Ethical Decision-Making in Nursing Practice: A Critical Examination

The assignment delves into the role of nurses in making ethically sound decisions within healthcare settings. It highlights the importance of understanding and applying the Nursing and Midwifery Board of Australia's Code of Professional Conduct, alongside other ethical frameworks referenced in literature such as Porter (2012) and Pavlish et al. (2011). The analysis underscores how continuous professional development, as discussed by Ross et al. (2013), equips nurses with the skills necessary to address moral challenges effectively. Through this exploration, it becomes evident that ethical awareness is crucial for maintaining trust and delivering high-quality care.

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LEGAL AND PROFESSIONAL ETHICAL ISSUES IN NURSING
Table of Contents
INTRODUCTION.....................................................................................................................................1
Case Analysis.............................................................................................................................................1
Roles and Responses for Nurses...........................................................................................................1
Legal and professional issues Raised....................................................................................................2
Lack of effective communication........................................................................................................2
Observation recording and documentation..........................................................................................2
Provision of Quality Practice...............................................................................................................3
Creative and Critical Thinking Ability................................................................................................4
Professional Mandate..........................................................................................................................5
CONCLUSION..........................................................................................................................................6
REFERENCES..........................................................................................................................................6

INTRODUCTION
Ethics refers to the moral principles, morals and values that are set to guide and govern a certain
specific group of people (Sadeghi and Khamarnia, 2011). A law is a system or rules and
regulations that are created by society or group leaders (e.g. government) and are officially
enforced to the people to govern and regulate their behavior and actions. In Australia, Registered
Nurses are thenurses that have basically passed through a nursing school, obtained training and
graduated after passing the national licensing examination from that specific country (Lartey,
2014). These nurses are trained to provide professional health care and medication services to
patients in hospitals and especially those that have already been discharged from hospital but still
care and regular observations. Additionally, they are responsible for educating patients as well as
their relatives on various health processes and procedures. Besides educating the patients and
their relatives, nurses in Australia alsotrain the community or society members about different
diseases, health care and medical processes and services that can be easily practiced (White and
Scott, 2015). With that in mind, it is important for every registered nurse to be completely aware
and conscious of their roles and responsibilities in a health institution (Durham, 2015). This is
simply because the nurses are in charge of the patients and therefore should be held accountable
of their practices and actions leading to any kind of result.
In this case study, the nurses are in charge of a child’s life but did take that responsibility as
serious as they should. My assignment is going to discuss the ethical practices the nurses in the
case study should have abided by, relating them to the actions made by the nurses.
Case Analysis
Roles and Responses for Nurses
Registered nurses often work in hospitals and other outpatient health institutions whereby they
provide services and support to the doctors and care for the patients. These nurses are responsible
for administering patient medications (Huynh et al, 2016), cleaning the patients and changing
their beddings, observing and monitoring patient’s condition especially when the doctor is not
around, maintaining patient records and communicating with the doctors among other things. In
addition to that, the registered nurses are supposed to provide emotional support to the patient’s
relatives as well as to the patients. However, not all nurses carry out all these duties. Nurses with

higher education levels are given other duties like helping surgeons during operations, basically
these duties vary depending on the level and type of patient care required.
Legal and professional issues Raised
Lack of effective communication
Just as mentioned earlier, nurses are responsible for sharing information about a patient’s
condition with the doctors responsible. Technically, nurses are the ones that spend more time
with the patients than the doctors and therefore have the opportunity to see changes in the health
conditions of the patient than doctors. Additionally, nurses are supposed to make regular patient
checkups and observations to ensure that they are getting better or rather not getting worse
(Pirinen et al, 2015).
Work Issue
In the case study, there was a complaint on lack of effective communication. The nurses were
accused of not providing effective communication channel between them and the pediatrician,
i.e. perhaps they failed to call, email, or provide physical information on what the observations
and diagnosis of the child was. The nurses failed to share important information with the
pediatrician which meant that the doctor did not have enough information to treat the child. In
this case, the nurses failed to adhere to the code and ethic on effective and efficient
communication between the nurses and the doctors. When the nurses do not share information
about the health condition of the patient with the doctor, then it will a longer time for the doctor
to point out and realize the real problem with the patient (Ridling et al, 2016). In the health
sector, communication is a key aspect because it involves sharing information with the common
goal of saving human life. However, due to lack of effective communication, the child in this
case study ended up dead simply because the doctor could not point out the problem earlier and
did not receive any information from the two nurses. This was, the nurses broke the code ethics
and failed to provide satisfactory professional practice.
Observation recording and documentation
It is always sensible for a patient’s health records to be kept safe in case of future reference. In
most health institutions, nurses are the ones that make patient observations, e.g. body
temperature measurements and other changes in a patient’s health condition which is basically a

