Analysis of Ethical Issues in a Nursing Case Study: Malawi

This essay presents a case study of Amos, a high school student in Malawi who died due to a healthcare provider's discriminatory decision during a cholera outbreak. The essay identifies ethical issues such as patient rights, autonomy, beneficence, and justice, analyzing them in relation to professional codes of conduct, human rights, and healthcare ethics principles. It examines the breach of nursing duties and standards, highlighting the triage nurse's negligence in denying care to Amos based on his residence. The analysis includes relevant legislation and professional standards, followed by recommendations for future nursing actions, emphasizing the need for education, reflective practice, and hospital support systems to prevent ethical breaches and improve patient care. The conclusion underscores the dynamic nature of healthcare, the vulnerability of nurses to ethical challenges, and the role of healthcare organizations in promoting ethical obligations.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author note

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Introduction
The essay deals with the case study of Amos, a high school student who was suffering
from cholera. There was a cholera outbreak in the Malawi and the students with array of severe
symptoms were admitted to the hospital for treatment. However, there were lack of sufficient
medical supplies because of which the triage nurse and the doctor on duty decided that the care
will be provided only to the students living in the high school’s boarding facility. Amos
presented to the hospital with severe symptoms was spared from illness as he was residing
outside of school premises. This action of the health care provider led to death of Amos. The
aim of the essay is to identify the ethical issues raised by the events in the case study of Amos.
Further the analysis of the issue is carried in relation to the notion of the professional codes of
conduct/ethics, human rights and dignity, principle of health care ethics and relevant professional
policies and legislations. Based on the analysis the relevant recommendations for future nursing
actions are presented.
Ethical issues
In nursing practice, challenges due to ethical issues are very common due to large
number of legal, ethical and professional duties. In the essay some are identified as evident from
the case study. According to scenario the main ethical issues are respect to patient right to live
and dignity, autonomy, beneficence, justice, and duty of care. These are professional and legal
duties in Malawi, which when breached leads to ethical issues (Kelleher, 2014). These are ethical
duties and any failure or negligence to execute emerges as ethical considerations. In case of
Amos the, patient was in emergency condition. He was undergoing severe dehydration and
needed immediate clinical attention. However, he was denied only on the basis that he was

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residing outside the school boarding facility. This was discriminatory act on the behalf of the
triage nurse and the doctor. The decision to care for students living in boarding was irrational.
Considering the lack of medical supplies, the nurse and doctor could have atleast provided a
first line care and then transferred to other hospital with better resources. The health care
providers did not consult with any other person holding authority over the allocation of
resources. It was right of the patient to live that was denied and it led to death. This can be
considered negligence and does not seem to be in favour of any local and national legislation or
the professional standards. The decision has not demonstrated any effort to prevent cholera and
maximise the patient care outcomes.
Analysis of ethical issue
According to the Human Right Act 1998, every patient has the right to proper treatment
and the health care practioners must not subject the patient to degrading treatment. The care
provides must respect the right to life and right to family and private life (Cohen & Ezer, 2013).
In this case it was found that the care providers have taken the life of Amos by neglecting the
emergency clinical condition. Further, Autonomy is the strong aspect of the ethical framework
in health care industry. This concept is found in the bioethical, moral and political philosophy. It
is the tool to determine the moral responsibility of the individual’s actions. For nurses, based on
the standards of ethics it implies them to respect the decision taken by the patient and their wants
(King, 2017). This was also the breach of the international code of ethics according to which it
is the inherent right of the nurse to protect the patient’s respect, right and dignity (Griffith &
Tengnah, 2017).It was unethical for the nurse to disrespect Amos’s decision and autonomy. It
would have facilitated professional and trustworthy relationship. As a first line of treatment, the
nurse could have administered the IV fluids to reduce dehydration that would have saved time

