Legal and Ethical Parameters in Nursing Practice - HLT54115 Case Study

This case study focuses on Mr. Joseph Weber, a 58-year-old patient with stage IV mesothelioma admitted for palliative care. The assignment requires an analysis of three key ethical issues: the use of restraints, pressure ulcers, and medication administration concerns. It involves discussing how to ensure ethical interactions with the client and family, including planning and implementing nursing interventions while adhering to legal and regulatory guidelines. The student must identify and relate consumer rights to the ethical issues, outline ethical principles, and demonstrate an understanding of current legislation. The case study emphasizes the importance of informed decision-making, addressing the conflict within the family regarding end-of-life care and medication, and the need for nurses to provide compassionate and legally compliant care. The student must provide evidence of in-depth research and competent application of ethical and legal concepts in nursing practice.

HLT54115 Diploma of Nursing
HLTENN008 - Apply legal and ethical parameters to nursing practice
Written Assessment Student Copy
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Instructions to Students
Welcome to the written assessment. To successfully complete the assessment
requirements, you need to follow the following instructions.
Step 1
Read the study guide and the related resources.
Step 2
Read this assessment to gain an understanding of what you need to do to complete the unit.
Talk to your trainer or supervisor and ask for help if you need to.
Step 3
Complete all questions in this assessment. Please write clearly in pen (not pencil). You
may attach printed answers if you prefer. Do not remove any pages from this assessment.
Step 4
Complete the cover sheet and attach to this assessment. We recommend you make and
keep a copy of your assessments.
Step 5
Submit for assessment.
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CASE STUDY:
Mr Joseph Weber is a 58 year-old gentleman who migrated from Luxembourg to Australia 25
years ago. He recently retired from his job after being diagnosed with Stage IV
mesothelioma that has spread to his hips, spinal column and brain. He has been admitted to
the health facility where you work. Mr Weber lives with Hepatitis B, he is at the end stages
of cancer. He has been admitted for palliative care, to be kept comfortable with medication
and nursing care. Mr Weber is non-verbal in his communication and occasionally swings out
during routine nursing interventions. He has hit nursing staff in the past. Some of your
nursing colleagues have suggested his hands be restrained to prevent him from hitting the
staff.
Mr Weber is physically frail, has muscle wasting and bony prominences. The skin over his
hip and scapula region became reddened and then began to break down from the pressure
of his body against the linen and mattress.
Mr Weber care plan directs staff to turn Mr Weber every 2 hours. However, because he
cries out from so much pain, nursing staff are wondering if they are really helping him with
routine nursing interventions. Mr Webber’s sister complains to you about her brothers care
and believes that the palliative care unit is not delivering care that meets his needs after he
was given an overdose of medications.
Mr Weber’s has been ordered opioid medication. The doctor discusses the end of life care
with subcutaneous morphine medication with the family. Mr Weber’s large extended family
are divided on what to do about the doctor’s advice. They tell you that they are worried that
the medication hasten his death but they do not want their father to be uncomfortable and in
pain.
Mr Weber’s son, Zac and daughter, Joanne share enduring power of Attorney of health and
financial matters. Mr Weber has refused all treatment and has a current “not for
resuscitation” order.
Presentation of the Case study
Type your assignment and use 1 ½ line spacing
Submit a minimum 1500 words, Maximum 2000 words.
Ensure that when you answer the case study task instructions that you have meet each task
element in the benchmark for satisfactory performance. This is also known as your Marking
Guide which follows the case study.
Task Instruction:
The following website may assist with this question
http://www.cancer.org.au/about-cancer/types-of-cancer/bladder-cancer.html
http://www.cancervic.org.au/about-cancer/cancer_types/bladder_cancer/diagnosing-
bladder-cancer.html
http://www.justinvass.com.au/bladder-cancer.html
Identify and describe a minimum of three key ethical issues within the case study.
Discuss how you will ensure that all your interactions with the client/family reflect ethical
concepts briefly explain Nursing ethics.
How would you plan and implement two nursing interventions for each key ethical issue.
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Within the strategies, ensure that you demonstrate that you are abiding within legal and
regulatory guidelines for EN (Div 2) practice.
Demonstrate that you understand the implications of current legislation and how they are
incorporated into your nursing interventions.
To ensure the clients rights, interests and decisions are supported, identify and relate
consumer rights and responsibilities to the three ethical issues identified.
To encourage the client’s rights to make an informed decision regarding their care, outline
the major ethical principles and relate them to the three key issues in the case study.
