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Essay on Ethical and Legal Issues in Nursing Assessment Answer

    Title of assignment

    An Essay on Ethical and Legal issues in nursing

    Instructions to Write the Essay

    An essay to be written on Ethical and Legal issues in nursing based on the case study given below.  This assessment has a weighting of 40%.

    You need to consider:

    • The legal and ethical concerns that the situation in the scenario raises.
    • The possible actions or inactions that could be taken and the implications of those actions.
    • You do not need to provide the ‘right’ answers, what you will be assessed on is your ability to determine the implications of different actions or inactions from a legal and ethical perspective. Firstly, think of the possible courses of action (or inaction) that could be taken and then consider, do any ethical theories support (or not) the actions that you discuss?
    • Which ethical principles, doctrines or concepts apply to the actions/inactions put forward and if so, how?
    • Do any of the ethical principles conflict with each other or with the law?
    • Which torts or other legal concerns apply to your suggested actions/inactions?

    Consider the Code of Conduct, Code of Ethics and RN Standards of Practice (2016), how do they apply to this situation?

    Scenario:

    On 18th January 2020, Nicole Mary Smith (pseudonym) was admitted to the Emergency department of a private hospital with the chief complaints of abdominal pain, poor appetite, and urinary symptoms. Upon review by the Emergency physician, she was admitted to the surgical ward for further investigations and symptom management. The patient is an 86-year old woman, who lives in an assisted living facility. Her daughter and her grandson live in a nearby suburb and often visit her. During the preceding two weeks, Nicole’s condition has drastically deteriorated. Her daughter appears to be anxious and has narrated her struggle to manage the visits to the hospital and her work and family responsibilities. The visiting Oncologist has refereed Nicole to the palliative care team after the initial diagnosis of metastatic ovarian cancer.

    You are the registered nurse looking after Nicole. You entered the room to administer pain relief, the patient’s daughter approaches you and says, “Why do you keep bothering us, do not give her any injections; she is going to die anyway”. She goes on, “I just cannot wait for all of this to be over; I have my own family to look after”. You realize her concerns and try to reassure her. However, you been new to palliative care and are finding the situation challenging.

    Write an academic essay on Ethical and legal issues in nursing, specific to the given scenario. Provide supporting evidence to your claims and include recommendations to improve future practice.

    General instructions for the assessment

    • The essay word limit is 2000 (plus or minus 10%). All words are calculated towards the word limit except for the cover page, title page, direct quotes, and end-text references. If you write less or more than this, penalties will apply.
    • The essay must be presented in accordance with this assessment Guidelines. Students can submit their written paper to Turnitin through Canvas at any time during the course but no later than the assessment submission deadline. Keep your Turnitin receipt as evidence of submission.
    • The essay will be written in academic essay format with an introduction, body and conclusion.
    • Students required to use the APA referencing system and select seven to ten refereed articles that provide the strongest evidence for your topic.
    • All articles must be ≤ 7 years old.
    • If student wish to apply for an extension, they can apply two days prior to the due date in writing, using the correct IHM form for requesting extensions, stating the grounds for the extension request and any evidence to support the extension (e.g. medical certificate).

    Assessment brief

    The essay should be structured under the same headings as the marking rubric, please consider both documents carefully as you construct your essay.

    Structure

    Here you will be assessed on your ability to form a logical piece of work that contains an introduction, which should inform the reader of the main content of the essay. The main body of the essay should contain a logical and cohesive development of ideas and your ability to sustain logical arguments.

    Application of critical thinking

    You will be assessed on your ability to consider the implications of the suggested actions/inactions and the application of theory to practice. You will also be assessed on your ability to support the arguments you put forward with evidence from appropriate literature.

    English language proficiency (ELP)

    As with all written assessment work that you undertake at IHM, you will be assessed for ELP within this assessment. You should make every effort to ensure that you pay close attention to the construction of sentences, ensuring spelling, grammar and syntax are correct. Poor writing will detract from the content of the essay. If you are unable to articulate the true meaning you are trying to portray you may lose valuable marks. If you are at all concerned about your written work, please see your lecturer.

    Writing based on evidence

    Assessment is designed to test your ability to synthesise evidence into an original piece of work.

