Ethical and Legal Frameworks in Nursing: A Case Study Analysis

This case study examines the ethical and legal frameworks in nursing through a scenario involving a registered nurse, Michelle, and a patient, James, in a public hospital. James, suffering from a pressure injury, experiences discomfort and requests assistance, but Michelle, concerned about his aggressive history, administers an injection without proper assessment or consultation. The case explores potential actions and ethical theories such as Deontology and Utilitarianism, as well as the violation of ethical principles like respect for autonomy and justice. Conflicts between ethical principles and legal concerns, specifically negligence, are discussed. The analysis highlights violations of the code of conduct, ethical standards, and RN standards of practice, emphasizing the importance of critical thinking, therapeutic relationships, and comprehensive assessments in nursing practice. The study underscores the significance of ethical decision-making and adherence to legal guidelines in ensuring quality patient care.

Reading Head: NURSING ETHICS 0
Nursing
February 24
2020
Ethical and Legal concepts of nursing.

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Contents
Introduction................................................................................................................................2
Possible Actions and Theories...................................................................................................2
Ethical Principles.......................................................................................................................3
Conflicts in Ethical Principles/Theories.....................................................................................5
Legal Concerns...........................................................................................................................6
Code of Conduct and Ethics.......................................................................................................6
RN standards of Practice 2016...................................................................................................7
Conclusion..................................................................................................................................8
References..................................................................................................................................9

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Introduction
Nursing is a profession that comes under the healthcare department. The main focus of this
profession is to take care of individuals. Proper care and support from nurses can improve the
health of a patient in a short period of time. Nursing is also helpful in providing quality
service to patient who is suffering from diseases. There are different approaches to nursing
depending on the situation. There are several changes that can be observed in nursing. All
these changes are made to meet the current requirements of people. There is some code of
conduct of nursing which is based on ethical and legal terms and conditions. These conditions
will provide a framework for nurses for their behaviour with patients and other people in the
hospital. Different countries have different sets of rules and regulations according to the
requirement of people of society (World Health Organization, 2020). This case study is
focused on the legal and ethical frameworks of nursing.
Possible Actions and Theories
In this case, there is a registered nurse, namely, Michelle who is working in a public hospital.
There is a patient, namely, James Keren he was admitted to hospital as he is suffering from
pressure injury unstageable. He is scheduled for treatment on the next day of which he is
admitted. James has a history of aggression and he is also on behavioural contract. At
midnight James complaint to Michelle about the discomfort, he is facing but rather than
offering him some treatment Michelle gave him injections thinking about his aggression and
ignored his problem. There are many other possible actions which can be taken by Michelle
such as,
Michelle should have listened to James problem patiently and then react upon it. She should
not keep in mind about the patient’s behaviour rather she should tell patients to calm down.

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Michele should have provided him proper care as he is already suffering from Disease this
problem can lead him towards a dangerous situation. Michelle should act more responsible as
she is a registered nurse in the hospital. This option supports the theory of “Deontology”.
This theory suggests that people should follow their duties while engaging themselves in the
decision-making process. If Michelle has thought about this principle she has acted
differently. She has listened to James and try to calm him down rather than giving him
injections (Chonko, 2017 ).
There is one more option that could have been taken by Michelle; she should have called
another nurse who is handling James. James is also telling Michelle to call the nurse that is
handling his case. But Michelle ignored his instructions and give him injections. The nurse
that is handling his case may know about his health condition and she would have taken
required action initially. This step can prevent the patient from pain and suffering which he
had faced because of the mistake of Michelle. In this case, Michelle has to follow the theory
of “Utilitarianism”. This theory suggests that actions should be taken which can benefit
maximum people. If Michelle would have called a responsible nurse problem may not cause
to the patient and he will also feel satisfied with this action. This may also help in decreasing
the temper of James (Chonko, 2017 ).
Ethical Principles
Ethical Principles are ethics by which evaluation of merits and demerits can be calculated in
the healthcare department. The medical principle can be called ethical only when it fulfils all
the conditions of Ethical principles. This principle basically sets general
framework/guidelines for all the people that are related to the healthcare department. These
principles will also make ensure that quality of care is provided to patients. Proper care will

