University Nursing Practice Standards and Ethical Implications Report

This report delves into the professional practice standards of nursing, emphasizing their critical role in patient care, ethical considerations, and legal implications. The study uses a case study of a patient with pancreatic cancer, diabetes, and hypertension to illustrate the complexities of medical...Read More

Running head: PROFESSIONAL PRACTICE STANDARDS OF NURSING
Professional Practice Standards of Nursing and its Implications
Name of the Student
Name of the University
Author Note

1PROFESSIONAL PRACTICE SANDARDS OF NURSING
Health and Health care, these two terms are not integrally related to each other, but it also
incurs a sense of responsibility, a sense of awareness as well as, a sense of morality among the
concerning Health Care Professionals (HCPs), who imparts health care and services, to the
patients. One such integral and significant unit of health care is the Nursing community. While
delivering proper care and service to the patients, there are specific systematic principles and
criterion, which needs to be impetised and followed(Harper & Maloney, 2017). These, based on
the medical, social, ethical, or legal perspective, play a significant role and act as a determinant
in molding the patient-nurse relation, are generally called the principles of professional practice.
In other words, these principles of nursing practice describe what everyone, from nursing staff to
patients, can expect from nursing, what comprises of safe and effective nursing care, as well as,
cover the variant elements of behavior, approach , attitude and professionalism that is associated
with proper health care. This study will emancipate the applications of these principles, as
mentioned earlier, in managing and deriving a solution for a complex scenario (as discussed
below). This study will shed an articulate emphasis on the different facets and aspects of these
principles.
Based on the case study which is being put forth, it can be said that the concerning patient
named Jean has a medical history of Type IV Pancreatic Cancer, along with two co-morbid
conditions – diabetes and hypertension. But the problem arose, regarding the further course of
the treatment procedure, because of a conflict between two aspects, that is, whether the patient
should be treated with a continuation of chemotherapy and associative palliative care or the life-
sustaining treatment should be forgone. Therefore, from the above scenario, the four aspects
which come to foreplay are the medical, legal, ethical, and social factors, respectively. From only
the medical scenario and health perspectives, the primary fact which comes to forth is, since the

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patient has cancer, therefore as a sort of immediate medical treatment, which seems feasible is
the continuation of the chemotherapy along with associative palliative care, as that is probably
the best medical assistance that can be offered to the patient. However, on the medical, legal, and
ethical grounds, the budding-in conflicting issue is that, when treatment is considered to be
devoid of any fruitful outcome, it may be withheld or withdrawn(Lasater et al.,2016). Therefore,
from this perspective, it is generally considered to be unreasonable or baseless, to conduct the
treatment of the disease with vigorous medical interventions when the controlling of the disease
is not feasible.
Again, there is a prevalently said belief that once a treatment gets initiated, it cannot be
terminated, though this assumptive conception is not supported by ethical, legal, or medical
basis. Adding on to it, there are being many incidents related to withholding or withdrawing life-
sustaining treatment, and many institutions have brought in plan of actions and policies for
dealing with these issues(Spence , Zhu, & Read, 2016). Therefore, the significant issues which
are being identified, concerning the aforesaid context, is the concept of withdrawal or
withholding of the medical treatment and whether it serves in, for the safety , security and
wellbeing of the patient.
Following this line of discussion, another question that arises is, regarding the consent of
the patient in agreeing to the withdrawal or withholding of the treatment. In relevance to the
given case study, though the patient was undergoing treatment for pancreatic cancer (stage IV),
the associative complications and side-effects of the vigorous treatment were taking a toll on her
health, which made her more firm and assertive regarding the discontinuation of the said
procedures. Thus, in this aspect, the concept of Informed consent, coms to fore. It is generally
defined as the patient's right to make decisions about his health and medical conditions(Alkouri,

