Faculty of Health Sciences: Inquiry for Professional Practice Essay

This essay examines ethical and legal issues in nursing practice, using a case study of a Registered Nurse (RN) named Fiona. The introduction highlights the importance of ethical and legal frameworks in healthcare, especially concerning emergent diseases and illnesses. The essay identifies legal, ethical, social, and medical facts from the case study, using the ISBAR method. Key topics include informed consent, legal issues like beneficence and liability, and ethical principles such as autonomy, veracity, justice, confidentiality, nonmaleficence, and beneficence. The essay also discusses professional issues like NMBA Standards of Practice and NSQHS standards. The conclusion emphasizes the significance of professional practice in nursing and the need for continued study in this area. The case study involves a patient, Fred, who had a laparotomy and is experiencing confusion, and the ethical dilemmas faced by the nurse in providing care while respecting the patient's wishes.

Running head: PROFESSIONAL PRACTICE 1
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Name
Institutional Affiliation

PROFESSIONAL PRACTICE 2
Introduction
Emergent dieases and illnesses have become a major issue in the modern world.For this
reason many countries have been forced to invest in their healthcare systems to improve the
quality of care.Nurses have a set of professional values that include legal, ethical, social and
medical facts that guide them as they carry out their daily duties (Cherry & Jacob, 2016). This
essay is meant to assess the principles of skilled nursing practice, define the moral and legal
frameworks for the profession to follow and apply them in different situations.
Identify the Problems
In the case study on Registered Nurse Fiona clinical handover notes, there are several
legal, ethical, social and medical facts that can be pointed out using the Identify, Situation,
Background, Assessment, and Recommendation(ISBAR) method. First, some of the legal facts
include whether the hospital is legally bound when the patient gets sicker as a result of his
actions of smearing faeces on himself and also pulling out his IV cannula both activities which
are hazardous for his health. Even if they are supposed to force the patient to get treatment they
have to wait for his consent so that he could get respectful treatment.
Some of the medical facts, in this case, are; first the patient Fred had laparotomy
performed on him the day before as a remedy for acute bowel obstruction. A laparotomy is a
procedure whereby the doctor makes an incision in the patient’s abdominal wall with the aim of
accessing their abdominal cavity when there is an issue in that area. In this case, Fred had an
acute bowel obstruction which is where a patient has a blockage in their bowel which affects
normal bodily functions, and the laparotomy was done as a means of remedying the situation.
Consent.

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In nursing, one crucial thing to remember when dealing with different patients in their
care is that the patients are entitled to have informed consent. Consent in nursing means a patient
is of sound mind to permit their healthcare givers to care for them, starting from being admitted
to the hospital until performing procedures such as surgeries(Matt, 2012). Therefore for a patient
to make an informed decision and give valid consent, they should know the risks, benefits, and
any other thing that can result from making a particular decision about the healthcare procedures
they may undergo. Legally all patients are entitled to this; hence, all professions in the health
sector are bound by law to respect this (González‐de Paz, Kostov, Sisó‐Almirall & Zabalegui‐
Yárnoz, 2012). In this case of the patient Fred, it is clear that his ability to make an informed
consent for treatment has been compromised, and it is observed in his actions that show a
deterioration in his mental capacity. Therefore according to the law, he is not able to decide on
his care. Some of the things that can be done are having an evaluation of his mental health and
also asking for consent from his family on the course of treatment (Hsu, 2011).
Legal Issues.
The nursing profession is governed by a code of conduct and principles which informs
nurses on how they are supposed to behave in the workplace. One law that applies here is
beneficence which is a principle that requires nurses and any other in the medical field to always
do the best to ensure that they promote the well being of those in their care. (Parahoo, 2014). The
legal issue, in this case, is shown whereby the patient has a right to consent to receive treatment,
and he refused to get treatment or cleaned since he saw that he was experimenting; hence, they
did not have his consent.Doctors are tasked with the responsibility of respecting patient’s right to
consent or act in accordance with beneficence (johnstone, 2011). Specific legislation that applies
here is the Australian Charter of Healthcare Rights, which spells out exactly what quality of

