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NURS1006 Decision Making In Nursing On Basis Of Given Case Study Assessment 3 Answer


Write an essay of around 2,500 words (+/-10%) that draws upon Steps 1 — 3 of the decision-making framework (McDonald & Then 2019) to explore and analyse the legal an ethical implications of the case study outlined below. You will be writing from the perspective of yourself as a nursing student. 

Instructions: Refer to the Student arning Centre resource 'writing  an essay' for detailed instructions about how to prepare, structure and write an academic essay. Your essay must have an introduction, body and a conclusion, and it must be referenced using APA style (2010,  6th

it is a good idea to use headings based on Steps 1-3 of the decision-making framework (McDonald & Then, 2019) to help you create a clear and structured argument. However, thi 

is not mandatory as the main focus is ensuring the essay structure and ideas are clear and logical. 

Academic papers are usually written in the third person, however some parts of this essay may require you to write in the first person (i.e. using and 'me') because you are writing from your own perspective as a nursing student. For example, when you are discussing how you would respond to the situation (Step 3). Regardless of whether you are using first o third person, it is expected that you use formal/professional language and writing style. 

Case Study: 

You are a nursing student on clinical placement in an intensive care unit (ICU) where you meet Juliet, a 48-year-old woman diagnosed with colon cancer. Juliet was a university lecturer in biochemistry, and she presented as alert, orientated and intelligent. Juliet understood her diagnosis and agreed to have surgery to remove the tumour and whatever else could be done. Following the surgery, she experienced multiple complications and remained in ICU for several weeks. During that time, Juliet required many surgical procedures and experienced significant pain. One day, Juliet was asked to sign a consent form for revision of her colostomy and removal of scar tissue. Juliet becomes angry, saying she does not want to suffer any me pain or undergo further procedures, but just wants to be left alone. You and the registered nurse taking care of Juliet inform the doctor of her wishes. The zi doctor prescribes se ion for Juliet and plans to come back later to obtain a signed consent form once Juliet has calmed down. 

Apply the decision-making framework (McDonald & Then 2019) to this case study (Steps 1-3 only). 

This case study was adapted from McDonald & Then 2019, p. 112-113. 


NURS1006 Assignment 3: Case Study


The concept of decision making in nursing is commonly referred to as ‘Clinical Judgment' that includes the conclusion making process concerning the patient's health status. This essay will broadly focus on a case study adapted from McDonald & Then 2019 using the Decision Making Framework from steps one to three. The Decision Making Framework primarily includes processes to explore various ethical and legal principles associated with registered nursing practice (McDonald & Then, 2019). The case study is about a 48-year-old woman, Juliet, who is being diagnosed with colon cancer. Following the diagnosis, she faced various medical complications and remained in the Intensive Care Unit (ICU) for several weeks. She was later asked to sign a consent form to remove her scar tissue, to which she denied undergoing further processes. The doctor, thus, prescribed sedation for Juliet and asked me as a registered nurse to obtain her signature with consent when she calms down. Hence, for this purpose, this paper will include three broad parts, Step 1, Step 2, and Step 3. The first step will include discussing the ethical and legal issues associated and the involvement of other individuals with the case scenario. The second step will broadly help evaluate the issue and help in structuring the ethical and legal principles involved (Standing, 2020). Lastly, Step three will echo the necessary action required to be taken in the case scenario, along with the mandatory reporting processes. 

Step 1

What are the ethical/legal issues? 

The ethical and legal issues in nursing practice revolve around the collision of various factors. These include the collection, use, value, and cost of the patients' data and information registered with the institution. It has been found from the case study that Juliet was herself a lecturer in the University for Biochemistry due to which she found familiar with the health issues, and the problem occurred in her journey of diagnosis for colon cancer (McDonald & Then, 2019). She was also found to be experiencing various medical complications. She was supposed to stay back in the ICU for several weeks that made her mental health get disturbed with the scenario. As a staff member of the hospital, it becomes essential to consider every aspect of the patient to offer the patient the best treatment and diagnosis for the health issue and complications (Cherry & Jacob, 2016). In this case, when Juliet agreed to undergo surgery to remove the tumor, she found experiencing various complications that could be possibly avoided with the help of better confrontation and advanced medical science. 

Step 1 involves identifying the ethical issues and legal issues that are perhaps associated with Juliet and me as a registered nurse for the patients. It has been found that there are broadly three types of ethical issues that could be found arousing in the field of nursing care and health care associations. These include ethical violations, ethical dilemmas, and ethical distress (Preshaw et al., 2016). Concerning the ethical violation scenario, it is commonly observed when a wrong decision is taken in a healthcare setting that becomes a serious and severe clinical violation. Similarly, an ethical dilemma is most commonly observed and found between two possible decisions or approaches available during the time of diagnosis and treatment. While one decision is found to be more appropriate for the scenario, the other is not so suitable for the situation in front of the healthcare professionals (Butts & Rich, 2019). Lastly, ethical distress is considered moral distress under which the principles and values are compromised to impose the healthcare professionals' decisions while treating a patient. 

