Nursing Ethics Case Study: Ethical Dilemmas in Nursing Practice

This case study examines the ethical dilemmas faced by nurses in an inner-city hospital, focusing on a 21-year-old patient named Sam with a history of drug-related psychosis who is experiencing acute abdominal pain and exhibiting agitated and self-harming behavior. The study explores the conflict between utilitarian and deontological approaches to patient care, particularly concerning the use of restraints. It analyzes various ethical principles, including autonomy, beneficence, non-maleficence, and justice, and discusses the relevance of professional codes of conduct, human dignity, and patient rights in the context of Sam's case. The analysis considers perspectives from different ethical frameworks such as utilitarianism, deontology, libertarianism, natural law, virtue theory, egalitarianism, and feminism, highlighting the complexities of balancing patient safety, autonomy, and the ethical responsibilities of healthcare professionals. The study also addresses the tension between the nurse's duty to care and the patient's right to self-determination, providing insights into the ethical considerations of managing patients with mental health issues in a hospital setting.

Running head: NURSING ETHICS
Nursing Ethics – Case Study
Name of the Student
Name of the University
Author Note

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The case study here focuses on a patient named Sam. Sam is 21 years old and is
admitted in hospital with acute abdominal pain however, he has past reported history drug-
related psychosis. Agitated and self-harming behaviour Sam have compelled the medical
team of the inner-city hospital to put him under restrain. However, as per Sam’s attending
nurse, Camilla thinks that such approach will only exacerbate Sam’s agitation resulting in
further self-harm. The following essay throws light on the ethical issues and nursing conflict
pertaining to this case. The essay also tries to highlight professional code of conduct of nurses
and human dignity rights in relation to this particular case.
Identification of ethical issues
Utilitarian approach: According to this approach, the decision is made on the basis
of the greatest amount of benefits to the greater number of individuals. It is also popularly
known as consequentialist approach and the outcome is associated with the morality of the
intervention. Here the approach is, harm of one individual is acceptable for the benefit of the
mass (Hsieh &Kramer, 2012).
Deontology: According to deontology, the action is undertaken only after
ascertaining the benefit of that particular individual for which the action has been framed.
This concept was first framed via a philosopher named name Immanuel Kant and hence it is
also popularly known as Kantian deontology (Gray& Schein, 2012).
Libertarianism: Libertarianism means liberty for all. It promotes personal liberty,
political liberty, personal freedom and vouch for autonomy. It also provides immense
emphasis of freedom of speech, judgement, decision making and self-ownership. As per the
concept of Rawl’s principle of justice, every individual must have equal share of rights in the
society (Woods, 2011).

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Natural Law: The legal theory recognizes law and morality as deeply connected
entity. Morality is regarded as a parameter of judging between what is right or wrong or good
and bad. According to the natural law theorists, the laws of the human beings are defined by
morality. Authority (as imposed by government) and no connection with the law of the
human begin. The term “natural law” is extracted from a basic thought. The thought is,
morality of human comes from the Mother Nature. The purpose of human is to sustain a
happy and healthy life therefore, the acts which are against that purpose are considered to be
unnatural or immoral (d'Entreves, 2017).
Virtue Theory: It is an approach in the ethics that give importance on individual’s
character as one of the critical element behind ethical thinking. This element stays ahead of
the deontology and consequentialism. The three main virtues of ethics are eudaimonism
(classical formulation of Virtue Ethics), agent based theories and ethics of care (Smith, 2011).
Egalitarianism: It is popularly known as equalitarianism. It promotes equality among
the human beings, irrespective of race, gender, financial background and age. Egalitarianism
is given immense importance in nursing care as it preaches equality and well-being for all.
However, few critiques criticize this concept because this model of ethics fail to address the
willingness to pay importance towards efficiency (Buchanan, 2010).
Feminism: the ethics of feminism is based on the respect towards the female
fraternity of the society. It is an initiative to rethink, revise and reformulate the grounds of
ethics to higher extent. This will help the female members of the society to be morally strong
and to lead equal share of happiness among the opposite gender that is men. This approach
questions the traditional laws and norms of the society that is directed towards the male
members. The feminist ethicists provides immense emphasize on the legal, political,

