NURS2004: Inquiry for Legal and Ethical Nursing Practice

The purpose of this assessment is to identify and describe the bioethical and legal issues related to contemporary nursing practice and apply them to a complex scenario to establish a professionally sound decision.

Use the framework provided on page three (3) to examine this situation from a legal and ethical perspective and decide on the best course of action to ensure professional practice is maintained.

CASE STUDY

Bessie Watkins is a 70-year-old, retired school teacher who was admitted to the hospice care unit of a small community hospital. She was diagnosed as having metastatic cancer that had spread from her left breast to her spinal column and ribs. She had decided not to have chemotherapy.  She was a single woman and had been living in her own home with her only sister. She was admitted to the hospital because she had become too weak to walk and could barely feed herself. Her admission orders noted that she was in the terminal stages of cancer and that she was to be kept comfortable with medication (narcotic) per continuous IV infusion.

As she became sicker, her bony prominences became more pronounced. A special mattress was ordered to help prevent breakdown of her skin, but the staff still needed to turn her several times a day to prevent bedsores and to change the bed linens. When they did, Miss Watkins cried out from the pain and begged the staff not to move her, so much that the staff wondered if they were really helping this patient by their nursing interventions.

Finally, the staff met to decide what they should do.

Nurse Joan, the head nurse for 4 years, insisted that Miss Watkins be turned at least every 2 to 3 hours for linen changes and for observation of her skin. After all, she pointed out, that was routine and minimal nursing care for all bed-ridden patients, and this was the standard of the unit. Any skin breakdown and its necessary treatment would be a very serious problem for Miss Watkins in her already severely compromised condition.

Bernadette, a nurse’s aide on the unit for almost 15 years, said that she could not stand to see this patient cry every time she was turned. She said that she would prefer that Miss Watkins’s sedation be increased to reduce her pain and facilitate linen changes.

Nurse Duncan, a recent graduate, voiced her opinion that the patient should have some say regarding her care. After all, she had terminal cancer, and not turning her would hardly make a difference in the overall outcome of her illness.

Nurse Lesley, the evening nurse, thought that the doctor ought to be the one to decide how often Miss Watkins should be turned. Then the nurses would not have to make a decision and could just follow their orders. The rest of the nurses strongly objected to this suggestion. Turning a patient, changing linen, and observing for skin breakdown are nursing measures, they argued, and they should decide together the appropriate nursing interventions for this patient.

LAW

  • Use WA or commonwealth legislation – laws from other states do not apply.
  • Refer to specific sections of the legislation.
  • Case law should be ideally Australian or English, but American and Canadian case law may also apply.
  • The best way to find relevant case law is to use the cases provided in the text book or in your reading.

ETHICS

  • You need to choose TWO different ethical theories to interpret the views of TWO different staff members.
  • Provide some description of each ethical theory including the history, benefits and limitations
  • Discuss how each staff members’ approaches match the ethical theories
  • Describe how their thinking compliments and/or conflicts with each other.

PROFESSIONAL PRACTICE

  • Refer to the information provided above in the law section

Identify TWO different elements from professional practice framework documents such as the NMBA Code of Conduct for Nurses, the NMBA Standards of Practice for Registered Nurses, the ICN Code of Ethics or the NSQHS Standards.