Professional Values, Ethics and Law - Case Study Example

PROFESSIONAL VALUES, ETHICS AND LAW Nursing, just like any other profession, experiences ups and downs. There are always different responses from different patients. The responses range from excellent or good care, poor or very poor care to care was neither good nor poor. It is important to note that all the responses revolve around ethics. Addressing practical issues in the daily activities is paramount to every nurse regardless of the ethical approaches presented. Some of the available ethical approaches are rule based, outcome based and virtue based. On the other hand, service users always have some expectations from caregivers such as entitlement to safe and competent care as well as positive attitude among others. Generally, ethical and professional competences are crucial in nursing. Nurses are required to be deeply aware of their legal, ethical and moral responsibilities while providing care. Key aspects of nursing profession are fundamental in regard to the fact that nursing should always be practiced within the law. Legal and professional accountability demand upkeep of the law and professional standards. The Nursing and Midwifery Council has been in the forefront of ensuring that the health and wellbeing of the public is safeguarded and that thorough investigation is carried out in regard to allegations of professional misconduct (Vincent2010). The body has really encouraged accountability in the nursing profession. However, there are still many issues arising from negligence and general misconduct within the nursing profession. This case therefore attempts to scrutinize and analyze some of the professional issues met within the nursing profession. It presents a case of two patients, Mr. Arnold and Mr. Ahmed who require pain medication. Nursing practice requires that nurses should strive to practice autonomously, compassionately and safely while ensuring that they assess and meet all the physical and mental needs of patients. Furthermore, nurses are required to utilize clinical governance practices to improve healthcare and manage themselves and others effectively. This case involves the issue of dispensing of drugs especially appropriate drug dosage. Nurses are required to administer drugs in an ethical manner. The case is about a first year student who was shadowing the ward sister who was caring for six patients on an acute medical admissions ward. Since it was a bank holiday, the ward was short staffed and the agency could not help in fulfilling the shortfall at the time. The patients who were left behind under the care of the student were Mr. Arnold and Mr. Ahmed who required pain medication of Oramorph, However, because Oramorph is a controlled drug, the sister asked a colleague to assist in administering the drugs. After admission of drugs, two hours later, Mr. Arnold who suffered from mild learning disabilities shouted at the visitors that came to visit him claiming that nurses withheld his pain medication. On the other hand, Arnold also claimed that the syringe that was used on him was half full. Another notable issue was the fact that Ahmed who was receiving palliative care was unusually quiet all afternoon. The student then reports the issue to the ward sister who admits having made the mistake of mixing the syringes and said she would just to up Mr. Arnold’s pain relief. The issues in this case are both ethical and professional, administering inappropriate amount of drugs is a sign of negligence and professional misconduct. Arnold and Ahmed were entitled to receiving right amount of drugs from the nurses. Medication error is common in medical practice and may include medication given in wrong amount; medicine prescribed incorrectly, medicine administered to a wrong patient or even omission of medicine (Bhatt 2000). Interestingly, most cases are never reported despite the demands by the profession to report any form of medication error. However, the errors may sometimes be very severe thus calling for immediate action to be taken (Lawson and Hennefer 2010, p. 9). A patient may either lead to patient morbidity or mortality hence calling for care and caution. The case above is among the many medication administration errors committed by many nurses across the world. Such kind of errors threatens patients’ safety and brings into question the competency of the nurses involved. According to Pozgar (2013), there may be some serious consequences to the nurses who commit the errors including being sued or even revoking practitioner’s certificate of practice. Nursing as a profession is guided by professional bodies that constantly monitor the operations of the practitioners. Bhatt (2000) argues that an error in medication may cost a patient’s life and therefore, addressing medication issues in relation to patient safety remains vital in order to reduce likelihood of administration errors. The initial challenge in this case is understaffing in the UK based hospitals. Having fewer patients to care