Nursing Care: A Reflection on Ethical Dilemmas and Patient Care

This report provides a reflection on a nursing care scenario involving a patient with schizophrenia who alleged physical abuse by a nurse. The student nurse analyzes the situation, considering the patient's mental state, the seriousness of the allegation, and their professional obligations. The report details the student's actions, which included reporting the incident and advocating for the patient. The student reflects on their decision-making process, ethical principles such as non-maleficence, and the importance of professional values in nursing practice. The analysis highlights the complexities of ethical dilemmas in healthcare, the need for thorough investigation, and the role of nurses in patient advocacy and ensuring patient safety and well-being. The report also references relevant literature on professional socialization, ethical values, and patient care.

Running head: NURSING CARE 1
Student name
Student No.
Unit
Title: A Reflection on Nurse Care and Values

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Part A
As a nurse I am under obligation to give care patients based on ethical issues. I therefore
need ethical knowledge to undertake my duties appropriately while giving legal, safe and ethical
care to my patients. Ethics teach that all patients should be best taken care of regardless of their
condition, colour, age, ethnicity, mental health or any other factor. Being a nurse, I know I am
responsible for my actions and my core responsibility is to ensure that all my clients are satisfied
with my service. I therefore have to function based on my values which are based on the nursing
ethics. My values form the basis on which my strategies, goals and actions are judged.

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Part B
A patient was admitted in the hospital with schizophrenia and other medical
complications like confusion and hyponatremia. The patient and his next of kin had been
explained that the patient would be put to fluid restriction of 750 ml per day due to his condition.
The patient however (due to his mental condition) persistently demanded more fluids and
threatened to create a disturbance to the whole hospital if his demand were not met. One of the
nurses requested to offer one on one care for this patient. I too was involved in his personal
hygiene. As I was undertaking my duties on the patient, he began crying. After some time of
questioning, he told me that he wanted to be moved out of that hospital because five days ago the
nurse caring for him slapped, pinched him and also occasionally used abusive words on him. He
said that after the return of his son, he would demand to be transferred to another hospital. I
apologized on behalf of the nurse and also reassured him that would not happen again. I reported
this to the nurse as we filled the Incident Report Form.
What?
From the scenario above, a schizophrenic patient, who happens to be having confusions
due to his metabolic disturbances made an allegation of physical assault against a nurse.
Considering his mental condition and the fact that the incident happened five days ago, raises
questions whether the patient is capable of raising such allegations. This incident cannot be
verified at this stage. The analysis and solution to this incident revolved around my reflection on
the action I was to take and if my action and judgement would be right or needed improvement. I
was the recipient of the allegation and having heard it I tried to understand and make sense out of
it (Weis & Schank, 2009). I was aware of how serious the allegation was if it was true and also

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aware of the harm it could cause on the nurse’s professional integrity if the allegation was
untrue. Being aware of the patient’s condition, I was moved by his veracity of recollection and
also his starting to cry as he explained the issue. To some point I believed the patient and
therefore due to my moral and professional obligation I escalated the issue to the nurse. I
discussed the matter with the nurse then filled the Incident Report Form, which was then
forwarded to the hospital management. I underwent a long period of self-examination, whether I
was a party to false allegation and also thought about the consequences to the nurse.
After intense reflection I came to a conclusion that my actions were right, not just
because of my professional obligation, to give the best care for the patient, but also due to the
fact that I believed on being the patients’ advocate in this matter that seemed inappropriate to
them (Rassin, 2010). My action seemed appropriate with the nurse. Maybe she went and spoke to
the patient and found out that there was enough evidence to deserve reporting the incident. This
gave me a more reassurance that I had taken the right step. The nurse also found out that it was
unclear to me on what I was to do on such a circumstance. She discussed the nurse ethics and the
implications of the incident with me. This was considerate and professionally helpful (Dehghani,
amosalanejad and Dehghan-Nayeri, 2015). On the patient side, he seemed to be pleased due to
the fact that he was being taken seriously, however, the fluctuation in his lucidity could mean
that there was need for more clarification on this matter. The patient also seemed more pleased
when I told him that the nurse was to be unassigned to him.
So what?
According to Poorchangizi, Farokzadian, Abbaszadeh, Mirxaee and Borhani (2017) it is
the professional responsibility of a health professional to ensure that a patient receives the best

