Case Study Analysis: Ethical Violations in Nursing Practice (NUR120)

This case study examines ethical breaches in nursing practice through the lens of a scenario involving a nursing student and a registered nurse. The case highlights three key transgressions: a registered nurse's unauthorized use of hospital resources and impaired performance due to being unwell, and a student nurse's breach of patient confidentiality by posting a photo of a wound on social media. The paper identifies violations of nursing standards, codes of ethics, and codes of conduct, specifically focusing on the implications of compromised patient care and breaches of patient privacy. It discusses the nurses' responsibilities to maintain their well-being and uphold patient confidentiality, emphasizing the legal and ethical consequences of these actions. The analysis underscores the importance of professional conduct, responsible use of social media, and adherence to ethical guidelines in nursing practice. The assignment also includes suggestions on what the nurses should have done differently to avoid ethical issues and ensure safe and responsive care.

Running head: INTRODUCTION TO NURSING
Introduction to nursing
Name of the student
Name of the university
Author note

2INTRODUCTION TO NURSING
Nurses are the frontline health professionals who are responsible for best care given to
the client within professional barriers. In order to provide care, nurses are require to use diverse
technologies and evidence based knowledge for avoiding ethical issues(Lachman, Swanson &
Winland-Brown, 2015).As discussed by Westrick (2016), it is the responsibility of nurses to
provide the best possible care to the patient applying nursing core values, without breaching
ethics. The case study represents an ethical issue regarding the use of social media of Dan who
was a registered the nursing student and illegal confiscation of medication of Registered Nurse
Jane. The purpose of the paper is to identify all of the transgressions and associated nursing
standard, code of ethics and code of conduct. This paper will discuss transgressions occurred in
the case study, code of conduct and ethics associated with it and what should the nurse have done
in following paragraphs.
The case study represents two ethical issues which have an impact on the nursing
practice and responsive care to the patient. In the case study, Dan who was a registered nursing
student, placed at my local hospital at smith place where his preceptor for morning shift was
Registered, Nurse Jane. During the morning medication round, Dan observed that the
registered nurse Jane who took paracetamol from the medication room and put it in the pocket
and justified that she needed it for her hangover. The first transgression observed in this case
study was illegal to use of hospital resources of Jane for the personal interest whereas it is the
accountability of nurses to use the hospital resources only for the best interest of patients. Using
hospital resources for personal interest is against the nursing code of conduct, values and nursing
standard (Schmidt & McArthur,2018). Later part of the morning, Jane was unwell and Dan had

3INTRODUCTION TO NURSING
to remind her of each patient and medication discrepancy. The second transgression in this case
study was appearing unwell of Jane and still conducting nursing duties and Dan had to remind of
her patients and medication discrepancies of patients. As discussed by Karimi et al. (2015), in
order to provide the best possible care to the patient, nurses are required to be mentally and
physically fit. In the current context, Dan had to remind her of her patients and medication
discrepancies which affected the practice of registered nurse and safety of patients. After lunch,
RN Jane directed Dan to assists her in complex vacuum dressing of a blind older patient. When
Jane left, Dan chatted with the patient and took a couple of pictures of wound and posted in the
social media. The third transgression occurred in this case study was posting the photo of the
wound on Facebook by Dan with the intention of showing it to his friends. The social network
increasingly become a potential tool for supporting health care processes such as gathering
information and sharing information, communicating with colleagues and other individuals of
the same working field. More than 40% of the health care consumers utilize social media for
their health care information; even health care professionals use social media for their
interactions with their colleagues and hospital (Beltran-Aroca, et al., 2016). However, as
discussed by Sinclair, Papps and Marshall (2016), exploiting social networking site with the
information of patients for personal interest is an ethical issue since the confidentiality and
privacy of the patient was breached in this case. It is an ethical and legal responsibility of the
nurse to maintain the confidentiality of patients in order to provide safe and responsive care.
Disclosing personal information create ethical issues since it questioned the safety of patients.
As discussed above three transgressions was observed in this case study which further
reduces the quality of care and affected nursing practice. In order to discuss the nursing

4INTRODUCTION TO NURSING
standard and ethical practice of nurses, two transgressions such as appear unwell of Jane while
providing care to the patient and posting the picture of the wound of older patient in social media
has been chosen. Considering the first transgression, Registered nurse Jane appeared unwell
due to a big night out and attended patient in order to provide care where student nurse Dan had
to remind her of patients and provided the medication discrepancies. This transgression violated
standard 3 ( maintains the capability for practice) of Nursing and Midwifery Board of Australia
which suggested that a registered nurse should respond in a timely manner to health and
wellbeing of self and others in order to maintain the capability of safe practice
(Nursingmidwiferyboard.gov.au., 2019). The rationale behind this is that as discussed by
Brennan (2017), the significant number of nurses conducts medication error because they neglect
their health which further question patient safety. Taking an insight of the situation, Jane
appeared unwell and still attended the professional practice which breached the standard 3 since
the inability to remember her patient and medication discrepancies might cause medication error
which further question patient safety. This nursing practice violated principle 7.1 (Your and
your colleagues’ health) of nursing code of conduct which states that registered nurses should
seek help and advice if they are ill or impaired to provide safe practice to the patient practice
(Nursingmidwiferyboard.gov.au., 2019). Nurses have the responsibility to maintain their mental
and physical health in order to provide safe practice which was absent in this case study, as Jane
was present in the hospital despite being unwell, highlighting breaching of a code of conduct 7.1
(Azarsa et al., 2015). Considering code of ethics of Nursing and Midwifery Board of Australia,
this practice violated Value Statement 4 (Nurses value access to quality nursing and health care
for all people) which stated that Nurses should value and accept responsibility for self-care
which involves maintaining their wellbeing, physical and psychological and strengths and

