Professional Values, Ethics and Law - Essay Example

Professional Values; Ethics and Law By Ethics in Nursing Introduction This study will focus on the case of Brian, a 76 year old man in hospital exhibiting aggressive behaviour that is likely to be violent. The nurses laced his tea with a sedative in order to make him go to sleep despite his refusal to take medication. The study will discuss legal, professional and ethical aspects that affect and guide the nursing profession in relation to Brian’s case. This will entail studying relevant laws like the NMC Code of Conduct and the Mental Disability Act of 2005. Nurses’ actions are expected to be within the confines of this code, supported by other relevant legislation. For this study, the Mental Disability Act of 2005 will be used to define a person with mental capacity and describe how the law covers patients with cases of mental disability. This law will be studied to ascertain whether Brian, the case subject, qualifies as an individual with mental disability, and how he ought to be treated. This study shall also look into ethics, in particular the theories and the four principles of Autonomy, Nonmaleficence, Beneficence and Justice (Tschudin, 2012), which guide the medical profession in terms of ethics when dealing with patients. They shall be used to study the case herein, and help to determine whether they were followed in the case of Brian. The professional, legal and ethical implications of this case will be discussed. The Nursing and Midwifery Council Code of Conduct and Professional Implications The NMC Code of Conduct was published in 2008. The Code forms the basis of professional practice in nursing, which is a professional that is charged with the duty of securing the health of the public. The NMC Code of Conduct has four main principles, which summarize the entire list of rules and regulations governing the professions of nursing and midwifery. The first principle is that the NMC Code of conduct dictates that nurses take the care of people as the most important part of their work. This involves treating people as individuals and offer personalised care, and in the process respect the dignity of the people they are taking care of (Tschudin, 2012). Nurses are expected to respect the rights of their patients. The nurses in the case study did not respect Brian’s rights as a patient. Instead of giving Brian personalized attention; the nurse opted to secretly spike Brian’s drink with sedative medication through me. I was not Brian’s physician, therefore giving me medication to give to him without informing me was not right. As much as Brian posed a threat to other people, he ought to have been professionally restrained for examination and, perhaps, personalized treatment. The nurse denied Brian his right to personalized healthcare. The second principle of the NMC Code of conduct is that nurses are expected to provide high standards of care and practice throughout their professional career. This is to ensure they handle the sensitive matter of human health with the care it deserves. Negligence on the part of nurses has proven to be very costly, and sometimes it has turned out to be fatal. This principle warns against negligence and advocates for ultimate professionalism by nurse in the course of duty (Tschudin, 2012). In the case study, Brian was not treated with the level of care a patient should be accorded. Apart from the covert administration of medication, Brian was left to go unconscious on his seat. This posed great danger to him. The third principle states that nurses are expected to work with other professionals to promote good health and protect the health and wellness of the people in their care, their families and the entire community. This principle shares the responsibility of safeguarding of human health across the medical profession, directing nurses to play their role in making the society a healthier place. In the case study, the nurse did not involve me as a student nurse in the decision to administer medication, yet he gave me the medication hidden in tea to give o a patient only to inform me later of the contents of the tea. The final principle of the NMC Code of Conduct is that nurses are expected to have the highest levels of openness and honesty, to uphold the reputation of the nursing profession and act with utmost integrity at all times. This principle seeks to establish a trustworthy nursing fraternity that can be relied upon by patients and colleagues in the execution of its duties. The nurse was not open and honest with both me as a colleague and the patient. He opted to act first before information, as should be the case. This goes against this principle. In addition, the nurse discussed the behaviour of a patient with me, a colleague. This shows a lack of respect to the patient’s confidentiality. On covert administration of medication, it is improper for nurses to act in isolation in disregard of the law on mental capacity, according to the NMC Code of Conduct (2008). It is advisable to consult other medical professionals and run tests to determine capacity before such action is taken. Brian was not confirmed as a mental case. Rather, it was assumed. The NMC Code of conduct prevails upon nurses to only administer medication covertly upon confirmation that the patient lacks the capacity to decide for himself. The law on capacity (Section 2& 3, Mental Capacity Act, 2005) must also be considered before such action is taken (Tschudin, 