Reflective Essay on Nursing Ethics and Practice: Analysis of a Case

This reflective essay delves into the critical aspects of nursing ethics and practice, using a case study to illustrate the importance of ethical responsibilities in patient care. The essay examines the ethical failures of a registered nurse whose negligence led to a patient's death, highlighting the importance of maintaining codes of ethics, providing mental and spiritual support, and ensuring honesty and integrity. The analysis emphasizes the nurse's failure to adhere to established protocols, such as documenting observations, arranging medical reviews promptly, and informing the medical officer of the patient's deteriorating condition. The essay also explores the broader implications of nursing ethics, including fair treatment, collaborative care, and the significance of attentiveness, responsibility, and competence in providing quality patient care. The essay references multiple sources to support the arguments and emphasizes the need for nurses to recognize patient deterioration and act promptly to ensure patient safety and uphold the highest standards of care. The essay concludes by reiterating the moral commitment nurses have to deliver proper care to all patients, underscoring the gravity of their responsibilities.

Running head: REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
Name of the Student
Name of the university
Author’s note

1
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
Each and every profession has its own code of ethics. Likewise nursing has its own codes
of ethics. The different codes of conduct for different professions may be confined to that field
but all of them share a common code that is honesty and dignity towards the work and not doing
things that may be harmful for someone (Johnstone, 2015). It is very essential for a nurse to
maintain the codes of ethics as nurses remain in the frontline along with the doctors in providing
an appropriate care to the patient. A nurse should respect the dignity and value of each and every
patient irrespective of the cast and the creed (Lachman, 2012). One of the ethical responsibilities
of the nurse is to provide mental and spiritual support to the patient apart from the physical
support. Furthermore honesty and self integrity is another ethical value that should be maintained
by the nurses. It is the duty of a nurse to be honest with the colleagues and the patient in order to
maintain self integrity and good personal moral standard (Johnstone, 2015). A proper nurse
should always strive to provide maximum care to the patient.
This case study focuses on the malpractices of a particular registered nurse, whose
negligence has cost the life of a particular person. This essay focuses about person A. who was
been admitted to the hospital with several complications like the shortness of breath, acute
diabetes, leg edema, tachycardia and other ailments. It was reported that the patient failed to
improve as days passed by since his admission in to the hospital. It should be discussed
beforehand that patient A, before his admission into the hospital has been said to visit the
hospital with the complaint of shortness of breath and on diagnosis it was found that he had fine
creps at the base of both the lungs and was having high BP. At the next day he was admitted to
the hospital. The patient as continuously having a feeling of discomfort due to the prolonged

2
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
back and abdominal pain, but it was found that the attendant did not serve him properly. The
patient was having severe abdominal pain and diarrhea but the enrolled respondent said that the
patient will be attended after the locum arrived. It is the duty of a nurse to take prompt actions
and in some cases push her own limits to provide care to the deteriorating patient. It was evident
from the case study that the respondent personally attended the patient but she did not document
the observations, in spite of the fact that his vital signs had not shown any improvement. It can
be expected from a registered nurse that she should maintain all the documents so that they can
be produced as and when required. As per the witnesses provided by the HCCC, the nurse should
have arranged for a medical review as soon as blood pressure was 89/53 and there was a
prolonged abdominal pain, which were the clear indications that the patient’s condition was
deteriorating. It is evident from the situation that the nurse failed to organize the medical
attendance for the patient.
Further research from the case study provides with the information that, as per the vital
signs shown by patient A, he was kept in the ‘Red Zone’, which signifies ‘Rapid response’ ,
which means that the patient has to be monitored by a healthcare professional or a rapid
response team within 10 minutes (Lachman, 2012). If any such cases arise, then the on-call
medical officer should be notified immediately. But the RN did not find it important to inform
the medical officer in charge, which shows her incompetency in the field.
As mentioned earlier that a nurse should assess the patient properly and should document
everything clearly either manually or electronically, as per the regimen of an evidence based
nursing.

