Ethical and Legal Violations in a Nursing Case Study

This case study analyzes the ethical and legal violations within a nursing scenario involving a 46-year-old woman, Jo, admitted to the emergency department with abdominal pain. The analysis highlights instances of professional issues and violations of ethical principles, including utilitarianism, deontology, non-maleficence, beneficence, and autonomy. The essay examines the delayed assessment, improper medication administration, and lack of patient consent, as well as negligence in prioritizing the patient's care. The case study critiques the actions of the nursing staff, emphasizing how the patient's rights and wellbeing were compromised. The discussion further underscores the significance of ethical decision-making, adherence to nursing standards, and the importance of patient-centered care in preventing such dilemmas. The student's work provides insights into the application of ethical frameworks and their implications in real-world nursing practice.

Running head: ETHICS
Case Study
Name of the Student
Name of the University
Author Note

1ETHICS
According to Huston (2013) professional issue in nursing practice refers to a
particular situation and/or issue that either compromises the care delivered to the client by
placing the latter at risk, or creates an impact on the ability of the nurses to provide services
that are consistent with the standards of practice. Upon encountering certain ethical dilemma
under situations that lead to failure of the nurses in considering the ‘right thing’, moral
distress is commonly experienced by them. Thus, a nursing professional is responsible and
accountable for making certain decisions that are quite consistent with the competent, safe,
ethical and compassionate practice. The first step that should be taken into consideration is
the identification of the professional practice issue that is placing the patient at an increased
risk (McCarthy & Gastmans, 2015). All nurses have an obligation to provide ethical care to
their patients.
Taking substantial time in exploring the issue helps in gaining an additional insight
and shared understanding among the healthcare team members. In other words, the
obligations of a nurse are not just restricted to providing optimal clinical care to all patients.
In the words of Burkhardt and Nathaniel (2013) prior to taking any action, in relation to
patient care, all nurses must consider the policies of the healthcare facility, the health care
laws, and the actions that will be in the best interests of the patients. Furthermore, it must also
be ensured that the nursing staff act in a way that provide support to the entire team, while
encouraging high level of client care. The essay will elaborate on a case study by explaining
the different ethical and legal violations that occurred in the scenario, and will further
illustrate the steps that could have been adopted by the nursing staff to prevent such
dilemmas.
The case study involved a 46 year old woman named Jo, who had been admitted to
the rural accident and emergency department, following an episode of abdominal pain. Upon
admission, although she had been triaged by the RN, there was a delay in assessment by the

2ETHICS
doctor due to a road accident patient. Furthermore, the patient also vomited dark coffee
ground fluid and was found to have aspirated during vomiting. A thorough analysis of the
case study suggests that there were several instances of professional issues that could have
been avoided by the nurse in charge of the patient. The two main ethical theories that are
valid of the case study are that of utilitarianism and deontology. Utilitarianism has often
been referred to as a large principle that focuses on the great good of the population. This is
one of the most influential and best known moral theories that helps in establishing whether
the actions are morally wrong or right.
Utilitarians are of the belief that the objective of morality is to make life healthier by
growing the quantity of good things such as, happiness and pleasure in the world, while the
bad things namely, unhappiness and pain. Furthermore, the theory of utilitarianism states
that best actions are defined by those that are able to maximise the wellbeing. Unlike other
forms of altruism and egoism, this theory considers the best interests of all person as equal
(Conway & Gawronski, 2013). This theory was found relevant to the case study when the
nursing staff and all healthcare professionals placed their attention in saving the life of the
person who had encountered the road accident. Although Jo was suffering from tremendous
abdominal pain and nausea, they decided to assess the accident victim, in the best interests of
the person. Although the practice of utilitarianism benefited the accident victim, the theory
also had some weaknesses such as, time consumption, lack of consent, and undefined
happiness (Kahane et al., 2015). This utilitarian approach has the potential of resulting in
harm to some persons, while the remaining outcome is supreme benefit (Boutilier et al.,
2015). This method is usually directed by the premeditated benefits or troubles for an
intervention and/or action, based on evidences. Although Jo was also aware of the accident
scenario and did not decide to bother the nursing staff, they did not take her consent as to if