2012). The nurses in Brian’s case did none of the above, and went ahead to sedate Brian’s drink without following due procedure. The NMC Code of Conduct provides guidelines for delegation of duties to competent staff. Despite being in training, the nurse in charge did not delegate the duty to administer medication to the patient. I was informed of the content of the tea I had been asked to give the patient a while later. This was a clear contravention of the NMC Code Number 29. Principles and Theories of Ethics and Ethical Implications Principle of Respect for Autonomy In the medical profession, the respect for autonomy of a patient would imply that the patient would be assumed to have the ability to perform with understanding and intentionally (Gillon, 2003). The patient is expected to act from free will, free from coercion and influence by any individuals or other factors. This principle forms the foundation for practicing ‘informed consent’ in the dealings regarding health issues between a patient and a physician. Nurses have a prima facie to respect the choices made by the patient (Gillon, 2003). Brian was not a confirmed mental illness patient. No tests had been performed to ascertain his mental capacity. The nurses in this case went against the principle of autonomy by performing covert administration of medication without due regard to the patient’s opinion and the procedures for taking such action. His freedom to decide what he felt was right for him was curtailed. Principle of Nonmaleficence This principle advocates for professionalism in handling patients. It requires nurse to not intentionally create injury or harm to a patient, either by an act of omission or an act of commission (Macklin, 2003). Imposing unreasonable risk of harm upon a patient is regarded as negligence. Law and Medical Ethics provide guidelines that help reduce instances that would amount to negligence (Gillon, 2003). The nurse went against this principle. The nurse may have created a situation for himself and the hospital had Brian reacted negatively to the medication that he slipped into his drink. There are chances that the patient could have allergies or other reactions to the sedative. This would mean that the nurses put him in unnecessary danger in the course of performing their duties. This would amount to intentional exposure of a patient to risk (Macklin, 2003). The nurses ought to have run a series of tests to determine whether Brian had any allergies or not. Being an aged man, Brian may have unknown medical conditions that would alter his health if exposed to the content of sedatives. Principle of Justice In healthcare, justice is a kind of fairness. This principle posits that persons regarded as equals should be given the same treatment (Macklin, 2003). In as much as resources are scarce and the distribution of any resource (like service) fairly and equally among all members of a set of patients being increasingly challenging, nurses are expected to be able to strike a balance in order to avert feelings of neglect from other patients (Gillon, 2003). This principle tries to ensure the needs of all patients are considered, having in mind that all citizens have the right to healthcare. In Brian’s case, he was not examined in a timely manner. He was left to cool off in a room with other patients before being given medication. If the nurse had addressed Brian’s case as urgent due to the danger he posed to others, he would have been examined and treated on time. Principle of Beneficence This principle prevails upon healthcare providers to be of actual value to a patient in addition to taking necessary measures to ensure the patient is safe from harm (Wheeler, 2012). This principle implies that a patient can have some form of a relationship with a healthcare professional in trust that the physician’s main objective will be to help the patient. Beneficence is a limited duty (Macklin, 2003). Despite signs that Brian was calm around me, he was not given a chance to build a relationship with me as a starting point for his treatment. He was unconscious before he was determined to suffer mental illness. Ethical Theories Deontology This theory states that individuals in the society should stick to their responsibilities when looking into an ethical impasse. The nurse in Brian’s case ought to have been responsible enough to treat Brian individually, instead of using me, a student nurse, to unknowingly administer medication on their behalf. He would have examined Brian and by virtue of being professionals undertaken the task of administering medication. Utilitarianism This theory posits that the decision that is ethically correct is the one that yields the greatest benefits to the majority. Founded on the aptitude to forecast consequences of an action, this theory allows for comparison of similar predicted outcomes to determine the best decision. The nurse in Brian’s case did not predict the consequences of their action. They acted without following due procedure, unaware of the consequences that would follow. If Brian was wrongly sedated, the nurse in the case study risked deregistration upon confirmation that he acted without following procedural guidelines. Rights Rights of an individual are given topmost priority, and are protected. They are considered as ethically correct as they are accepted and practiced by a large proportion of the population. Brian’s rights were violated in more than one way. To start with, the nurse opted to administer