Case Study Analysis: Legal and Ethical Concerns in Nursing
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Case Study
AI Summary
This case study analyzes legal and ethical issues in nursing practice, focusing on a 70-year-old patient, Mavis, who underwent a laparotomy and presents with postoperative confusion and altered vital signs. The assignment critically examines the nurse's actions and inactions, highlighting deviations from ethical principles such as beneficence, non-maleficence, and justice, as well as legal standards of practice. The analysis explores potential actions the nurse could have taken, such as more frequent assessments and addressing potential complications, and their implications. It also covers ethical dilemmas related to patient autonomy and the nurse's responsibilities. The case study emphasizes the importance of informed decision-making, adherence to legal and ethical guidelines, and the impact of nurses' actions on patient outcomes, including the implications of medication administration, recognizing complications and the role of supportive ethical theories in nursing practice.
Legal and ethical issues in nursing practice
Introduction
Legal and ethical principles are the formulated theories that aid the nurse in decision making,
judgment and implementing the nursing care professionally. Code of conduct, code of Ethics
and Nursing and midwifery board of Australia’s standards of practice are the Ethical
principles that help the nurse in decision making in nursing practice. Nurses are responsible
to abide by both legal and ethical standards in the nursing practice. Ethical standards help the
nurse to understand the rights of the patient and importance of teamwork for the better
outcome. Aim of the assessment is to Critical analyze the legal and ethical issues in the case
study. Assessment is made to study the possible actions or inactions that could be taken, the
implications of the actions. Ethical principles, doctrines or concepts that are applied or
ignored in the case study are also analyzed for the better understanding and future learning.
The legal and ethical concerns in the case study
Analysis of the legal and ethical issues in the case study helps the nurse to improve the knowledge
and skill for the benefit of the patient. Mavis is an aged retired nurse undergone laparotomy for an
acute bowel obstruction. Her first postoperative day was uneventful and her vital signs were abnormal
during the time of assessment. She was confused, disoriented and anxious. Mavis was aggressively
shouting at the nurse. This incident shows that there is a significant change in the physical and mental
status of the patient (Adhikari, 2016). Following the altered behavior of the patient the nurse wanted
to rule out the reason for the mood change and she was checking the medications. Standard 4 of
standards of practice states that the nurse must conduct assessment that has to holistic. In this case, the
assessment done by the nurse was not holistic. According to the code of ethics the nurse has to ensure
privacy to the patient. In this case scenario, the nurse provided privacy for the patient even though the
patient was mentally unstable. Autonomy and beneficence are the ethical principles implemented in
the case scenario. The nurse was doing good for the patient even though she yells at the nurse. The
nurse was respectful even though Mavis was screaming at her and helped her to clean herself.
Introduction
Legal and ethical principles are the formulated theories that aid the nurse in decision making,
judgment and implementing the nursing care professionally. Code of conduct, code of Ethics
and Nursing and midwifery board of Australia’s standards of practice are the Ethical
principles that help the nurse in decision making in nursing practice. Nurses are responsible
to abide by both legal and ethical standards in the nursing practice. Ethical standards help the
nurse to understand the rights of the patient and importance of teamwork for the better
outcome. Aim of the assessment is to Critical analyze the legal and ethical issues in the case
study. Assessment is made to study the possible actions or inactions that could be taken, the
implications of the actions. Ethical principles, doctrines or concepts that are applied or
ignored in the case study are also analyzed for the better understanding and future learning.
The legal and ethical concerns in the case study
Analysis of the legal and ethical issues in the case study helps the nurse to improve the knowledge
and skill for the benefit of the patient. Mavis is an aged retired nurse undergone laparotomy for an
acute bowel obstruction. Her first postoperative day was uneventful and her vital signs were abnormal
during the time of assessment. She was confused, disoriented and anxious. Mavis was aggressively
shouting at the nurse. This incident shows that there is a significant change in the physical and mental
status of the patient (Adhikari, 2016). Following the altered behavior of the patient the nurse wanted
to rule out the reason for the mood change and she was checking the medications. Standard 4 of
standards of practice states that the nurse must conduct assessment that has to holistic. In this case, the
assessment done by the nurse was not holistic. According to the code of ethics the nurse has to ensure
privacy to the patient. In this case scenario, the nurse provided privacy for the patient even though the
patient was mentally unstable. Autonomy and beneficence are the ethical principles implemented in
the case scenario. The nurse was doing good for the patient even though she yells at the nurse. The
nurse was respectful even though Mavis was screaming at her and helped her to clean herself.