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help in fast recovery of the patient (Chonko, 2017 ). There are different types of principles
such as Principle of Beneficiaries, Least harm, Respect of autonomy, and Justice.
 Principle of Respect for Autonomy
This principle of nursing suggests that the decision making of nurses should be focused on
allowing people to be able to take decisions on their own. This principle says that every
individual has the right in their life. Every individual deserves respect because they
understand their emotions and feelings. In this case, this principle is also violated by
Michelle, as he does of respect the choice of the patient. The patient has told Michelle to call
his in-charge nurse as she is aware of health problems from which James is suffering. The
only thins which is in mind of nurse is about the behaviour of the patient. And she though
every action of patient is guided by his behaviour. And therefore she does not understand the
need to call the in-charge nurse of James and without her consultation, Michelle has also
given injections. This may lead to a problematic situation if a charge nurse has not arrived on
time. As a result of that, James will have to face problems in the future (Chonko, 2017 ).
 Principle of Justice
This principle of nursing suggests that ethical justice should be provided to principles through
decisions of the decision-maker. This principle also suggested that ethical decisions should be
consistent with the ethical theories in most of the cases. There are some diplomatic conditions
in which this principle cannot be followed. But in his case, Michelle is ethically wrong. She
takes the major decision of patients’ life on her understanding. She has not done justice with
the patient, James. Even after James explained his discomfort then also Michelle does not
take any serious course of action to provide patients with care and comfort. It is her duty as
she is also a registered nurse but instead, she has taken some other decision which may result

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in more serious problems to the patient. Michelle should have taken decisions according to
ethical and legal principles (Chonko, 2017 ).
According to Michelle, she has taken the right decision. But she has ignored the health of the
patient. It is the main focus of nurses to take care of patients’ health and she has ignored that.
She has taken a decision based on her assumptions. Michelle has also ignored the bell of
James the second time because of patients’ behaviour. She has not even checked the reason
for the discomfort of the patient.
Conflicts in Ethical Principles/Theories
Yes, there are conflicts between Ethical principles and there is also conflict between ethical
principles against law. There are generally four ethical principles that are observed in
nursing. There is a conflict between the principle of Right for Autonomy and Beneficence.
The right of autonomy principles also has a conflict with theories such as the theory of
Utilitarianism and theory of right (Gof, 2018).
According to the principle of Beneficence, the decision-maker has all the right to make
decisions according to their assumption and understanding. This principle also suggests that
decisions are taken on the basis of profit to a maximum number of people. This principle is
mainly attached to the theory of Utilitarian whereas the Principle of Right to autonomy states
that decision making should be focused on allowing people to make decisions for their own.
These decisions should be based on their thoughts as they understand their feelings and
emotions better than anybody else. People have a complete right to live their life according to
their lifestyle. This principle generally supports individual thoughts of people who are able to
make decisions for their own.

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The theory of Utilitarianism has the same views as that of the Principle of Beneficence and
less harm. Both of these principles are based on this theory. Principle of Right to Autonomy
and Theory of Utilitarianism has conflicting views as both of these has opposite point of view
regarding decision making powers. But the theory of right and Principle of right to autonomy
also have conflicting views as the Theory of right gives the highest priority to the decision of
society and decisions of individuals are considered secondary. All decisions of this theory are
based on assumptions and thinking of people living in society. Society will decide what right
they want to be applicable. But the principle of Right to autonomy delivers the opposite point
of view as this principle prioritize individual decisions as an individual has full right on their
own life. They can take decisions for their own.
Legal Concerns
In this case, a legal concern that is involved is “Negligence”. Negligence is considered to be
an act of omission or commission that does not meet established standards of care of the
patient. In this case, Michelle has totally ignored the health of James. This may have result
negatively to the health of James. The nurse does not show any concern regarding the health
of the patient. She did not even follow the instructions of the patient. She just shows concern
about the behaviour of the patient. The nurse thought the patient is having discomfort
because of his aggression (Burke, 2020).
Code of Conduct and Ethics
There are different codes of conduct and ethics that are set by the government of the country.
These codes are developed so that patients can receive proper healthcare facilities. To
develop these codes research is conducted on recent reports of public and patient. These
codes consist of six principles. In this case, the code of conduct and ethics which is been
ignored are Nurses should respect the dignity of patients and treat them as individuals; Nurses