3
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
It was reported in the case study that the respondent called up the clinical nurse manager to
arrange for the medications for a patient older than patient A, but she did not raise any issue
regarding patient A, which indicates gross negligence from her. A nurse should be upholding the
highest standards of care to the patient according to the codes of ethics. But here we can find that
she could not understand the credibility of the situation. After about an hour the respondent and
another registered nurse completed an ISBAR form where she recommended that patient A is
deteriorating and should be reviewed ASAP. It should be noted that a complaint was amended by
the HCCC, which says that in spite of being a registered nurse under NSW, it is very shameful
that his nursing practice has been below the standard as expected from a registered nurse. A
nurse should be responsible for protecting and advocating safety and rights of the patient. A
nurse should be able to maintain self moral standards (Chadwick & Gallagher, 2016). In order to
thrive in her own career she is bound to perform the duties she is entrusted with.
Researches have suggested that hospital staffs often miss the signs of deterioration in
patients. The key reason behind this is that they fail to fill in the charts and documents based
upon the observations. It is the duty of a nurse to observe and to report the deteriorating patients.
It should be always remembered that health care outcome is always proportional to the effort and
care delivered by the nurses and the midwives (Russell, 2012). A nurse should be able to exhibit
empathy and compassion with the patients. A nurse should be able to create mutual trust between
her and the patient. We come to know from this case study that the patient is 81 years old which
indicates, he was already suffering from several physical and emotional turmoil, due to ageing. It
is evident from the case study the patient was continuously refusing food and medicine. Good
nurse should know how to deal emotionally with the elderly patients. She should have tried some
alternative methods of feeding (Christensen & Kockrow, 2013).

4
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
Researches have shown that proper nursing care has often shown improved health as
compared to the one with just medications (Grace, 2017). Ethics in nursing includes fair and
equal treatment for all patients irrespective of the age, gender, economic status, disability, and
ethnicity. A nurse should encompass collaborative as well as autonomous care to individuals, but
the above case study shows that registered nurse could not assess the importance of the condition
and didn’t pay attention to the patient’s deteriorating condition (Grace, 2017).
In case a health care setting is unable to provide an appropriate care to the patient or a health
care organization is not equipped with proper tools and medicines, then the deteriorating patient
should be shifted any other hospitals. In case of patient A , this crucial decision was being taken
at last but it was too late to save the patient. It is the duty of a nurse to monitor and document all
the signs and symptoms of the patient. The conduct of the concerned nurse was below the
professional code of conduct.
It was found from the case study that Patient A died of septicemia. It should be noted
from the case study that the patient was suffering from a number of co-morbidities like leg
edema. The infection might have spread from his leg. Proper interventions could have been taken
to prevent the spreading of the infection internally. According to the accused registered nurse the
concerned health care setting lacked the improved technologies and tools, in such a case she
could have insisted the doctors for a handover of the patient to somewhere better, which could
have at least saved his life.
Researches show that nurses have the power to recognize the deterioration in patients
through intuitions. Addition of ‘worry or concern’ to the rapid response system often provides

5
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
opportunities to the nurses to act upon their intuitions and obtain medical assistance at an early
stage of deterioration (Christensen & Kockrow, 2013).
Patient and nurse interaction often facilitate this process. There are some general ethics
of care, which are- attentiveness, responsibility, responsiveness of the nurse and competence
(Christensen & Kockrow, 2013).
Attentiveness involves the detection of the needs of the patient; attentiveness refers to the
stepping out from their own personal preference system to provide the appropriate care. An
hourly rounding facility should be present, where the nurse would be asking the patient directly
about his or her needs every hour (Butts & Rich, 2012). This ensures that the patient is not
neglected. A nurse should continuously try to increase her competence. In reference to the
nursing ethics, there is no vagueness that nurses have the responsibility of their assigned patients.
However it can be concluded that when a person chooses to be a nurse, she has to make a
moral commitment to deliver a proper care to all the patients (Butts & Rich, 2012). Such an oath
should not be taken lightly. Care should be always considered as an ethical task and should be
delivered as a part of the duty, which cannot be found in the given case study.

6
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
References
Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., ... & FIRST2ACT™
Research Team. (2014). Undergraduate nursing students' performance in recognising and
responding to sudden patient deterioration in high psychological fidelity simulated
environments: an Australian multi-centre study. Nurse education today, 34(5), 691-696.
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.
Christensen, B. L., & Kockrow, E. O. (2013). Foundations of Nursing-E-Book. Elsevier Health
Sciences.
Dawson, S., King, L., & Grantham, H. (2013). Improving the hospital clinical handover between
paramedics and emergency department staff in the deteriorating patient. Emergency
Medicine Australasia, 25(5), 393-405.
Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students
through simulation to recognize and respond to the deteriorating patient. Journal of
Advanced Nursing, 69(11), 2375-2388.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones &
Bartlett Learning.
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

7
REFLECTIVE ESSAY ON NURSING ETHICS AND PRACTICE
Lachman, V. D. (2012). Applying the ethics of care to your nursing practice. Medsurg
Nursing, 21(2), 112.
Leget, C. (2013). Analyzing dignity: a perspective from the ethics of care. Medicine, health care
and philosophy, 16(4), 945-952.
Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett
Publishers.
Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing
Regulation, 3(3), 36-42.