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care possible. Poorchangizi et al. (2017) continue by saying that a nurse is obligated to sharing a
report of patient abuse to the relevant authorities that is their superiors despite the reliability and
capability of the patient. Analysing this matter ethically would claim that the nurse should
invoke the principle of non-malificence which mandates every health professional to ensure that
the patients are not only armed but also no harm can come to them. I had considered speaking to
the nurse and the management in unofficial setting but this could not alter the appropriate course
of action. This incited me more towards finding out what conclusion or course of action would
be more appropriate and proper for this incident.
Now what?
Considering that the patient had reported the incident of his abuse, it is therefore right
that thorough and appropriate investigation was needed on the allegation. Unassigning the nurse
from caring for the patient was proportionate and appropriate. One could think that it would have
been more satisfying if the nurse was suspended from work, but after reviewing the patient’s
mental condition, his confusion and psychotic nature, one could draw some uncertainty about the
veracity of this allegations and therefore such an action could be inappropriate and unduly bias to
the nurse. When the patient was reporting the incident, I apologized on behalf of the nurse and
assured the patient that this would not happen again. This showed a professional sense of
responsibility to the patient (Bang, Kang and Jun, Kim, Son, Yu, & Kim 2011). It also made him
believe that his complaint was being seriously taken care of and that we were sorry that it
happened. This in fact was the appropriate professional course of action.
When analysed, I definitely had two outcomes for this incident, either I believed the
patient or not. Lai and Pek (2012) who claim that Cruess and Cruess believed in professional
expertise, a condition whereby for a student to evolve to a professional practitioner, they are

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judged by their ability to solve issues from a deep and holistic understanding of an incident. This
is gained and developed over a long period of experience and grows to a more robust concept
when tested in a heath care setting. This occurrence has helped me understand better the
elements of such a situation. If this occurs again, I would be more confident to professionally
deal with it other than taking long reflection after my action. Analysis of this situation has helped
me understand it is during these times when a health professional evolves and go beyond the set
line of behaviour. This enables the health professional to function in the environment of
uncertainty and address problems holistically and in the right way.

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References
Poorchangizi, B., Farokhzadian, J., Abbaszadeh, A., Mirzaee, M., & Borhani, F. (2017). The
importance of professional values from clinical nurses' perspective in hospitals of a
medical university in Iran. BMC medical ethics, 18(1), 20. doi:10.1186/s12910-017-
0178-9
Lai, P. K., & Lim, P. H. (2012). Concept of professional socialization in nursing. International e-
Journal of Science, Medicine & Education, 6 (1) 31–35.
Weis, D., & Schank, M. J. (2009). Development and psychometric evaluation of the Revised
Nurses Professional Values Scale (NPVS-R). In Sigma Theta Tau 17th International
Nursing Research Congress Montreal, Canada. http://hdl. handle. net/10755/152288.
Rassin, R. M. (2010). Values grading among nursing students–Differences between the ethnic
groups. Nurse education today, 30(5), 458-463.
Dehghani, A., Mosalanejad, L., & Dehghan-Nayeri, N. (2015). Factors affecting professional
ethics in nursing practice in Iran: a qualitative study. BMC medical ethics, 16(1), 61.
Bang, K. S., Kang, J. H., Jun, M. H., Kim, H. S., Son, H. M., Yu, S. J. & Kim, J. S. (2011).
Professional values in Korean undergraduate nursing students. Nurse education today,
31(1), 72-75.