3PROFESSIONAL PRACTICE SANDARDS OF NURSING
AlKhatib, & Kawafhah, 2016). Informed concent, as the term suggests, is generally based on the
legal and ethical aspects of patient autonomy. In a generalized way, there is a tetrad of
components of informed consent which encompass around, that the patient must have the
liberttyas well as the capacity to make the decision, thehealth care professionals must thorough
them with all the relevant and neccesary information on the treatment, test, or procedure
including the expected benefits and risks, along with the chances of probable positive outcomes
or risks. Moreover, the patient must be able to grasp the relevant information, and based on that,
should willfully grant consent or permission , without any compulsion or any sort of influence.
Needlessly, the applicability of informed consent lies in the context of withholding or
withdrawing the treatment, in case the said medical treatment exerts no such considerable effect
in the progression of the treatment. It also reaffirms the fact that even if the concerning health
professional considers the treatment to be devoid of any outcome, the decision or the choice of
the patient should be a priority. Also, on the legal grounds, it can be said that a patient's consent
must be given, either expressively or implicitly, regarding the flow of the treatment. In other
words, the patient should be the final decision-maker. Permission is also needed because the
concerning HCP and the patient , sort of , enters into a pact in which the concerning HCP
employs skills, reasoning and judgment to impart the best possible treatment and, in return,
receive payment from the patient. Therefore, these agreements demand affirmative responses of
all parties, making a patient's knowledge of what he or she is consenting to be essential. Again,
there are certain exceptions to the said rule, such as, any emergency in which medical care is
needed immediately to prevent severe or irreversible harm, or any Incompetence or any sort of
complications, in which someone is unable to give permission , or is disagreeing to give
cobnsent, for a particular treatment procedure.Thus, in such situations, the decision of the

4PROFESSIONAL PRACTICE SANDARDS OF NURSING
concerning HCP remains prior and validated. Therefore , in relevance to this particular case
instance, the patient’s decision should have an ultimate say.
Following the concept of informed consent, another aspect which is of immense
significance is the applicability of the ethical concepts and principles. For Health Care
Practitioners (HCPs), ethics encompasses an introspective practical application of
theories(Phellan, 2020) and principles relevant to the objectives mentioned above as well as to
delve into certain significant aspects like character growth of an individual in terms of
professionalism and organizational skills. The four ethical principles which are considered to be
significant and relevant in terms of the health care provided to the patient are - Autonomy,
Beneficence, Non-maleficence, and Justice.
The first and foremost principle, in this aspect, is Autonomy. As the term suggests, a
sense of autonomy embodies the concept of self-rule or self-authority in any aspect(Liberman,
2017). In terms of Health care ethics, a sense of autonomy validates the concept of respecting an
individual for what he is. Therefore, as per this concerning ethical principle, a Health care
professional should always give impetus to the patient’s self-worth or self-dignity. The second
principle involves the concept of Beneficence(Hitchcock, 2013). It revolves around the
perception of being good and beneficial to someone. This ethical principle indeed sums up the
core priorities of health care because it genuinely caters to the prevalent perception and belief
that it is an obligation on the part of the health care professionals to serve and help the needy,
irrespective of any situation. The third one includes the concept of Non-Maleficience(Liberman,
2017). As per this ethical principle, the health care professional should always abide by the belief
of delivering harmless and beneficial health services to the patient. And lastly, the ethical
principle of justice determines the extent to which the delivery of health care is provided in a just

5PROFESSIONAL PRACTICE SANDARDS OF NURSING
and equitable manner(Concannon, Gillibrand & Jones, 2019). This ethical principle ensures
protection from any sort of impartiality as well as encompasses the concept of reinforcing the
sense of justice regarding the maintenance of self-worth of any person.
As said, the ethical norms or principles that fit well into the given situation, are the
principles of Autonomy and Non-maleficence most predominantly. But, the matter of informed
consent regarding withholding the treatment also aligns with the ethical principle of justice.
However, the applicability and compliance of these ethical principles lead to a sense of conflict,
as well, especially when it is related to the matter of making the best possible choice for the
wellbeing of the patient. In the context of the given situation, the first set of disambiguity might
arise between the principles concerning the sense of autonomy, that is, to prioritize the patient’s
choice and to respect it, and the sense of being non-maleficient, that is, to serve beneficial health
services to the patient irrespective of every situation While another conflict that might bud in is
between the sense of autonomy and sense of justice. This is because to pay heed to the patient’s
choice of withholding or withdrawing the treatment, the room for the contradiction of the ethical
principle of justice increases.
Another aspect that comes to the foreplay is the professional standards concerning the
health care professionals, especially the nursing unit. Professional standards refers to the degree
or level of health services and care in each phase of the nursing process. They reflect a desired
and achievable level of performance against which a nurse's actual performance can be
compared. The primary purpose of professional standards is to direct and maintain a safe and
clinically competent nursing practice, and to guide them towards serving a useful and beneficial
service to the patients. Concerning these professional practice standards (of registered nurses),
code of ethics, and code of conduct, are essential as well. These are a set of behavioral patterns

