Analysis of Nursing Ethics in Clinical Practice: A Case Study

This essay examines a case study concerning the death of a patient due to alleged negligence by a registered nurse. The analysis focuses on breaches of nursing ethics, comparing the nurse's actions to the NMBA standards of nursing. The essay details the patient's deteriorating condition, including symptoms like breathlessness, diabetes, and leg edema, and highlights instances where the nurse failed to recognize and respond to critical vital sign changes, such as low blood pressure and rapid respiratory rate. The essay discusses the nurse's failure to arrange medical reviews, provide proper clinical handovers, and address the patient's prolonged pain and refusal of food. The essay also discusses the ethical responsibilities of nurses, including respect for patients, honesty, and professional responsibilities, and how these were not met in the case. The conclusion emphasizes the importance of adhering to the nursing code of conduct to ensure safe and competent patient care.

Running head: NURSING ETHICS IN CLINICAL PRACTICE
NURSING ETHICS IN CLINICAL PRACTICE
Name of the Student
Name of the university
Author’s note

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Reflective essay on nursing ethics and practice
With the increasing demands of health care the duty of the nurses and the midwives are
also increasing. The nurses now go hand in hand with the doctors to provide appropriate care to
the patients. One major responsibility of the nurses is to endeavor to improve both health care
environments and conditions of employment to increase the quality of health care delivery.
(Johnstone, 2015).
This essay aims to analyze the case study provided and reflect upon the codes of ethics
that have been breached in this case. We have also compared and contrasted the role of the
concerned nurse with the NMBA standards of nursing (Butts & Rich, 2012).
The following essay focuses on a case study, which accounts for the death of a particular patient
due to the negligence of a registered nurse. In order to reflect upon the code of ethics of the
concerned registered nurse, it is essential to get a brief over view of the patient. The case
proceeds like, Mr. A was suffering from acute breathlessness, diabetes, tachycardia and leg
edema and some other age related health problems, which became severe when he was admitted
to the hospital. It should be noted that MR. A had already visited the hospital 2 days before his
admission to the hospital, with the problem of breathlessness and low BP. On diagnosis it was
found that he was having high BP and fine creps at the base of his lungs. He was administered
with an oral Lasix, which actually did not improve his symptoms. After 2 days he was admitted
to the hospital with more deteriorating condition. As days passed by the patient’s condition
deteriorated. During his last few days he suffered from diarrhea and acute chest pain. Finally
when he was being assessed for a clinical handover to some other improved health care setting,
he expired. The case study draws attention to the malpractices of a registered nurse who was in
charge of the patient A. Her gross negligence took away the life of a particular person.

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It is evident from the cases study that the patient was having severe abdominal cramps
and diarrhea. The respondent did properly document his vital signs. It should be understood that
earlier assessment and monitoring of the patient can lower the risk of deterioration in patients.
It was reported that on 11 January the practitioner failed to recognize the patient A’s
deteriorating conditions and implement care regimen for the patient. The respondent should have
arranged for a medical review when she saw that the blood pressure was 89/53 and her
respiratory rate was 40-44, which signifies bradychardia. It signifies that Patient A was having
too low BP than the normal. In spite of seeing that Patient A was having a fast resting heart rate
the nurse did not call for any medical review. The abnormal vital signs were clear indicates of his
deteriorating conditions. It was reported in the complaint that although the respondent personally
attended the patient, she did not note down the observations. From the beginning of the case
study it can be noticed that the patient was suffering from a prolonged back pain, but the medical
officer and the respondent did not bother to look into the reasons of prolonged pain. It was
mentioned in the case study that the patient had stopped taking food and drinks out of pain and
thus could not mobilize due to extreme weakness. The concerned RN could have applied some
alternative methods of administering food to the patient. The white cell count in patient A has
risen from the normal count, which was a clear condition of deteriorations. The respondent had
admitted in front of the committee that she was concerned about the patient’s condition and
ensured that the hospital was not well equipped to deal with such critical conditions. As per the
statement of the respondent, she had been informed at the clinical handover that the health
practitioner who was attending the patient had gone away, and as there was no doctor available
she waited for the locum to attend the patient. It was reported that the patient A suffered from
continual diarrhea, but this time also the respondent failed to monitor the vital sign. The vital