    Referencing

    Students are expected to learn and apply the conventions of each document type and to learn and apply the current APA system of referencing and formatting (currently APA version 6). All writing must be based on the best possible evidence, with sources cited in accordance with the APA system. A requirement of all assessment in this course is that you cite references in the APA style.

    Formatting

    All written assignments must be formatted in APA style. According to the APA style manual this means that your assignment must have:

    • Font: Times New Roman, 12 point.
    • Page margins: One inch (2.54cm) from top, bottom, left and right side of each page.
    • Body text line spacing: Double-spaced.
    • Paragraph indentation: Indent the first line of each paragraph by one-half inch from the left margin. (Use your word processor’s Help feature for instructions on formatting paragraph indentation.)
    • All text is left-justified, with an unjustified (ragged) right margin.
    • Do not hyphenate words at the ends of lines.
    • Use a running head throughout the paper. (If possible, use your word processor’s Header function to place it automatically on every page.) The header should appear one-half inch below the top of the page, flush left, in all capital letters; it is a shortened version of the paper’s title (up to 50 characters, including spaces). The page number appears in the upper right corner.
    • Student number and date of submission included in footer.
    • Reference lists have single line spacing with a line break between entries. Each entry has a hanging indent. The font used in reference lists is size 12 times new roman, with italics for book and journal titles in accordance with the APA system. 

    General presentation of essay

    For full details, please refer to the APA guide. This checklist is a quick way to ensure that the essentials have been implemented.

    The paper should be set out in the following order: 
    • Title page (cover page);
    • Main text of the paper;
    • References list (with hanging indents, single line spaced, one line break between entries); 
    • Appendices (if applicable); 
    Font: Times New Roman size 12
    Margins should one inch (2.54cm) from top, bottom, left and right side of each page. (slight variations on this will not be problematic)
    Double line spacing throughout the paper.
    The reference page: single spaced
    If headings are used, they must be consistent throughout the paper according to the American Psychological Association (APA) heading.
    All pages numbered (numbers in the top right) from the start of the paper
    Student number and date of submission included in a header or footer.
    All statements that are not common knowledge or opinion based on evidence in accordance with ‘when to cite’ table
    All citations in accordance with the APA system.
    The paper has a clear structure in accordance with the conventions of academic writing, with APA headings used to aid navigability
    The language used is appropriate to the document type, subject matter and context
    Content is relevant to and conforms with assessment instructions
    Self-evaluation performed with reference to rubric

     Title page

    Your assignment should have a title page formatted like below;

    The abbreviated title for the running head continues on each subsequent page, but the words ‘Running head:’ appear before it only on the cover page. Anything within <angle brackets> is to be removed, including the bracket, and replaced with the student’s own content.

    You can download an editable template of this title page, combined with some planning of the structure to get you started, by clicking this icon: 

    Title Page Checklist

    Title page information should include student name,
     
    ID number,
    Unit code and title,
    Title of assignment (descriptive of content),
    Name of Unit Chair or Lecturer,
    Due date,
    Extension date (if applicable), and
    Word count. (The word count does not include headings, title page, references page, reference citations and direct quotes. Penalties apply if >10% over or under the word limit).


    Answer

    Essay on Ethical and Legal Issues in Nursing

    INTRODUCTION

    Nurses are facing ethical dilemmas in their day today clinical practice and here are certain situations where the right answers are not clear. This becomes even more evident when nurses are caring for end of life or palliative treatment. During the end of life care especially in cancers, patient and family experience a varied emotionranging from grief, anger, frustrationto fear of loss. In such conditions,nurses playrole of mediator, caregiver and medicinal help. This decision between the ethics and legal is a challenging task. Nurses often face ethical and legal dilemma during their work schedule.Atthe end of life care, nurses may feel dilemmasarising from situations such as patient autonomy, non- beneficial care, symptom management and communication barriers. A nurse in such cases should always navigates in between the ethical concerns and legal consideration which could provide the patient with the best of the care opportunities through dignity. The objective of this paper is to evaluate the ethical and legal principle that could arise while caring for a cancer patient in the palliative care unit.  The paper also analyses the possible action results fromaccount of palliative care,the given situation and how it is justifiable through code on conduct and code of ethics. 