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enough for transferring the patient to bigger facility stably. The nurse and the doctor breached
the duty to prevent the patient from worsening condition. The decision was not in patient’s best
interest. Anything which does not promote the patient’s good is not considered as the best
practice for nurse.
The provider-patient relationship model is inclusive of the ethical principle of patient’s
autonomy, respect, beneficence, justice and non-maleficence (Shrestha & Jose, 2014). Taking
about beneficence, it is the obligation of the nurse to act in best interest of the patient. In case of
Amos, any alternate strategy instead of denial of care could have promoted his health benefits.
According to principle of justice the nurse and the doctors are orally, professionally and legally
obliged to the fair provision of care. The prioritisation of care and the distribution of the health
care resources should be able to ensure equality and equity (King, 2017). As per prioritisation of
care, Amos should have been given first priority and made alternate arrangement for other
students proposed to be admitted for cholera from same school. This was unjustified action as
there may be other school boarders who are not as servery ill as Amos, but may receive on time
care. This behaviour demonstrates that the nurses did not care for the specific needs of the
patients. The triage nurse did not demonstrate the advocacy role, courage and honesty. It may be
considered as negligence in fulfilling the duty of care despite being competent in practice. In the
eyes of law, this may lead to the civil law suit (Cerit & Dinç, 2013). The harm caused to the
patient and the family was foreseeable.
The act of negligence can be related with the breach of the standards of care. These
standards are set to guide clinically competent and safe practice. In this case the nurse did not act
in culturally safe manner. The nurse did not use the skills and knowledge in the best interest of
the patient (Grace & DRN, 2017). According to Nurses and Midwives Council of Malawi, there

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are set standards and code of ethics for nurses to demonstrate caring attitude, sensitiveness to the
patient needs, and empathetic understanding (nmcm.org.mw, 2018). However, the triage nurse
was insensitive to the needs of Amos and denied care despite Amos’s pleas and argument that he
was still a student of the high school. It caused him to return home severely dehydrated, undergo
shock and death on arrival. It could have been prevented by the involving other governmental
and non-governmental organizations for additional support or medical supplies. These ethical
issues should be prevented as it may greatly impact the public’s trust on the health care provision
(Percival, 2014). There may be public loss of faith due to lack of safety and prevent the
development of the therapeutic relationship. Therefore, this issue calls for the immediate
strategies for preventing the breach of the heath care ethics and legislations.
Recommendations
Many nurses were found with lack of awareness of ethico-legal issues in nursing. They
lack formal education in this area and thus they fail to address the challenges presented in the
medical environment. Merely, establishing the standards and polices does not guarantee ethical
conduct of the health care professionals. To prevent future events like Amos, there is need of
formal education and training in this area. It is suggested for implementation to better guide the
safe nursing care (Standing, 2017). The triage nurses and other nurses who have encountered
situations like Amos’s death must rationally reflect on the actions to provide better care in future,
obliging to the code of ethics, professional standards and legal duties. Nurses need to engage in
reflective practice to be able to manage the professional and personal impact of addressing the
health and wellbeing issues of the patient. It will better help take responsibility and
accountability for the actions (Thompson & Pascal, 2012). Regular surveys and audit will help
determine the nurse’s knowledge of ethical issues and any breach of code of ethics. There must

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be support of nurse’s ethicist in the hospital is recommended to allow nurses to approach with
any kind of ethical dilemma (Brown, Kitson & McKnight 2013). In case of deliberate breach of
care, the hospital authority must take stringent actions such as cancelling license of nurses (Holt
& Convey, 2012).
Conclusion
The essay discussed the ethical issues in the case scenario of Amos. The patient’s
condition was critically discussed and it was found that the ethical considerations in the event
were associated with the beneficence, human rights and dignity, respect to life, and autonomy.
There was breach of nursing duties of care and professional standards by denying care provision
to Amos. The essay discussed the nurse’s role and responsibilities in reaction to standards and
code of ethics. Health care sector is dynamic and the nurses are vulnerable to the legal, ethical,
and professional challenges. The nurses are frontline carers for patients and her prone to ethical
issues The health care organisations must play an active role in monitoring the breach of
professional standards and ethical obligations by training, formal education, survey, feedback
and regular audit.

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