medic could come for a patient to his
residence to offer treatment, it is common practice nowadays that a patient needs to
visit a health care facility for the same service where there are complexities involved
(Hoch, & Kozlowski, 2014). One such complexity includes the roles that each medic
plays and the potential danger that a hospital possesses to the patient. In the sense
that, a patient may be in need but fail to get assistance as a result of the division of
labor. Additionally, in the clinical placement experience example above, the team leader
does not appear to subscribe to the notion of patient-focused care. In her position, she
ought to have offered more than just giving a response on what she is entitled to do.
This puts the patients in danger of contracting the infection at the hands of nurses.
Patient-focused care is one where nurses or any other medics put the interest of
patients first in all shapes or form. Research indicates that the complexity of
organizations in modern-day hospital is making service delivery to be inefficient
(Travaglia et al., 2011). There is poor accessibility of resources or proper organization
that can promote the efficiency of services to patients. Additionally, in every situation,
there ought to be a second in solving the problem rather than waiting (Kaye et al.,

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2015). The study stipulates that continuance restructuring is essential and one that aims
at patients focused care.
On the other hand, the fact that the doctor in charge advices us to use the latest
procedure for our safe handling of tools is a good step towards good practices of clinical
governance. Additionally, there is a daily audit where one can record his or her
grievances in regards to the dissatisfaction of the activities of the day. It demonstrates
that the hospital is keen in putting in place the right measures as far as clinical
governance is concerned. A study conducted in 2011 on clinical governance on rural
hospitals suggest that one of the reasons that there is so much injuries and
malpractices in hospitals is lack of proper clinical governance causing a scenario where
nurses and other staff feel free to handle patients and carry out procedures without strict
adherence to correct procedures (Travaglia et al., 2011).
Lastly, health care centers embrace the need for patients to have their rights
upheld and respected. Patients have rights to receive the highest medical care
attainable, to access care and to be treated with respect without violation of any of their
right unless in exceptional cases (Epstein, & Street, 2011). For example above, the
patients’ health care is at risk due to the patient close to them. Their anxiety and worry
about the risk of infection is not attended to or well taken into consideration as it should
be. In addition to that, it is a human right for anyone to be safe and feel safe but this
does not appear to be the case in the example above (Gagnier et al., 2014). The
leadership in the hospital has created roles that nurses ought not to indulge in certain
aspects. Additionally, the team leader opts to ignore the calls of the patients at the
expense of their vulnerability to infection. In regards to patients’ human rights, the

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patient fails to get the highest medical care attainable in regards to safety and protection
of any danger or harm from infection or exposure to the same (Ignatavicius, &
Workman, 2015). It is in violation of the basic tenets of human rights of patients. In
almost all countries, patients have a right to remedy and duty of care. According to
research by Sydney Law School on health complains and regulatory reforms, it
suggests that patients who are under admission programs are often on venerable state
and more often than not. Some of their rights, which include right to information and
consent and access to care are often violated (Faden, Beauchamp, & Kass, 2014). It is
thus, the responsibility of the leadership of health care to put up measures that protect
the rights of patients.
Conclusion
Thus, leadership in healthcare centers plays a crucial role in determining the
provision of services. Good leadership which entails a healthy relationship between
senior and junior staff can fasten delivery of services, and in this case, safe handling of
patients. Some of the best practices that leaders in healthcare must embrace are
encouraging autonomy among junior staffs, promoting accessibility to resources and
finding ways to stimulate motivation. On the other hand, even though there has to be a
division of labor and responsibility based on ability, it ought not to be at the expense of
patients but rather for the benefits of patients. Policies put in place must be geared
towards promoting safety, embracing human rights of patients and one that is to the
best interest of patients. Lastly, the clinical example demonstrates that nurses can offer
best and worst services. Also, nurses can tend to follow organization’s rules which do

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not favor patients although there are those that will demonstrate their willingness to
always look for solutions despite the organizational obstacles that exist.

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References
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., ...
& McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in
nine European countries: a retrospective observational study. The Lancet,
383(9931), 1824-1830.
Botterill, L. C., & Hindmoor, A. (2012). Turtles all the way down: bounded rationality in
an evidence-based age. Policy Studies, 33(5), 367-379.
Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., ... &
Stafford, E. (2010). Leadership styles and outcome patterns for the nursing
workforce and work environment: a systematic review. International journal of
nursing studies, 47(3), 363-385.
Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative
effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., Riley, D., & CARE Group.
(2014). The CARE guidelines: consensus-based clinical case report guideline
development. Journal of clinical epidemiology, 67(1), 46-51.
Gardner, G., Gardner, A., & O'connell, J. (2014). Using the Donabedian framework to
examine the quality and safety of nursing service innovation. Journal of clinical
nursing, 23(1-2), 145-155.

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Hoch, J. E., & Kozlowski, S. W. (2014). Leading virtual teams: Hierarchical leadership,
structural supports, and shared team leadership. Journal of applied psychology,
99(3), 390.
Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book:
Patient-Centered Collaborative Care. Elsevier Health Sciences.
Kaye, J., Whitley, E. A., Lund, D., Morrison, M., Teare, H., & Melham, K. (2015).
Dynamic consent: a patient interface for twenty-first century research networks.
European Journal of Human Genetics, 23(2), 141.
Lamont, S., Stewart, C., & Chiarella, M. (2017). Capacity and consent: Knowledge and
practice of legal and healthcare standards. Nursing ethics, 0969733016687162.
Reem, A. D., Kitsantas, P., & Maddox, P. J. (2014). The impact of residency programs
on new nurse graduates' clinical decision-making and leadership skills: A
systematic review. Nurse Education Today, 34(6), 1024-1028.
Scholl, I., Zill, J. M., Härter, M., & Dirmaier, J. (2014). An integrative model of patient-
centeredness–a systematic review and concept analysis. PloS one, 9(9),
e107828.
Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015).
Associations between characteristics of the nurse work environment and five
nurse-sensitive patient outcomes in hospitals: a systematic review of literature.
International journal of nursing studies, 52(4), 817-835.

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Travaglia, J. F., Debono, D., Spigelman, A. D., & Braithwaite, J. (2011). Clinical
governance: a review of key concepts in the literature. Clinical Governance: An
International Journal, 16(1), 62-77.
Winslow, S. A., Fickley, S., Knight, D., Richards, K., Rosson, J., & Rumbley, N. (2011).
Staff nurses revitalize a clinical ladder program through shared
governance. Journal for Nurses in Professional Development, 27(1), 13-17.

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Appendix
The experience is one in which there is conflict between doing good to help a patient or
following rules and doing nothing. I was trying to help the patient even though my
leader was reluctant. I managed to help them though partially but at a later time.
It boosts my morale that I was trying to do a good thing. I was influenced by the
moral obligation and ethical principles to always do well. I think I should have
involved the leaders in a more approachable manner maybe she could have
arranged for an earlier intervention. It has taught me that it is true that poor
ventilation and closeness to a person infected with tuberculosis can lead to
transmission of the disease. Also, nurses are obliged to cross borders and do
well to patients, and lastly, it is good to maintain good relations to leaders for they
may be of help.