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ideological and economic grounds of women with respect to their gender status in the society
(Mahon & Robinson, 2011).
Analysis of ethical issues and conflicts
The concept of ethics is associated with the moral dilemmas which generates out of
the conflicts of obligation and other faced consequences. In this particular case study, the
major moral dilemmas which clash with the ethics in nursing are the concept of utilitarianism
and deontology. Here the statement made by Julia is concerned more about the concept of
utilitarianism. Such approach may harm a particular individual but the overall beneficial
outcome of such approach can surplus the negative effects. Here, if Sam is set free, he may
harm the other nurses or patients present in ward thus reducing the chances of maximum
benefit. However, deontology claims that harm is acceptable irrespective of the consequence.
On the other hand, Camilla’s is inclined more towards the theory of deontology. She is
concerned about the patient, Sam and is expected negative outcome as a result of
restrain.Again as per the virtue theory, the character of an individual must be taken into
consideration while providing a critical judge. Julia is type-casting Sam as per his behaviour
and with his previous medical condition, drug-related psychosis. She is not at all considerate
his wellbeing. She is not at all concerned about the negative outcome of the restraining order
on Sam. However, Camilla is concerned about Sam as she is a believer of the egalitarianism
theory. This concept preaches equality among all human irrespective of race, religion, age,
gender and social status. Camilla is also concerned about the safety of the other fellow
patients in the same ward and the health care professionals like the nurses and the doctors.
Here Sam is abusing Camilla and hence the ethical concept of feminism is coming at stake.
But before considering the ethical concept of feminism, Camilla is thinking more about the
concept of egalitarianism and libertarianism. Passing down the restraining orders over Sam
will violate the ethics of egalitarianism and libertarianism and it will prevent Sam from taking

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independent approach. It will also hamper his liberty of independent decision maing, indepent
movement (Kontio et al., 2010).
Discussion of professional codes
According to the codes of professional ethics for nurses in Australia, patients are required to
given equal care for the benefit of the health and well-being. These codes of ethics have been
framed in order to maintain a proper balance in the nursing and healthcare profession.
According to the professional code of conduct, nurses need to preach health care in a
culturally competent manner; this manner needs to be safe for all patients and must be kept in
accordance with the Australian standards of the nursing. Nurses are also instructed to practise
in accordance with the present laws in the field of nursing along with other rules, which are
related with the nursing practise in the healthcare profession. The nursing professional code
of conduct also states that the nurses are there to respect the ethnicity, dignity and cultural
values of the patients who are under their care and they must also give respect to their way of
thinking and thoughts. Another important aspect of nursing is to maintenance of
confidentiality. Here the nurses are strictly restricted from disclosing patients’ personal
information including names, address and other medical information to others. Here others
mean other health care professionals or anonymous people. They can only share the
information when instructed to do so by the patients and when patient is unable to give the
consent then authority of giving permission goes on the patients’ family members. Moreover,
during the coruse of disease prognosis and treatment process, that is while the patient stays in
the hospital, nurses are required to remain honest towards the patients. They are required to
provide the patient up to date information about their disease prognosis, the kind of treatment
they are receiving and the future plans of the treatment. The importance of this theory lies in
the fact that it helps in the development of confidence and trusting relationship among the
nurse and the patient(Nursing and Midwifery Board of Australia, 2017).