for is essential to proper nursing. The ward sister must have been overwhelmed by the six patients she was handling in the acute medical admissions. This prompted her to delegate her duties hence the cause of all the problems. Inability by the agency to fulfill the shortfall is a serious although a common concern in nursing. Most organizations have taken the responsibility of prioritizing for nurses instead of nurses prioritizing their own schedules. Nurses should work in the environment free from stress and any other form of interference. Stressful working characterized by understaffing may demoralize nurses. Healthcare practices require much courage because of the fear of the cost of action. Nurses therefore should be given a number of manageable patients. This is integral because stress or straining may lead to moral distress (Staunton and Chiarella2012, p. 23-7). Moral distress may deter nurses from pursuing their course of action apart from inhibiting professional nursing practice. Understaffing is among the factors that contribute to moral distress hence leading to care being compromised or even increasing the chances of committing errors during practice. Arnold and Ahmed certainly received wrong or rather improper drug administration. Understanding legal and ethical concerns relating to drug administration is crucial in nursing practice (Gavura 2010, p. 6). Nurses are subject to both criminal and civil law just like any other individual. Mostly, the UK laws touch on issues dealing with health and safety, drugs regulation and different aspects of human rights considering that nurses are highly accountable to patients (Rubenfeld and Scheffer2015, p. 9-12). Some of the most important duties for nurses include the duty of autonomy, confidentiality and duty of care to all patients which are supplemented by the principles of beneficence (Bhatt 2000, Web). The principle of non-maleficence which demands that the nurses should avoid harm is also very crucial and needs to be observed by all the nurses across the board. The Clinical Ethics Committees and the Research Ethics Committees have recently been charged with the duty of ensuring more ethical advice is given to the nurses. The nursing profession is regulated by a stern code of ethics accompanied by very strict disciplinary measures under the umbrella of the Nursing Midwifery Council (Carvalho, Reeves, and Orford 2011, p. 3). The NMC is deemed stronger than the legislative bodies in UK and has the power regulating medical practitioners through the Register of Medical Practitioners (Nursing and Midwifery Council 2007, Web). A high standard of conduct is therefore paramount in the delivery of services to patients .Nurses are expected to comply with the guidelines put in place by the NMC. In fact, obtaining a license for practice largely depends on the nurses’ ability to prove that they intend to follow the set guidelines. Another important body that may be involved in the case is the General Medical Council which protects the public by ensuring that only nurses deemed fit can practice and further providing important guidelines regarding what the practitioners are expected to do. Also, the British Medical Association handles cases that deal with ethical matters as well as provision of important guidelines (Merry and Mccall 2001, p. 24-7).The two bodies are therefore crucial in maintaining sanity within the nursing profession. The judiciary does not seem to have enough thresholds to undertake many medical cases because they involve some aspects of confidentiality in the public interest (Staunton and Chiarella 2012, p. 5-8). Statute and case law are the legal frameworks that are currently used in UK although some aspects of judicial differences are felt. Case law plays an important role in monitoring ethical standards in nursing such as the issue at hand. The court is always expected to make decisions to the best interest of the patients as well as the medical practice guidelines although it is normally assumed that nurses are competent in their decisions (Rubenfeld and Scheffer 2015, p. 4-6). Breach of ethical standard is always regarded as an act of negligence and malpractice as seen in the case of Arnold and Ahmed. The nurse who administered the medicine was supposed to provide a degree of care as that provided by other nurses. This is a legal obligation that the nurse owed to the patient but she did not meet the required standard (Nursing and Midwifery Council 2007, Web). The patients therefore suffered some injury. Arnold suffered pain while Ahmed slept almost the whole afternoon implying that he suffered an emotional injury. The nurse was obligated to exercise her own skill and competence while handling the two patients, just as it would have been handled by nurses in the similar level. The student nurse had every reason to be concerned because she was involved in a serious legal and ethical violation. Arnold and Ahmed’s concerns were to be addressed immediately because the cases comprised legal and ethical violation