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maintain trust by providing safe and competent care and Nurses act with integrity to maintain
patients’ trust (College of Nurses of Ontario, 2019).
All these codes are violated in this case. Initially, the nurse ignored the complaint of the
patient about discomfort and then she also ignored the instructions given by the patient to call
the nurse in charge. Further without showing any care about patients’ health nurse has
injected the patient with an injection. This shows her careless attitude towards patients’
health. By this act, she has also lost the trust of the patient. She should have treated the
patient with proper care and consult with the in-charge nurse before giving him any dose of
injection. It would have resulted negatively to patients’ health. Nurses are expected to
maintain integrity with the patient and treat them with care and respect. Nurses do not have to
react because of the behaviour of patient they are supposed to take decisions which will show
some positive result in patients’ health (College of Nurses of Ontario , 2020).
RN standards of Practice 2016
There are some standards that are specially set for registered nurses. There are seven
standards that are set for register nurses. All these standards are interconnected with each
other. These standards are:
1. Thinks critically and analyse nursing practice.
2. Engages in a therapeutic and professional relationship.
3. Maintain capability for practice.
4. Comprehensively conducts assessments.
5. Develops plans for nursing practice.
6. Provides safe, appropriate and responsive quality of nursing.
7. Evaluates outcomes to inform nursing.

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In this case, a nurse should have thought critically before handling the situation. Since
Michelle is a registered nurse she should have followed all the standards. Before initiating
any action she should have also informed the nurse in charge and she should have also taken
her opinion before injecting the patient. All these standards are applied in this situation as
Michelle violates all these standards (Nursing and Midwifey Board of Australia, 2016).
Conclusion
Nursing involves many ethical and legal considerations. All these considerations are set by
the government of every country to ensure proper care of the patient. Nurses have to follow
these codes of conduct so that they can ensure that they follow all ethical and legal
considerations. Nursing is also important as it is vital for the health of the patient. If proper
care is given to the patient then there are chances that the patient will show fast recovery and
it will increase the trust of the patient in nursing. There are some special code of conduct and
standards which are set for registered nurses. And registered nurses are required to follow all
these standards’ so that the quality of nursing can be maintained.

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References
Burke, A. (2020). Legal Rights and Responsibilities: NCLEX-RN. Retrieved 02 25, 2020,
from Registered Nursing Org.: https://www.registerednursing.org/nclex/legal-rights-
responsibilities/
Chonko, L. (2017 , 07). ETHICAL THEORIES. Retrieved 02 24, 2020, from DSOF :
https://www.dsef.org/wp-content/uploads/2012/07/EthicalTheories.pdf
College of Nurses of Ontario . (2020). Code of Conduct for Nurses. Retrieved 02 25, 2020,
from College of Nurses of Ontario: https://www.cno.org/en/protect-public/code-of-
conduct-for-nurses/
College of Nurses of Ontario. (2019). Code of Conduct. Torento.
Gof, J. A. (2018). Intraprofessional Conflict among Registered Intraprofessional Conflict
among Registered. Florida: NSU Florida.
Nursing and Midwifey Board of Australia. (2016, 06). Registered nurse standards for
practice. Retrieved 02 25, 2020, from Nursing and Midwifey Board of Australia:
file:///C:/Users/systemjp/Downloads/Nursing-and-Midwifery-Board---Fact-sheet---
Registered-nurse-standards-for-practice.PDF
World Health Organization. (2020, 01 09). Nursing and midwifery. Retrieved 02 25, 2020,
from World Health Organization:
https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery

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