6PROFESSIONAL PRACTICE SANDARDS OF NURSING
in accordance with the ethical, legal, and professional perspectives that give in the ideal way of
dealing with the patients(Zahedi et al, 2013). As per the given situation, the code of ethics that
stays valid and applicable is, that the nurses should provide a complete and transparent idea
about the said situation truthfully for facilitating autonomous and independent decision-making
by patients and their families, and thereby, guide them in making the right choice(Olson &
Stokes, 2018). On the other hand, the code of conduct that fits into this situation is that the nurse
should respects the rights of the patients as individuals in making informed choices in care and
help and should respect the decisions made by the individual and maintain its privacy and
confidentiality, through limiting the access to all personal records written and computerized to
authorized persons only(Nursing and Midwifery Board of Australia, 2018). Again, as per the
NSQHS (National Safety and Quality Health Safety) standards(Flaningan, 2016), the relevant
standards as per the complying situation are Clinical Governance and Comprehensive Care,
which implies a proper and effective screening of the patients , alomg with an individualized care
plan, to minimize the health risks and to provide a better health service to the patients.
When talked about the professional standards of nursing and legal aspects,
Documentation of all the information and proceedings related to the patient becomes another
aspect of immense significance(Alkouri, AlKhatib, & Kawafhah, 2016). Patient clinical reports,
administrator’s records, and other documents related to patients and organizations provide
assistance and relevant evidences in legal matters. Thus, incomplete, inaccurate, untimely,
illegible, or inaccessible documentation can surge in legal anomalies and can even tamper with
that of a justified and proper decision making on the part of both the concerning health
professionals and the patient.

7PROFESSIONAL PRACTICE SANDARDS OF NURSING
Therefore, based on the above relevant aspects and the give illustrative situation, it can be
inferred that professional practice standards, along with its ethical and legal implications, play a
vital role in modulating the decision taken for the wellbeing of the patient. Moreover, about the
given situation, it can be concluded that since the treatment is more or less , futile, in terms of
patient’s response towards it, and its associative physiological outcomes, therefore patient’s
choice of withholding the treatment should be given the priority. However, the patient should be
kept under vigilance to decide on whether to implement any change in the decision which is
being taken.

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References
Alkouri, O. A., AlKhatib, A. J., & Kawafhah, M. (2016). Importance and implementation of
nursing documentation: review study. European Scientific Journal, 12(3).
Concannon, M., Gillibrand, W., & Jones, P. (2019). An exploration of how ethics informs
healthcare practice. Ethics and Medicine, 35(Spring 201).
Flanigan, K. (2016). NSQHS standard-patient identification. ACORN: The Journal of
Perioperative Nursing in Australia, 29(1), 23.
Harper, M., & Maloney, P. (2017). The updated nursing professional development scope and
standards of practice. The Journal of Continuing Education in Nursing, 48(1), 5-7.
Hitchcock, T. (2013). Ethics and Law for the Health Professions, by Kerridge I, Lowe M,
Stewart C. The Federation Press, Annandale, 2013. Emergency Medicine
Australasia, 25(5), 482-482.
Lasater, K. B., Sloane, D. M., McHugh, M. D., & Aiken, L. H. (2019). Quality of end‐of‐life
care and its association with nurse practice environments in US hospitals. Journal of the
American Geriatrics Society, 67(2), 302-308.
Liberman, A. (2017). Wrongness, responsibility, and conscientious refusals in health
care. Bioethics, 31(7), 495-504.
Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses.
Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive
statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9-20.

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Paudel, B., & Shrestha, G. K. (2016). Perception on Informed Consent Regarding Nursing Care
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Phelan, P. S. (2020). Organizational Ethics for US Health Care Today. AMA Journal of
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Spence Laschinger, H. K., Zhu, J., & Read, E. (2016). New nurses’ perceptions of professional
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