as per the Code of Ethics for Registered Nurses (Killion and Dempski 2006, p.53). Guidance for decision making in regard to ethical matters is constituted in the Code of Ethics. The nurse who administered the drug was supposed to be sensitive and make decisions in the best interest of Arnold and Ahmed. In that regard, the nurse was answerable to her act because she was supposed to act in a manner that is in line with her professional responsibilities. She was supposed to protect her own integrity in her dealings with the patients (Merry& Mccall 2001, p. 34-6). It is important to note that drug administration is an important aspect of nursing and therefore, it should be done appropriately. Interestingly, drug administration encompasses several instances of error and some of the common errors include wrong dose, strength and the frequency of medicine. According to NMC guidelines, the nurse who administered the drug is accountable for her actions. She was supposed to apply her professional expertise and judgment but she failed to do so (Thorns2010, p. 282-5). The other nurse who delegated the work to her is not liable because whoever administered the drug should remain accountable for her own actions and omissions regardless of administering the drug as a team or with multidisciplinary team. NMC demands that the nurse was supposed to be aware of the patient care before administering the drug (Nursing and Midwifery Council 2007, Web). In the case, the nurse was supposed to be fully aware of Arnold and Ahmed’s care plans before administering the drugs. Additionally, nurses, as per the NMC, should be aware of the therapeutic use of the medicine that they intend to administer (Pozgar 2013, p. 23-5). The nurse was supposed to have a full understanding of the consequences or even the side effects of the drug before administering it. She was also accountable in understanding the precautions and contra-indications of the drugs before administering the drug to the two patients. However, it seems that she did not take all these important aspects while administering the drug. The nurse ought to have followed the right procedures in administering drugs to the right patient and dose (McBride-Henry and Foureur2005, p. 2). Administering the right dose to the right patient at the right time could have helped in this case. In the case, the nurse administered wrong dose to the wrong client thereby causing ethical issues. The nurse had the responsibility of ensuring that the prescription is clearly written and that in case of any uncertainty, she could have consulted an authorized subscriber. However, in her case, she understands what should be administered. Her problem was not wrong subscription as it applies to the act according to the NMC. The main issue in the case is administering the drug to the wrong patient. NMC demands that a nurse or a prescriber should be able to be sure of the identity of the patient who should recieve the drug (Nursing and Midwifery Council 2007, Web). This is where the challenge is, instead of administering the drug that was meant for Ahmed, she confuses the drugs and gives it to Arnold. The nurse who administered the drug had a duty of care and was therefore both ethically and legally liable for her actions. Arnold and Ahmed had the right of taking the drugs. The six rights of medication administration should be exercised for a successful administration of drugs. The six rights include the right to drug, right dose, right route, right time, right patient and right documentation. The nurse who administered Oramorph had the legal responsibility of knowing the correct dose since no two people are alike and that drug doses must be individualized. She would have been aware that response to drug actions depends on various factors and that administering the correct dose would be the only solution to the patients. She was supposed to be sure of the safe dosage range for the two patients and be sure to administer using standard measuring device. Right patient is among the most important rights to consider as per the NMC guidelines. Nursing and Midwifery Council (2007) posits that being certain about the identity of the patient is deemed crucial before administering the drug. A nurse must be able to check a few issues with the patient just to confirm the identity. The nurse who administered Oramorph to both Arnold and Ahmed could have verbally asked the patients their names and date of birth for identification purposes before administering the drug (Huddleston 2013, p. 34). Also, The nurse could have visually check the patients name bands against the name on the prescription and perhaps avoid using the patient’s bed number or room because that could have misled her. The nurse who administered the drug must know the dire consequences or rather side effects of using Oramorph or any other drug (Thorns 2010, p. 282-5). At least being aware of the consequences could have made her more cautious while administering it. However, it seems that she assumed the consequences