Ethical Decision-Making and Patient Care: A Report on Nursing Practice

Desklib provides past papers and solved assignments for students. This report details ethical dilemmas in nursing.

Contents
SECTION 1..............................................................................................................................................1
SECTION 2..............................................................................................................................................2
SECTION 3..............................................................................................................................................3
SECTION 4..............................................................................................................................................4
REFERENCES..........................................................................................................................................7
SECTION 1

Graduation in nursing is the process of gaining education and qualification for social and
health related services. The programme that will be nominated here and discussed is the
Western Health Nursing programme. The programme is managing in three core health and
nursing care hospitals including Footscray hospital, Sunshine hospital and Williamstown
hospital. The programmes also include some other hospitals and day care practices in
Williamstown (Western Health Programme., 2013). The services from this programme are
usually concerned at western population of Melbourne with estimated population of
800000. The programme aims at providing integrated services to the user including the
acute tertiary services, primary care, and emergency care, medical and surgical care. It also
has set some specialized ambulatory clinics. The focus of the programme is to provide
services to adults, aged care, pediatric and newborns. The programme till date has around
6500 employees with view to enhance the service base and quality. The programme covers
around 1569 square km and is fastest growing corridors in Australia, the chief values in
nursing practice are being followed by the programme including compassion, accountability,
respect, safety and excellence (Western Health Programme., 2013.) The programme
presents the teaching strategy in all the nursing hospital it is associated with. Some more
advantageous aspects of this programme is the fast growing rate of the hospitals base and
education growth among the collaborations. It provided undergraduate nursing programme
at all its centers. It provides learning environment to the students that is in acute clinical
setting and helps in development of the practice in a better way. One more important
aspect of the programme is that during the course of study the clinical teachers from
institutes as well as supervisors will be provided to the student that helps them throughout
their qualification. The chief aim of the programme is to enhance the nursing practice in
order to train the new students for collaborative working and better quality service delivery
(Western Health Programme., 2013.)
SECTION 2

Clinical assessment
While a patient asked for the assistance for repositioning her bed, I could see a pressure
injury on her sacrum but while the patient was handled to me by another nurse this injury
was not mentioned. In this situation it is my duty to report the injury and assess the cause of
injury. The injury was assessed by me with help of the grading scale (Vélez-Díaz-Pallarés et
al., 2016). The injury was grade 2 in nature as it had partial thickness skin loss that involved
the epidermis and dermis or both. The injury resented with an ulcer that had abrasion or a
mild blister. It is also tender and painful when physically examined. If not treated properly it
can expand up to deeper tissues of the skin.
The assessment revealed how the injury was making the patient uncomfortable and was
also not reported and recorded adequately (Vélez-Díaz-Pallarés et al., 2016). It was either
missed by the nurse that was in charge before me or it was not being properly recorded.
Hypothesis
The hypothesis indicates that may be the nurse that handled the patient to me forgot to
mention about the injury that is her mistake and example of negligence or the injury was
not assessed and considered in first place by the nurse.
In either of the case the nurse has to be accountable for the incidence and needs to be
questioned for the same. Also the proper reporting of this incidence is to be considered
where the negligence or such careless practice is to be brought into consideration.
Action and Rationale
My first action after assessing the wound and injury to the patient would be to provide the
primary care for her injury. Cleaning the wound by following aseptic measures and applying
some ointment on it will be the first aid provided. The wound will be assessed and reported
properly and recordings will be presented to the doctor for further treatment of the
condition (Glasper., 2015). The cause of the injury will be known by taking proper history
from the patients and also going through the patient records. This will provide clear
identification of the reason of the wound and help in further treatment planning for the
injury (Bhattacharya and Mishra., 2015).