    Ethical principles and legal considerations in palliative care

    Palliative care is a team approach which identifies the need of the patient and its family. The whole scenario of palliative care especially in cancer cases depends on initiating and maintaining the dedication of the team. The nature of the nurse-patient relationship is the centre key concept of any ethical framework in nursing (Velan et al 2019). The ethical principles that should be addressed depending on the bond of true kindness and effective communication.Ethical implications and legal foundation are closely related in respect to such cases where the end of life decisions and palliative treatments are to be considered. As the ethical principle deals with the of the nurses are used all the judgements and morals including the license, practising act and the standard of care (Agarwal & Epstein, 2018). In Australia, the legal consideration in nursing practices should abide by consent to medical treatment and palliative Care Act 1995, Criminal Code Section 282A and section 259, medical treatment health director act 2006 and the power of attorney act 2006, RN standard of practice 2016

    Clinical Integrity

    The above scenario shows us that the daughter of the patient does not believe in the continuation of the treatment which she thinks is undesirable as the patient is commencing toward her death. However, this demand of the family member does not go with the nursing ethics of clinical integrity. The ethical issue of clinical integrity believes in providing medicinal or surgical intervention to end care patient in palliative care so that the total wellbeing of the patient can be accounted for. This imposes that the healthcare intervention provided by the nurses should not be unethical and non-beneficial to an individual. In the above scenario, the biggest ethical issue that comes on the way is demand of the family member regarding the decision and choices which could lead to inadequate collaboration or poor communication among the health care professionals and the family member/patient.This may affect the care planning all though in palliative care the terminal conditions the treatment could not be as effectivealthough the death has not been imminent.

    Autonomy

    Usually, in palliative care and medicine family have various beliefs or may not support the disclosure of information to the patient on the same plane as the healthcare providers. But the main principle of ethical conduct states that patient should have adequate knowledge and information about the condition he is suffering from (Kassim et al, 2020). The full-fledged information allows significant decision making regarding the choice of treatment. Although in the above-stated case scenario the daughter does not want the continuation of the treatment and thinks that her mother is going to die anyway but counselling regarding taking care for her and complete detailed information should be given respect for her autonomy should be considered. As per the palliative care amendment Bill the administration of treatment in the case of cancers which includes palliative care should be governed by an advised legal foundation (Suva e al, 2019). The emphasis of the AME Queensland was on with the basic principle of respect to autonomy in a terminally ill patient by healthcare professionals when it comes to refusal and acceptance of medical treatments. Ethical and legal issues in palliative units play a significant role especially in diseases like cancer where the patient is slowly moving towards death (Edwards, 2016).

    Beneficence

    This is defined as the principal of doing good deeds to the patient. It is described as the interventional applications that are done by the nurses or physician for the benefit of the patient. This serves as the protection of the right of health services and consumer act. The health care provider should be aware of implications of his actions and should treat the patient accordingly(Hui & Bruera,2016).In case description we can see that the daughter of Nicole Mary Smith does not want her mother to take injections andinsisted to stop the injections. Although her daughter has her own commitments healthcare professionals including the nurse should motivate the family and introduced her to the benefit of therapeutic procedure and harmful effect concealing information from patient further.This would include not administering medication without informing or consent of the patient although her daughter is appealing for it.

    Non-maleficence

    The principal is used in the home or palliative care system at the hospital l(Wilson et al, 2019). Nurses should exercise on the involvement of risk in the prescribed intervention or whatever he or she is doing. This ethical principle advice nurses to refrain from any intention or activity of the wrongful act. If there is any dilemma which appears professionally like in the above scenario where a nurse has been asked to consciously stopsthe medication for the patient it is always advisable to seek help from the regulatory body or counselling which can guide towards the legal and ethical rightful path (Banner et al, 2019).

    Informed consent

    Consent issues arise as the patient in the critical care unit or palliative care are unable to decide their clinical setting or progression of treatment.  The principle of informed consent is based on the doctrine of autonomy. That a person should be completely aware and let to decide on his or her treatment acceptance or rejection. The ability of a patient to process and understand the information to make informed decisions is a key component of palliative care. As the scenario in Marry shemay notbe ableto decidedue to sedative condition, consent should be collected from legal member responsiblehowever if not satisfactory which is in the case, legal counsel should be consulted (De Lima et la, 2014).