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healthcare services that patients in all areas in Australia should expect from the various medical
professions, including nursing (Yoder-Wise, 2014). In this case, RN Fiona did the right thing by
respecting her patient’s wishes and then reporting it to her supervisor at the end of her shift
through the handover notes since the bill of rights expect nurses to respect patient wishes.
Another legal issue that presents itself in this case in regards to the field of medicine is
the principle of of liability. This is used when healthcare providers knowingly harm patients in
the course of the provision of care.The principle guides individuals and teams to know if they
are liable for patients harm(George, 2011). The one principle that applies, in this case, is that of
negligence or, more specifically, gross negligence, which means that the nurse intentionally did
not do her duties of caring for the patients hence caused harm to them as a direct result. If the
case was taken to court they would consider four facts to bring judgment.First, they would
consider if it was the nurse’s duty to care for the patient or if the nurses breached their contract
by not performing the tasks that were expected of them.They would also consider the harm
caused to the patient as a result of inneffectice care. Finally,they would also consider the direct
cause of the damage to the patient(Fouka & Mantzorou, 2011). In this case it can be argued that
if Fred gets an infection as a result of applying dirt on his incision, RN Fiona will be liable since
it happened under her care and she did nothing to clean the wound however she had a dilemma
since the patient did not consent to it (Huston, 2013).
Ethical Issues and Principles.
Nurses face ethical issues and dilemmas daily as they carry out their different
tasks;hence, there are a set of principles that guide them to make the right decision when they do.
In this case, the first principle of autonomy is meant to help nurses respect every patient in their
care. Hence this will help the RN Fiona know that she was right in respecting the wishes of the

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patient, and then she reported the case so that her supervisor can take the next step, which could
include forcefully cleaning Fred so that he does not get an infection. Another principle is
Veracity, which expects nurses always to be truthful about everything they encounter during
their shift caring for patients. RN Fiona practiced this in her ISBAR handover notes, where she
detailed all that happened while caring for Fredwhich, in turn, will help his doctor know what
next to do. The next principle is justice, which calls for nurses to treat all their patients with
fairness and always equitable. Therefore, this means all patients are treated with no preference,
and they get care when they need it. In this case, the care provided was standard and fair
(Anderson, Malone, Shanahan & Manning, 2015).
Another one is confidentiality, which requires hospitals to keep the information provided
by patients private and only use it in regards to treating the patient. In this case, it is vital to keep
Fred’s symptoms confidential.This is particularly due to the fact that his mental capacity seems
to be affected.Nonmaleficence is essential in the nursing profession as it expects nurses to
protect those in their care from things and situations that cause them harm. In this case, this was
not practiced by RN Fiona did not clean Fred, who had soiled and dirtied his risking infection;
thus,she let the patient to get harmed. Finally, the principle of Beneficence where nurses are
expected to do good, and with Fred’s case, the RN was in a dilemma whether to forcefully clean
him hence deal with physical symptoms or respect his wishes (Shaw, Houghton, Casey &
Murphy, 2010). The two principles of autonomy and Nonmaleficenceconflict with this case
study, the first one calls for respecting individual patients while the other one calls for nurses to
do no harm and in this case respecting Fred’s wishes would directly lead to him getting an
infection from the dirt he has smeared in his wound.
Professional Issues.

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Nurses, like other professions, have sets of laws that govern them when practicing, and
these laws can be similar in different countries and at the same time, differ depending on the
country they are exercising.NMBA Standards of Practice is an example of laws governing the
nursing profession. The code is intended to guide nurses to practice safety while fulfilling the
different duties according to their professional specialty (Collinset al., 2013). Also, the code is in
place to ensure that nursing maintains a high level of professionalism, which will lead to patients
respecting and trusting them, thus making experiences in hospitals better for both sides. These
standards, In this case, the code can guide RN Fiona in upholding her decision of not doing
anything for Fred since she was respecting the fact that he did not consent to be cleaned and by
respecting his wishes he stopped harming himself like pulling out the Intravenous cappulla
(Bowrey & Thompson, 2014).
Finally, the RN NMBA Standards of Practice and the NSQHS standards are in place to
guide Registered Nurses in Australia (Boyd & Sheen, 2014). These standards are in place to
ensure that there is a level of professionalism in nursing, thus meaning that patients all across
Australia are equally treated. These standards expect nurses to develop patient treatment plans
for those in their care hence ensuring that they think through the treatment and document all
steps they will take,and therefore it will be easy to ensure that there is accountability. Also, this
standardsexpect that nurses assess their work after shift hence meaning that they will learn from
any mistakes made and future patients will receive better care. In this case, there was a lack of it
since the RN clearly states that she did not know what to do in the situation, which is dangerous
for Fred and any other patient in his care (Ulrich, 2010).It is essential to document and evaluate
every step taken in professions such as nursing as it aids communication with other members of
the medical team to improve efficiency in treatment(Blair & Smith, 2012). (Matt, 2012)

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Conclusion.
In conclusion, nursing is a vital profession in which every human in this world gets
exposed at one point in their lives. This, therefore,shows that it is an essential profession, and
thus they are exposed to several issues while performing their duties. Different countries have set
up different policies and codes which are critical in helping guide nurses deal with these issues
pertaining to their profession to ensure that patients get the care they deserve. Therefore this
shows the need for more studies to be carried out on the subject of professional practice in
nursing.
References

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