The interventions that will be followed will include, keeping the skin dry and clean, avoid
massaging of bony prominence and any such posture that would enhance the injury,
provide proper intake of nutrition’s, maintain current levels of activity and mobility, and
reposition the patient every two hours. All these interventions will reduce the risk of
infection and progress of the injury as well helps in recovery (Bhattacharya and Mishra.,
2015).
The nurse who handled the patient to me will be questioned on why such an important
detail from patient Performa was missing and not conveyed (Moore and Cowman., 2015). If
the nurse is found guilty to have missed the injury or forgotten to convey the detail during
handling she should be reported under act of negligence to the supervisor and trained
effectively to avoid such instances in future.
SECTION 3

As the four requests each of them urgent in its own sense and with respect to each patient
being important for them individually are presented all together, here I am in ethical
dilemma to how to address all these concerns all together or at once. I will manage to
address these demands one after another on the basis of its priority.
The most priority demand here is of patient 1 that is Mrs Peterson, as she had a stroke 2
weeks ago and is hemiplegic since then her paralysis made her vulnerable to falls and at
high risk of falling. She needs assistance with her bowel ensuite and her demands should be
ordered on priority basis. As bowel movement is naturally occurring philological process and
needs immediate attention. The patient has requested for assistance and if she tries to
move herself she has high chances of falling and getting hurt. To avoid any such incident I
will be addressing her first with help of another staff member and assist her to the
washroom (Goh et al., 2016).
The second priority patient is the patient 3 who is Mr Young that is nil by mouth and has IV
therapy running at 167mls per hour. Here the infusion pump is about to be empty and is
beeping. Here the patient is complaining of pain that is due to improper IV insertion or
complication. His IV fluid is to be refilled immediately and his IV tubes and insertion is to be
rechecked and inserted at different pint with better access to the vessels. Here the patient is
nil by mouth that means his entire nutrition is dependent on the IV fluids that is being
presented and through the IV setup. Any complication in this process may lead to restricted
nutrition and further complication. Pain at the site may indicate the complication of sepsis
or infiltration that should be changed and assessed n priority basis to avoid any infection or
complications (Zerwekh and Garneau., 2017).
Pateint 4 who is Mr Stavropoulous needs to be addressed on third number as his medication
time is of 8.00 am but as seen his blood glucose levels are reduced at 7.00am, he needs to
be provided with some amount of sugar and glucose supplements or breakfast before
providing him the ventalin and prednisolone. It is always advised to take prednisolone after
having food or breakfast in morning as the drug irritates the stomach lining and so the
patient is required to be provided food before administration of this medication (Skidmore-
Roth., 2018)

At last the patient 2 that is Mr Walters is addressed as his demand was of least priority in
nature and he needs assistance to gets ready for the theatre he is going to. The last thing
can be scheduled by making the patient described her to get ready for the theatre as this
condition will not require any clinical or medical interventions and can be delayed a little.
Also the charts for the patient can be handled to ANUM by searching for it.
SECTION 4

While I collected the patient back from theatre he reported me of pain that is severe in
nature and tagged it as 6 out of 10 on the pain scale. As I reach the ward the recovery RN
asked me to sort the pain killer on my own and provide it to the patient as she was too busy
and needed some space for the work she already was caught up into. The drug chart had
panadol and panadeine for the pain relief and I preferred that patient should not leave the
recovery ward with uncontrolled pain but the RN just shook me off by saying she already
provided me with him and now she cannot help me with anything for this patient. This
situation made me go through a severe confusion and dilemma of what next I should do or
plan to do that fits the best interest of my patient. According to the NMC code of practice
the first clause states that prioritize the patient that means the nurse has duty to prioritize
the patient no matter of the workload or anything else (Griffith., 2015). Patient should be
the chief centre of care and top most priority. I tried to follow the ethical rules and prioritize
my patient by seeking all information regarding him but the uncooperative behaviour of the
RN made it difficult for me to provide appropriate care to the patient (Griffith., 2015).
It is seen that conflicts in nursing and health care occur very frequently and is a part of
health and social care but every nursing individual should be trained and have ability to
resolve such conflicts and direct their practice mainly focusing the patient. When the RN
denied me of any help or any more information regarding the patient or help for monitoring
of managing the pain that patient was suffering from I decided to act wisely and resolve the
conflict between us. She mentioned that she handled the patient to me so now it was my
duty and concern to take care of the patient’s requirements and she had other work to do
and cannot help me anymore. According to the NMC code of ethics it is nurse’s duty to
behave in a professional manner and so the unprofessional behaviour by the RN was
evident I decided to take charge and use accommodating technique to resolve the conflict
(Gabrielsson, Sävenstedt and Olsson., 2016). Firstly I explained the RN that the patient is our
top most priority and both of us should work collaboratively to provide care to him as it is
not who is in charge but it is important that the patient receives appropriate care. I
compromised by asking her for help again and accommodating her requirements by
exchanging some of her tasks that I can do while she can attend this patient ( Lee and Lee.,
2015).