patient’s behavior or progress. When these nurses make these observations, it is ethical for them
to record them in writing to be able to document them effectively. These records are very crucial
because they act as evidence to be used by the doctor to prescribe medication to the patient
(Pavlish et al, 2011). In addition to that, these records can also act as evidence in a court of law
in case the nurse is cued and complaints filed. These records can also be used by a different
doctor whenever the patient needs transfer. It is therefore important for a nurse to ensure that
they have a record and have documented the observations made when the doctor was absent or
unavailable (Sharmil et al, 2015).
Work Issue
As per the case study information, the two nurses failed to record the observations they made
about the child’s health condition. By them not providing a recorded documentation of the
observations they made, may be interpreted as a work issue, which is basically: they actually did
not conduct any observations, none at all or they made the observations but failed to record them
in writing. However, the point that was made from the complaint that was filed was that the
nurses failed to produce any observation records which means that they failed to perform one of
their most important responsibility hence breaking their code of ethics and professional laws.
Provision of Quality Practice
A registered nurse’sduty is to provide professional care and support to patients. According to
Dunn Lopez et al, 2017, providing care and support involves performing different activities like
giving medications, educating them on better ways to take care of themselves by making small
professional talks with them, taking their health condition measurements and making frequent
checkups on their progress among other things. According to Nursing and Midwife Board of
Australia, registered nurses are trained to perform these activities professionally and it is their
duty to do so. By doing this, they basically make use of their knowledge, skill and expertise. It is
important to note that, there is a direct correlation between the quality of a nurse’s practice and
the health condition turn-up of a patient. Good or high quality patient care and patient outcomes
results from high quality health care and support received from the nurse in charge (Choi,
2015).Therefore, the nurses should be completely focused and determined to provide the best
practice to the patients according to their professional standards.
Work Issue

From the case study, the nurses failed to provide quality service to the infant by failing to record
their observations about its health changes and also failing to communicate effectively with the
pediatrician as well. Because of lack of observation records and effective communication, the
doctor failed to get an understanding of where the child was suffering from early enough to give
treatment. The nurses kept the information to themselves which is certainly not a professional
behavior.
Creative and Critical Thinking Ability
Nurses are professionally trained people. This means that they have effective and efficient skills,
expertise and knowledge to take care of patients in a health care facility (Pasila et al, 2017).
Registered nurses are trained on how to take care of different kinds of patients suffering from
different diseases and from different age groups. With that in mind, nurses (especially Australian
nurses) are supposed to be effective and good critical thinkers which is a skill or attribute that in
most cases is said to be a person’s original ability. This is one of the most important skills that a
registered nurse should have. With critical thinking, nurses are able to make rational decisions
when it comes to developing plans on patient treatment and observation plans or schedules
(Ballard et al, 2016). Critical thinking will enable a nurse to effectively identify a problems,
determine a suitable solution for solving the problems and choose the best and most effective
method and technique to reach and implement the solution. In addition to that, the nurses that are
able to think critically have the opportunity to strategize on their ideas, theories, concepts and
plans that relate to patient care (Toren and Wagner, 2010). Nurses that think critically have
always been precise, logical, accurate, clear and fair which basically are some of the characters
and aspects that lead them to their success.
Work Issue
In this case study, the nurses involved failed to think critically by failing to communicate
effectively with the pediatrician and also when they failed to keep observation records about the
infant’s health condition. The two nurses did not seem to have made the logical or rational
decision by not recording and documenting the infant’s observation. The nurses did not think of
the consequences that would arise in case they failed to document their observations. Also, they
did not consider the effects of failing to keep in touch with the pediatrician. In this case, they
actually lacked the ability to think critically hence leading them towards making such mistakes