3ETHICS
she considered it correct to wait for few minutes, while emergency treatment was offered to
the accident victim.
The deontological ethics is another normative ethical theory that elaborates on the
fact that mortality of all actions must be based on determining the rightness or wrongness of
the particular action, under a set of specific rules, in place of the action consequences
(Paquette, Sommerfeldt & Kent, 2015). Cline (2014) opined that deontology binds a person
to some obligations and rules. In contrast to the concept of utilitarianism, deontology
comprises of the ethics of duty that governs the morality of actions, based on its nature. Thus,
the damage is often unacceptable, regardless of its consequences. The fact that while Jo was
getting increasingly nauseated, and experienced severe pain, her vital signs were assessed at
regular intervals to gain a sound understanding of her physiological status.
When compared to other nursing departments, nursing professionals working in the
emergency departments are found to encounter a plethora of specific and difficult issues that
are related to consent for treatment, whether they act independently, or are entitled with the
duty of carrying out treatment that is prescribed by the physicians. Emergency treatment is
usually given, in relation to the doctrine of necessity, under conditions where the adult
patients are incapable of providing consent (Gooding & Flynn, 2015). However, such
interventions and treatment should not be forced on capable adults who refuse it (Caulfield &
Zarzeczny, 2014). In the case scenario, the patient was subjected to endoscopy following
consent approval. However, her consent was not taken into consideration before the
administration of the medications. Four common ethical principles that govern the process of
decision making are non-maleficence, beneficence, justice, and autonomy. The role of a
nurse involves implementing actions that do not harm others. Thiessen et al. (2015) stated
that the primary obligation of the nurse should have been to inflict any kind of harm upon the

4ETHICS
patient, in an intentional manner. The further sections of the essay would critically highlight
the instances where the ethical code of the nursing framework was rigorously violated.
According to the facts presented by the case study, it can be mentioned here that the
procedure in which the patient was administered care was not an example of an effective
treatment. It has been mentioned in the case study that the Jo was administered Pethidine 100
mg and Maxolon 10 mg for her pain and nausea. It should further be critically noted that the
patient had vomited coffee ground fluid prior to the assessment but no attention was paid to
the issue. Also, the case study did not present any example of proving a medication or
intervention for the vomiting tendency of the patient. There has been no evidence in the case
study with regard to the consideration of the medical history of the client. This can be
identified as a major lacuna in terms of proving positive care to the patient. The consideration
of the medical records of the client was important in order to deduce an idea about the
allergic reactions caused by the pharmaceutical drugs that the client is susceptible to.
Also, the administration of the drugs and the dosage prescribed clearly did not suit the
patient and the vomiting of the coffee ground fluid could be considered as a major side effect
of the prescribed drug. Studies reveal that, administration of Pethidine is associated with a
wide spectrum of side effects that include, vomiting, pertinent nausea, constipation, dizziness,
sedation and diaphoresis. In addition to this, studies have further revealed that the side-effects
associated with the administration of the pharmaceutical drug, Maxolon include, restlessness,
dizziness, nausea, vomiting and bowel disturbances (Eydi et al., 2014). Therefore, it can be
said that the administration of the above mentioned drugs to the client at this point of time
was not appropriate. Also, a consideration of the past medical history of the client in
association with the possible side-effects of the patient should have been undertaken prior to
the administration of the medication to the client. In addition to this, it should further be
critically noted that the patient and her partner were not educated about the medical health

5ETHICS
condition of the client. The professionals did not provide any intimidation to the client or her
partner about the aetiology of the health condition and the treatment intervention that would
be undertaken in order to promote patient recovery. This clearly presents a violation of the
non-maleficence code of nursing conduct that is expected to be stringently followed by the
nursing professionals. The ethical code of non-maleficence clearly mentions ‘do no harm’ to
the patient. This can be partially accredited to the fact that enthusiastic medical and nursing
practitioners are disposed to using cures that they believe will do well, without assessing
them sufficiently to guarantee they do no injury to the patients. Thus, the nurse should not
have gone further than prescribing the two medications that are known to exert certain side
effects, and treat the patient Jo, unless it was certain that the treatment was unlikely to be
damaging or that the patient and her partner were well knowledgeable of the potential
benefits of the medicines that outweigh the probable risks. However, the condition of the
client in the case study deteriorated through the course of the medical intervention.
The term beneficence often refers to certain actions that endorse the wellbeing of
others. In the therapeutic context, it often encompasses taking actions that aid in the best
interests of all service users and their family members (Martela & Ryan, 2016). However,
there remained an uncertainty in the case scenario, regarding the exact definition of nursing
practices that could have helped the patient. Although an intravenous line had been inserted,
followed by prescription of Maxolon and pethidine, Jo became drowsy and again vomited
coffee ground fluid. This indicates that the nurse had the idea of benefiting the patient.
However, the dilemmas could have been avoided if a due consideration was given to the
previous medical history, her medicinal allergies and the demands and preferences of the
patient and her partner.
The case study further mentions that on account of a motor bike accident the care-
professionals were extremely busy in attending the accident casualty and the medical