Ethical issues in the case study and who is involved

The main ethical issues that have been found in the given case scenario revolve around the fact that the patient is now getting mentally disturbed with the complications occurring during the diagnosisJuliet has been found getting angry and mentioning that she is no more interested in getting any pain further or undergo any procedures for anything (McDonald & Then, 2019). Ignoring the patient's mental condition, the allotted doctor has been found seeking a consent signature by prescribing sedation for the colostomy and removal of her scar tissues. Her mental condition is found to be disturbed with the circumstances her body has to face. If this situation is not claimed and resolved, the patient might start feeling anxious about getting out of the hospital environment, irrespective of what medical circumstances one has to face (Epstein & Turner, 2015). Thus, the scenario involves the doctorregistered nurse, and Biochemistry patient as a part of the ethical dilemmas occurring during the medical treatment of colon cancer. 

Step 2

Evaluate the issue. What are the ethical/legal principles involved in this case? 

While evaluating the issues associated with getting a consent signature of a patient who is now mentally disturbed with the medical process followed by the healthcare professionals, it becomes essential to consider the ethical and legal principles associated with the case scenario (Salminen et al., 2016). It has been found that for this particular case scenario of Juliet as a patient of colon cancer, identifying some essential ethical/legal principles is mandatory. These include autonomybeneficencenon-maleficence, and professional negligence as the ethical and legal principles to be considered widely in this particular case scenario (Wagner & Dahnke, 2015). Perhaps the non-maleficence and professional negligence fall under the legal principles, but the bifurcation could be neglected based on common principles. 

Ethical Principles: Autonomy 

Autonomy as an ethical principle can be defined as a right to make decisions based on self-will or freewill that would be best for one’s own life. This principle, commonly referred to as Patient Autonomy, usually focuses on understanding the meaningful work-oriented relationship in nursing practices (Cusack, 2019). Concerning the case scenario, it becomes essential to consider Juliet’s autonomy that Juliet thinks would be best suitable for her treatment and life, concerning the complications and pain she is undergoing during the treatment of her colon cancer. It has also been found that Juliet herself is a University professor for Biochemistry and knows the pros and cons of the medical aspirations that the institution and medical staff are taking on behalf of her (McDonald & Then, 2019). It becomes essential to consider this ethical principle more comprehensively to understand what is required in the particular case scenario. In medical science and the healthcare profession, autonomy is most commonly referred to as the patient's right to make informed decisions about their own medical care. This principle is also suggested and underlining the importance of seeking the patient's consent in written format before undergoing the allotted or decided treatment (Beattie et al., 2019). Thus, it could be formally echoed that Juliet has all the right to decide whatever she wants for her medical treatment after facing so many complications and pain for diagnosing her tumor and colon cancer


This principle echoes that healthcare professionals and providers must possess all the required actions to benefit the patient in every situation (Cusack, 2019). Thus, the intention of healthcare professionals must be oriented towards benefiting the patients in the first place. This principle arises from the ethics of beneficence and justice in nursing care, concerning which the patient is required to be treated with quality gestures and perspectives (McDermott et al., 2018). Precisely, the principle of beneficence is considered a moral obligation that revolves around the act for the patients' benefit. It broadly includes some elements that become essential to consider before imposing any medical decision for the treatment and diagnosis of the patients admitted. These include altruismlovehumanity, and promoting goodwill for others (the patients) (Taylor, Mndolo & Baker, 2017). It has been found from the case study that Juliet is angry because she thinks the healthcare professional and me, as a nurse, are not caring about the pain that she is undergoing during the treatment. It becomes essential to communicate well before imposing any decision for the patient's medical treatment to make them realize that the healthcare team cares about all the aspects and complications that the patient is going through (McDermott et al., 2018). In this case scenario, it becomes essential to consider the mental treatment in the first place so that Juliet becomes familiar with the perception that the healthcare professionals would minimize the potential harm that might cause her pain (McDonald & Then, 2019). For this purpose, it becomes my moral duty to communicate and educate Juliet well enough to clearly develop a vision of getting minimum pain during the removal of her scar tissues. 

Legal Principles: Non-maleficence

Non-maleficence is considered a principle that echoes a treatment with no-harming or says the least harm possible to reach a beneficial outcome and treatment. Breaching the nursing research ethics, guidance, and application in practice with legal constraints might make the institution or organization fall into complexities. In this case, patients' treatment and lives matter the most (Doody & Noonan, 2016). In the case study, the only issue that Juliet is facing is that the healthcare professionals undertake several processes and procedures to diagnose the treatment of her colon care (McDonald & Then, 2019). These processes and procedures are causing her pain and harm to her mental health as well. The principle of non-maleficence also states that nurses must not harm the patients intentionally (Jafari et al., 2019). While reviewing her case scenario, it has been found that irrespective of her autonomy, the doctor has prescribed sedation to calm enough to get her consent signature on the form, which is not legally correct. To support the motion, the Mental Health Act of 2016 aims to legitimize mental healthcare and mental illness of patients undergoing treatment for several weeks (Gajwani et al., 2016). As a registered nurse, it becomes essential to avoid all such cases where the legal complications might arise due to the ignorance of autonomy and non-maleficence. Thus, this legal principle has to be considered before intervening what the doctor has prescribed to be me. 

