Ethical and Clinical Practice Issues of Medication Administration - Case Study Example

Ethical and Clinical Practice Issues of Medication Administration Name Institution Ethical and Clinical Practice Issues of Medication Administration Introduction Ethical and legal issues can arise in the situation where a nurse administers medication, after making assessments that a patient does not have the adequate knowledge to make the decision on his own (Hamric, Hanson, Tracy & O'Grady, 2013). Nurses are also required to act within their scope of practice and knowledge in the situations they assume to be emergencies, to sustain or improve the health of a patient (Butts & Rich, 2013). In Australia, there exists a Code of Professional Conduct for Nurses, which sets the minimum standard of the ways in which a professional person should practice, either within or without his or her professional setups, with the purpose of ensuring a good standing of the nursing profession (Nursing & Council, 2012). The Code of Professional Conduct for Nurses in Australia and Code of Ethics for Nurses in Australia, in accompaniment with other published standards of practice, provide a professional and legal guideline for responsible and accountable nursing practice (Nursing & Council, 2012). In this case study, a recently registered nurse and a senior nurse are involved in making legal and ethical decisions to save the life of a patient. The patient who had been receiving morphine through intravenous infusion post-operatively, has been vomiting for a long time and after reporting to the senior nurse (Tim), the recently graduated nurse (John) is instructed to cease the infusion of morphine, and instead give the patient Metoclopramide 10mg intravenously. John refuses to give the patient metoclopramide without a written order, but Tim continues with the action himself and the patient gets an allergic reaction, requiring urgent medical attention. This essay discusses the ethical and clinical issues related to this case due to the actions of the nurses, with respect to the scope of practice, legal aspects and ANMAC standards and competencies. Ethical and Clinical Practice Issues of Medication Administration The first issue in this case study, as a result of the actions of the nurses, is lack of fulfilment of duty of care where a nurse is required to make clarifications with other members of the health care team. While John practiced the duty of care by seeking clarifications with Tim, the senior nurse (Tim), did not practice with accordance to the Australian legislation of health care because he did not consult the doctor who had instructed the administration of morphine, or the specialist handling the patient’s case. Nurses are required to perform their duty of care through clarifying some aspects of care with other members of the health care team (Grealish, 2012). John, after noticing that the patient had been vomiting for some time, did not change the medication because his scope of practice does not allow him to, and therefore, he performed his duty of care well by notifying Tim. Tim, on the other hand, did not perform his duty of care well because he did not seek confirmation from the physician in charge of the patient before changing the patient’s medications. Yanhua and Watson (2011), states that a nurse should obtain supervision and instruction whenever necessary, before implementing nursing practices or procedures. This increases their competency in providing goal oriented nursing care. According to Griffith and Tengnah (2014), there is no clear distinction between an advanced nurse and other nurses. Advanced nurses should, therefore, be in a position to be accountable of their own actions and to act within the limits or boundaries of their practice and competence (Griffith & Tengnah, 2014). In critical care, there exists a medication order chart, which is a written form of documentation that is used to structure interactions between nurses and doctors and among nurses (Jacob, Barnett, Sellick & McKenna, 2013). Nurses and doctors have different levels of knowledge and legal authority. Nurses act as go-between between patients and nurses, and therefore, they are required to share information between patients and their physicians (Schneider, Schneider & Whitehead, 2013). When the patients are in a position to understand the information being offered by the nurses, the nurses should share that information with the patients clearly. In this case, Tim may be subjected to litigation because he did not follow the decisions making protocol in administration of medications. Secondly, the legal issue of negligence is also witnessed in the case. John had witnessed earlier that the patient had been vomiting throughout the previous shift, until when he decided to report the issue in the evening. According to Nursing and Council (2012), code 1.2, that registered nurses should fulfil their duties, by recognizing responsibilities that will prevent harm to the patient. Furthermore, according to Nursing and Council (2012), code 1.3, registered nurses should recognize unsafe or unprofessional practice and respond appropriately to them. The role of a nurse is to promote the health and wellbeing of patients (Yanhua & Watson, 2011). A nurse should be professionally accountable for the decisions they make towards giving care to patients. Furthermore, nurses should use their clinical governance processes, to sustain and improve their standards of health care giving and nursing practice (Hamric, Hanson, Tracy & O'Grady, 2013). While nurses are required to respond confidently and autonomously to uncertain situations, John failed to do so because he watched as the patient vomited throughout the previous shift. He should have responded to the patient’s situation to improve his wellbeing, but his lack of response portrays negligence of his duty of care. According to Hamric, Hanson, Tracy & O'Grady (2013), nurses in Australia are required to act first to make sure the health of the public is safeguarded. They should be accountable for person centred, safe and compassionate nursing care that respects human rights and dignity. In addition, nurses should make ethical decisions on when to act and the right actions required, to maintain and improve the health and wellbeing of their patents (Butts & Rich, 2013). There is the issue of lack of practicing in accordance to the organizational policies and the guidelines for professional standards. Every nurse is required to be knowledgeable of the relevant professional standards and the organizational policies (Nursing & Council, 2012). For example, a nurse should be aware that he or she should not cease or change medication of a patient, without a written order from the doctor in charge of the patient. In this case, John was very strict in following the regulations of nursing profession because he stated that he would only give the patient metoclopramide under written orders. Tim, on the other hand, did not comply with the organizational policies of nursing profession, in Australia, because he administered the anti-emetic without a written order. Consequently, the patient had an allergic reaction. According to