medication on Brian without probing his mental capacity despite seeing that Brian had refused medication. In addition to that, Brian’s right to proper healthcare was not guaranteed, given the manner in which he was treated. Casuist This theory compares a current ethical issue with other examples of the same kind and their results. Brian’s case can be compared to the petition of RM v. The Scottish Minsters (2008) where a patient supposed to have mental illnesses was accorded too much security. The court assessed whether it was necessary for him to be accorded such security and found otherwise. In Brian’s case, it was not necessary to proceed with covert medication as he was not aggressive a short while later. This shows that the nurse disregarded the ethics of the profession. Virtue This theory judges an individual by his character as opposed to an action that may be different from his usual behaviour. Brian was judged to be mentally ill from an altercation incident in the streets. There was no examination on his character undertaken. This was unethical on the part of the nurse. The Mental Capacity Act (2005) and the Legal Implications The Mental Capacity Act of 2005 was enforced in England and Wales in the year 2007. This Act was drafted and passed with the aim of protecting and empowering individuals who are unable to make sound decisions on their own at a specific time (Brammer 2005). The people covered by this Act include individuals with dementia, stroke, brain injuries or learning disabilities (Johnston, 2007). It also covers people who suffer mental health problems. The Mental Capacity Act (2005) operates on the assumption that everyone has a mental capacity which grants them the ability to make their decisions for themselves provided they have enough information, time and support to make that decision. While anyone can assess mental capacity, a medical doctor can be trusted to formally assess a mental case and determine medication to that effect. In legal circles, a solicitor may be called upon to determine mental capacity (Johnston, 2007). Brian did not undergo a medical examination to ascertain his mental status. This shows a contravention of this Act. This Act goes further to elaborate what it means not to have a mental capacity. The legal definition is that individuals without mental capacity are not able to make particular decisions for themselves. An individual may lack the mental capacity because of a disability or an illness (Johnston, 2007). They have the disadvantage of not being able to process and understand information that they may require in order to make a decision on a particular topic. Even if they understand, individuals with mental health problems cannot retain such information for an amount of time long enough to enable them to make the required decision. These individuals also cannot communicate the decision they have made to another party effectively in addition to not being able to use the information they get to make their decision (Brammer 2005). Section 2 of this Act states that a person lacks capacity if at a particular time he is unable to make a decision on a particular matter, due to a disturbance in the functions of the brain or an impairment. Section 3 stipulates that a person should not be treated as lacking mental capacity unless all possible efforts to help them have failed. Section 6 goes further to say that any act has to be examined to ascertain whether it would be least restrictive on the patient’s freedom and rights. The nurse did not take time to assess whether Brian had a mental capacity to explain the reason for his agitation. The reason why Brian may have had a mental capacity at the time of his sedation is because he was calm and seated for about ten minutes. Capacity is checked on a decision-by-decision basis and is not permanent. This shows a violation of Sections 2 and 3 of the Mental Capacity Act (2005). The application of this act differs with the situation at hand. For a person who suffers mental health problems, the application of this Act will rely on how they feel at the particular moment, or rather, how their condition appears to affect them at a particular time (Brammer 2005). Others have displayed the ability to make sound decisions at a later time, which can be assumed to be the case from Brian’s calmness. Conclusion Brian’s case was not handled with due regard to the ethical principles and theories’ guiding the medical profession. The nurse in this case study did not consider the fact that Brian may not qualify as a mentally ill individual as stipulated in the Mental Capacity Act (2005). He disregarded the procedures of covert drug administration as stipulated in the NMC Code of Conduct. Instead of performing tests on the subject to establish Brian’s mental capacity he proceeded with medication. In J.G. v. Mental Health Tribunal for Scotland, a medical report on the mental state of the patient was made by the mental health officer. This was not the situation in Brian’s case. This indicates negligence and irresponsibility on the part of the nurse, as he may have exposed Brian to the danger of taking unnecessary medication. This act may endanger the life of a patient. In addition, Brian was not accorded personal treatment, opting to administer medication through me instead of doing it himself as Brian’s physician. The nurse’s actions were unethical and may have attracted consequences. Reflection Description Brian, a 76 year old man, was brought into a mental