    Failure to provide adequate pain relief 

    In legal consideration, reasonable pain care management and failure for providing adequate pain treatment in context to the patient is considered as medical negligence. A case from South Australia Supreme Court in 1980 decided a penalty on healthcare provider due to unreasonable failure to take in adequate pain history.Hence nursing caring for cancer patient who are in the end of the stages professional, ethical obligations should be followed as per the state guidelines that define the true professional standards. Absence of any directive principle makes the end of life decision making difficult for families of patients who are no longer to speak for themselves. In the above case scenario also, we can see that patient is not able to decide for herself hence her family should be involved in life-related shared decision-making.

    Withdrawal of medicinal interventions/Surrogate decision

    One of the basic concerns regarding ethical and legal issues while caring for cancer patients is regarding the withdrawal of medicinal intervention. Although the family of the patient is pushing for stoppage of medical intervention it has its own legal as well as ethical obligations (Schiller et al, 2019).The rational decision of withholding or withdrawing the medication should be monitory,based on burdens and benefits on the health of the patient however patients and their families decide to stop medication or interventions.Although, this is governed by family member or the caregiver, consideration should always be givento difference between continuity of treatment versus allowing the patient to die(Campbell& Black, 2014).

    The doctrine of Double effect

    During the final stages of life in palliative care, few concerns arise regarding the administration of palliative medication in the case. In such a situation. The doctrine of double effect comes into the rule. This addresses the issue of medication given by the healthcare professionals to relieve the pain and symptom of the patient which is lawful however it could speed the deterioration of conditionor commencement of death.this doctrine employees when a person is near his death. In South Australia it is only applicable to the terminal phase of terminal illnesses. Australia has confirmed the doctrine of double effect as part of its law. Many other countries like the United Kingdom United States New Zealand and Canada have also realised it as part of their legislation (Emanuel et al, 2016).

    Torts

    Application of double effect or withdrawal of medical intervention may raise legal concern or torts related to malpractice or negligence. In such scenarios the caregiver or family of the patient goes through a variety of emotions. This could push the nurse to take decisions based on judgement and observation which could go against ethical and legal implications. In Australia, it is the legal right of every citizen to have factual information about their current medical situation because of this law full entitlement all the health care professionals who are delivering the palliative care, as well as the family members of the patient, are part of a legal and ethical decision making. In the such cases the family of the patient wishes to hide the information from the patient which is not unusual. However, it is not fair, legal as well as ethical from the health care practitioners’ side to lie to the patient in the guarding the current situation and should inform her about her forthcomingtreatment (Myers, 2015).                        

    Malpractice

    Malpractice by the state law is defined as the act of omission or commission toward the patient that does not fulfil the standards of care or could be intended to cause injury. As per the code of ethics and RN standard of practice, Nursesmust provide every aspect of nursing care as per the established standards of care, which is competent and safewhich is done in a timely scheduled manner (Price et al, 2019).

    The key components of malpractice as per the law include causation of harm, damages to the patient, a duty that was owed was breached, or this breach of duty may cause director indirect harm to the patient.

    Negligence

    Negligence is another act that provides insight when a health care professional fails to meet established standards of care. It is different from malpractice as it lacks elements of malpractice which are essential to be considered malpractice (Pesut et al, 2019). Any actions of care or medication intervention omission in the above case can be considered as the negligence.

    CONCLUSION

    In a clinical practice nurses come across various complex situations that requires rational analysis, critical thinking and decision making. Every healthcare professional has their own considerations, some may consider this situation worse than death, but whatever decision is taken by professionals should be guided under the foundation of ethical and legal code of conduct. As per Australian law it is not acceptable to administer medication or stop any medication without consent. This case has provided an in-depth analysis and understanding on how a nurse should practice under the legal and ethical guidelines. Hence it become clear that whatever the situation it is a nurse should never pass through the legal boundaries. This case also provided information about the significant issues that could be faced by a nurse in palliative care and how affectively these types of dilemmas could be handled.

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