Law And Ethics Nursing Assignment Assessment Answer

Nurses face many challenges on a daily basis in their operations.  Not only do nurses provide the best possible care to their patients, but have to do so staying well within their ethical boundaries.  Understanding these boundaries can become complex in certain situations.  It is therefore an imperative for the nurses to have a sound knowledge in the ethical principles and code of ethics for nurses practiced in Australia. This is important, as this knowledge of ethical principles and code of ethics is used as an effective tool in decision making and clinical reasoning.  This academic essay will briefly discuss the ethical theories and how it relates to the ethical principles which help form the code of ethics of nurses in Australia.  This will be followed by the analysis of a complex case scenario of two patients regarding physical restraint and how ethical principles and code of ethics for nurses in Australia are applied to decision making.  This paper will also discuss different strategies that if used, would calm both patients without using physical restraint.

The evolution of ethical principles is influenced by the ethical theories and philosophies dated back to the ancient Greek medieval times (Ozolins, & Grainger, 2015).  Some examples of these ethical theories are Utilitarianism, deontology, and virtue ethics (Ozolins, & Grainger).  Utilitarianism is a consequential theory that states that merit of one’s actions can only be determined by its consequence (Ozolins, & Grainger, 2015).  Deontology distinguishes right from wrong by following the correct rules, and the virtue ethical theory describes that by practicing being good, honest and brave, a person develops good moral character (Ozolins, & Grainger, 2015).  Based on these definitions, ethics can be viewed as a discipline which determines right or wrong in behaviour from how one behaves (Ozolins, & Grainger, 2015). These ethical perspectives have given rise to ethical practice that form the ethical principalism.  The most common ethical principles used in health care are those of autonomy, non-maleficence, beneficence and justice (Johnstone, 2016).

Autonomy refers to the ability of a person to make decisions according to their personal value, thus in the nursing practice, one should respect the rights of patients and individuals (Ye, Xiao, Yu, Wei, Wang, & Luo, 2018). Non-maleficence discusses that one should avoid causing harm towards others (Ye et al, 2018). Justice refers to benefits and risks which should be fairly distributed to all people, and beneficence defines that one should take steps to help others (Ye et al, 2018).  These ethical theories form the ground on which the code of ethics of Australia are based and practiced.  This code of ethics form part of a normative framework which establishes standards by prescribing the rules of conduct which the nurses are expected to follow (Johnstone, 2016).

Referring to the case study regarding Mrs. Stock and Mr. Bogg who had impaired decision-making ability, three principles will be discussed.  Autonomy, beneficence and in Mrs. Stock’s case non-maleficence.

The first principle autonomy states that one should respect the rights of an individual to make their own decisions about their health care (Ye et al, 2018).  In this case both Mrs. Stock and Mr. Bogg could not be allowed to give informed consent in regard to their care. It is clear that both the patients did not have a clear state of mind to understand the risk and benefits of the interventions  of restraint and therefore the clinical partners failed by acting on the situation without gaining informed consent and breaching both the patients’ autonomy (Ye et al, 2018).  This can cause an ethical dilemma unless the clinical partners can explain the reasons behind their actions (Ye et al, 2018).

Both situations relate to the value statements displayed in the Nursing and Midwifery Board of Australia (NMBA) Code of Ethics for nurses.  Value statement two (VS2) states ‘Nurses value and demonstrate respect and kindness for self and others’ (The code of ethics for nurses in Australia [VS2], 2008).  Value statement five (VS5.2), states‘Nurses value the legal and moral right of people, including children, to participate whenever possible in decision-making.  ‘Nurses also recognises and respect the rights of people to engage in shared decision-making’ (The Code of ethics for nurses in Australia [VS5.2], 2008).

Furthermore, the clinical partners owe a duty of beneficence to Mrs Stock and Mr Bogg by using their clinical interventions, as it would result in a positive outcome (Ye et al, 2018).

This could be seen that by physical restraining Mrs. Stock in order to obtain a urine sample via an in/out urinary catheter, her diagnosis could be confirmed, and the correct treatment supplied to improve her confusion and well-being could be taken depicting a positive outcome (Ye et al, 2018).

In Mr Bogg’s situation the principle of beneficence was the best course of action to take regarding restraint as a protective intervention to minimise the risk of harm towards him and the rest of the health care team following his intoxication and not being co-operative.  This situation is displayed in the Code of ethics of nurses in Australia value statement six (VS6.1) that states ‘Nurses value a culture of safety and recognises and avoid situations where their ability to deliver quality care may be impaired (The Code of ethics of nurses in Australia [VS6.1], 2008).

In addition to beneficence in Mrs Stock situation, non-maleficence can act as a side effect to physical restraint (Zeller, Nordstone, & Wilson, 2017).  Even though Mrs. Stock was confused it can be argued that she could still have a sense of understanding towards her situation.  Her clinical intervention was to insert a urinary catheter to obtain a urine sample which is an invasive procedure. This could have caused psychological trauma to Mrs. Stock which in future can prevent her returning to hospital for treatment (Zeller, Nordstone, & Wilson, 2017).

This situation relates to the Code of ethics for nurses in Australia value statement two (VS2.2), ‘Nurses recognise the vulnerability and powerlessness of people in their care.  The power relativities between a person and nurse can be significant, particularly where the person has limited knowledge experiencing pain and loss of self-determination (NMBA Code of ethics of nurses in Australia [VS2.2], 2008).

There are strategies that can be used to prevent physical restraint; however it is an area that lacks resources and education (Carlson, & Hall, 2014).  Healthcare workers need to practice their self-awareness in order to recognise their strength and weaknesses.  Characteristics of strengths can include:  staying calm, being respectful, and practicing empathy while caring for patients, particularly for those who are confused to result in positive outcomes (Carlson, & Hall, 2014).  This strategy would be a suitable strategy in the case of Mrs. Stock.  

In Mr. Boggs situation where intoxication is administered a result of aggression, it is important to learn the triggers of an aggressive and aggravated patient that can lead to danger.  Triggers to look out for include:  changes in facial expression, tone of voice, tension in shoulders and fist clenching (Carlson, & Hall, 2014).  Positive strategies such as de-escalation which relate to staying calm and not verbally threatening the patient, whereas non-verbal de-escalation include: body stance, maintain eye contact and personal space (Carlson, & Hall, 2014).  

Other positive strategy is the use of a familiar person or family member known to the patient to assist in the de-escalating process (Spencer, & Johnson, 2016).  If all else fail to work on the aggressive patient, then an effective strategy of seclusion can be used as a last resort before using physical restraint.  Seclusion refers to locking a patient alone in a room that he or she cannot leave without the assistance of staff (Kuivalainen, Vehviläinen-Julkunen, Louheranta, Putkonen, Tiihonen, & Tiihonen, 2017).

In summary, it is important for nurses to have a thorough knowledge of the ethical principles and code of ethics developed for nurses in Australia.  These frameworks will guide nurses to work within their ethical practice and prevent dilemmas.   Furthermore, nurses and healthcare workers need to use effective strategies to prevent physical restraint wherever possible, and only use restraint in the face of imminent danger.