5INTRODUCTION TO NURSING
limitation (Nursingworld.org., 2019). This code of ethics was breached in this case study since
Jane continued her practice despite being unwell which limited her capability of providing the
best possible practice.
Considering the second transgression, the register nurse student Dan posted the photo of
the wound of a blind elder patient during his practice for showing the wound to his peers. This
behavior of Dan violated standard 6 of Nursing and Midwifery Board of Australia (provides
comprehensive safe, quality practice) which suggested that a registered nurse should provide
safe, comprehensive quality practice by following the ethical practice
(Nursingmidwiferyboard.gov.au., 2019). In the current context, Dan disclosed the confidentiality
and privacy of the patient by posting it on Facebook and disrespected the dignity and privacy of
the patient. As discussed by McMeekin et al. (2015), nurses should maintain confidentiality and
privacy of patients for patients’ security in order to respect the dignity of patients and disclosing
any information may disrespect the dignity and give rise to an ethical issue, as observed in this
case study. Considering the code of conduct of Nursing and Midwifery Board of Australia, this
gesture of Dan violated 3. 5 principles (Confidentiality and privacy) which stated that nurses
should respect the confidentiality and privacy of patients by seeking informed consent from
patients before disclosing information (Nursingmidwiferyboard.gov.au., 2019). Dan posted the
picture without obtaining informed consent from the patient or family member which further
disrespected the confidentiality of the patient, highlighting breaching of principle 3.5.
Considering the code of ethics, the gesture of Dan violated Value Statement 7 (Nurses value
ethical management of information) which stated that nurses should be able to do ethical

6INTRODUCTION TO NURSING
management of the information in order to respect the privacy and confidentiality of the patient
(Nursingworld.org., 2019). As discussed by Hendersoa and Dahnke (2015), ethical management
of the patient has a positive or negative effect on the care provision of the patient since the
patient may experience judgment, stereotypical behavior from surroundings because of
disclosure of the confidentiality of the patient. Hence, disclosure of the information of patient
breached nursing practice which further has a potential impact on the care provision.
These two transgressions, specifically the behavior of Dan and Jane have strong legal
and ethical implications. Considering the first transgression where Registered nurse Jane
appeared unwell due to a big night out and attended patient in order to provide care where
student nurse Dan had to remind her of patients and provided the medication discrepancies, the
ethical and legal implication of practice is compromising the quality of the care. As discussed by
Karimi et al. (2015), in order to provide safe and responsive care a nurse should take
responsibility for maintaining her physical and mental wellbeing. A significant number of nurses
failed to provide safe and responsive care to the patient because of neglecting their own health.
Nurses generally experience psychological distress such as anxiety, depression or burnout
because of inability rest from the heavy workload (Fong, 2016). Consequently, the negligence of
wellbeing reflects in their behavior and patient care has been compromised. The nurses tend to
commit frequent medication error; documentation error and sometimes assessment error which is
serious ethical and legal issues, breaching the human rights of receiving safe and responsive are
under the legislation of Human right act (2011) (Fida, Laschinger & Leiter, 2018). These errors

7INTRODUCTION TO NURSING
reduce the patient satisfaction and trust of a patient for health care sectors (Gómez‐Urquiza et al.
2017).
Considering the second transgression, the future ethical and legal implication of the
behavior is that the patient may be subjected to the social inclusion, stigmatization by society and
may experience being the victim of cyber-crime. As discussed by Ravichandran and Arulchelvan
(2017), any inappropriate post in the social media or posting personal information of the patient
by nurses causes ethical issues since nurses disrespected the confidentiality and privacy of the
patient. After posting the information, patients may be subjected to the high psychological
distress because of the exposure of the information; patients may experience social inclusion or
stigmatization which further minimizes patient satisfaction (McMeekin et al., 2015).
Considering the first transgression, the student nurse should have suggested her preceptor
registered nurse Jane to take a leave for the day or take care of herself which is crucial to provide
quality care to the patient. As discussed by Bonifas (2015), it is the responsibility of a nurse to
take care of her colleague and ensure the wellbeing of her colleagues. Dan could take her to the
supervisor and asked the supervisor to assist Jane to take leave and to assist him to provide care
to the patient in order to avoid the ethical issues regarding patient safety and ensuring best
possible care. Considering the second transgression, the registered nurse student Dan should
keep the confidentiality and privacy of the student since it is the responsibility of a nurse to keep
the information confidential for avoiding any ethical issue and providing safe practice. Even if he
wanted to show the wound of the patient then he should have asked for permission in the form of
informed consent from the patient or family members of the patient (McMeekin et al., 2015).