and non-professional actions. It is important to note that if the nurses were critical thinkers, they
would think better and come up with a plan to record and share information on their observation
with the pediatrician.
Professional Mandate
Registered nurses must have passed through a nursing school to gain their training and
knowledge on the profession. Registered nurses training is aimed at providing absolute and
professional health care and support for the patients in hospitals and out of hospital, but require
professional health care (Matsumoto et al, 2014), i.e. hospitals, schools and other private and
public health care centers (Zahedi et al, 2013). In many professional practices, the parties
involved ought to provide high quality services, especially in hospitals nurses are expected to be
driven by professional values and professional accountability to take care and support the
patients allocated to them.According to NMBA, all registered usually have one thing in common
which is that they have passed through a nursing school, college or done a nursing university
course and therefore have acquired the required knowledge, expertise and knowledge to practice
the nursing profession. This means that these nurses have the mandate to provide exemplary
nursing services to the patients that they attend to (Porter, 2012). However, their values and
ethics will be effective only if they are able to coordinate effectively with their patients. A
collaboration between the patients and the nurses will certainly be able to produce best results on
nursing services towards better nourishment of the human life and health condition of the
patients (Choi et al, 2014).Therefore, to be able to provide the intended health care and support
to patients, a registered nurse must have the required skills and knowledge that will enable them
to effectively collaborate with patients as well as their relatives. On the other hand, the
Australian laws also offer protection to the regulatory organizations so that they are not entirely
blamed for the nurses’ practices. In other words, nurses are guided and governed by laws and
ethical codes that push them towards achieving their sole mandate, taking care of human life or
rather saving human life (Bruton et al, 2016). In this case study, the nurses failed to carry out
their mandate by not performing their specific roles and responsibilities. Technically, it is the
responsibility of nurses to make patient observations, regular checkups, keeping and
documenting patient records. However, in this case, the nurses failed to provide any record of the
patient observations as well as failed to make effective communication with the pediatrician.
According to Pavlish et al, 2011, the nurses are supposed to share the information about the

child’s observation with the pediatrician but they failed to keep in touch, never called, returned
calls, provided any record of their observations which basically makes their actions ignorant and
un professional.
CONCLUSION
Registered nurses are people who have passed through a thorough and intense training and
education system. However, in the health industry, legal and ethical issues play a very crucial
part in this industry simply because the parties are given authority over human life. In the case of
the nurses, the ethics, laws and code of ethics are extremely fundamental to provide governance
and guidance over their actions and overall practice. The nurses are the people who are involved
with patients for longer periods than the doctors and therefore need close and frequent
regulations and laws that will guide their actions about patient treatment and care. Generally, in a
health sector, there are legal, ethical and professional guidelines which should be adhered to by
the nurses, doctors and other practitioners. Therefore, they have the mandate to perform and
practice their profession and provide quality care in the process. However, in Australia, the
nursing profession requires certain skills and qualifications like critical thinking, strong and
effective communication skills, accountability and desire and determination to achieve required
results. For instance, the nurses involved in the case study should have had the desire to save the
child’s life and not be ignorant about their profession. I addition to that they should have been
ready to perform their roles and responsibilities by providing quality service and care e.g.
through recording and documenting their observations as well as communication with the
pediatrician about the infant’s health condition and their results. However, they failed to do all of
that which basically may have led to the child’s death. Therefore, it is important to ensure that
every nurse is aware of the laws, ethics and professional standards that are expected of them in
their practice.

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