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Standards - 6 of the standards of practice states that the Nurse has to use appropriate processes to
identify and report the potential and actual risk. In this case, the potential and actual risk for Mavis is
postoperative confusion. (Barkhordari-Sharifabad, 2018).Postoperative confusion is common in
aged people after major surgery. The signs and symptoms are confusion, disorientation, and
anxiousness. The nurse was not aware of the potential and actual complications of anaesthesia and
surgery. One of the causes of postoperative dementia in elderly patients is the fluid imbalance. In this
case study Mavis was on IV fluids but she did not void for nine hours. The nurse was incapable to
correlate the causes and the patient condition. Conduct statement- 1 of the Code of Professional
Conduct for Nurses (2015) states that the nurse has to ensure safety for the patient. In this
case study, the nurse failed to rule out the potential complications which made the patient pull
out the IV cannula and she stepped out the bed. Conduct statement -7 (2015) states that the
nurse has to do informed decisions making for the person receiving the nursing care. In this
case the nurse failed to do informed decision making instead she was searching for the drug
that has possibility to change the mood of the patient and reporting the incident to the shift
coordinator.
Possible actions or inactions that could be taken
The case scenario, clearly states that it was first day post-op for the patient and her recovery so far has
been uneventful (Gallagher, 2017). So, the nurse could have done every half an hour assessment on
vital signs and the mental status examination to prevent postoperative delirium. One of the
complications of general anaesthesia is urinary retention, the nurse could have informed about urinary
retention within an hour or two of finding urinary retention (Lee, 2017). The patient is febrile and
her heart rate is elevated which is the typical symptom of post-operative infection. Post-operative
infection in the first post-operative day reflects that the nurse did not implement the universal
precautions and proper hand washing to prevent the same. The nurse could have used proper hand
washing technique and universal precautions to prevent the post-operative infection.
identify and report the potential and actual risk. In this case, the potential and actual risk for Mavis is
postoperative confusion. (Barkhordari-Sharifabad, 2018).Postoperative confusion is common in
aged people after major surgery. The signs and symptoms are confusion, disorientation, and
anxiousness. The nurse was not aware of the potential and actual complications of anaesthesia and
surgery. One of the causes of postoperative dementia in elderly patients is the fluid imbalance. In this
case study Mavis was on IV fluids but she did not void for nine hours. The nurse was incapable to
correlate the causes and the patient condition. Conduct statement- 1 of the Code of Professional
Conduct for Nurses (2015) states that the nurse has to ensure safety for the patient. In this
case study, the nurse failed to rule out the potential complications which made the patient pull
out the IV cannula and she stepped out the bed. Conduct statement -7 (2015) states that the
nurse has to do informed decisions making for the person receiving the nursing care. In this
case the nurse failed to do informed decision making instead she was searching for the drug
that has possibility to change the mood of the patient and reporting the incident to the shift
coordinator.
Possible actions or inactions that could be taken
The case scenario, clearly states that it was first day post-op for the patient and her recovery so far has
been uneventful (Gallagher, 2017). So, the nurse could have done every half an hour assessment on
vital signs and the mental status examination to prevent postoperative delirium. One of the
complications of general anaesthesia is urinary retention, the nurse could have informed about urinary
retention within an hour or two of finding urinary retention (Lee, 2017). The patient is febrile and
her heart rate is elevated which is the typical symptom of post-operative infection. Post-operative
infection in the first post-operative day reflects that the nurse did not implement the universal
precautions and proper hand washing to prevent the same. The nurse could have used proper hand
washing technique and universal precautions to prevent the post-operative infection.