8INTRODUCTION TO NURSING
On a concluding note, it can be concluded that nurses are the frontline health
professionals who are responsible for the best care given to the client within professional
barriers. Therefore, it is the responsibility of nurses to provide safe and responsive care. The
case study represents two ethical issues which have an impact on the nursing practice and
responsive care to the patient. Three transgressions have been identified in a case study, out of
which two transgressions has been chosen. Appearing unwell of registered nurse which violated
the 3rd standard of NMBA, 7.1 principles of code of conduct and 4th value statement of code of
ethics where each standard and code suggested that nurses should maintain their wellbeing in
order to provide safe care. The posting picture of a wound by Dan violated the 6th standard of
NMBA, 3.5 principles of code of conduct and 7th value statement of code of ethics where each
standard and code suggested that a nurse should respect dignity by keeping confidentiality of the
patient. These ethical issues can be avoided by proper training and proper ethical practice.

9INTRODUCTION TO NURSING
References:
Azarsa, T., Davoodi, A., Markani, A. K., Gahramanian, A., & Vargaeei, A. (2015). Spiritual
wellbeing, attitude toward spiritual care and its relationship with spiritual care
competence among critical care nurses. Journal of caring sciences, 4(4), 309.
Beltran-Aroca, C. M., Girela-Lopez, E., Collazo-Chao, E., Montero-Pérez-Barquero, M., &
Muñoz-Villanueva, M. C. (2016). Confidentiality breaches in clinical practice: what
happens in hospitals?. BMC medical ethics, 17(1), 52.
Bonifas, R. P. (2015). Resident-to-resident aggression in nursing homes: Social worker
involvement and collaboration with nursing colleagues. Health & Social Work, 40(3),
e101-e109.
Brennan, E. J. (2017). Towards resilience and wellbeing in nurses. British journal of
nursing, 26(1), 43-47.
Fida, R., Laschinger, H. K. S., & Leiter, M. P. (2018). The protective role of self-efficacy
against workplace incivility and burnout in nursing: A time-lagged study. Health care
management review, 43(1), 21-29.
Fong, C. M. (2016). Role overload, social support, and burnout among nursing
educators. Journal of Nursing Education, 29(3), 102-108.
Gómez‐Urquiza, J. L., Vargas, C., De la Fuente, E. I., Fernández‐Castillo, R., & Cañadas‐De la
Fuente, G. A. (2017). Age as a risk factor for burnout syndrome in nursing professionals:
a meta‐analytic study. Research in nursing & health, 40(2), 99-110.

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Henderson, M., & Dahnke, M. D. (2015). The ethical use of social media in nursing
practice. Medsurg Nursing, 24(1), 62.
Karimi, L., Cheng, C., Bartram, T., Leggat, S. G., & Sarkeshik, S. (2015). The effects of
emotional intelligence and stress‐related presenteeism on nurses’ well‐being. Asia Pacific
Journal of Human Resources, 53(3), 296-310.
Lachman, V. D., Swanson, E. O. C., & Winland-Brown, J. (2015). The New'Code of Ethics for
Nurses with Interpretative Statements'(2015): Practical Clinical Application, Part
II. MedSurg Nursing, 24(5), 363.
McMeekin, D. E., Hickman, R. L., Douglas, S. L., & Kelley, C. G. (2017). Stress and coping of
critical care nurses after unsuccessful cardiopulmonary resuscitation. American Journal
of Critical Care, 26(2), 128-135.
Nursingmidwiferyboard.gov.au (2019). Code of conduct for Nurses in Australia. Retrieved from
https:// nursingmidwiferyboard.gov.au.org.au/resources/code-conduct-for-nurses-
australia/
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - Registered
nurse standards for practice. Retrieved from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx
Nursingworld.org. (2019). Code of Ethics for Nurses. Retrieved from
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-
for-nurses/

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Ravichandran, K., & Arulchelvan, S. (2017, February). Structural Equation Model Analyzed on
Cyber Crime and Media Awareness in India. In 2017 Second International Conference
on Recent Trends and Challenges in Computational Models (ICRTCCM) (pp. 141-146).
IEEE.
Schmidt, B. J., & McArthur, E. C. (2018, January). Professional nursing values: A concept
analysis. In Nursing forum (Vol. 53, No. 1, pp. 69-75).
Sinclair, J., Papps, E., & Marshall, B. (2016). Nursing students' experiences of ethical issues in
clinical practice: A New Zealand study. Nurse education in practice, 17, 1-7.
Westrick, S. J. (2016). Nursing students’ use of electronic and social media: Law, ethics, and e-
professionalism. Nursing education perspectives, 37(1), 16-22.
Zheng, R., Lee, S. F., & Bloomer, M. J. (2016). How new graduate nurses experience patient
death: A systematic review and qualitative meta-synthesis. International journal of
nursing studies, 53, 320-330.