health ward after he was embroiled in a street altercation. On arrival to the hospital, he showed signs of agitation, moving about the ward in agitation while shouting. He then threatened to attack a patient who had approached him. Brian had refused any form of medication since his arrival at the ward. After a while, Brian was taken in the quiet room and he sat next to me without any incident for about ten minutes. A nurse then approached me and asked me to give Brian a cup of tea because he did not appear to react violently towards me. It was after taking that cup of tea when I noticed that Brian had fallen asleep on his chair. The nurse later shared with me his relief when I entered the nurses’ office, saying that he had put some sedative medication into Brian’s cup of tea to prevent him from having another episode of havoc. Feelings Before giving Brian his cup of tea, I did not think Brian was bound to have another moment of aggression. After the nurse revealed to me the contents of the tea, I felt Brian might have been given medication wrongly and against his will. Evaluation The worst part of this experience was that the nurse had secretly added sedative medication to Brian’s cup of tea probably because Brian had refused to take medication. This was not the right move, considering he was not in any state that could cause an alarm and prompt for the use of sedatives. Brian had a moment of agitation before, but at the particular moment he was given medication he was calm and seated quietly. This was the time the nurses needed to assess Brian to determine whether he did not have mental capacity. Analysis It became clear to me that Brian had been given medication against his will and without his knowledge. This was a clear breach of the NMC Code of Conduct and the Mental Capacity Act (2005). It would have been more professional for the nurse to conduct further studies into the Brian’s behaviour before drawing a conclusion that he suffered a mental problem. The nurse also went against the ethical principle of autonomy by administering sedative medication on Brian without assessing his mental capacity after he had refused medication. Conclusion The nurse went against the law and guiding principles by acting secretly to administer medication on Brian. This would have been avoided had more studies been undertaken to determine the inability of Brian to decide whether he needed medication or not. The nurse also did not inform me as a student nurse of the covert medication despite Brian not being in my care. He did not give personalized care to Brian as required in the NMC Code of Conduct. Action Plan If this situation is to recur, I would advise the physician available to perform more tests to determine the mental health of the patient and to consult him before administration of any medication. I would also recommend that the nurses adopt professional ways of dealing with patients and treat the patient personally as opposed to using other patients to give medication. In addition to that, I would propose that the nurses treat cases of mental disability with more seriousness. The nurses in this study exposed members of the public and other patients to danger by failing to restrain Brian during his moment of aggression. References Bassot, B. 2000.The Reflective Journal. London, UK: London. Brammer, A. 2005.The Mental Capacity Act 2005. The Journal of Adult Protection, 7(2), 44-48. Brown, R., & Barber, P. 2009. The Mental Capacity Act 2005 a guide for practice (2nd ed.). Exeter [England: Learning Matters. Code Of Medical Ethics: Current Opinions with Annotations, Including the Principles Of Medical Ethics, Fundamental Elements of the Patient-Physician Relationship And Rules of the Council on Ethical and Judicial Affairs 1994 ed. 1994. Chicago, Ill.: The Association. Gillon, R. 2003. Ethics Needs Principles; four Can Encompass the Rest…and Respect For Autonomy Should Be "first Among Equals". Journal of Medical Ethics, 29(5), 307- 312. Johnston, C. 2007. The Mental Capacity Act 2005 and Advance Decisions. Clinical Ethics, 2(2), 80-84. Levett, C. 2010, September 1. Reflections on Practice. Australian Nursing Journal, 1, 34-40. Macklin, R. 2003. Applying the Four Principles. Journal of Medical Ethics, 29(5), 275-280. Mental Capacity Act 2005: Code of Practice 2007 final ed. 2007. London: TSO. Mental Capacity Act 2005: Deprivation of Liberty Safeguards: Code of Practice to Supplement the Main Mental Capacity Act 2005 Code of Practice.. (2008). London: TSO. Pattison, S., & Wainwright, P. 2010. Is The 2008 NMC Code Ethical? Nursing Ethics, 17(1), 9-18. Shanahan, D. 2010. Mental Capacity Act 2005– Implications for People with Learning Disabilities Mental Capacity Act 2005 – Implications for People with Learning Disabilities. Nursing Standard, 25(8), 31-31. Sheather, J. 2008. The Medical Ethics Committee of the British Medical Association - principles and pragmatism. Clinical Ethics, 3(2), 91-94. Sheather, J. 2006.The Mental Capacity Act 2005.Clinical Ethics, 1(1), 33-36. The code: standards of conduct, performance and ethics for nurses and midwives. (2008). London: Nursing & Midwifery Council. Tschudin, V. 2002.Ethics in nursing: the caring relationship (3rd ed.). Edinburgh: Butterworth-Heinemann. Veatch, R. M. 1997. Medical ethics (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. Wheeler, H. 2012. Law, ethics, and professional issues for nursing: a reflective and portfolio- building approach. Abingdon, Oxon: Routledge. Read More