or it was just an act of negligence. Oramorph is believed to have the possibility of causing drowsiness or dizziness and that in an overdose, it has serious side effects. In an overdose, a patient may become very sleepy or even experience slow breathing as was the case with Ahmed who was found sleeping the whole of the afternoon. However nurse who administered the Oramorph to Arnold and Ahmed could have taken an immediate action to prevent any potential harm as per NMC’s Section 9, standard 24 that addresses management of adverse events (Nursing and Midwifery Council 2007, Web). She must have not realized the harm or the mistake she did until she was notified by the nurse student. The nurse only looked horrified initially and later admitted that there was no harm done. The best thing, the nurse could have taken an immediate action to remedy the harm especially on Ahmed and record the errors in the patient’s notes and further alert the prescriber (Killion and Dempski 2006, p. 56). The nurse took the issue lightly and even said that there was no harm adding that she would top up the dosage. That was very unprofessional of her considering the time and even the medication guideline. Exercising the right moral action is paramount for palliative care patients like Ahmed. The nurse was ethically responsible to provide the right prescription and the right dosage of Oramorph. Failure to give the right medication would therefore imply that she is morally accountable for her actions (Elliot and Liu 2010, p. 300-303). Ahmed needed a lot of attention and care because he was a palliative patient. However, he ended up receiving the opposite in the hands of the nurse who administered the medication. The nurse should take full responsibility of her actions (Waite 2005, p. 3-6). The nurse should have taken great caution while administering the medication. Risks associated with medication administration are very clear especially for professional nurses. This is unethical situation and one of the ways of dealing with this is being sent to the agency board of disciplinarians to handle the case (Thorns2010, p. 282-5). She should also be reviewed by the bodies such as NMC to confirm the credibility of her qualifications. Moreover, the nurse who administered the medications should be sued by Ahmed and Arnold’s families respectively to pay for the damages. The court will be charged with the responsibility of deciding on whether she was liable or not (Erlen 2001, p. 82-85). The court will determine the level of damage caused as well as the nurse’s competence in relation to her duties. Additionally, the court will assume, in their decision that the nurse is competent and that everything she does should be in the best interest of the patients (Waite 2005, p. 12-9). The court will be serving the public interest in this case. The public interest in this regard involves remedy awarded to the case. However, the court may not be able to have the full potential of making decision since there are specific bodies responsible for such kind of cases. Healthcare laws and ethics are so crucial and must be closely followed by practitioners. Medication errors may have very serious consequences for the patients such as morbidity. Failure to adhere to the NMC standards may also cost the practitioner his or her job. It is therefore a requirement that all nurses observe the rules and regulations governing their profession. This is crucial in avoiding unnecessary mistakes or errors that may lead to death. The case has clearly shown some of the medication errors made by nurses across the globe yet some even go unnoticed. May be, future research should focus on the ways of revealing errors made during medication. It is apparent that the nurse who administered the medication did not follow the guidelines provided by the NMC while administering the medication. Her clients therefore suffered the consequences that were directly caused by her actions. In that regard, the nurse is squarely accountable for her actions. She is therefore, ethically, morally and legally accountable for her actions as a registered nurse. There are a number of actions that can be taken against her for clearly interfering with the patients’ rights. Being a professional, the patients fully depended on her for their treatment, both physically and emotionally or even implied. However, she did not live up to the patients’ trusts and professional code of conduct. References Bhatt, AD 2000, Medication Errors: Malpractice Implications & Prevention,Clininvent, viewed 5 May 2015. Carvalho, S., Reeves, M., and Orford, J 2011, Fundamental aspects of legal, ethical and professional issues in nursing, Huntingdon, Cambridgeshire. Elliot, M., and Liu, Y2010, The nine rights of medication administration: an overview, British Journal of Nursing, vol. 19, no., pp. 300-305, viewed 5 May Erlen, J 2001, Medication Errors: Ethical Implications.OrtopNurs 2001 Jul-Aug; vol. 20, no.4, pp.82-5, viewed 5 May 2015. 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