CONTENT -
BENCHMARK FOR
SATISFACTORY
PERFORMANCE
Competent
Very clear structure
and purpose.
Addresses all legal
aspects of care
within the scope of
an enrolled nurse.
Thoughts and ideas
clearly expressed.
Evidence of in
depth research.
Assessor Comments
Answer:
Facts of the Case
Mr. Joseph Weber, aged 58 years, shifted to Australia after being detected with Stage IV of
Mesothelioma. This disease had migrated to his hips, spinal cord and brain. He also had
hepatitis B and suffered from last stage of cancer. He was admitted to the hospital under
palliative care for further treatment. Mr. Weber could not speak and often during the
treatment by the nurses, he used to lose control and hit the nurses. It was suggested by the
nurses to tie up his hands. He was also neglected on account of his body weight against the
linen and mattress. His skin had turned red and the deterioration had started. He is
supposed to be moved and turned around but that was not done due his shouts of agony.
Mr. Weber’s sister protest about the inadequate care an a overdose of medicenes. Upon the
commanding of opioid medication for his treatment, the doctor talked about the life care
stopping with skin morphine medication with his family. His family confides with the doctor by
letting him know that they want to free Mr. Weber of the excruciating pain and gift him a
painless death. Mr. Weber’s children, Zac and Joanne share powers of attorney upon health
and financial matters. Presently, Mr. Weber has declined all kinds of treatment.
Identification of 3 key ethical issues:
After studying the facts of the case, the major ethical issues that crop up are discussed
below:
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First Issue
Due to the excruciating pain suffered by Mr. Weber out of the mesothelioma and hepatitis B,
there can be chances whereby he can lose his temper. The will to live and ethical behavior
vanishes in front of the intensity of the pain. Moreover, he had become non verbal. Hence,
his attacking the nurses during the treatment and his violence is justified. But suppressing
his hands is a sign of unethical behavior and becomes humanity on the part of the nurses.
Since they are trained to deal with patients, it is unexpected that they such activities. This
will increase the pain of the patient and will to struggle with the pin would disappear (Bevans
& Sternberg, 2012).
The nurses can have a conversation with the family of the patient to speak to Mr. Weber
about his violence. It would be feasible for them to make him understand, rather than the
nurses, that the nurses are doing their duties. The nurses should explain that letting the
nurses complete their duties would put him in a more comfortable state and free him from
pain. Hitting on the nurses would a hurdle in his treatment. The nursing staff would bring in
more staff who possess experience regarding this matter. Nurses who are patient and not
very tough on the patient should deal with Mr. Weber to deal with the issue. The suppressing
of his hands would not be the right solution. These methods are completely legal and is
based upon the present legislation. Giving of mild anaesthesia or other drugs, prescribed by
a specialized doctor during the nursing intervention would also be legal. Over dosage should
be strictly prohibited (Crist & Grunfield, 2013). Stringent action and regulation should be
given to prevent such an issue lest it could lead to other side effects.
However, the above should be done only after the permission of the patients family. The
dosage should abide with the regulations otherwise the clients can issue their consumer
rights. The client should be well informed by the nurses, about the results and possibilities of
such usage. Before the implementation of such procedures, the interests o the clients should
be known. The nurses should not hide anything from the consumers (Zahedi et al., 2013).
Second Issue
The next key ethical issue under the case study is when Mr. Weber is made to lie on the
bed. The linen and the mattress of the bed causes discomfort to him. A kind of bed soar is
happening to him but there is negligence. There is prescription that should be turned around
after a span of every 2 hours. Due to his infirmities, his skin has become dilapidated. He has
become very lean and his bones and muscles have lost their luster. He has become a bony
structure. This is the main reason he should be turned around after little spans. His skin has
become red and they are breaking down. But the nurses do not do much to help him (Dante
et al., 2011). Since he is unable to bear the agony, he cries and whimpers a lot. The nurses,
consequently don’t come and turn him around. They are being negligent towards him.
Rather, the nurses are under the impression that if they go to aid him he would shout more.
This is unethical. They are not giving their best to serve Mr. Weber. This unethical behavior
is just aggravating the pain and causing more discomfort for him. His bed soar is increasing
and spreading to the other parts of the body.
In this matter, the nurses should be more vigilant. It is the duty of the nurses, to take special
care for the serious patients. The adequately trained nurses should be allocated for the
purpose of decreasing this pain. Despite the patient’s continuous scream, they should be
efficient enough to perform their duties. The patient should be turned after every 2 hours.