She agrees to exchange some small tasks where her time can be managed and we can work
together by promoting appropriate care to the patient. She went through the charts of the
patient again and identified the main drugs used for the patient and replenished the dosage
that relieved the pain for the patient. Meanwhile I understood from her and asked her to
use an appropriate format like ISBAR to handle me the patient with mentioning every detail
(David and Waxman., 2018). She acted in the manner and the patient care as well as the
ethics of the practice was followed.
Education and provision of feedback is another essential thing that I learnt during this
incidence (Glasper., 2015). As the patient was caught up in the conflict between me and RN
the step to prioritize his needs was essential to be taken and was rightly done. Patient
education regarding the appropriate reporting of the symptoms and medications was done
with feedback provision where the feedback on the services by us was taken from the
patient. The feedback helped us to improve our services and provide better quality services
with every passing day. Also this incident made me aware of how the conflicts in nursing can
be accommodated or avoided and also collaborated as per the situation and the person it is
occurring with. Hence the use of appropriate style for resolution is the ability of the
competent nursing professionals in order to resolve the conflict and provide better quality
care to the patient.
REFERENCES

Bhattacharya, S. and Mishra, R.K., 2015. Pressure ulcers: current understanding and newer
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Association of Plastic Surgeons of India, 48(1), p.4.
David, J. and Waxman, B.P., 2018. Adding kindness at handover to improve our collegiality:
the K-ISBAR tool. Medical Journal of Australia, 209(11), pp.482-483.
Gabrielsson, S., Sävenstedt, S. and Olsson, M., 2016. Taking personal responsibility: Nurses'
and assistant nurses' experiences of good nursing practice in psychiatric inpatient
care. International journal of mental health nursing, 25(5), pp.434-443.
Glasper, A., 2015. Can the new NMC Code improve standards of care delivery?. British
Journal of Nursing, 24(4), pp.238-239.
Goh, H.T., Nadarajah, M., Hamzah, N.B., Varadan, P. and Tan, M.P., 2016. Falls and fear of
falling after stroke: a case-control study. PM&R, 8(12), pp.1173-1180.
Griffith, R., 2015. Understanding the code: working in partnership. British journal of
community nursing, 20(5), pp.250-252.
Lee, Y. and Lee, H., 2015. Role conflict and conflict management styles of hospital
nurses. Korean Journal of Stress Research, 23(3), pp.147-158.
Moore, Z.E. and Cowman, S., 2015. Repositioning for treating pressure ulcers. Cochrane
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Vélez-Díaz-Pallarés, M., Lozano-Montoya, I., Correa-Pérez, A., Abraha, I., Cherubini, A.,
Soiza, R.L., O’Mahony, D., Montero-Errasquín, B. and Cruz-Jentoft, A.J., 2016. Non-
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practice recommendations. The SENATOR-ONTOP series. European Geriatric Medicine, 7(2),
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Western Health Programme., 2013. Retrieved from
(http://www.westernhealth.org.au/EducationandResearch/Education/Pages/Graduate-
Midwife-Program.aspx) last accessed on 2/05/2019.
Zerwekh, J. and Garneau, A.Z., 2017. Nursing Today-E-Book: Transition and Trends. Elsevier
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