The nurse was assessing the medications only after the patient developing altered behavior. The nurse
could have assessed the medication during the time of taking over and could have learned the side
effects of the prescribed medications. The nurse left the patient alone in a state of confusion,
disorientation, and decreased blood pressure (Haddad, 2019). The nurse could have get help from
her colleague, to be with the patient when she leaves the patient for reporting. If the colleagues are
busy, then the nurse could have asked the assistant of the patient to be with patient or else she could
have raised the side rails of the bed, before leaving the patient. These proposed actions would have
controlled the behavior of the patient.
The implications of the actions
The nurse is accountable for all the actions performed by her. She needs to implement all the
nursing intervention with the rationale which is safe and productive. In the case of Mavis,
there are actions that lack rationale. The Nurse failed to do assessment frequently in the time
duration of every half an hour (Chironda, 2016). The implication of the action is the nurse
was unable to find the physical and mental change promptly. The nurse failed to do the
assessment on the medications of Mavis during the time of takeover, so, she was reviewing
the patient’s medication when there is need for action. The nurse lacks knowledge about the
physical and psychological complications of anaesthesia and surgery.
Urinary retention and altered mental status is the common complication of the anaesthesia.
Altered vital signs show that the patient had a post-operative infection. Lack of knowledge
results in lack of action which may lead to severe complication. The nurse was incapable to
link the cause and clinical manifestations and unable to plan and implement the nursing
interventions. The Nurse was doing an assessment and reporting the condition of the patient
but she did not implement any nursing interventions to manage the situation. The nurse was
unaware of the potential complications of her actions (Chironda, 2016). So she did not raise
could have assessed the medication during the time of taking over and could have learned the side
effects of the prescribed medications. The nurse left the patient alone in a state of confusion,
disorientation, and decreased blood pressure (Haddad, 2019). The nurse could have get help from
her colleague, to be with the patient when she leaves the patient for reporting. If the colleagues are
busy, then the nurse could have asked the assistant of the patient to be with patient or else she could
have raised the side rails of the bed, before leaving the patient. These proposed actions would have
controlled the behavior of the patient.
The implications of the actions
The nurse is accountable for all the actions performed by her. She needs to implement all the
nursing intervention with the rationale which is safe and productive. In the case of Mavis,
there are actions that lack rationale. The Nurse failed to do assessment frequently in the time
duration of every half an hour (Chironda, 2016). The implication of the action is the nurse
was unable to find the physical and mental change promptly. The nurse failed to do the
assessment on the medications of Mavis during the time of takeover, so, she was reviewing
the patient’s medication when there is need for action. The nurse lacks knowledge about the
physical and psychological complications of anaesthesia and surgery.
Urinary retention and altered mental status is the common complication of the anaesthesia.
Altered vital signs show that the patient had a post-operative infection. Lack of knowledge
results in lack of action which may lead to severe complication. The nurse was incapable to
link the cause and clinical manifestations and unable to plan and implement the nursing
interventions. The Nurse was doing an assessment and reporting the condition of the patient
but she did not implement any nursing interventions to manage the situation. The nurse was
unaware of the potential complications of her actions (Chironda, 2016). So she did not raise
the side rails before leaving the bedside for reporting. Implementing every single action with
the rationale prevents the complications and promotes the health of the patients.
Supportive Ethical theories for the actions
Beneficence is one of the ethical principles which states that the nurse must do only
good for her patient in all situations. The nurse caring for Mavis missed some of the
necessary actions. The reason may be the hectic condition of the unit. But the patient
has right to receive safe and quality nursing care (Zirak, 2015). The nurse should have
ensured prompt care even in her busy schedule. Non-Maleficence is one of the well
known Ethical principles of nursing. It states that the nurse should not do harm to the
patient. The harm specified in the Ethical principles is direct and indirect harm. In this
case scenario, the nurse neglected some of the nursing interventions and she also
performed some actions without rationale.