Professional Negligence 

As per NMBA (Nursing and Midwifery Board – August 2008), every registered nurse in the Australian demographic location has a duty of care outlined under the country's legal obligations (Medway, Sweet & Muller, 2020). We all are supposed to possess nursing practice by establishing quality care for our patients and keeping in mind the law of the country's medical sector (Johnstone, 2015). Concerning this motion, professional negligence might result when a healthcare professional fails to justify the quality care for their patients that negatively impacts the patients. It has been found in the case study that when the Biochemistry lecturer, Juliet, was admitted to the hospital for the diagnosis of her cancer, she believed that the procedures would be less painful as she trusted the advanced science and experience of the medical staff in the hospital (McDonald & Then, 2019). In contrast, she denied undergoing any diagnosis any further after a point where the medical staff was seeking her written consent to remove the scar tissues. According to the Civil Liability Act of 2003, breaching the medical practice and standards would develop various complexities for the medical staff (Carver, 2015). Thus, the doctor's decision to prescribe sedation for Juliet without her consent might result in developing various legal complexities for the health care organization that is preventable with the mode of right communication and education. Thus, the nurses and staff in this case study could be answerable to vicarious liability for negligence if harm occurred due to the prolonged restraints they have placed on Juliet. 

Step 3

What action should be taken?

Referring to the case study, it is found that the main issue to be resolved is to ask for the consent of Juliet for further treatments, which comprises legal principles. However, she is fed up with the enormous pain due to which various surgical procedures are at stake. Thus, firstly, the registered nurse and I for Juliet would help her calm down, considering all the painful parameters. Once she is calmed down, we will encourage her to open up and have a conversation with the doctor to remove all her confusion regarding her informal decision. Further, as a healthcare professional, it becomes essential to assess the patient-teaching and paternalism concepts to the admitted patients (Kilbride & Joffe, 2018). Hence, after clearing all her doubts, another action will be taken that will ask her to sign the informed consent form because ethically, consent represents a patient’s autonomy. As seen in the above sections, ethical and legal principles are the patient's right to choose in between, and thus, the consent can also be withdrawn at any time (Martinez et al., 2015). After this, Juliet will have to comprehend her decision whether she wants to sign the consent or not. Hence she will take full responsibility for her own action. The choice made by both the healthcare professionals and Juliet will be comprehended according to the principles of ethics, and the patient, in this case, will need to provide the hospital with a significant justification of her choice.

Mandatory reporting

While executing the informed consent, the registered nurses need to understand the patient's autonomy and report the risks associated with the patient’s health status. Nurses can efficiently execute this action as they are empowered to know ethical and legal principles connected to informed consent (Butts & Rich, 2019). The nurse understands the concept of paternalism and autonomy that helps them report all the potential and associated risks of the surgeries undergoing in the healthcare institution (Einboden, Rudge & Varcoe, 2019). The issues that I found are mandatory to report are concerned with the patient's consent, state of mind, behavior towards the surgical procedures, the nursing environment, and the procedures included before and after the surgery. The patient's mood can be connected to the visits during the surgical procedures and the number of tests performed on him/her. The issues that lead to restrain the patient's behavior or state of mind might also be connected to the pre-operative assessments and post-operative care (Moraes et al., 2016). Therefore, it is important to study the changes associated with Juliet and put them into action. It might make her feel more vulnerable and comprehensively increase the chances of potential risks during surgery; hence, they are also required to be necessarily reported to the healthcare professionals.

Colon Cancer Care 

While taking care of colon cancer patients, the most important aspect that a nurse needs to keep in mind is to provide them with information about their condition. Concerning the case study, the patient's state of mind plays a crucial role during diagnosis and surgery. As a registered nurse, it becomes essential to have insights into the patient’s psychosocial needs and refer them to a concerned doctor if they are found with distress (Blakely et al., 2015). Another action that could be included in this scenario is improving the communication factor between Juliet and the healthcare professionals around her. During such serious diseases, it becomes difficult to let the patient interact with her family due to which various norms fall into places (Lawrence et al., 2016). Hence, for the betterment of Juliet's health and mental condition, the last action that would be oriented towards her colon cancer care is developing a Communication Bridge between herself and me as the registered nurse. 


To conclude, the study has significantly found inclining towards accumulating the shreds of evidence from the case study to justify the decision-making profess framework suggested by McDonald's and Then in 2019. It has been justified that the various stages or steps of the decision-making framework have supported colon cancer intervention. The case study involved a medical journey of Juliet, who was undergoing a diagnosis for her cancer issues. Thus, concentrating on this segment, the essay has echoed the legal and ethical issues in step 1, legal and ethical principles in step 2, and required action to be taken in step 3. The paper has also investigated the orientation of various Acts that supported the notion of quality healthcare services. Lastly, various other portions have also been discussed that including evaluating the issue, legal complexities, and mandatory reporting with quality colon cancer care. 

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