The skin should be cleaned, medicated and maintained in the most hygienic ways. Then
only the disease could be prevented. The nurses should interact with the family members so
that they too can cooperate in this matter. They could explain to the patient about the
importance of the treatment and it would give him peace. The nurses can implement ways of
distraction for the patient so that his attention is diverted towards a recreational activity while
the nurses do their tasks (Kim & Bates, 2013). This would give him lesser pain. With the
incorporation of these measures, the involvement of the nurses could be increased and for
the betterment of the patient. These ways are absolutely legal and are abided by the latest
statutes. The family of the patient should be made aware of the status of the patient’s health.
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In case of new treatments to be started by the nurses, prior consent of the family should be
taken. Every little step should be at par with the consumer rights.
Third Issue
The third ethical issue which has been laid stress upon in the case study is, the absence of
the adequate care which is to be given to serious patient. Mr. Weber’s sister had also
protested against over dose of medications. the nurses had a tendency to ignore him
because he always groaned in pain. In order to keep him quiet and not get disturbed
themselves, the nurses gave medicenes, which resulted in the usage of more quantity than
prescribed. This over dosage could result in further deterioration in his health. Moreover, the
desired care was not given to him. He was neglected many a times. The timely care was
missing. This is sheer unethical behavior on the part of the nurses. This also means a
breach of their duties and commitments to patients. When patients are under palliative
medication, it means their end is near (Morrison & Korol, 2014). They would not live ling but
the time during which they are to survive, they should survive in peace. With the help of the
medication, the pain is ceased temporarily. The nurses do not take care of him as required
to be done for such a serious patient like Mr. Weber.
The nurses should incorporate more skilled and efficient staff. The more skilled staff would
be able to cater to the needs of the patient and their high degree of care. The medications
should be given from time to time. The exact quantity of medicenes should be provided, as
prescribed by the doctor. The hygiene of the patient’s health should be maintained by the
nurses. This helps in the prevention of capturing more disease. Since the patient is weak,
the adequate nutrition should be provided by the nurses with complete care (Schluter et al.,
2011). The nurses should interact more with the family members of the patient so that the
family too could aid in the patient recovery. The members of the family should persuade the
patient to listen to the nurses and convince them to cooperate with the treatment. This would
in turn, benefit the patient’s health to a greater extent. While incorporating new modes of
treatments and strategies the previous consent of the family is essential. The family should
be aware of the ways their patient is being treated. Their wishes should also be given
importance. The nurses should follow the existing rules and regulations prescribed for the
patient in accordance with the latest statutes. The methods should be legal and scientific.
The consumer rights and obligations are applicable upon the service of the nurses. In case
of a breach of duty, the family members of the patients can refer to the consumer forum for
the adequate relief (Por et al., 2011).
Thus, the unethical behaviors from the nurse’s side should not be encouraged. The nurses
should follow their codes of conduct and ethics. They should be dutiful in serving all the
patients that come before them.
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References
Bevans, M. and Sternberg, E.M., 2012. Caregiving burden, stress, and health effects among
family caregivers of adult cancer patients. Jama, 307(4), pp.398-403.
Crist, J.V. and Grunfeld, E.A., 2013. Factors reported to influence fear of recurrence in
cancer patients: a systematic review. Psycho
‐Oncology, 22(5), pp.978-986.
Dante, A., Valoppi, G., Saiani, L. and Palese, A., 2011. Factors associated with nursing
students' academic success or failure: a retrospective Italian multicenter study. Nurse
Education Today, 31(1), pp.59-64.
Kim, J. and Bates, D.W., 2013. Medication administration errors by nurses: adherence to
guidelines. Journal of Clinical Nursing, 22(3-4), pp.590-598.
Morrison, K.B. and Korol, S.A., 2014. Nurses' perceived and actual caregiving roles:
identifying factors that can contribute to job satisfaction. Journal of Clinical Nursing, 23(23-
24), pp. 3468-3477.
Por, J., Barriball, L., Fitzpatrick, J. and Roberts, J., 2011. Emotional intelligence: Its
relationship to stress, coping, well-being and professional performance in nursing students.
Nurse education today, 31(8), pp.855-860.
Schluter, P.J., Turner, C., Huntington, A.D., Bain, C.J. and McClure, R.J., 2011. Work/life
balance and health: the Nurses and Midwives e‐cohort study. International Nursing Review,
58(1), pp.28-36.
Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., Maddah, S.B.,
Cheraghi, M.A., Mirzabeigi, G.H., Larijani, B. and Dastgerdi, M.V., 2013. The code of ethics
for nurses. Iranian journal of public health, 42(Supple1), p.1.
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