For Example, The nurse failed to put the side rails before leaving the patient, the
patient got down the bed, she removed the IV cannula, removed her dress and she was
smearing the feces over the surgical wound which causes harm to the patient. The
ethical principle of justice states that the nurse has to show fairness to all the patients
equally. In the case scenario, the nurse was showing fairness only after the patient got down
from the bed and was performing actions that can significantly affect the recovery (Manda-
Taylor, 2017). The nurse was knowledgeable and skilfull enough to prevent potential
complications. She did not implement the nursing interventions to stabilize the vital signs,
manage the urinary retention and potential complications of anaesthesia and surgery.
Variance in ethical principles
the rationale prevents the complications and promotes the health of the patients.
Supportive Ethical theories for the actions
Beneficence is one of the ethical principles which states that the nurse must do only
good for her patient in all situations. The nurse caring for Mavis missed some of the
necessary actions. The reason may be the hectic condition of the unit. But the patient
has right to receive safe and quality nursing care (Zirak, 2015). The nurse should have
ensured prompt care even in her busy schedule. Non-Maleficence is one of the well
known Ethical principles of nursing. It states that the nurse should not do harm to the
patient. The harm specified in the Ethical principles is direct and indirect harm. In this
case scenario, the nurse neglected some of the nursing interventions and she also
performed some actions without rationale.
For Example, The nurse failed to put the side rails before leaving the patient, the
patient got down the bed, she removed the IV cannula, removed her dress and she was
smearing the feces over the surgical wound which causes harm to the patient. The
ethical principle of justice states that the nurse has to show fairness to all the patients
equally. In the case scenario, the nurse was showing fairness only after the patient got down
from the bed and was performing actions that can significantly affect the recovery (Manda-
Taylor, 2017). The nurse was knowledgeable and skilfull enough to prevent potential
complications. She did not implement the nursing interventions to stabilize the vital signs,
manage the urinary retention and potential complications of anaesthesia and surgery.
Variance in ethical principles
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Ethical dilemmas are common in nursing practice. The nurses are responsible to implement
decision-making strategies in the situations of ethical dilemmas. In this case scenario, the
patient was repeatedly saying that she wanted to go home (Balan, 2016). But the nurse was in
the state of the dilemma of fulfilling the desire of the patient or to tell her that she is not going
home. In the state of confusion, patient removed her clothing and she was smearing her
faeces over the surgical wound. The patient refused assistance and she also refuses the wash.
She was yelling at the nurse and asked the nurse to leave her (Ramos, 2015).
Ethical dilemmas in this situation are, Autonomy- the patient has rights to choose her
treatment and the nurse has to respect the opinions of the patient. But in the case of Mavis,
the nurse should not do as per the desire of the patient since it may affect the patient’s health
and safety. Justice is one of the Ethical principles that states that the nurse should ensure
equal nursing care for the patients and the hospital resources has to use equally for all the
patients. In the case scenario, the ward was busy and the nurse has to prioritize the nursing
according to the need of each patient (Ramos, 2015).Equal distribution of nursing care can
significantly affect the patient’s health who are in need of more attention. The nurse has to
handle Ethical dilemmas wisely. The nurse has to use effective decision-making strategies to
ensure safe and quality nursing care for the patients.
Legal concerns for suggested actions
The nurses are liable for all the actions performed in the nursing practice. The nurse must
abide by the law and Ethical principles while caring for the patients. Legal concerns for the
suggested actions help the nurse to understand the importance of rationalized nursing care
and evidence-based nursing care. The primary responsibility of the nurse is to the prevention
of complications and the promotion of health (Wagner, 2015).The continuous assessment
decision-making strategies in the situations of ethical dilemmas. In this case scenario, the
patient was repeatedly saying that she wanted to go home (Balan, 2016). But the nurse was in
the state of the dilemma of fulfilling the desire of the patient or to tell her that she is not going
home. In the state of confusion, patient removed her clothing and she was smearing her
faeces over the surgical wound. The patient refused assistance and she also refuses the wash.
She was yelling at the nurse and asked the nurse to leave her (Ramos, 2015).