Yanhua and Watson (2011), a nurse should assess, report and document the status of the patient. A nurse is also required to report and document the type of nursing care that is rendered completely and correctly. One of the most important things that a nurse should monitor is the response of the patient to the medications administered and reports them before substituting them (Jacob, Barnett, Sellick & McKenna, 2013). Administration of treatments and medications should be followed according to doctor’s orders, and before making an ethical decision of changing them, a nurse should have done satisfactory evaluations of the patients situation to avoid legal issues due to negative responses (Jacob, Barnett, Sellick & McKenna, 2013). Lack of interpersonal skills and excellent communication skills can be witnessed in this case. Nurses must always use effective and respectful communication during their practices (Griffith & Tengnah, 2014). In this case, John lacks effective communication skills because the patient had been vomiting the whole day and he did not communicate the situation to other members of the health care givers, earlier. Tim, on the other hand, failed to make consultations with the doctors in charge, meaning that he lacks appropriate communication skills. Hospitals in Australia have a wide range of communication technologies which nurses can utilize to obtain information before making adjustments, to ensure that the adjustments are reasonable and that they promote the health and wellbeing of the patient (Griffith & Tengnah, 2014). Furthermore, before substituting the medications or making other decisions that may impact the patient, nurses should share information with the patient, who may help in decision making through shedding some light on his values, preferences and other medical conditions (Schneider, Schneider & Whitehead, 2013). In this case, the patient was allergic to metoclopramide and had the nurses shared their decision with him, he could have probably given them information that he was allergic to some components of the metoclopramide medication. This could have avoided an allergic reaction that worsened the state of the patient. This issue could form a basis for litigation that relates to failing to practice the level of care that is reasonable. A litigation relating to negligence may also arise. An ethical issue is witnessed in the case when Tim responds urgently to what he thought of as an emergency, which later caused an allergic reaction. Nurses are faced with various ethical dilemmas during their practice. When functioning in their varied roles, nurses sometimes make ethical decisions that may impact themselves or their patients (Schneider, Schneider & Whitehead, 2013). Nurses are sometimes expected to use their knowledge, without making any consultations, to determine the kind and level of nursing intervention necessary in some situations, and then make the necessary implementations (Jacob, Barnett, Sellick & McKenna, 2013). A nurse may conclude that he or she can manage the health care need of a patient or that a higher level of care is needed and refer the patient to a physician or a midlevel practitioner (Jacob, Barnett, Sellick & McKenna, 2013). In this case, John realized that he could not manage the health care need of the patient within his scope of practice, and therefore, made an ethical decision of reporting the issue to the senior nurse. Tim, on the other hand, determined that he could manage the situation within his scope of practice, and substituted the patient’s medication. Tim may have made this ethical decision with the intention of responding to an emergency, in order to save the life of the patient. His actions made the situation worse for the patient later because he had an allergic reaction. Tim made the decision of responding to what he thought was an emergency, instead of consulting higher level practitioners. Schneider, Schneider and Whitehead (2013), states that nurses play a critical role in emergency preparedness, and they are required to respond effectively during a crisis. A nurse serves as the bridge between a patient and a doctor, and therefore, has to make good decisions during emergency situations. Conclusion In conclusion, this case has various legal, scope of practice and ethical issues. Firstly, a nurse is required to make consultations or clarifications with other members of the health care team and therefore, the issue of lack of fulfilment of duty of care is witnessed. Before changing the medication of the patient from infusion of morphine to administration of metoclopramide intravenously, Tim should have consulted the physician in charge. Secondly, negligence can be witnessed because John witnessed earlier that the patient was vomiting and failed to report. According to Nursing and Council (2012), the first standard of professional practice of ANMAC, is that nurses should consider the legislation related to nursing practice and health care during practice. Tim failed to follow the organizational policy by failing to obtain a written order before substituting medication. There was lack of effective communication skills in the case. John could have reported earlier that the patient was vomiting during the previous shift. Furthermore, there are various ethical issues related to nursing professions. Nurses have to make decisions that may impact them or their patients. Nurses, however, have to make decisions within the set limitations of their scope of practice and the minimum set standards of Code of Professional Conduct for Nurses in Australia and Code of Ethics for Nurses in Australia. When responding to emergency situations, nurses are required to make reasonable decisions that improve the wellbeing of the patient. References Butts, J. B., & Rich, K. L. (2013). Nursing ethics: Across the curriculum and into practice. Jones & Bartlett Publishers. Grealish, L. (2012). How competency standards became the preferred national technology for classifying nursing performance in Australia. Australian Journal of Advanced Nursing, The, 30(2), 20. Griffith, R., & Tengnah, C. (2014). Law and professional issues in nursing. Learning Matters. Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (Eds.). (2013). Advanced practice nursing: An integrative approach. Elsevier Health Sciences. Jacob, E. R., Barnett, A., Sellick, K., & McKenna, L. (2013). Scope of practice for Australian enrolled nurses: Evolution and practice issues. Contemporary nurse, 45(2), 155-163. Nursing, A., & Council, M. (2012). Code of ethics for nurses in Australia. Canberra: ANMC, 2002. Nursing, A., & Council, M. A. (2012). National guidelines for the accreditation of nursing and midwifery programs leading to registration and endorsement in Australia. Nursing, A., & Council, M. A. (2012). Registered Nurse Accreditation Standards. Australian Nursing & Midwifery Accreditation Council, Canberra, Australia. Schneider, Z., Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: Methods and appraisal for evidence-based practice. Elsevier Australia. Yanhua, C., & Watson, R. (2011). A review of clinical competence assessment in nursing. Nurse education today, 31(8), 832-836. Read More