6ETHICS
condition of Jo was extensively ignored and over looked. This presents another example of
ineffective care being provided to the patient. This particular instance, presents a violation of
the ethical code of nursing conduct in relation to patient negligence. Nursing professionals
solemnly pledge to commit themselves to serve the patient at each instant and effectively
provide care. However, the case study clearly revealed that the medical health condition of Jo
was completely ignored. The client was not even assessed in an appropriate manner and the
nursing professionals were busy in dealing with the victim of the motor bike accident.
According to the ethical standards of the nursing profession, nursing professionals under no
circumstances should compromise with patient priority which was completely overlooked in
this case (Kangasniemi et al., 2013). It should further be noted that, the ethical guidelines of
the nursing profession were violated in terms of providing effective person-centred care to
the patient.
In addition to this, it should be further noted that the client was accompanied by her
partner to the hospital. However the case study does not mention a single instance where the
client was involved in the decision making procedure. Also, the care givers and the nursing
professionals did not engage the partner of the client in the clinical decision making process
and while designing a course of intervention. This presents an example of the violation of the
ethical standards of nursing in terms of adapting an effective and person-centred care
approach while delivering care. Also, it should be noted that the care professionals did not
involve the client’s partner while undertaking the decision making process. This could be
considered as an example of violating the consideration of following a family-centred
approach while devising an appropriate patient intervention. The maintenance of autonomy
in term of patient autonomy as well as the partner’s autonomy was not given any importance
and as a result the patient was not provided an effective treatment intervention.

7ETHICS
In accordance to the Tort’s law applicable in the nursing profession, it has been
mentioned that a nursing professional must stringently adhere to the ethical code of conduct
and guidelines of the nursing profession at all times (Grace,2017). In this regard, it has
further been stated that the nurses could possibly encounter two torts the first being an
example of the intentional tort and the second being the example of an unintentional tort. Tort
can be defined as an ethical mistake committed on account of negligence (Lacobucci et al.,
2013). In this case, the care givers presented an example of intentional tort where the care
provided to the patient was not effective on account of negligence and malpractice. The client
in the case study was not properly accessed and was not provided appropriate care. Further,
the nursing professionals engaged in the care giving process did not present an example of
delivering competent care to the patient or establish a positive therapeutic relationship with
the client. The registered nurse and the concerned team of nursing professionals failed to
engage in an efficient decision making process. Also the team failed to maintain an effective
communication and coordination other associated health care professionals to provide an
effective care, maintain a record of the patient documentation, assessment and evaluation of
the medication administered to the patient. These instances can critically be highlighted as
malpractice and violation of the ethical conduct and the professional nursing standard
guidelines (Arnold & Boggs, 2015). Therefore, to summarise the entire clinical scenario, it
can easily be said that the patient was denied quality medical service on account of
negligence and malpractice at the end of the nursing professionals and the interdisciplinary
medical experts involved in the care process.
Furthermore, the moral principles of autonomy, moral equality, and respect for
humanity apply to the case scenario. According to the code of ethics, the nurse should have
abided by the value statement that requires them to value the quality of care that is delivered
to all people. Furthermore, the value statement 2 also requires them to value kindness and

8ETHICS
respect for self, as well as others. Valuing informed decision-making is utmost imperative in
relation to the value statement 5 (NMBA, 2005). Thus, under such a situation, the nurse
should have valued the interests of Jo and her partner, while making informed decisions
regarding her health status. Additionally, the patient rights in South Australia entitles them
with the right of being treated with utmost reasonable care and skills by experienced
healthcare practitioners. They are also entitled with the right of exercising their opinions for
undergoing medical treatment, following obtaining reasonable explanations on what the
intervention encompasses and the associated risks (Legal Services Commission of South
Australia, 2017). The duty of care refers to a legal obligation in the tort law that is generally
imposed on a person who requires adherence to certain standards of reasonable care, during
the conduction of actions that have the potential of foreseeably harming others. The
Australian law usually determines whether the scenario being talked about is able to fit within
a recognised category related to duty of care.
The Medical Negligence Law is also related to the scenario. The common principles
of this law requires a patient to prove that the health professionals owed a certain duty of
care, breached it by some omission or act, and resulted in financial or physical harm to the
patient and family members (Solicitoradvice.com, 2016). Thus, it can be stated that there
were several breaches of ethics and laws in the case scenario that violated the health and
safety of the patient.
Hence, to conclude it can be said that the nursing profession has been considered to be
the most novel profession that is solely based on providing care to the patients and
establishing a positive therapeutic environment. The client in the mentioned case study was
not served appropriately and the nursing professionals violated the major ethical
considerations of the nursing intervention. To provide an effective intervention to the patient,
the professionals must have adapted a person centred approach and must have thoroughly

9ETHICS
explained the medical condition to the patient before proceeding with the designing of the
treatment intervention process. Further, the professionals should have thoroughly conducted
an assessment and evaluate the previous medical history prior to undertaking a clinical
decision. The patient as well as her partner should have been equally involved in the decision
making process so as to proceed with an effective treatment care intervention. The case study
typically revealed examples of failure to maintain patient autonomy, negligence and violation
of non-maleficence. Therefore, these ethical considerations should be appropriately taken
care of and stringently adhered to in order to promote positive patient outcome and quality
patient service.
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