Ethical dilemmas in this situation are, Autonomy- the patient has rights to choose her
treatment and the nurse has to respect the opinions of the patient. But in the case of Mavis,
the nurse should not do as per the desire of the patient since it may affect the patient’s health
and safety. Justice is one of the Ethical principles that states that the nurse should ensure
equal nursing care for the patients and the hospital resources has to use equally for all the
patients. In the case scenario, the ward was busy and the nurse has to prioritize the nursing
according to the need of each patient (Ramos, 2015).Equal distribution of nursing care can
significantly affect the patient’s health who are in need of more attention. The nurse has to
handle Ethical dilemmas wisely. The nurse has to use effective decision-making strategies to
ensure safe and quality nursing care for the patients.
Legal concerns for suggested actions
The nurses are liable for all the actions performed in the nursing practice. The nurse must
abide by the law and Ethical principles while caring for the patients. Legal concerns for the
suggested actions help the nurse to understand the importance of rationalized nursing care
and evidence-based nursing care. The primary responsibility of the nurse is to the prevention
of complications and the promotion of health (Wagner, 2015).The continuous assessment
helps the nurse to prevent complications. Prevention of complication reduces the duration of
hospitalization. In the case scenario, the nurse was not aware of the medications of her patient
and the related adverse reactions of the patient. The legal concern in medication
administration states that the nurse has to be aware of the action, adverse reactions, and
precautionary actions for the medication administered to her patients.
The nurse has been knowledgeable and skill full to meet the health needs of the patient. In the
case scenario, the nurse was not aware of the complications of the general anaesthesia for the
elderly patient. So, she was unable to identify the clinical manifestations of the potential
complications of general anaesthesia and surgery (Pesut, 2019).Elevated vital signs show that
the patient had infection. The nurse was incompetent to rule out the cause and clinical
manifestations. The nurse has to ensure safety to the patient which is the very important legal
concern in the nursing practice. The nurse has to raise side rails to ensure safety for the
patient.
Conclusion
Analysis of the legal and ethical principles in the case scenario helps the nurse to understand
the importance of implementing nursing care abiding the law and ethics. Legal and ethical
concerns in the case study show that the nurse failed to implement Ethical principles in some
areas of nursing care. Possible actions suggested in the case improve the understanding of the
nurses. Supportive ethical principles prove that the nurse has to implement all the nursing
actions with rationale. Discussion on the Ethical dilemma helps the nurse to understand the
importance of effective decision making in the situation of ethical dilemmas. Legal concern
for suggested actions emphasis that the patient has the right to receive the safe and quality
hospitalization. In the case scenario, the nurse was not aware of the medications of her patient
and the related adverse reactions of the patient. The legal concern in medication
administration states that the nurse has to be aware of the action, adverse reactions, and
precautionary actions for the medication administered to her patients.
The nurse has been knowledgeable and skill full to meet the health needs of the patient. In the
case scenario, the nurse was not aware of the complications of the general anaesthesia for the
elderly patient. So, she was unable to identify the clinical manifestations of the potential
complications of general anaesthesia and surgery (Pesut, 2019).Elevated vital signs show that
the patient had infection. The nurse was incompetent to rule out the cause and clinical
manifestations. The nurse has to ensure safety to the patient which is the very important legal
concern in the nursing practice. The nurse has to raise side rails to ensure safety for the
patient.
Conclusion
Analysis of the legal and ethical principles in the case scenario helps the nurse to understand
the importance of implementing nursing care abiding the law and ethics. Legal and ethical
concerns in the case study show that the nurse failed to implement Ethical principles in some
areas of nursing care. Possible actions suggested in the case improve the understanding of the
nurses. Supportive ethical principles prove that the nurse has to implement all the nursing
actions with rationale. Discussion on the Ethical dilemma helps the nurse to understand the
importance of effective decision making in the situation of ethical dilemmas. Legal concern
for suggested actions emphasis that the patient has the right to receive the safe and quality
nursing care. It also underlines that the nurse is also liable to carry out nursing care to
promote health and prevent complications.
promote health and prevent complications.
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References
Adhikari, S., Paudel, K., Aro, A. R., Adhikari, T. B., Adhikari, B., & Mishra, S. R. (2016).
