Legal and Ethical Issues in a Clinical Setting - Case Study Example

Legal and Ethical Issues in a Clinical Setting Name Institution Legal and Ethical Issues in a Clinical Setting Background This is case of Kieran Darragh, a 17 years old male who died after suffering from complications related to tonsilsin, a mysterious circumstance. The deceased had a history of suffering from tonsillis before, where he started feeling unwell on Monday 25 August 2008 but reported to work anyway. On visiting the doctor a day later, the doctor recommended him to use antibiotics in form of cephalexin where the deceased used panadeine forte. His condition deteriorated on 27 August, two days after, as he started feeling sleepy than usual and his voice changed as recorded by his mother. His family rushed him to the hospital, where he waited for 5 hours 15 minutes before a doctor attended to him despite being received as an emergency case. A nurse confirmed the presence of two large tonsillis with pus and reported to the doctor who was not around through a telephone call. The doctor telephoned that the deceased should be given morphine and panadol, which commenced at 5.45 pm. The patient complained of itchy face, a possible side effect of overdosing morphine. According to the records provided by nurses, the oxygen saturation and high respiration rate were abnormally high. The patient was found dead later with a body coldness that hinted that he had pass away at least 20 minutes earlier. Central Idea Evidently, the way the diseased was received and handled raises many questions. Firstly, the case was an emergency yet the deceased had to wait for 5 hours and 15 minutes to be attended to by a doctor. Secondly, the measurements taken by the nurses were not only alarming but also inadequate. Apparently, the sickness was not serious enough to cause the death of the patient but the way the deceased was handled was the sole reason behind his demise. By using this case as an example, this paper aims at addressing the causes of death due to human errors. The paper will assess the mistakes that were done by the health care providers leading to the death of the patient. Role of Nurses Acute tonsillitis is a sudden inflammation of the tonsils located at the back of the throat, a condition that can be examined through a physical exam (Brook, 2007). Tonsils may block the passage of air leading to breathing difficulties in patients. Although tonsils may not lead to the death of the patient, difficulty in breathing may lead to the lack of oxygen in the patient’s blood system and accumulation of carbon dioxide leading to death (Brook, 2007). The observation made on the oxygen concentration was to check whether the problem was interfering with the breathing process of the diseased. In this case, a low oxygen level of 88% was recorded, an indication that the patient was not breathing properly. Therefore, there was a need for the nurses to provide oxygen for the patient until the condition of the diseased stabilized (Brook, 2007). Nurses are supposed to handle emergency cases with high level of professionalism, efficiency, and a lot of care to ensure that the condition of the patient is stabilized (Finkelman & Kenner, 2010). Additionally, the wait time for emergency cases should be kept as minimum as possible to ensure that the life of the patient is saved. In the emergency department, the nurses are tasked with the determination of the severity of each case to determine, which patient should be attended first (Holland & Roberts, 2013). Additionally, nurses are tasked with the duty of observing the condition of the patients, providing the latest observation to the doctor and following doctor’s instructions on what they should do next (Huston, 2013). Therefore, nurses are supposed to make important decisions by considering the policies of the healthcare facility, the protocols to be followed and procedures that would guide their actions (Finkelman & Kenner, 2010). Documenting the condition of the patient and all the conversations on the patient should be clearly documented for future retrieval (Iyer, Levin, & Shea, 2006). Nurses have the duty of documenting all the information concerning the patient from arrival to the time the patient is discharged. All the measurements taken, patient’s responses, tests conducted, and medication provided should be recorded to provide an easy follow up of the patient. The nurses should communicate all the responses from the patient and reaction to treatment should be communicated back to the doctor to assist the doctor make well informed inferences on the treatment to be taken. This will assist the nurse in the next shift to continue from where the outgoing nurse stopped. Such records provide for the continuation of treatment and management of the patient’s condition leading to recovery (Nagelkerk & Huber, 2005). The records are usually important in solving complains, where the nurses and the hospital will use the documents to determine the truth. Reflection on the Case Professionalism This case provides a good learning experience on the need of professionalism in the nursing career. Apparently, the nurses failed to deal with the case in a professional manner as the planning for handling the patient was not enough (Finkelman & Kenner, 2010). The nurses failed to involve a doctor once they observed serious conditions of the deceased such as low oxygen and high reparation rates. In addition, there was a communication breakdown among the nurses as they failed to coordinate well. When asked whether she communicated with her seniors about the condition of the deceased, nurse Featon claimed that she communicated with one of them but did not record the conversation. Additionally, she was not in a position to mention a particular nurse she communicated