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Discussion of human dignity/ rights
The profession of nursing rightly recognises human rights as universal rights of the
people. It is the moral responsibility people to protect the inherent dignity along with equal
worth to every other member. The concept of human rights in the profession of nursing
encompasses proper respect, recognition and protection of the economic, civil, cultural,
political and social rights. This protection of all the basic rights is equally applicable to all the
individuals who are admitted in a hospital for treatment. The nursing profession
acknowledges that there exist a strong relationship among the human rights/dignity and the
health of the human being. Any negligence in the human rights hampers the mental peace of
the person, this hamper of mental peace hampers the metal well-being and this gets reflected
in the physical well-being of the patient. Thus in other words it can be stated that there exist a
strong relation with physical well-being and human right and thus human rights need to
maintained in order to promote speedy recovery. Here the human rights of Sam is being
hampered as he has been put under the orders of restraining. This act to restraining will arrest
is right of liberty of speech of independent decision making and freedom of movement. This
restriction will harm the mental well-being of Sam, as mentioned by Camilla and causing a
negative outcome on his overall health. However, since Sam is using abusing words and
performing threatening activity inside the hospital word like removing his IV Canulla, he is
threatening the human rights of the other fellow patients who are under the same ward and
hence preservation of the human rights of quality care of the other patients, the restraining
orders of Sam is justified. But the statement made my Julia at the end of the case study is not
at all acceptable in the basis of the human rights because Sam being a human deserves quality
care irrespective of his behaviour as it is an outcome of his diseased condition and not
intentional (Nursing and Midwifery Board of Australia, 2017).
Discussion of ethical principles

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The ethical principle of autonomy preaches freedom for every individual. So the
restraining order in the case study of Sam is against the principle of autonomy. The principle
of autonomy is based on two concepts, one is the act of liberty that is the right of self-
determination and another one is the act of agency that is the freedom to make own decision.
In this case, Sam is not prevented from taking his own decision like decision of movement or
speech via the orders of restraining. The act of restrain over the patient is incompatible with
the principle of autonomy. The act of beneficence confers moral obligation upon the
caregivers in order to act for the benefit of the concerned patient. So in order to act with
beneficence, the healthcare professionals should only react when the benefits endanger the
associated coast and risks, which are related to the procedure or nature of action. In case of
Sam, the safety of the other patients and nursing staffs are compromised and here comes the
justification for the orders of restraining. However, the act of beneficence should always be
constrained by the act of autonomy in order to prevent the human rights of the patients who
are subjugated to the concerned medical needs. The act of non-maleficence promotes no
harm to the patient. Here no harm means no physical restrain to as restraining is also
associated with certain degree of physical threat. So under the act of non-maleficence,
physical restraining is treated as unethical. However, non-maleficence also promotes
prevention of harm to the other people also. Here restraining orders have been passed to
prevent harm to the other patients as well as the other healthcare professionals. So the here
the orders of restrain towards a drug addicted boy is ethical and justified as his act his
threatening the security of others. According to the case study report, Sam is pulling out his
IV cannula so restraining also prevents the chances of self-harm. The concept of justice is
complex conundrum when the patients are forcefully detained against their will, especially
when they are detained in order to prevent the risks to others (Mohr, 2010; Nursing and
Midwifery Board of Australia, 2017).

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Proposals for professional practice
The first recommendation which I would like to suggest is proper research to generate
safe alternatives to restraints so that it does not harm patient’s dignity. Moreover, I think that
there is an urgent requirement for the development of the personalised, trauma-informed
interventions. It would serve as an immediate alternative for the current authoritarian medical
practise prevalent in the health care sectors. Another recommendation which I would like to
make is the threats of restraint must be elaborately discussed in the scientific literature of
nursing so that the nurses might evaluate the consequences of restrain before passing down
the orders. Here Sam has been ordered to put under restrain on the basis of one sided
approach that is prevention of threats towards the other patients and nurses, which is justified
from this angle. However, since Sam is a separate individual altogether, his has equal share of
rights to expressing his thoughts and deserves equal care for speedy recovery and thus the act
of restraining is going against Sam from this point of view. (Mohr, 2010).
Thus from above discussion it can be concluded that, the act of non-maleficence,
beneficence comes at stake when the orders of restraining is passed against nay particular
patients. However, it can also be claimed that the benefits of the patients must ge given
priority before passing down any orders. As per the human rights of the nursing profession
every patients deserve equal share of care and hence act the statement of Julia is going
against it. However restrain is supported by the law of deontology but can negatively impact
patient resulting in a conflict between libertarianism and egalitarianism.

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