Knowledge, attitude and practice of healthcare ethics among resident doctors and
ward nurses from a resource poor setting, Nepal. BMC medical ethics, 17(1), 68
Retrieved from https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-
016-0154-9
Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2018). Ethical
competency of nurse leaders: a qualitative study. Nursing ethics, 25(1), 20-36
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Balan, G. G., Trifan, A., Savin, C., Balan, A., & Gologan, E. (2016). Beneficence and
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Nursing Ethics (pp. 55-68). Springer, Cham Retrieved from
https://link.springer.com/chapter/10.1007/978-3-319-49250-6_5
Adhikari, S., Paudel, K., Aro, A. R., Adhikari, T. B., Adhikari, B., & Mishra, S. R. (2016).
Knowledge, attitude and practice of healthcare ethics among resident doctors and
ward nurses from a resource poor setting, Nepal. BMC medical ethics, 17(1), 68
Retrieved from https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-
016-0154-9
Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2018). Ethical
competency of nurse leaders: a qualitative study. Nursing ethics, 25(1), 20-36
Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0969733016652125
Balan, G. G., Trifan, A., Savin, C., Balan, A., & Gologan, E. (2016). Beneficence and
Behavior Control: Ethical Dilemmas in Gastroenterology. Revista de Cercetare si
Interventie Sociala, 55 Retrieved from https://www.ceeol.com/search/article-detail?
id=520696
Chironda, G., & Bhengu, B. (2016). Ethical, legal and cultural implications in the
management of chronic kidney disease (CKD) patients: A critical review of
literature. Transactions of the Royal Society of South Africa, 71(2), 137-143 Retrieved
from https://www.tandfonline.com/doi/abs/10.1080/0035919X.2016.1146928?
journalCode=ttrs20
Gallagher, A. (2017). Care ethics and nursing practice. In Key Concepts and Issues in
Nursing Ethics (pp. 55-68). Springer, Cham Retrieved from
https://link.springer.com/chapter/10.1007/978-3-319-49250-6_5
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Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526054/
Lee, K. S., Koo, K. C., & Chung, B. H. (2017). Risk and Management of Postoperative
Urinary Retention Following Spinal Surgery. International neurourology
journal, 21(4), 320–328. doi:10.5213/inj.1734994.497 Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756820/
Manda-Taylor, L., Mndolo, S., & Baker, T. (2017). Critical care in Malawi: The ethics of
beneficence and justice. Malawi Medical Journal, 29(3), 268-271 Retrieved from
https://www.ajol.info/index.php/mmj/article/viewFile/163204/152692
Nursing and Midwifery Board of Australia. (2015) ‘Supervision guidelines for nursing and
midwifery. Retrieved 25 September 2015’, Retrieved from
www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/reentry-to-
practice.aspx
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., ... & Janke, R.
(2019). Nursing and euthanasia: A narrative review of the nursing ethics
literature. Nursing ethics, 0969733019845127 Retrieved from
https://journals.sagepub.com/doi/full/10.1177/0969733019845127
Ramos, F. R. S., Brehmer, L. C. D. F., Vargas, M. A., Trombetta, A. P., Silveira, L. R., &
Drago, L. (2015). Ethical conflicts and the process of reflection in undergraduate
nursing students in Brazil. Nursing ethics, 22(4), 428-439 Retrieved from
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Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: applying
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from https://www.jenonline.org/article/S0099-1767(14)00517-0/abstract
Zirak, M., Hasankhani, H., & Parizad, N. (2015). The ethical reasoning ability of nurses and
nursing students: a literature review. Iranian Journal of Medical Ethics and History of
Medicine, 7(6), 15-28 Retrieved from http://ijme.tums.ac.ir/browse.php?
a_id=5498&sid=1&slc_lang=en
https://journals.sagepub.com/doi/abs/10.1177/0969733014538890
Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: applying
utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300-306 Retrieved
from https://www.jenonline.org/article/S0099-1767(14)00517-0/abstract
Zirak, M., Hasankhani, H., & Parizad, N. (2015). The ethical reasoning ability of nurses and
nursing students: a literature review. Iranian Journal of Medical Ethics and History of
Medicine, 7(6), 15-28 Retrieved from http://ijme.tums.ac.ir/browse.php?
a_id=5498&sid=1&slc_lang=en
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