with, as she did not recorded the conversation as required in the nursing profession. Failing to record all the details on the deceased were not only unprofessional but also gross misconduct as far as nursing is concerned (Stainton et al., 2011). Therefore, the inconsistency and unconvincing account of the nurse showed that the nurses were working in an unprofessional manner. Legal Aspect of the Case After assessing the circumstances surrounding the death of the deceased, it is clear that the patient died due to negligence of the nurses on duty. The records provided on the account can be used as hard evidence against the nurse on duty. The nurses tasked with nursing him failed to perform their duties well. By failing to record all the information about the deceased, the evidence can be used to sue the nurse on duty, where she may end up being losing her job or serve a jail term (Wheeler, 2012). Additionally, failing to inform the doctor about the high rate of respiration and low oxygen concentration contributed were gross mistakes that can incriminate the nurse taking care of the deceased. On the other hand, the family of the deceased has a ground to sue the hospital for failing to offer emergency services on time. The wait time before being attended by a doctor, the lack of a resident doctor, and offering medication through telephone calls are enough reasons to justify compensation through the court (Westrick & Dempski, 2009). Ethical Issues Nursing as a profession is driven by high standards of ethics since the career deals with people’s wellbeing (Diane & Fowler, 2008). The response the registered nurse gave when she reported on the condition of the deceased was not recorded. Therefore, there is a likelihood that the nurse did not report the case after all, which can be interpreted as carelessness. These mistakes are unethical as far as nursing is concerned. It is also very clear that the nurse was not close to the patient since she had only nine patients under her care, an indication of uncaring attitude. Recommendation Permanent Doctor The hospital needs a doctor to provide the services in person rather than through telephone calls. One of the reasons for the death of the deceased was the fact that the nurses had to rely on the services of a doctor who was away. For example, the deceased reacted to the medication offered, where the medication was ceased after the patient complained of itching on his face. Therefore, presence of a doctor at any moment of day and night will assist in saving many lives, as the doctor will be part of the assessment. Communication There is a need for the healthcare providers, especially nurses to communicate all the important information on the condition of their patients (Otong, 2007). There is a need for the nurses to work in a professional manner and avoid any informal communication. Additionally, recording every activity as required will be used in solving similar issues, as patients are not always guaranteed recovery. Therefore, proper recording will assist the nurses in future case, as it will provide consistence and convincing account on their efforts to save life (Iyer, Levin, & Shea, 2006). This will assist them to convince family and friends of patients who pass away while under their care. Wait time There is a need for the hospital to reduce its wait time before a doctor attends to a patient (Nagelkerk & Huber, 2005). Evidently, a doctor attended to the deceased after five hours yet the patient was brought in as an emergency case. The nurses realized about the death of the deceased much later when the body was already cold, an indication that he died more than 20 minutes earlier. Therefore, the nurses should ensure that they attend to the patient timely to detect any problems on time and make the necessary emergency efforts to save the life of the patient. Conclusion Nursing is a unique career that requires high level of professionalism since any loss or mistake has everything to do with the patients’ life. As seen in the case, professionalism, ethics and legal consideration are important in guiding the nursing career. The death of the patient was avoidable as the misconduct of the nurses contributed greatly to the death of the patient because they failed in performing their duties as required. Therefore, the case provides a wonderful learning experience for aspiring nurses to avoid such mistakes that may cause the death of a patient. References Brook, I. (2007). Anaerobic Infections: Diagnosis and Management. New York, NY: Informer Healthcare USA. Diane, M., &Fowler, M. (2008).Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association. Finkelman, A., & Kenner, C. (2010). Professional nursing concepts: Competencies for quality leadership.Sudbury, Mass.: Jones and Bartlett. Holland, K. & Roberts, D. (2013). Nursing: Decision making skills for practice. Oxford: Oxford University Press. Huston, C. (2013). Professional issues in nursing: Challenges and opportunities (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Iyer, P., Levin, B., & Shea, M. (2006). Medical legal aspects of medical records.Tucson, AZ: Lawyers & Judges Pub. Nagelkerk, J., & Huber, D. (2005). Study guide for Leadership and nursing care management, (3rded.). St. Louis: Saunders Elsevier. Otong, D. (2007). Nurse-client communication: A life span approach.Sudbury, Mass.: Jones and Bartlett. Stainton, K., Hughson, J., Funnell, R., Koutoukidis, G., & Lawrence, K. (2011). Tabbner's Nursing Care Theory and Practice. (5th Ed.). London: Elsevier Health Sciences APAC. Westrick, S.J, & Dempski, K.M. (2009). Essentials of nursing law and ethics.Sudbury, Mass.: Jones and Bartlett. Wheeler, H. (2012). Law, ethics, and professional issues for nursing: A reflective and portfolio-building approach. Abingdon, Oxon: Routledge. Read More