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signs displayed by the Patient A made him to place in the ‘red zone.’, which according to the
NSW health policies signifies a critical condition where the patient should be assessed by any
medical officer or a critical care team within 10 minutes. If situations does not permit then the on
–call medical officer or any general practitioner should be immediately notified (Dawson, King
& Grantham, 2013). In spite of the patient’s vital signs in the red zone, the respondent did not
arrange any medical help. One notable incident that should be mentioned in order to analyze the
role of the concerned nurse is that Ms. Jones, who was the clinical nurse manger, visited the
hospital, but the RN did not find it important to raise patient A’s condition to the Ms. Jones.
There are seven different standards of NMBA nursing. They are-
Standard 1: (Critical thinking and analyzing) and standard 4 (comprehensive conduction
of the assessments) It is the duty of a nurse to research more on the patient’s condition to provide
a patient specific care. In this case a profound knowledge regarding the monitoring and assessing
the vital signs. The vital signs of the patient were not up to the standard, but the RN did not
understand the credibility of the situation. The respondent was well aware of the leg edema in the
patient, but she did not bother to apply any therapeutics to control the infection, which ultimately
led to the death of the patient by septicemia. Another incident that aligns with the breaching of
the standard is that the respondent did not provide any review to Mr. Jones, when she visited the
hospital, because the respondent did not find it a serious issue to be informed to the nurse
manager.
Standard 6: Provision of safe, appropriate and responsive quality nursing (Chadwick &
Gallagher, 2016). It can be observed from the case study that the concerned respondent did not
arrange for any medical review, when she came to know about the abnormal vital signs of

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Patient A. As observed by the registered nurse Michelle Parker, the respondent was aware that
Patient A was in the red zone and needs medical attention promptly, failing to which the
condition might deteriorate, yet the respondent did not make any arrangements for a medical
review.
Thus it can be seen clearly that standard 1, 4 and 6 of the nursing conduct is being breached in
this case.
There are certain ethical responsibilities of nurses which include respect for the patients and the
colleagues, commitment to the patient, honesty and self integrity, professional responsibilities
(Johnstone, 2015).
Patient A died of Septicemia, which could have occurred from his leg edema. The nurse
would have paid attention in maintaining tissue perfusion or proper circulatory volume. Proper
prognosis, providing information about the diseases would have helped in spreading of the
disease to the blood (Gastmans, 2013).
It should be mentioned that if a hospital is not equipped with tools, technologies or even skilled
doctors suitable for the patient, it is necessary to shift the patient to some other clinical setting
without any delay (Bogossian et al., 2014). In case of patient A, the decision of shifting him to
some other hospital was much delayed and the patient succumbed to death. Awareness from the
caregiver’s side could mitigate the risks of mortality in clinical settings (Johnstone, 2015).
Another professional behavior was expected from the respondent’s part is a proper
clinical handover. A proper clinical handover containing all the details always helps other nurses
and the doctors in charge to understand the background of the patient at a go and also saves time.

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Researches indicate that a proper clinical handover always reduces the risk of patient
deterioration and mortality.
There are certain codes of conduct that nurses should uphold during their professional
course. The code of ethics for the nurses acts like yard stick in order to evaluate the conduct of
the nurses. The nursing code of ethics involves respect, trust, partnership and integrity towards
the patient. Nurses will not be able to fulfill their role effectively if the care- client trust is not
built (Johnstone, 2015).
It is the duty of a nurse to assist a patient in simple tasks like eating, bathing and
grooming (Butts & Rich, 2012). As registered nurse I should be able to directly supervise the
medical assistants, which ultimately free up a physician’s time and increase the quality of care in
the environment of primary care. It is also evident that the patient is elderly and is already
suffering from the emotional ups and downs and has already reached the last phase of his life
(Gastmans, 2013). As a nurse I should be able to provide a holistic care of approach to the
patient (Chadwick & Gallagher, 2016).It was given in the case study that the patient as refusing
food. I would have tried some alternate ways of feeding him. As a nurse I should be able to
exhibit compassion and empathy to the patient. For providing a patient-centered care to elderly
persons, it is necessary to create a conducive and a non threatening environment for the patient
(Chadwick & Gallagher, 2016).
As a new graduate nurse the aspects that can be brought to practice are the correct
monitoring of the vital signs and consultation with the doctor and preparation of a proper clinical
handover.

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Researches show that good nurses are blessed with the power to understand the
deterioration in patients via intuitions. Worry or concern in addition with the rapid response
system often provides the nurses with opportunities to believe on their intuitions and obtain
medical help at an early stage of deterioration (Fisher & King, 2013). Nurse-Patient interactions
often help to facilitate this process. Attentiveness, responsibility, competence and responsiveness
are some of the general ethics that has to be maintained (Christensen & Kockrow, 2013).
Nevertheless it can be concluded that it is the moral commitment of a nurse to deliver a
safe and competent care to a patient. In the given case study it can be clearly seen that the
registered nurse did not meet up to the nursing code of conduct and abide by the code of nursing
ethics, which induced the factors that are responsible for the death of patient A.

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